THE
CANADIAN
NURSE
1977 INDE>
VOLUME 7:
Official Journal
of the Canadian Nurses' Association
JANUARY-DECEMBER 197:
LEGEND
A — Abstract
E
— Editorial
Ja — January
Jl
~ July
F — February
Au
— August
Mr — March
S
— September
Ap — AphI
Oc
— October
My — May
N
— November
Je — June
D
— December
ABORTION
Abortion counseiiing (Easterbnwk. Rust) 28ja
Health happenings in the news. l?Ja
ABOL'-YOtSSEF. Enaam
Nursing practice around the world. Eastern Mediterranean. 43Au
ACCREDITATION
CCHA guide for long term care centers. lOD
Montreal nurse heads accreditation bixly (porti l8My
ADOLESCENCE
The Canadian Institute of Child Health (Andrews) 2IJI
A child life program in action. 42N
A comparative study of the self-acceptance of suicidal and non-
suicidal youths (Westwood) A, 4.1Je
From A to Z with adolescent sexuality (Schlesinger) 340c
The juvenile diabetic (Polowich. Elliott) 24S
ADMSORY COL'NCIL ON STATl'S OF WOMEN
Health happenings in the news. l3Ja
AFGHANISTAN
Corine Marlatt in Afghanistan with MEDICO. 51 My
AFRICA
Nursing practice around the world (Diereini) 41Au
AGING
See also Geriatrics
Better qualified personnel would benefit aged, lOF
A caring experience (Bawden) 24Ap
Frankly speaking (Duffie) 40Ap
"It's time to go home now - . ." (Ford) 31Ap
Living to eat (Grenby) 42 Ap
Making the most of "the golden years" (Grenby) 39Ap
Needed: a new way of helping (McAlary) 45Ap
Practical concerns for nursing the elderiy (Macdonald) 25Ap
The seventh age — caring makes the difference. 23Ap
Special issue. 23-57Ap
ALBERTA. DIVISION OF LOCAL HEALTH
Central registry for community nursing, 140c
ALBERTA ASSOCIATION OF REGISTERED NURSES
Allocates S36.000 to continuing education. I 10c
Edythe Huffman, named 1977 Nurse of the Year. 40J1
Helen Sabin named AARN honwary member. 9JI
ALCOCK, Denise
Hey. what about the kids? 38N
ALCOE, Shirley
Chairman. CTRDA. Nurse's Section. 52Mr
ALCOHOLISM
Did you know .... I40c
Nursing the alcoholic patient (McGee) 30Je
AMBULANCES
Women in ambulance services, lOJe
AMERICAN ASSOOATION OF NEUROSURGICAL NURSES.
ANNUAL MEETING
Canadian delegates, 8Je
AMERICAN LUNG ASSOCIATION
Nursing fellowships offered. lOS
ANDERSON. C. Marilyn
The continuing learning activities of graduates ... A. 50Oc
ANDERSON. Joan
World Federation for Mental Health (Zilm) lOOc
ANDREWS. Marilyn
Bk. rev.. 53N
ANDREWS, Sharon
The Canadian Institute of Child Health. 21JI
ANSTEY. Olive E.
President of the ICN. SOS
ANSTIES ALCOHOL LIMIT
Did you know . .. 140c
ARTHRITIS
The other side of the uniform (port) {Camiletlii 48Mr
ARTinCIAL INSEMINATION
Reproduction and the test tube baby (Pakalnis, MakoroCO) 34F
ASH WORTH. Lynn
Lecturer. (Jueen's University. 160c
ASSOCIATION FOR THE CARE OF CHILDREN IN
HOSPITALS
Hey, what about the kids! — Commentary (Post) 44N
ASSOCIATION OF CANADIAN COMMUNITY COLLEGES
Health educators examine alternatives to current system. 8Ja
ASSOCUTION OF NEW BRUNSWICK REGISTERED
Nl RSING ASSISTANTS
NB RNAs set up separate organiiation. lOS
ASSOCIATION OF NURSES OF PRINCE EDWARD ISLAND
PEI nurses promote changes in properly laws. 18My
ASSOCIATION OF NURSES OF THE PROVINCE OF QU EBEC
See Order of Nurses of Quebec
ASSOCIATION OF REGISTERED NURSES OF
NEWTOUNDLAND
Brief to govt on nursing homes. 9D
Launches status study. lOJe
AUDIOMSUAL
42Je. 44JI. 54Au.
AUDIOVISUAL AIDS
Adolescence and learning disabilities. 44J1
The adolescent iliad. 44Jt
Behavior modification component in the treatment of obesity. 44J1
Birth control: the choices, 44JI
Breathing exercises for the expectant mother. 42Je
Canada safety council brochures. 42Je
Charge: Incompetence, a mock hearing of the Discipline
Committee of the CNO. 15F
Crisis intervention. 44JI
The curb between us. 44J1
Eat, drink and be wary. 44JI
Emergency treatment of acute psychotic reactions due to
psychoactive drugs. 42Je
Ethics and the law in practice, 54Au
For tomorrow we shall diet. 44JI
Grieving due to loss of body image; don't cry lor David. I5F
How to communicate. 42Je
Human dynamics of weight control, 44J1
Idea exchange: Education in the electronic age, (Escott) I5F
Infant failure to thrive. 44J1
The neurological evaluation of the maturity of newborn mlanis.
42Je
No tears for Rachel, 42Je
One step ahead. 42Je
Patient teaching. 42Je
St. John/Red Cross multi-media project. 18My
Team up to control infection. 44JI
Vasectomy. 44Jt
Vocational rehabilitation in a community hospital. 44JI
What's good to eat? 42Je
Your move. 42Je
ALTOMATION
Things that go bump in the night (Wixthington) t90c
AWARDS AND PRIZES
CNA executive director receives RCN Honorary Fellowship (port).
9Ja
Dawn Marie Hanson. $3,000 scholarship (port) 48S
Dorothy Percy receives Florence Nightingale award. 8D
Eleanor Grace Pask, receives a Si .KW scholarship (port) 48S
Gayle Bielte. received the Lillian Campion Award from RNAO.
48N
Heather Marion Ogilvie. awarded S4.500 to begin doctoral studies
(port) 48S
ICN announces 1977 3M winners, 16My
Ingeburg UrsulaSchamborzki.receivesaSI ,tlOU scholarship (port)
SOS
Isabel Caroline Milton, receives a 53,000 scholarship (ptwl) 48S
Jane Buchan, winner of the White Sister's Uniforms Inc.
Scholarship Award of $1 ,000 and a CNF award ot $2,000. 48S
Jeannicce Beryl Larsen. awarded the Kalherine E. MacLaggan
Fellowship of S4.500, 48S
Joan Irene Wearing, awarded a 53.000 scholarship. SOS
Judy Hill Memorial Scholarship. 1977. 48N
Kiyoko Matsuno. receives a 53.000 scholarship (port! 48S
Laurie Dawn Reid, receives a 53.000 scholarship. 48S
Lifestyle award program announced. 16Mr
Marilyn Darlene Bottehll. receives 53.000, 48S
NBARN ScholarNhips. I4D
New Brunswick Association of Registered Nurses. 48Ja
Rae Mclntyre Chittick was honored at CNA's annual meeting
(pt>rt) lOMy
RNAO Fellowships. 48N
Sheryl Ann Lapp, awarded the Helen McArthur Canadian Red
Cross Fellowship of 53.500. 48S
Wendy Lynn McKnighl. receives $2,000 (port) 48S
BAGOLE, Barbara
Representative. P.E.I,. CCCN. 52Mr
BAJNOK. Irmajean
Bk re\.. 46J1
BALL, (^eratdine
NBARN scholarship. UD
BARBER, Jackie
The tip of the icebfe, ■
BARR, Laura VV^JB-
Assistant exct^awAreclur »>t patient sciwres, Sunn>bfiX'k '
Medical C\-nirv. AtN
I
BARRINGTON, Patricia
The scll-carc unit (porit -WF-
BAKTKI.S. Diane
The role ot Ihc head nurse in primary nursin^MportnGood. Lampe)
:6Mr
BATCHKLOR. Grate
fi'-ordmaUir Conlinuing Edueation Division ot Conimunily
Healih. f-acult> ot Medicine U ut T (porti 4SJa
BAIMGART. Alice J.
Dean School of Nursing Queen's Universily, 40JI
BAWDEN, Mary Elizabeth
A earing experience. 24Ap
Clinical wordsearch. 25Mr. 42My. 38Je, 39JI. 27Au. 37D
BAYCREST GERIATRIC CENTRE
A conlinuum of care (Emondj S2Ap
BEAL'CHAMPS. Franclne
Represenlalive. Quebec. CCCN. 52Mr
BEERLING. Toni
Represenialivc. Saskaichewan. CCCN. 52Mr
BEGIN, Munique
Replaces Lalonde in cabinet shuflle. 9N
BEHAVIOR
Behavioral therapy (MacDonaid) 26J1
Nursing the acutely psychotic patient (Berezowskyl 23F
BEREZOWSKY, Janel B.
Care vs. custodialism (de Cangasi -i6Jc
Nursing the acutely psychotic patient. 25F
BERGERON, George
Appointed liaison officer of NBARN. 4QN
BERGMAN. Rebecca
First vice-president of the ICN. 50S
BERNARD. Columbienne
NBARN scholarship. 4SJa
BF-SEL. l.orine
NBARN holds 6ist annual meeting. 6S
Roundup of critical issues. CNA annual meeting 1977. 8Je
BESSETTE. Michel C.
Idea e.xchange: A hazard of intraventxis therapy. ^4Je
BIBBV. Lillian
Si John Ambulance investiture. 1415
BIETTE. Gayle
Received the Lillian Campion Auard from RNAO, 4!iN
BIRT. Eaye
F.mployment Relations Oftlcer. PE! Nurses Provincial Collective
Bargaining Committee, 52Mr
BLO<JD TRANSFL'SION
A new kHikai blood trans tusion therapy: aulotrans fusion ( Halward)
BLOOM, Jeff A.
Secretary Primary Care-Outreach Project Committee. U of T (port)
48Ja
BOHN-BROWNE, Regina
Appointed to the faculty. McMasler. 170c
Has received a NHRDP Scholar award. 170c
BOISVERT. Cecile
Vice-chairman, CCCN. 52Mr
BONILLA. Irma Sandoval
Nursing around the world. South and Central America. 47Au
BOOK REVIEWS
The alcoholic. 55Mr
Anderson. Paul D., Clinical anatomy and physiology for allied
health sciences, 48JI
Arnow, Earle L.. Introduction tti physiological and pathological
chemistry. 46JI
Badgley. Robin F. Report of the committee on the operation of the
abortion law, 45Je
r Barber. Janel M.. Adult and child tare, 46U
^ Kathryn E.. Teaching children wjlh developmental
(caie approach, 46J1
nary anatttmy, 54My
;iti\ retarded and society. 46D
Benstm. Evelyn f- ■> health and nursing practice
lOmm) 45D
Nomian, bniiHiuruil care ot the facially burned and
..fcti. 54N
atr, Oole L., Thi^ expanded lamily: <. hiiilbeanng (Salerno)
53N
■•■■' -■ ^ '-* • ■ -■ ' - ■ IfiJe
lutal and the
Clark. Ann L.. Childbearing: a nursing perspective (Alfonso) 47 J!
Craig, Grace J . Human development. 54N
DcCastro. Fernando, The pediatric nurse practioner; guidelines for
practice ( . , et al) 53N
DeGowin, Elmer. Bedside diagnostic examination (DeGowin)4«JI
Dona van, Helen M,. Nursing service administration: managing the
enterprise. 54My
Donovan, Maureen Ivers. Cancer care nursing (Piercef 55S
Fagothey. Austin. Right and reason: ethics in theory and practice.
48J1
Fischer. Josef E.. Total parenteral nutrition, 47JI
Fordyce, Wilbert, Behavioral methods for chronic pain and illness,
5IOc
International Nursing index 1976 Cumulation, 55My
Jacoby, Florence. Nursing care of the patient with burns, 55Mr
Leahy. Kathleen M.. Community health nursing, by . . . et al.
45D
Leininger. Madeline, Barriers and facilitators to quality health
care. 50Ja
Leininger, Madeleine, ed., Health care dimensioni: health care
issues (Buck) .S4My
Mclnnes. Mary Elizabeth. Essentials of communicable diseases.
50F
Marriner. Ann, The nursing process: A scientific approach to
nursing care. 46 Jl
Mills, Gretchen C. Discussing death: a guide to death education
(et al) 55Mr
Moses. Donald A. . Are you driving your children to drink? Coping
with teenage alcohol and drug abuse (Burger) 540c
Passman, Jerome. The EKG — Basic techniques for interpretation
(Drummond) 35S
Pillitteri. Adele, Nursing care of the growing family: a maternal-
newborn text. 53N
Quinn, Joan. Community health and nursing practice. (Benson)
45D
Safilios-Rothschild. Conslantina, Love, sex and sex roles. 53N
Sagebeer, Josephine Evans, Maternal health nursing review, 50F
Schultz. Rockwell. Management of hospitals (Johnson)^5N
Schweer. Jean E.. Creative teaching in clinical nursing (Gebbie)
5IOc
Skydell. Barbara. Diagnostic procedures. A reference for health
practitioners and a guide for patient counseling, 50F
Stone. Sandra, cd.. Management for nurses: a mullidisciplinary
approach ( . . . et al) 550c
StoTTs. Alison, Geriatric nursing, 55N
BOOKS
^OJa. 5()F. .S5Mr. 54My. 45Je.46JI. 54Au. 55S. 510c. 53N. 45D
BOTTERILL. Marilyn Darlene
Receives $3 .OCX) scholarship. 48S
BOWES, Leona Margaret
Most distinguished graduate in nursing. U. Of Saskatchewan.
52Mr
BOYLE, Barbara
Dear Mr. Rajabally (Murthy) 7D
BRADLEY, Kathryn
Provincial representative. Alberta, CCCN, 52Mi
BRAZEAl, Suzanne
Director of the Family Planning Division. Health and Welfare.
16My
Family planning moves into high gear, nurses active in federal
program. 16 My
BREAKEV. Joan
Past chairman. CCCN, 52Mr
BRIANT. Nora J.
Frankly speaking: What every reasonable and prudent nurse should
know. I3Je
BRITISH COLL MBIA G0VF;RNMENT EMPLOYEE
RELATIONS Bl REAl
B.C. nurses accept two-year contract, 8Je
BROOKS. Eaye
Assistant professor. Queen's University. I60c
BROWN, May
Secondary school nursing, a changing fiKus. 420c
BROWN, Patricia Lynne
Course leader. University of Alberta, 160c
BLICHAN, Jane
White Sister's Uniforms Inc. Scholarship Award of SI. 000 and
CNF award of $2,000, 48S
Bl RGESS, Phyllis
Retired as director of nursing at Princess Margaret Hospital.
Toronto. 51 My
BURKE, Juliette
Protective isolation unit. Montreal General Hospital, 26Au
BLRKE. Marvin M.
President of the Canadian Addiction Foundation (CAF) 49N
BURNFIELD, I^U
Assistant professor. Queen's University. I60c
BURNS
Burn update (LeFort) l6Au
Coping with pain: strategies of severely burned children (Savedra)
2iJAu
Nutrition and the burn patient (Fortier) 30Au
BURWELL, Dorothy
Psychodrama and the depressed elderly. 54Ap
BUTLER, Barbara
Anorexia nervosa: a nursing approach (Duke, Stovel) 22Je
— C —
CALENDAR
55Ja. 8F. 54Mr. 50My. 39Je. 41JI. 4Au. 51S, 80c, 12N, I5D
CAMELETTI, Yolanda
The other side of the uniform; living with Adult Still's Disease
(port) 48 Mr
CAMERON, Margaret
St. John Ambulance Investiture. 14D
CAMPAGNOLO, lona
World Federation for Mental Health (Zihn) lOOc
CAMPING
Cystic fibrosis-camp Couchiching . four summers (Scott) I4je
CANADIAN ADDICTION FOUNDATION
Marvin M. Burke, president, 49N
CANADIAN ASSOCIATION OF NEUROLOGICAL ANU
NEUROSURGICAL NURSES
First affiliate member of CNA, l3My
CANADIAN ASSOCIATION OF UNIVERSITY SCHOOLS Of
NURSING
Kathy Lauzon appointed executive-secretary. I2Je
CANADIAN COUNCIL OF CARDIOVASCULAR NURSES
Meeting. 8D
Members of the Executive Committee. 52Mr
CANADIAN COUNCIL ON HOSPITAL ACCREDITATION
Accreditation guide of long-term centers of care. lOD
Montreal nurse heads accreditation body (port) l8My
CANADIAN FOUNDATION FOR ILEITIS AND COLITIS
Research award to Jo-Ann Tippetl Fox, 179c
CANADIAN HEART FOUNDATION
Cardiovascular nurses meeting. 8D
CANADIAN HEMOPHILIA SOCIETY
Hemophiliacs studied. I30c
CANADIAN INSTITUTE OF CHILD HEALTH
A personal responsibility (Andrews) 21J1
CANADIAN MEDICAL ASSOCIATION
Robert Gourdeau. president. SOS
CANADIAN NURSES ASSOCIATION
Appoints director of Labor Relations Services. 18My
Budget I97S. lOD
MARN hosts first national seminar on standards ol nursing
practice. 6N
Constance A. Swinton. on loan from CIDA (port) 4IJ1
Financial statements and auditors' report, 56Ap
Glenna Rowsell direcnx of Labor Relations Services (port) 48^
H. Rose Imai. director of professional services (port) SOS
Hallie Sloan, nursing coordinator (port) 40J1
Health promotion program: phase two. IIJI
Mary E, (Sally) Robertson, summer residency (port) 4IJ1
Nicole Eon taine.DirectOT of Public Relations Services ( port) 52M
Perspective (Gilchrist) E, 3My
Rep attends world food symposium. I40c
Research study reveals few key changes in nursing employmen
education patterns since 1966. l2Mr
Respiratory nurses seek CNA affihation. I lOc
CANADIAN NURSES ASSOCIATION. ANNUAL MEETING
Head table guests. 1 1 My
News. lOMy
Notice of . . ., I2Ja
Program. lOD
Resolutions, l2My
Roundup of critical issues. 8Je
CANADIAN NURSES ASSOCIATION, BOARD OF
DIRECTORS
CNA supports special interest groups, 130c
Highlights trom CNA Directors' meeting, i3My
Hold work session to consider nursing directions. ISMr
Meeting October 20-21, lOD
II
CANADIAN NURSES* ASSOCIATION. CONVENTION 1978
June 25-28 in Toronto, UAu
CANADIAN NtRSES ASSOCIATION. EXECUTIVE
DIRECTOR
Rcpixt lo membership. 1 1 My
CANADIAN NIRSES ASSOCIATION. HEALTH
PROMOTION PROJECT
Nurses try out fitness model, 7N
CANADIAN NURSES ASSOCIATION. LABOR RELATIONS
SERVICE
Appoints direcior. 18My
CANADIAN NIRSES ASSOCIATION. LIBRARY
See Library update
CANADUN NURSES ASSOCIATION. SPECIAL
COMMITTEE ON NURSING RESEARCH
Evaluation of OHA Nursing Competency Mode! Project, lOD
Portiait. l2Ap
CANADIAN NURSES ASSOCIATION TESTING SERVICE
Comprehensive exam scheduled tor !980, lOD
Slaiement of income, 59Ap
CANADIAN PUBLIC HEALTH ASSOCIATION. N.W.T.
BRANCH
Nurse heads N.W.T. Public health association, 12Ja
CANADIAN TUBERCULOSIS AND RESPIRATORY DISEASE
ASSOCIATION. NURSES- SECTION
Arlene Draffm Jones, chairperson, 48N
Shirley Alcoe, Chairman. 52Mr
CANADUN UNIVERSITY NURSING STUDENTS
ASSOCIATION
Is sending two representatives to the 1977 ICN Congress in Tokyo,
5 I My
CANADIAN UNIVERSITY SCHOOLS OF NURSING
CUNSA delegates meet in Calgary to examine nursing and the law
(Parish) I6Mr
CANCER
Coping with cancer: a symposium for everyone. 7Je
Health happenmgs in the news. t3Ja
Laryngectomee leaflet (Vandewaier) 48Au
Mirrormg (Kilcuchi) 3 I Mr
Report of the Task Force on Cervical Cancer Screening
Programmes (ihe Walton Report) l2Ap
CARE/MEDICO
Corine Marlatt in Afghanistan with MEDICO, 5 1 My
Patricia A Phillips, project director (port) 52Mr
Sharon Dawe with CARE/MEDICO in Honduras (port) 12Je
CARMACK. Marilyn L.
Assistant executive director of RNABC (port) 160c
CARSTAIRS, Morris
World Federation for Mental Health (Zilm) iOOc
CARTER, Rosalyn
Wwld Federation for Menial Health (Zilm) lOOc
CARTY, Elaine
Allernative birth centers (Rice) 31N
CASE, Oarrie
ARNN launches status study, lOJe
CEREBRAL PALSY
Listening does help (Winberg. Hobson) 40S
CHARTRAND. Pauline
Family planning moves into high gear, 16My
Nurse consultant for the Family Planning Division. Health and
Welfare. 16My
CHILD CARE
Singing signing smiling (Samanslti) 28F
CHILDREN
The Canadian Institute of Child Health: A personal responsibility
(Andrews) 21JI
CHILDREN'S HOSPITAL OF EASTERN ONTARIO
A child life program in action. 42N
CHITTICK. Rae Mclnlyre
Honored at CNA's annual meeting (port) lOMy
CHOQUET. Rita
Si, John Ambulance Investiture, 1 40
CHUNG. Hsin Hsin
Nursing around the world. Western Pacific. 45Au
CLARKE. Heather F.
Challenging the status quo, 40Ja
CLINICAL SPECIALTIES
VGH reorganizes nursing department, 8N
CLOAREC, Val
Executive Director. SRNA resigned to goto Dept. of Health (port)
52 Mr
COFFIN. Tnstam T.
St. John Ambulance Investiture. MD
COLBERG. B. June
Instructor. Grant MacEwan Community College (port) 5 1 My
COLLECTIVE BARGAINING
See also Labor relations
B.C. nurses accept two-year contract, 8Je
B-C. nurses join public employees, 13JI
Perspective (Gilchrist) E, 3My
Perspective (Hanna) E, 40c
Separate collective bargaining body for Alberta. 13JI
COLLEGE OF NEW CALEDONIA, PRINCE GEORGE, B.C.
Glennyce Sinclair appointed Director of Ihe Diploma Nursing
Program, 51 My
COLLEGE OF NURSED OF ONTARIO
Helen M, Evans, appointed president. 170c
COMER. Mary
Representatives — to the 1977 ICN Congress. 5lMy
COMMISSION ON GRADUATES OF FOREIGN NURSING
SCHOOLS
Adele Herwitz appointed executive director. 5iMy
COMMONWEALTH NURSES FEDERATION
Rachel Palmer, President, 52Mr
COMMUNICABLE DISEASES
Health happenings. 12F
Special isolation unit. lOOc
COMMUNICATION
Did you know .... 16Mr
Laryngectomee Leaflet (Vandewater) 48Au
Listening does help (Wmberg. Hobson) 40S
Singing signing smiling (Samanski) 28F
COMMUNITY HEALTH SERVICES
An analysis of the application for the concept of family-centered
care in public health nursing visits (Cunningham) A, 45JI
A caring experience (Bawden) 24Ap
Central registry for community nursing, I40c
Community resources for the elderly: 2 programs.
(Schattschneider) 47Ap
Day ther^y centre: the role of the [H-imary care nurse (Morlok)
50Ap
Frankly speaking, government for whom? (GosseUn) 19My
Idea exchange (LeBlanc. Schultz) 29My
Listening does help (Wmberg. Hobson) 40S
McGiil Research Unit to study community health nursing. 9Ja
Retired nurses aid elderly in Alberta. 9J1
CONFERENCE ON FAMILY POLICY
Family life delegates examine health care. lOJe
CONGRESSES
CNA rep attends world food symposium, 140c
CUNSA delegates meet in Calgary to examine nursing and the law
(Parish) 16Mr
MARN hosts first national seminar on standards of nursing prac-
tice, 6N
MARN standards meeting. 9D
RNAO's nursing process project underway. 8N
Annual Meeting of the Association of Canadian Community
Collfoes. 8Ja
Cardiovascular nurses meeting — Toronto Heart Foundation. 8D
A conference for supervisors, 6S
Coping with cancer: a symposium for e^>yone, 7Je
Emergency nurses hold sixth annual conference, 6N
Forum for public health nurses, 2nd. sponsored by RNAO, l2Ja
International Childbuth Education Association. l2Ja
N-S. occupational health nurses hold seminar. I2JI
Orthopedic nurses hold education day, I2Ap
Pediatric audiology workshop aids nurses, l2Au
Things that go bump in the night (Worthington) I90c
Thirtieth World Health Assembly in Geneva, Switzerland. 7J|
World Federation for Mental Health draws 2100 concerned
professionals (Zilm) lOOc
CONSERVATION
Perspective (Hanna) E, 3N
CORONARY CARE UNIT
See Intensive care facilities
CORMIER. Simone
NBARN holds 61st annual meeting. 6S
C0L:NCIL on DRUG ABUSE
Health happerungs in the news, 13JI
III
CROSBY, Elizabeth. F.
Childhood diabetes: the emotional adjustment of parents and child.
20S
CROSSWORD PIZZLE
(Glenn) ^9}^
CROZIER. Donna Elaine
Lecturer, University of Alberta. I60c
CUBA
Health exchange program receives official approval, 16My
CUNNINGHAM. Rosella
An analysis of the application of the concept of family -centered
care in puUic health nursing visits, A. 45J1
CURTIS. Charlotte
Bk rev . 54My
CYSTIC nBROSIS
Cystic fibrosis-camp Couchiching (Scotti 14Je
DAVIDSON, June M.
Bk. rev.. 55S
DA VIES. Lorraine
Disaster planning, 46My
DAWE. Sharon
With CARE/MEDICO in Honduras (port) 12Jc
DAWSON, Elizabeth
Instructor, Grant MacEwan Community College iport) 51My
DAY, Rene A.
Bk. rev.. 48J1
DAY HOSPITAL. EDMONTON. ALBERTA
Community resources for the elderly (Schattschneider) 47Ap
DAY THERAPY CENTRE, HAMILTON. ONTARIO
The role of the primary care nurse (Morlok) 50Ap
DEATH
Anatomy of a death (Estabrooks) 30Oc
Connection (Inns) 43My
Health happenings. 12F
One gentle man (Walsh) (port) 56Ap
Right to die. 45J1
DE CANGAS. Jose
Care vs. custodialism (Bcrczowsky) 36Je
Dear Mr. Rajabally, 6D
DELIVERY OF HEALTH CARE
MARN representatives meet with cabinet, l2Mr
NBARN holds 6!st annual meeting. 6S
Accountability (Poulin) 30F
Challenging the status quo. 40Ja
Family life delegates examine health care. lOJe
Health exchange program receives official approval. I6My
Hey. what about the kids? (Alcock) 38N
Hospitalization (Laing) 35N
New horizon for nursing. Part 2, Nursing practice around the
world. 40Au
Ontario nurses document declining standards of care. 14Ap
Perspective (Hanna) E, 3Au
DESAI. Kanchan
We took physical fitness to the county fair (by . . . ei al) 25Je
DE SILVA. Hilda
Nursing around the world. Southeast Asia, 46Au
DIABETES
Childhood diabetes (Crosby) 20S
The juvenile diabetic (Polowich. Elliott) 24S
Tn-Hospital diabetes education centre (Laughame. Sieiner) I4S
DUGNOSIS
A school screening program that works iGurr) 24D
DICKSON. Anne
Protective isolation unit, Montreal General Hospital. 26Au
DIER. Kathleen A.
Associate dean. University of Alberta. 16
DISASTERS
See Emergencies
DOHERTY, Grace
Early identification of developmental imr»airinculs m intanls h
to iut»e month'- of age. A. 5Z^
DOIRON. Cheryl
NBARN schoiarstiip. 4gJa
DOUCET. Glen^
Idea exchange: well woman and health awarencM clinic, 5tAt
DRUGS
Drug ad walchdog assumes re^ponsihiliiy. lOF
Hcalt^i happenings in the news, I3JI
Programmed learning: cardiac depressants (Warkentin) 30My
DUFHE, John
Frankly speaking: Aging: the niylh and the reality. 40Ap
DUKE. Mary Jane
Aniirexia nervosa: a nursing approach (Buller. Siovel) 22Je
DUMAS. Louise
Postoperative cardiac surgical patients' opinions about structured
preoperative leaching by the nurse, A. 44Je
DUMOUCHEL, Nicole M.
St. John Ambulance Investiture, i4D
DYKSTRA, Anne
With CARE/MEDICO in Indonesia (port) 48Ja
EASTERBROOK. Bonnie
AbtTtion counselling: a new role for nurses (port) (Rust) 28Ja
EASTERN MEDITERRANEAN
Nursing practice around the world (Abou-Youssefi 43Au
ECONOMICS
The taxman cometh (Grenby) 36Ja
EDUCATION
Alberta nurse educators form new association. 8Je
CNA research study reveals few key changes in nursing
employment, education patterns since 1966, )2Mr
Education in health care in an inierculturai maternity service
(Nemetz) A. 52N
Frankly speaking; Dear Mr. Rajaball) iPrcwse el al) 6D
Health educators examine alternatives to current system. 8Ja
Idea exchange (Education in the electronic age) (Escoti) I5F
Internal evaluation of an experimental dacum curriculum in a
diploma school of nursing (Haliburton) A, ?0Oc
MARN representatives meet with cabinet. [2Mr
Mrs. B. and me (Sproul) 46F
NBARN presents brief to education committee. 7Je
The nurse continuum perspective (McGee) 24Ja
Programmed learning: cardiac depressants (Warkentin) 30My
Why nursing? (1-eckie, L.orreei 30D
EDUCATION. BACCALAUREATE
UNB announces changes in nursing program. I2F
Members back MARN at special meeting, 7N
EDUCATION. CONTINUING
AARN allocates $36. (XK) to continuing education, 1 lOc
The continuing learning activities of graduates of two diploma
nursing programs in Ontario (Anderson) A. 50Ot
Did you knpw . . . I6Mr
Frankly speaking: so you want to make a comeback (McKeekan)
26F
Frankly speaking: what every reasonable and prudent nurse should
know (Briant) l3Je
Orthopedic nurses hold education day. l2Ap
The tip of the iceberg (Barber) 3IJa
EDI CATION. DIPLOMA PROGRAM
The continuing learning activities of graduates of two diploma
nursing programs in Ontario (Anderson) A. 50Oc
Internal evaluation of an experimental dacum curriculum in a
diploma school of nursing (Haliburton) A, 50Oc
Orientation and inservice programs for teachers in Canadian two-
year schools of nursing (Field) 44D
Perlormance expectations of new grads. I2JI
A program that dares to be different (port) (Skelloni 36Mr
EDUCATION, GRADUATE
MARN representatives meet with cabinet, 1 2Mr
U of Victoria focuses on elderly, I lOc
M.Sc. (Applied) offered to non-nurses. l3Ja .
ELFERT. Helen
Selected aspects of the chidbearing experience . (Leonard) A
43Je
EMERS. Barbara
'irecior. SRNA (port) 6IAp
T, 6IAp
EIXIC
RNAO. communi'-iiuons
ELLIOTT. Ruth
Ttx ^venile diabetic: m nr out oi .
ELLIS, Patty
Bk rev.. 50F
EMERGENQES
Burn updalet what you need lo k^.'^
'are oi the rape victim m emei
['id you know . , 16Mr
' (Poiowich) 24S
ml buj ^- 'I L'f-ort) l6Au
Disaster planning (Davies) 46My
Emergency nurses hold sixth annual conference. 6N
MARN suppOTts Alert. 15Mr
Nurse to direct Information Centre at Hospital for Sick Children,
I2F
Nutrition and the burn patient (Forlier) 30Au
Ready for any emergency 200-bed hospital-in-a-box (LeFori)
45 My
A study of continuity of nursing care from the hospital emergency
room into the home (Perkjn) A. 43Je
Things that go bump in the night ( Worthington) I90c
EMERGENCY NURSES ASSOCIATION OF ONTARIO
Hold sixth annual conference. 6N
EMIGRATION AND IMMIGRATION
A Canadian grad goes to the States (Zin) 460c
CNR holds policy session. 9Au
EMOND, Suzanne
Baycrest Geriatric Centre: a continuum of care. 52Ap
EMPLOYMENT CONDITIONS
Belter wwking conditions for nurses. 6S
ENGLISH. John
Appointed to the faculty, McMasier. I70c
ENTEROSTOMAL THERAPY
Helping young ostomy patients help themselves (Tisdale) 30JI
ENVIRONMENT
Did you know? 13JI
Health happenings in the news. l3Ja
Highlights from CNA Directors* meeting. I3My
World Environment Day — June 5, 1977 (Hanna) E, 3Je
ESCOTT, Manuel
Ethics and the law in practice. S4Au
Idea exchange (Education in the electronic age) I5F
ESTABROOKS, Carole
Anatomy of a death. 30Oc
NBARN scholarship. 48Ja
ETHICS
Accountability: a professional imperative (Poulin) 30F
Code of ethics implemented in Quebec. l3Ja
Ethics and the law in practice (Escolt) 54Au
EUROPE
Nursing around the world (Stallknecht) 43Au
EVALUATION STUDIES
Mrs. B. and me (Sproul) 46F
EVANS. Helen M.
Appointed president of the Council of the College of Nurses of
Ontario. I70c
EVERARD. Jean
Nurses try out fitness model, 7N
EYES
Glaucoma: awareness prevents blindness (French) 20Oc
FACULTY
Orientation and inservice programs for teachers in Canadian two-
year schools of nursing and sources of satisfaction and dissatis-
faction as perceived by these teachers (Field) A, 44D
FAMILY
Changing paiierns of marriage and family living. 140c
Family life delegates examine health care. lOJe
The father's side; a different perspective on child-birth (Leonard)
16F
Helping a family and their premature baby grow together (Murphy)
42S
Spouses need nurses too (Silva) 38D
FAMILY PLANNING
Family planning moves into high gear, nurses active in federal
program, 16My
Health happenings in the news, l3Ja
Reproduction and the test tube baby; a muted explosion . , -
(Pakalnis, Makoroto) 34F
FAWKES, Barbara
Ren fellow named acting ICN head, 18My
FELLOWSHIPS
See Awards
FIELD. Carol
Orientation and inservice programs for teachers in Canadian two-
year schools of nursing. A. 44D
FINCH. Elizabeth
Sexuality and the disabled. I9Ja
FINLAY. Lynda
NBARN scholarship. 14D
FIRST AID
Burn update: what you need to know about burns (LeFort) I6A
FITZPATRICK, Lynda
How do you feel about . - - working nights? 34S
See also Ford, Lynda
FLAHERTY. M. Josephine
First report as PNG lo CNA Board. lOD
Resigned as dean. Faculty of Nursing, UWO (port) 51 My
UWO Dean of Nursing addresses Seneca College Education D:
l5Mr
FLANAGAN. Eileen
Receives LLD from McGiII. 14D
FLETCHER. Geraldine
We took physical fitness to the county fair (Desai . . , etal)25j-
THE FLORENCE L. MACKENZIE DOWNTOWN
CONVALESCENT CENTRE
"It's time to go home now . , " another look at nursing hon
(Ford) 3IAp
FONTAINE, Nicole
Director of Public Relations Services, CNA (port) 52Mr
FORD. Lynda
Idea exchange (The difference between night and day) 46Ja
"It's time to go home now . . ." another look at nursing hom
31Ap
A question of balance; the effects of chronic renal failure and lo
term dialysis, 19Mr
See also Fitzpatrick, Lynda
FORTIER. Rosemarie Repa
Nutrition and the burn patient, 30Au
FOURNIER. Fernando
NBARN scholarship. I4D
FOX. Jo-Ann Tippett
Appointed lo the faculty. McMaster, I70c
Fellowship. Medical Research Council. I70c
FRAZER. Diane
NBARN scholarship, I4D
FREEMAN, Anna
Representative, Nova Scotia. CCCN, 52Mr
FRENCH, Eileen
Glaucoma: awareness prevents blindness, 20Oc
FRENCH, Patricia Harcourt
A gift of tomorrow. 20JI
FULKERTH. Margaret A.
St, John Ambulance Investiture. 14D
FUNGER. Gail
To direct Information Centre al Hospital for Sick Children. 1
FURNELL. Margery
Has joined Alberta Social Services and Community Health. Di
sion of Local Health Services. I60c
GARRETT. Nancy
Bk. rev.. 45Je
GAULTON. Lucille
Secretary of NBARN. 9S
GENETICS
Reproduction and the test tube baby; a muted explosion . . .
(Pakalnis, Makoroto) 34F
GERIATRICS
See also Aging
Baycrest Geriatric Centre: a continuum of care (Emond) 52A(
Behavioral therapy (MacDonald) 26J1
Better qualified personnel would benefit aged. lOF
Community resources for the elderly: 2 programs (Schattschneid
47Ap
God's love and a jar of honey (Moynihan) 28S
Perspective (Kerr) E, 4Ap
Practical concerns fw nursing the elderly in an institutional sett
(Macdonald) 2SAp
Psychod-ama and the depressed elderly (Burwell) 54Ap
A quiet day . . . (McKenna) 20Je
Retired nurses aid elderly in Alberta, 9Jl
Secrets of long hfc, I40c
U. of Victoria focuses on elderly, I lOc
GILCHRIST. Joan
Perspective, 3My
GIRARD, Alice
St. John Ambulance Investiture, 14D
GIROLARD, Nicole
NBARN scholarship, 48Ja
IV
(.LASS, Helen
Roundup of critical issues, CNA annual meeting 1977. 8Jc
GLASS. Mary Ann
NBARN scholarship. I4D
GLAUCOMA
Glaucoma: awareness prevents blindness (French) 20Oc
GLENN, Maria Rubilie
Crossword puzzle. 39Ja
GOOD. Vivian
The role of the head nurse in primary nursing (ptirl) (Bartels.
Lampe) 26Mr
GOSSELIN. Unda
Frankly speaking; government for whom? I9My
Rountfcjp of critical issues. CNA annual meeting 1977. 8Je
GOURDEAt. Robert
President of the Canadian Medical Association, SOS
GOt'THREAL'. Suzanne M.
Of R.M. Brown Consultants (port) I60c
GOW, Christina
Bk. rev., 50F
GRANT MACEWAN COMMUNITY COLLEGE
A. Judith Prowse. appointed chairman of the Health Sciences
Depanmeni (port) 48N
Appointments. 51 My
B. June Colberg. Instructor. Extended Care Nursing Program,
51My
Elizabeth Dawson. Instructor of the Occupational Nursing
Certificate Program (port! 5 1 My
GRANTHAM, Mariene A.
Appointed Director of Nursing Service. Victoria General Hospital,
Halifax, Nova Scotia, 48Ja
GRAVELLE, Henriette
Appointed CNA translator. 48Ja
GRAYDON, Jane
Outposl nursing in northern Newfoundland <Hendry) 34Au
GREEN, Esther
Appointed to the faculty, McMaster. I70c
GRENBY, Mike
Living to eat: nutrition for senior citizens. 42Ap
Making the most of "the golden years". 39Ap
The taxman comelh (port) 36Ja
GRENFELL. Wilfred T.
Outpost nursing in northern Newfoundland (Graydon. Hendry)
34 A u
GURR, Jean F.
A school screening program that works. 24D
GYNECOLOGY
Idea exchange: well women and health awareness clinic (Doucet)
5IAu
HAGAR, Lorraine
The nursing process, a tool to individualized care. 380c
HALI BURTON, Jane Clare
Internal evaluation of an experimental dacum curriculum in a
diploma school of nursing. A. 50Oc
HALL. Laura
Murphy's glue. 42D
HAL WARD, Margaret Anne
A new look at blood transfusion therapy: autotransfusion. 38My
HANDICAPPED
Congenital dislocated hip (Nichoh 14JI
Sexuality and the disabled (Finch) l9Ja
HANNA, M. Anne
Perspective. E. 2Ja. 4F, 4Mr. 2J1. 3Au. 3S. 40c. 3N
World Environment Day — June 5. 1977. E. 3Je
HANSON. Dawn Marie
$3,000 scholarship (port) 48S
HASTINGS-TREW, Joyce
St. John Ambulance Investiture. 14D
HAYES. Marjorie
St- John/Red Cross multi-media project. l8My
HAYNES. Jo Anne E.
Appointed to the faculty. McMaster. 170c
HEALTH AND WELFARE CANADA
Begin replaces Lalonde in cabinet shuffle. 9N
Federal transfer health services bo Yukon, 9D
M. Josephine Flaheny's first report to CNA Board. lOD
M. Josephine Flaherty Principal Nursing Officer (port) 5tMy
NorahO'Leary Nursing Consultant. Health Programs Branch. 48Ja
Norah O'Leary, Health Standards Directorate of the Health
Programs BraiKh (port) 50S
Nutrition Canada Dental Report. UOc
HEALTH EDUCATION
Day therapy centre the role of th" primary care nurse (Morlok)
50Ap
Health happenings, I40c
Idea exchange: well woman and health awareness clinic (Doucet)
51Au
The nurse's role in health assessment and promotion. 40Mr
Nurses to complete new health fwms, 8Ja
Secondary school nursing, a changing focus (Brown) 420c
HEART
MARN supports Alert. 15Mr
Postoperative cardiac surgical patients' c^inions about structured
preoperative teaching by the nurse ([>umas) A. 44Je
HEART DISEASES
The elTects of continuity in nurse-patient assignment among a
selected group of preoperative aortocoronary bypass patients
(Rosa) A. 45JI
Programmed learning: cardiac depressants (Warkentin) 30My
HEMOPHILIA
Hemophiliacs studied. 130c
HENDERSON, Ian W.D.
Drug ad watchdog assumes responsibility (port) lOF
HENDRY, Judith M.
Outpost nursing in northern Newfoundland (Graydon) 34Au
Peter: an infant with a myelomeningocele (port) I5Ja
HERWITZ, Adele
Appointed executive director of the Commission on Graduates of
Foreign Nursing Schools. 51 My
HEWITT, Michael
St John Ambulance Investiture, 14D
HILL. E. Jean M.
Retiring as Dean of the School of Nursing at Queen's University.
40JI
HINDE, Donna
Bk, rev., 55N
HISTORY OF NURSING
Four score and ten (Wilkinson) 260c, I3N, 16D
HOBSON, Joan
Listening does help: one patient's experience (Winberg) 40S
HODNETT. Ellen
Fetal monitoring: why bother? 44Mr
HOLDER. J. Patricia
Director of Nursing. The Princess Margaret Hospital (port) 5 1 My
HOME CARE
Better qualified personnel would benefit aged. lOF
Future for VON despite budget cuts, 7J1
St. John/Red Cross multi-media project. 18My
HONDURAS
Sharon Dawe with CARE/MEDICO (port) t2Je
HOSPITAL FOR SICK CHILDREN. TORONTO
Nurse lo direct Information Centre. 12F
HOSPITAL NURSING SERVICE
The practice environment as perceived by new graduate nurses
(Kay) 52N
The nurse continuum perspective (McGee) 24Ja
HOTCHKISS, Peggy
We took physical fitness to the county fair (Desai . . - et al) 25Je
HUFFMAN, Edythe
Named 1977 Nurse of the Year by AARN, 40J1
HUNTER, Margaret M.
St. John Ambulance Investiture. 14D
IDEA EXCHANGE
46Ja. 15F, 29My. 34Je. 5IAu.
ILES, J. Penny
Cuddle bathing can be fun (McCrary) 24My
ILLICH. Ivan
World Federation for Mental Health (Zilm) lOOc
IMAI, H. Rose
Director of professional services al CNA (port) SOS
IMMIGRATION
See Emigration and immigration
V
IMMUNIZATION
Health happenings in the news. I3Ja
INDIANS AND ESKIMOS
Health happenings in the news. 13Ja
INFANTS
Bottle holders banned by federal officials. 130c
A child life program in action, 42N
Cuddle bathing can be fun (lies, McCrary) 24My
The father's side; a different perspective on childbirth (Leonard)
16F
Helping a family and their premature baby grow together (Murphy)
425
Peter: an infant with a myelomeningocele (Hendry) l5Ja
Practical guide to preventing neonatal heat loss (Williams. Lancas-
ter) 28My
INFECTION CONTROL NURSES OF NEW BRUNSWICK
Organize. 1 2D
INFLUENZA
Health happenings in the news. 13Ja
INFORMATION SERVICES
Nurse to direct Information Centre al Hospital for Sick Children.
I2F
INJECTIONS, INTRAVENOUS
Idea exchange: a hazard of intravenous therapy — cored particles
(Bessette) 34Je
INNES, Jean E.
Bk. rev.. 54My
INNS. Rebecca
Connection (port) 43My
INPUT
4Ja. 6F. 6Mr. 6Ap. 4My. 4Je. 4J1. 4S. 60c. 4N. 4D
INTENSIVE CARE FACILITIES
Things that go bump m the night ( Worthington) I90c
INTERNATIONAL CHILDBIRTH EDUCATION
ASSOCL\TION
International authorities to address ICEA conference on the family.
12Ja
INTERNATIONAL CONFERENCE ON MEDICAL DEVICES
Things that go bump in the night (Worthington) I90c
INTERNATIONAL COUNCIL OF NURSES
Announces 1977 3M winners. 16My
Area members, SOS
ICN seeks director. I4Au
Olive E. Anstey. president, 505
Ren fellow named acting ICN head, l8My
Verna Huffman Splane. 2nd Vice-President (port) 40J1
INTERNATIONAL COUNCIL OF NURSES. BOARD OF
DIRECTORS 1977-1981
Officers. SOS
INTERNATIONAL COUNCIL OF NURSES. CONGRESS 1977
CUNSA sending two representatives. 5IMy
Health happenings. 14Ap
ICN meets in Tokyo (Suberviola) 6Au
New hcffizons for nursing. Part 1 , 38Au, Part 2. 40Av
Nine new member associations: Fiji, Mauritius. Puerto Rico.
Swaziland. St. Lucia. Paraguay, Sudan, Western Samoa and
Honduras. 6Au
Perspective (Hanna) 2J1
Representatives — to the 1977 ICN Congress. 5 1 My
Welcomes student nurses. 8Ja
INTERNATIONAL COUNCIL OF NURSES. COUNCIL OF
NATIONAL REPRESENTATIVES
CNR holds policy session. 9Au
INTERNATIONAL GRENFELL ASSOCIATION
Outpost nursing in northern Newfoundland (Graydon, Hendry)
34 Au
INTERNATIONAL LABOUR ORGANIZATION
Better working conditions for nurses, 6S
INTERPERSONAL RELATIONS
Hospitalization and personality change: recognition vital to nursing
care (Lake) 44 Ja
The nurse continuum perspective (McGee) 24Ja
INTERPROFESSIONAL RELATION^
The nurse continuum perspecii.e (McGse) -
INWOOD. Martin
Hemophiliacs studied. I '^Ck:
ISOLATION
Special isolation uoil. lOOc
JENKINS. Anne
Du^ector. PflfiBtnc Nursing. VGH (port) 8N
JOB SATISFACTION
ARNN launches status study. lOJe
JONES. Arlene DrafTin
Chaiiperson of CTRDA Nurses' Scclion, 48N
KATHERINE E. MACLAGGAN FELLOWSHIP
Jcnniece Beryl Larsen. awarded S4.50(). 4KS
KAY. Gloria
The practice environment as perceived by new graduate nurses,
52N
KEAST, Ron
Idea exchange; education in the electronic age (Escott) I5F
KELLOGG FOUNDATION
M.Sc. (Applied) offered to non-nurses. I3ja
KEMP. Isabelle
Provincial representative. Ontario. CCCN. 52Mt
KERR. Janet C.
Perspective tptirt) E. 4Ap
KERR, Marion
CNA rep attends world food sytnposium. 140c
KHOKHAR. David
Bk. rev.. 46JI
KIDNEY
Knowledge reported by chronic renal failure patients in four areas
related to self-care (Smith) -'iOOc
A question of balance; the effects of chronic renal failure and
long-term dialysis (Ford) l9Mr
KIEREINI, Eunice Muringo
Nursing practice around the world. Africa. 41Au
KIKUCHI, June
Mirroring. 31 Mr
KNOWLES. Calhy
Protective isolation unit, Montreal General Hospital. 26Au
KOAZK, Therese
Bk. rev.. 47JI
KOZIEY, Roberta L.
Lecturer. University of Alberta. 160c
KUCINSKAS. Angela
Awarded the Judy Hill Memorial Scholarship. 48N
KYLE, Mavis E.
The development and testing of an instrument for assessment and
classification of patients by types of care. A. 44D
— L —
LABELLE, Huguelte
Professional responsibility: an international concern. .^8Au
SRNA diamond jubilee. 8JI
LABOUR RELATIONS
B.C nurses join public employees. 13JI
CNA appoints director of Labor Relations Services. 18My
Glenna Rowsell assumed the new position at CNA House in Otuwa
(port) 48N
CNA directors hold work session to consider nursing directors.
15Mr
Frankly speaking; government for whom? (Gosselin) l9My
Perspective (Gilchrist) E. 3My
Perspective (Hanna) E. 40c
Separate collective bargaining body for Alberta. I3J1
LABRADOR
Outpost nursing in northern Newfoundland (Graydon. Hendry)
34Au
LACROIX, Eliane
French translator at CNA (port) 48Ja
LAING. Gail Patricia
Uospttalization: is it always a negative experience? 35N
IS!^MM> M
Hospitalization and persora I ii> change: recognition vital to nursing
care. 44ia
LALONDE. Marc
Begin replaces l-alonde in cabinet siii:(ne, 9N
LAMMER, Marie
rommunicatiOTis officer. Saskatchewan Rcjiisiered Nurses
Association, 6IAp
LAMPE. Sosan
The role of the head nurse in primary nursing (pan) l B.i: ids. Good)
26Mr
LANCASTER, Jean
Practical guide to preventing neonatal heat loss (Williams) 28My
LANTZ. Bonnie
Director. Surgical Nursing. VGH (port) 8N
LAPP, Sheryl Ann
Awarded the Helen McAnhur Canadian Red Cross Fellowship, of
$3,500. 48S
LARSON. Jenniece Beryl
Awarded the Katherine E. MacLaggan Fellowship of $4,500. 48S
I.ATHROP. Judy
Appointed chairman of the nursing dept. Mount Royal College.
Calgary Alberta (port) 14D
I.AUGHARNE. Elizabeth
Tri-Hospita! diabetes education centre: a cost effective,
cooperative venture (Stciner) I4S
LAUZON, Kalhy
Appointed executive-secretary of CAUSN. 12Je
LAVOIE. Line
NBARN scholarship. I4D
LAW REFORM COMMISSION
Protection of life. 13My
LAWRANCE, Michael J.
Appointed to the faculty. Mc Master. 170c
LEADERSHIP
The nurse continuum perspective. 24Ja
UBLANC, Francine
Idea exchange (Schultz) 29My
LECKIE, Irene
Why nursing? (Lorree) 30D
LEFORT. Sandra
Burn update. 16Au
Care of the rape victim in emergency. 42F
Ready for any emergency. 45My
LEGER. Micheline
NBARN scholarship. 14D
LECISLATION
CUNSA delegates meet in Calgary to examine nursing and the law
(Parish! 16Mr
Ethics and the law in practice (Escott) 54Au
PEI nurses promote changes in property laws. 18My
Right to die, 45JI
LEMIELX, Louise
Director. RNAO's nursing process project underway. 8N
Joined the staff of the RNAO. 40J1
LEONARD. Linda
The father's side; a different perspective on childbirth. 16F
Husband-father's perceptions of labour and delivery. A. 44Je
Selected aspects of the child bearing experience . . . (Elfert) A.
43Je
LEPROSY
Did you know .... 14Au
LEWIS. Jean E,
St. John Ambulance Investiture, 14D
LEWIS, Lou
Bk. rev., 50F
LIBRARY UPDATE
56Ja,52F,56Mr,52Ap,S5My,48Je,48J1.55Au,,S6s,5.50c,56N.
47D
LINDABURY, Virginia A,
Managing editor of two magazines in Naples, Rorida, 51My
LINDENSMITH, Sandra
Body image and the crises of enterostomy, 24N
I.INDQUIST. Janet
Nurse heads N.W.T. Public
Health Association. 12Ja
LINQCIST. Mabel W.
St. John Ambulance Investiture. 14D
LITTLE. Doreen
Bk. rev., 54My
LORREE, Donald J.
Why nursing? (Leckie) 30D
LYNCH, Mary
St. John Ambulance Investiture, I4D
McALARY. Richard
Needed: a new way of helping, 45Ap
VI
McCANN, Beveriey
We took physical fitness to the county fair (De.sai . . . et al) 25.
McCRARY, Marcia
Cuddle bathing can be fun (lies) 24My
MACDONALD, Larry
Behavioral therapy. 26J1
MACDONALD, Myrtle I.
Practical concerns for nursing the elderly in an institutional settin)
25Ap
McGEE, Arlee D.
The nurse continuum perspective, 24Ja
Nursing the alcoholic patient, 3()Je
McGILL UNIVERSITY, SCHOOL OF NURSING
McGill Research Unit to study community health nursing, 9Ja
M.Sc. (Applied) offered to non-nurses, I3ja
MACINTYRE, Gayle
Awarded the Judy Hill Memorial Scholarship, 48N
MclVOR, Janet
Flying to work, 34D
McKENNA, Sharon
A (juiet day . . ., 20Je
McKENZIE, Ruth
Lecturer, (Queen's University, 160c
Mcknight, Wendy Lynn
Receives $2,000 scholarship (port) 48S
MACLEOD, Ella
Expanded roles in respiratory nursing — the respiratory nur
clinician for quality care, 35J1
McLEOD, Mona
Bk. rev , 5IOc
MACLEOD, Vivian
NBARN scholarship, I4D
McMASTER UNIVERSITY
Appointments, 17C)c
McMEEKAN, L, Patricia R,
Frankly speaking: so you want to make a comeback, 26F
McNEIL, Madeleine
Membership secretary, CCCN, 52Mr
McNULTY, Matthew F,
NLN elects man as vice-president, 7Je
McPHAIL, lT«ne
St. John Ambulance Investiture. I4D
MAKOROTO, Josie
Reproduction and the test tube baby (Pakalnis) 34F
MANITOBA ASSOCIATION OF REGISTERED NURSES
Host first national seminar on standrads of nursing practice. 6
Standatds meeting, 9D
Supports Alert, 15Mr
MANN, Judy
Second vice-president of NBARN, 9S
MARITIME PROVINCES HIGHER EDUCATION
COMMISSION
NBARN presents brief to education committee, 7Je
MARLATT, Corine
In Afghanistan with MEDICO, 51 My
Manitoba nurses study implications of development of nursii
standards, lOJI
Members back MARN at special meeting, 7N
Representatives meet with cabinet, l2Mr
Sets up referral service, 12Ja
MARSHALL, Donna
Protective isolation unit, Montreal General Hospital, 26Au
MATSUNO, Kiyoko
Receives a $3,000 scholarship (port) 48S
MAY, Thdma J,
St. John Ambulance Investiture. 14D
MEAD, Margaret
World Federation for Mental Health draws 210O concerned
professionals (Zilm) IOOc
MELLOR, Ruth
Appointed Regional Director for Ontario of the VON. 49N
MENTAL HEALTH
NBARN brief on mental health services, 12S
World Federation for Menul Health draws 2 100 concerned profi
sionals (Zilm) IOOc
METROPOLITAN TORONTO FORENSIC SERVICE
Michael Samuel Phillips, appointed deputy directc
administration, 160c
MIDWIFERY
Aliernative birth centers (Rice. Carty) 31N
MIKOSKI, Christina
Bk rev . 510c
MILITARY NIRSLNG
Four scor« and len (Wilkinson) 260c. I3N. 16D
MILLER, Winifred M.
Direcior. Psychiatric Nursing, VGH (port) 8N
MILLS, Joan
Executive secretary of the RNANS, 48N
MILLS. Winnifred Qaire
Lecturer, University of Alberta. I60c
MILTON, Isabel Caroline
Receives a S3 .000 scholarship (port) 48S
MONTEMURO, MatirKn
Appointed to the faculty, McMaster. I70c
MONTREAL GENERAL HOSPITAL. CENTRE FOR
ADVANCED STUDIES IN PRIMARY CARE
- New primary care centre opens in Montreal. I2S
MOORE, Janet
Bit. rev . 55N
MORGAN, Janice B.
St. John Ambulance in\estiture. I4D
MORLOK, M. Ann
Day therapy centre: the role of the primary care nurse, 50Ap
MOYNIHAN, Dawn
God's love and a jar of honey. 28S
MUCK. Nancy
NBARN scholarship. I4D
MULLIGAN, Mary Jane
Director RNABC. nor mirse apjpointce. 14D
MURDOCH, Jean
Directorof the school of nursing at the Halifax Infirmary, Halifax,
N.S..49N
ML RPHY, Norma J.
Helping a family and their [xemature baby grow together. 42S
MURTHY, Joan
Dear Mr. Rajabally (Boyle) 7D
MUSSALLEM. Helen K.
CNA executive director receives Ren Honorary Fellowship (port)
9Ja
Report to membership. I IMy
Thirtieth World Health Assembly in Geneva. Switzerland ( port ) 7J1
MYELOMENINGOCELE
Peter: an infant with a myelomeningocele (Heniy) 15Ja
NAKAMOTO. June
Directs. Obstetrical. Gynecological Nursing. VGH (port) 8N
NAMES
48Ja. 52Mr. 6IAp. 51My. l2Je. 40J1. 48S. I60c. 48N. I4D
NATIONAL COUNCIL OF THE GIRL GUIDES OF CANADA
Nurses to ccHnplete new health forms. 8Ja
NATIONAL LEAGUE FOR NURSING
NLN elects man as vice-president, 7Je
NELSON, Jean
St John Ambulance Investiture. I4D
NEMETZ, Emma
Education in health care in an intercultural maternity service. A,
52N
NEUROLOGICAL NURSING
Annual meeting. American Association of Neurosurgical Nurses.
8Je
NEVITT, Joyce
Bk. rev.. 510c
NEW BRUNSWICK ASSOCIATION OF REGISTERED
NURSES
Awards, 48Ja
Brief on mental health services. 12S
George Bergeron, appointed liaison officer. 49N
Presents brief to education committee, 7Je
61st annual meeting, 6S
Scholarship. I4D
Supports provincial consultant in psychiatric nursing, 9Ja
NEW BRUNSWICK HEALTH SERVICES
NBARN brief on mental health services, I2S
NEWFOUNDLAND
Outpost nursing in northern Newfoundland (Graydon. Hendry)
34Au
NEWS
8Ja. lOF, I2Mr, l2Ap. lOMy, 6Je. 7JI, 12Au,6S. IOOc,6N,8D
NICHOL, CcUa
Congenital dislocated hip. I4J]
Congenital dislocated hip: Lisa. I8J1
NIGHT DUTY
How do you feel about . . . working nights? (Fitzpatrick) 34S
Idea exchange (The difference between night and day) (Ford) 46Ja
NIXON. Margaret
Heads Mamtoba interest group, 14Au
NORTH AMERICA
Nursing around the world (Schlotfeldt) 44Au
NORTHERN HEALTH SERVICES
Four score and ten: Part three (Wilkinson) 16D
CXitposl nursing in northern Newt'oundland (Graydon. Hendry)
34Au
NORTHWEST TERRITORIES REGISTERED NURSES'
ASSOCIATION
Mae Wright, honorary member. I4D
NURSE PRACTITIONER
Margaret Nixon heads Manitoba interest group. 14Au
Outpost nursing in northern Newfoundland (Graydon. Hendry)
34Au
Personality profiles reflect new maturity, 9S
NURSING
CNA directors hold work session to consider nursing directions,
l5Mr
Frankly speaking: so you want to make a comeback (McKeekan)
26F
MARN hosts first national seminar on sundards of nursing prac-
tice, 6N
Perspective (Harma) E. 4Mr
The practice environment as perceived by new graduate nurses
(Kay) 52N
RNAOs nursing process project underway, 8N
Standards of Nursing Practice Project. lOD
NURSING ADMINISTRATORS ASSOCIATION OF NOVA
SCOTIA
Set up special interest group. 1 2D
NURSING CARE
Accountability: a professional imperative (Poulin) 30F
Expanded roles in respiratory nursing — the clinical nurse
specialist: an individual perspective (Robinson) 35J1
Expanded roles in respiratory nursing — the respiratory nurse
clinician for quality care (MacLeod) 35JI
Hospiulization and personality change: recognition vital to nursing
care (Lake) 44Ja
Mamtoba nurses study implications of development of nursing
standards. lOJl
The nursing process, a tool to individualized care (Hagar) 380c
One gentle man . . . (Walsh) (port) 56Ap
Perspective (Hanna) E. 3S
Privacy: the forgotten need (Schultz) 33J1
A study of continuity of nursing care from the hospital emergency
room into the home (Perkin) A, 43Je
NURSING EDUCATION
See Education
NURSING EDUCATION MEDIA PROJECT (NEMP)
Ethics and the law in practice. 34Au
Idea exchange (Education in the electronic age) (Escott) I5F
NURSING HOMES
ARNN brief. 9D
CCHA guide. lOD
"It's time to go home now . . ," another look at nursing homes
(Ford) 3IAp
Needed: a new way of helping (McAlary) 45Ap
NURSING MANPOWER
Accountability: a professional imperative (Poulin) 30F
A Canadian grad goes to the States (Zin) 460c
CNA research study reveals few key changes in nursing employ-
ment, education patterns since 1966. 12Mr
Coast-to-coast reports indicate few nursing positions available.
lOJa
MARN sets up referral service. l2Ja
Perspective (Hanna) E. 2Ja
NUTRITION
Amrexia nervosa: a nursing approach (Butler. Duke. Slovel) 22Je
Did you know .... 130c
Health happenings in the news, 13JI
Living to eat: nutrition for senior citizens (Grenby) 42Ap
Nutrition and the burn patient (Fortier) 30Au
Nutrition Canada Dental Report. 1 lOc
— O —
OBSTETRICS
Alternative birth centers (Rice, Carty) 31N
Cuddle bathing can be fun (lies. McCrary) 24My
Education in health care in an intercultural maternity service
(Nemetz) A. 52N
The father's side; a different perspective on childbirth (Leonard)
I6F
Fetal monitoring, why bother (Hodnett) 44Mr
Food-releveni stimuli. I40c
Husband-father's perceptions of labour and delivery (Leonard) A,
44Je
International authorities in address ICEA conference on the family,
l2Ja
Selected aspects of the childbearing experience as described by
sixty couples (Elfert. Leonard) A, 43Je
OCCUPATIONAL HEALTH
Especially for you, nurse (Weller) 20M>
Flying to work (Mclvor) 34D
Health happenings in the news. l3Ja
N.S occupational health nurses hold seminar. 2IJ1
OGILVIE, Heather Marion
Awarded S4.500 to begin d.K:toral studies (porl) 48S
OKA, Betty
Director of nursing. Shaver Hospital for Chest Diseases. I4D
OKANAGAN COLLEGE. BRITISH COLUMBIA
A program that dares to be different (port) (Skelton) 36Mr
O'LEARY, Norah A
Nursing Consultant, Health Programs Branch of Health and Wel-
fare Canada, 48Ja
Standards of Nursing Practice Project, lOD
Health Standards Directorate of the Health Programs Branch.
Health and Welfare Canada (port) SOS
ONCOLOGY NURSING SOOETY
Health happenings in the news, l3Ja
O'NEILL, Sheila
Roundup of critical issues. CNA annual meeting 1977, 8Je
ONTARIO CANCER INSTITUTE
Phyllis Burgess retired as director of nursing. 5 IMy
ONTARIO HOSPITAL ASSOCIATION
Competency Model Project. lOD
ONTARIO NURSES ASSOCIATION
Ontario nurses document declining standards of care. l4Ap
OPERATING ROOM NURSES OF GREATER TORONTO
OR nurses hold 10th conference, 7Je
ORDER OF NURSES OF QUEBEC
Code of ethics implemented in Quebec. l3Ja
ORIENTATION
Orientation and inservice programs for teachers in Canadian two-
year schools of nursing (Field) A. 44D
ORTHOPEDICS
Orthopedic nurses hold education day, l2Ap «
OSTOMY
Body image and the crisis of enterostomy (Lindensmith) 24N
Helping young ostomy patients help themselves (Tisdale) 30J1
People with temporary colostomies (Wood. Watson) 28N
OUELLETTE, Suzanne
NBARN scholarship. 14D
OULTON, Judith
President of NBARN. 9S
OUTPOST NURSING
Four score and ten (Wilkinson) 160
— P —
PAIN
Coping with pain: strategies of severely burned children (Save^ka^
28Au ^
PAKALNIS. LucUle
Reproduction and the test tube huhy fMakorot
PALMER, Rachel
President. Commonwealth Itftnes' Federation. 52Mi
PARAPLEGIA ^lK
A gift of lomonou » French) KUI
PARISH, Debi
CUNSA delegates meet m Calgary. l6Mi
PASK. Eleanur Grace
Receives a SI. 100 scholar&hip (port) 48S
Specialization in nursing, 34Mr
1
PASSEY. Iris
On the Forensic Nursing Comminee of the RPNA. 48Ja
PATIENT EDUCATION
A child life program in action. 42N
Childhood diabetes: ihe emotional adjustment of parents and child
(Crosby) 20S
Helping young ostomy patients help themselves (Tisdale) 30J1
Hey. what about the kids? (Alcock; 38N
Hospitalization; is it always a negative experience? (Laing) 53N
The juvenile diabetic: in or out of control? (Polowich. Elliott) 24S
Programmed learrring: cardiac depressants (Warkentin) 30My
Tri-hospilal diabetes education centre: a cost effective, cooperative
venture (Laugharne. Sterner) MS
PATIENTS
Consumer rights and nursing (Slorch) A, 52N
The development and testing ot an instrument for assessment and
classification of patients by types of care (Kyle) A. 44D
God's love and a jar of honey (Moynihan) 28S
Hospitalization and personality change; recognition vital to nursing
care (Lake) 44Ja
Nursing the acutely psychotic patient (Berezowsky) 23F
Perspective (Hanna) E. 4Mr
Privacy: the forgotten need (Schultz) 33J1
The self-care unit; a bridge to the community (Barrington) 39F
Spouses need nurses too (Silva) 38D
PATTEN, Mary E.
Professional responsibility: an international concern- ICN plenary
session. 39Au
PEDIATRICS
The Canadian Institute of Child Health: a personal responsibility
(Andrews) 2IJI
A child life program in action. 42N
Childhood diabetes: the emotional adjustment of parents and child
(Crosby) 20S
Congemul dislocated hip (Nichol) 14JI
Congenital dislocated hip: Lisa (Nichol) 18JI
Coping with pain: strategies of severely burned children (Savedra)
28Au
Did you know .... L30c
Early identification of developmental impairments in infants birth
to nine months of age (LXihertyi A. 52N
Helping A family and their premature baby grow together (Murphy)
42S
Helping young ostomy patients help themselves (Tisdale) 30J1
Hey. what about the kids? (Alcock) 38N
Hey. what about the kids? — Commentary (Post) 44N
Mirroring (Kikuchi) 3IMr
Nurse to direct Information Centre at Hospital for Sick Children.
12F
The nursing process, a tool to individualized care (Hagar) 380c
Pediatric audiology workshop aids nurses. 12Au
Peter: an infant with myelomeningocele (Hendry) l5Ja
Practical guide to preventing neonatal heat loss (Williams.
Lancaster) 28My
The rewards of research, cuddle bathing can be fun (lies, McCrary)
24My
PEPLAU, HildeKard E.
Third vice-president of ICN Board of Directors. 50S
PERCY, Dorothy
Receives Florence Nightingale award. 8D
PERKIN, Cathenne Ann
A study of continuity of nursing care from the hospital emergency
roofh into the home. A. 43Jc
PERSPECTIVE
2Ja. 4F. 4Mr. 4Ap. 3My. 3Je. 2J1, 3Au, 3S. 40c, 3N
PETERS. Joan
Bk rev,. 550c
PHARMACEITICAL ADVISORY BOARD
Drug ad watchdog assumes responsibility, lOF
PHILLIPS, Michael Samuel
Appointed deputy director-administrauon. Metropolitan Toronto
Forensic Service, 160c
PnOLLiPS. Patricia A.
Project dirocior. CARF/MEDICO (pon) 52Mr
^.
PHYSICAL OTNESii
CNA hcakh pcooiiMion prf^ani phjse iwo, 1 IJl
Did you know . lOF
n..^ .,,,, tnow- 13JI
lor you. mirse: jroga for tired !l-l"> and aching back
Tj 20My
Health Happenings. I40c
Ufcktyle award program armouiKed. I6Mr
The nur$e"» role in health assessment and proiii'non JOMr
We took physical fitness 10 the county fair (Il>uai . ctal.)25Je
Nurses try out fitness model. 7N
i
PICKERING. Edward A.
VON appoints financial adviser (port) I lOc
PINE. Barbara
Appointed to the faculty. McMaster. i70c
POISONS
Nurse to direct Information Centre at Hospital for Sick Children.
I2F
POLOWICH. Carol
The juvenile diabetic: in ot out of control? (Elliott) 24S
POST. Shirley
The Canadian Instinite of Child Health (Andrews) 2 IJl
Health happenings. 12F
Hey, what about the kids? — Commentary, 44N
POULIN, Muriel A.
Accountability: a professional imperative. 30F
POUPART. Therese
RccOTding secretary. CCCN. 52Mr
POVERTY
Perspective (Hanna) E, 4F
POWERS, Maureen
Appointed executive directw of the RNAO (port) 12Je
PRACTICAL NURSING
NB RNAs set up separate organization. lOS
PREGNANCY
Health happenings, 12F
PRIMARY CARE
Accountability: a professional imperative (Poulin) 30F
Day therapy centre; the role of the primary care nurse iMorlok)
50 A p
New primary care centre opens in Montreal. 12S
The role of the head nurse in primary nursing (Bartels, Good,
Lampe) 26Mr
PRISONS
Caring fw the forensic patient (Wcffden) 21Ja
PROFESSIONS
New hOTizons for nursing- Part 1. Professional re^onsibility.
38Au
Perspective (Hanna) E, 4C)c
PROWSE, A. Judith
Appointed chairman of the Health Sciences Department. Grant
MacEwan Community College m Edmonton. Alberta (port)
48N
PROWSE. Gail A.
Dear Mr. Rajabally. 6D
PSYCHIATRIC NtRSING
Anorexia nervosa: a nursing approach (Butler, Duke. Siovel) 22Je
Care vs. custodialism (de Cangas, Berezowsky) 36Je
Caring for the forensic patient: a supportive approach to individuals
in conflict with society iWorden) 2lJa
NBARN supports provincial consultant in psychiatric nursing. 9Ja
Nursing the acutely psychotic patient (Berezowsky) 23F
Psychodrama and the depressed elderly (Burwell) 54Ap
The self-care unit: a bridge to the community (Barrington) 39F
PUBLIC HEALTH NURSING
An analysis of the implication of the concept of family -centered
care in public health nursing visits (Cunningham) A. 4SJI
Frankly speaking; government {<x whom? (Gosselin) 19My
Idea exchange (LeBlanc. Schultz) 29My
Murphy's glue (Hall)42D
Nurse heads N.W.T, Public Health Association. l2Ja
Ontario PHN's hold second open forum, l2Ja
PUBLIC SECTOR EMPLOYEE COORDINATING COLiNCIL
B.C nurses join public employees. 13JI
QUALITY OF HEALTH CARE
Expanded roles in respiratory nursing — the clinical nurse
specialist: an individual perspective (Robinson) 35JI
Expanded roles in respiratwy nursing (MacLeod) 35JI
Ontario nurses document declining standards of care. 14Ap
Quality assurance off to flying start. 12Au
QUEEN'S UNIVERSITY. SCHOOL OF NURSING
Alice \. Baumgart. named Dean. 40JI
New appointments, 160c
QUINN, Paula
NBARN scholarship. 48Ja. 14D
RAONE, Barbara
Roundup of critical issues. CNA annual meeting 1977. 8Je
RAJABALLY, xMohamed H.
Nursing education. 30S
RAKOCZY. Mary
Bk. rev.. 46Je
RAMOS. Z«iiida
Protective isolation unit. Montreal General Hospital. 26Au
RANKIN, Lorna
Bk. rev , 55S
RED CROSS
Four score and ten (Wilkinson) 16D
St- John/Red Cross multi-media project. 18My
REGISTERED NURSES' ASSOCUTION OF BRITISH
COLUMBIA
Directors, non nurse appointees. 14D
Ins Passey on the Forensic Nursing Committee of the Ret:
Psychiatric Nurses' Association. 48Ja
Marilyn L- Carmack. appointed assistant executive direct^'
I60c
West coast nurses stage 65th annual RNABC meeting, 12 "
REGISTERED NURSES ASSOCIATION OF BRITISH
COLUMBIA. STATEMENTS
The nurse's role in health assessment and promotion. 40Mr
REGISTERED NURSES ASSOCIATION OF NOVA SCOTU
Better quahtled personnel would benefit aged. lOF
Joan Mills, appointed executive secretary. 48N
NS nurses anend 68th annual meeting. l4Au
REGISTERED NURSES ASSOCIATION OF ONTARIO
Carole Elliott, communications officer, 6IAp
Citizens' council. 6Je
Louise Lemieux- Charles has joined the staff. 40J1
Margaret Risk, assistant director- practice in the Nursing Divisior
61Ap
Maureen Powers appointed executive director the RNAO 'por
12Je
Nursing process project underway. 8N
Ontario PHN's hold second open torum. l2Ja
REGISTERED NURSES ASSOCIATION OF ONTARIO.
ANNUAL MEETING
RNAO delegates prepare now for future shock. 6Jc
REGISTERED NURSES ASSOCIATION OF ONTARIO.
CITIZENS' ADVISORY COUNCIL
RNAO delegates prepare now for future shock. 6Je
REGISTERED PSYCHIATRIC NURSES' ASSOCIATION
Ins Passey on the Forensic Nursing Committee. 48Ja
REGISTRATION, LICENSURE
CNA dircctOTs hold work session to consida nursing direction
l5Mr
REHABILITATION
Caring for the forensic patient; a supportive approach to individua
in conflict with society (Worden) 21Ja
A gift of tomorrow (French) 20J1
REID, Laurie Dawn
Receives a $3.(K)0 scholarship. 48S
RENCZ. Sandra A.E.
Appointed lecturer in nursing. UNB. 52Mr
RESEARCH
43Je. 45J1. 5(X)c. 52N. 44D
An analysis of the application of the concept of family -centere I
care in public health nursing visits (Cunningham) A, 4SJi
CNR holds policy session. 9Au
A comparative study of the self-acceptance of suicidal and
non-suicidal youths (Westwoodi A. 43Je
Consumer rights and nursing (Siorch) A, 52N
The continuing learning activities of graduates of two diplon;
nursing (wograms in Ontario (Anderson) A. 50Oc
The development and testing o\ an instrument for assessment an
classification of patients by types of care (Kyle) A. 44D
Early identification of developmental impairments in infants birt
to nine months of age (Doherty) A. 52N
Education in health care in an intercultural maternity servic
(Nemetz) A. 52N
The effects of continuity in nurse-patient assignment among
selected group of preoperative aortocoronary bypass patien^
(Rosa) A. 45J1
First psoriasis education and research centre. 9N
Husband-fathers perceptions of labour and delivery (Leonard) A
44Je
Internal evaluation of an experimental dacum curriculum in
diploma school of nursing (Haliburton) A. 50Oc
Jo-Ann Tippett Fox. Student Research Award from the Canadia
Foundation for Ileitis and Colitis. 170c
Knowledge reported by chronic renal failure patients in four arc;
related to self-care (Smith) A. 50Oc
McGill Research Unit to study ccwnmunity health nursing. 9Ja
Vill
Orientation and inscrvice programs for leachere in Canadian two-
year schools of nursing (Field) A, -WD
Posioperalive cardiac surgical patients* opinions about structured
preoperative teaching by the nurse (Dunusi A. 44Jc
The practice cnMronment as perceived by new graduate nurses
(Kay) 52M
Regina Bohn-Browne. nurses in primary care. I70c
Report of the Task Force on Cervical Cancer Screening
Programmes (the Walton Report) l2Ap
The reward of research, cuddle bathing can be fun (lies. McCrary)
24My
Selected aspects of the childbcaring experience as described by
sixty couples (Elfen. Leonard) A. 43Je
A study of continuity of nursing care from the hospital emergency
room into the home iPcrkm) A. -llJe
Survey on nurse researches. 12D
RESPIRATORY DISEASES
Expanded roles in respiratory nursing — the clinical nurse
specialist: an individual perspecuvc (Robinson) 35J1
Expanded roles in respiratory nursing — the respiratory nurse
clinician for quality care (MacLeod) 35JI
Nursing fellowships offered. lOS
Respiratory nurses seek CNA affiliation, I lOc
RICE. Alison
Alternative birth centers (Cartyj 3IN
RICHARDSON. Margaret
Bk. rev.. 53N
RISK Margaret
Assistant director- pracdce in the Nursing Division. RNAO. 61 Ap
ROBERTSON. Mary E. (SaUv)
Summer residency at CNA (port) 4IJI
ROBINSON. Lee
Expanded roles in respiratory nursing — the clinicaJ nurse
specialist: an individual perspective. 35J1
ROLLS. Barbara
Director RNABC. non nurse appointee. I4D
ROSA, Julia M. Petletier
The effects of continuity in nurse-patient assignment among a
selected group of preoperative aonocoronaiy bypass pabents.
A. J5JI
ROWSELL, Glenna
Director. CNA Labor Relations Services. 18My. 48N
ROY. Helene
Provincial representative. New Brunswick. CCCN, 52Mr
ROYAL COLLEGE OF NLRSING
CNA executive du-ecior receives Ren Honorary Fellowship (pon)
9Ja
Ren fellow named acting ICN head. 18My
ROYAL VICTORIA HOSPITAL. MONTREAL. PALLIATIVE
CARE L>IT
Health happenings. 12F
RLST, Beth
AbortioD counselling (port) ( Eastcrbrook) 28Ja
RYAN. Sheila
Director ot Nursing. UBC Medical Centre. Dept of Psychiatry.
49N
SABIN, Helen
Named AARN honorary member, 9JI
ST. JOaN AMBULANCE
St. John/Red Cross multi-mcdia project. I8My
5T. JOSEPHS HOSPITAL. HAMILTON
A new look at blood transfusion therapy (Haiward) 38My
jAMANSKI. Mary Dean
Singing signing smiling. 28F
:^ASKATCHEWAN. DEPT. OF HEALTH
Val Cloarec. Director of Vital Statistics (pon) 52Mr
SASKATCHEWAN REGISTERED NURSES ASSOOATION
Diamond jubilee celebrates sixty years of growth and progress. 8JI
Barbara Ellemers, Executive Director (port) 61Ap
Marie Lammcr. communications officer. 6IAp
Performance expectations of new grads. I2JI
(Quality assurance off to flying start. i2Au
Val Cloarec. executive director, resigned (port) 52Mr
»^AVEDRA. Marilyn
Coping with pain. 28Au
iCHAMBORZKt. Ingeburg Lrsula
Receives a SI.CMXJ scholarship (port) SOS
SCHATTSCHNEIDER. Hazel
Community resources for the elderly. 47Ap
SCHILLING, Karin von
Bk rev..46JI
SCHLESINGER. Benjamin
From A to Z »ith adolescent sexuality. 340c
SCHLOTFELDT. RozeUa M.
Nursing around the world. North Amenca. 44Au
SCHMITT. Ann
.^ppoinied to the faculty. McMaster. I70c
SCHOLARSHIPS
Nursing fellowships offered. lOS
SCHOOL NLRSING
Secondary school nursing i Brown) 420c
SCH RIDER, Larry
Bk. rev.. 55Mr
SCHLXTZ. Anne
Idea exchange iLeBIano 29My
SCHLLTZ, Ellen D.
Privacy. 33JI
SCHNTRR. Therese
I>rector of Nursing Service. Royal Columbian Hospital. New
Westminster. BC . 14D
SCHWARZ. Marianne
NBARN brief on mental health services, 12S
SCOLIOSIS
Health happenings. 12S
A school screening program that works (Gum 24D
SCOTT. J. Karen
Cystic fibrosis-Camp Couchiching . . . four summers. 14Je
SEBtRN. Isabelle
Dear Mr. Rajabally. 7D
SEGLIN, MarilyoDe
Idea exchange (Education in the electronic age) (Escott) ISF
SENECA COLLEGE. TORONTO
L'WO Dean of Nursing addresses Seneca College Education Day.
l5Mr
SEX
Abortion counselling (Eastcrbrook, Rust) 28Ja
Care of the rape victim m emergency (LeFort) 42F
From A to Z with adolescent sexuality (Schlesinger) 340c
Sexuality and the disabled (Finchi l9Ja
SHEA, Julia A.
Bk. rev.. 54N
SHIELDS. Judith
Provincial representative. British Columbia. CCCN. 52Mr
SHIELDS, Mary
Bk. rev.. 55 Mr
SHRINERS SCHOOL SCOLIOSIS PROGRAM
A school screening program that works (Gurr) 24D
SILVA. .Mary Cipriano
Spouses need nurses too. 38D
SINCLAIR. Glennyce
Director of the Diploma Nursing Program, College of New
Caledonia. 5 1 My
SKELTON, Judith M.
A program that dares to be different (port) 36Mr
SKIN
First psoriasis education and research centre, 9N
SLOAN, Hallie
Nursing coordinator at CNA (port) 40JI
SMALE. Shirley
Assistant professor. (Queen's University. I60c
SMITH. Bonnie Lee
Director of Nursing. Jewish Convalescent Hospital in Chomedcy.
Uval. Quebec, 49N
SMITH. Rosdyn
Director of nursing. Children's Hospital. Vancouver, BC . 5IMy
SMITH. Susan Dawn
Know ledge reported by chronic renal failure patients . . .A.50Oc
SMOKING
Health happenings. I2S
SOOETIES. NLRSING
.Alberta nurse educators form new association. 8Je
CNA supports special interest groups. 130c
Highlights from CNA Directors' meeting. 13My
IX
Margaret Nixon heads Manitoba interest group. 14Au
New Brunswick infection control nurses. I2D
.Nova Scotia nursing service administrators set up special interest
group. 1 2D
Orthopedic nurses hold education day. 12Ap
Respiratory nurses seek CNA affiliation, llOc
SOUTH AND CENTRAL AMERICA
Nursing around the world fBonilla) 47Au
SOITHEAST ASIA
Nursing around the world ide Silva) 46Au
SOME. Margaret D.
Personality profiles reflect i»cw maturity. 9S
SPALDI.NG. Jean W.
Bk. rev.,48JI
SPARKS. F.L. (Nan)
Bk. rev.. 47J1
SPEQAL INTEREST GROUPS
CNA supports special interest groups. 130c
SPEOALTIES. NURSING
Expanded roles in respiratory nursing — the clinical nurse
specialist: an individual perspective (Robinson) 35JI
Expanded roles in respiratory nursing — the respiratory nurse
clinician for quality care (MacLeod) 35JI
Specialization in nursing iPask) 34Mr
SPEECH
Siging signing smiling (Samanski) 28F
SPENCE. Perely
Protective isolation unit. Montreal General Hospital. 26Au
SPITZER. Walter O.
.New primary care centre opens in Montreal. I2S
SPLANE. \erna Huffman
2nd Vice-PreMdent of the ICN (port) 40JI. 50$
SPROUL. Heather
Mrs. B and me (port) 46F
STAFFING
How do you feel about . . working nights? (Fitzpairick) 34S
Perspective iHanna) E. 3S
STAINTON, Colleen
Bk. rev.. 50Ja. 540c
STALEY. Ann G.
Bk rev . 54N
STALLKNECHT. Kirsten
Nursmg around the world, Europe. 43Au
STEINER. George
Tri-hosjMial diabetes education centre (Laugharne) 14S
STOCKWELL. Carolyn
Chairman. CCCN. 52Mr
STORCH. Janet L.
Consumer rights and nursing. A. 52N
Survey on nurse researches, I2D
STOVEL, Toni
.■\n(.Texia nervosa (Butler, Dukei 22Je
STR.ATHCONA RETIRED NURSE SERVICES
Retired nurses aid elderiv in .Mberta. 9Jl
STl DENTS
ICN welcomes student nurses. 8Ja
Mrs B and mc (Sproul) 46F
SUBERMOLA. Viviane
ICN meets in Tokyo. 6Au
SLIODE
A comparative study of the self-acceptaiKC of suicidal and non-
suicidal youths (Weslwood) A. 43Je
SULLIVAN. Judith
Personality profiles reflect new maturity, 9S
SL>NYBROOK MEDICAL CENTRE
Laura W. Ban, ^^pointed assistant eiec'j'?'.^ I't-' i
services, 48 N
SITERMSORS
A conference for supervis r.. bS
The role of the he-' -^.i'^ - -*■'«*«■». n-.rMn,- R^nriv r>n.>3
Lampe) 26Mr
SURGERY
Body imaiiL .i:ij the crisis of emerostoroy (Lindetismith> 24N
The effe^!^ of contioaity in nursepatient assignment among a
selecii^vi ^oup of preopcnitve aortocorooary bypass patients
(Rosai r.45JI
Helping y^Bc>s Mosetvcs (Tisdale* 30J1
Laryngec^^Hle, -Au
People wilh leniporary colostomies (Wood. Watson) 28N
Postoperative cardiac surgical patietlts' opinions about structured
preoperative teaching by the nurse (Dumas) A. 44Je
Spouses need nurses too (Silva) 38D
StTTIE, Kalhryn
NBARN scholarship. 48Ja
SWEDEN
Needed: a new way of helping (McAlary) 45Ap
SWINTO.N, Constance A.
On loan to CNA from CIDA (port) 41JI
— T —
TAAM, Gina
Provincial representative. Manitoba. CCCN. 52Mr
TAXATION
The taxman comelh (Grenby) 36Ja
TAYLOR. Helen
Montreal nurse heads accreditation body (port) 18My
TEETH
Did you know , , , 1 30c
TISDALE. Hildegard
Helping young ostomy patients help themselves. 30JI
TOMPKINS, Catherine
Appointed to the faculty. McMaster. 170c
TORONTO AREA INTEREST CROUP OF THE ORTHOPEDIC
Nl'RSES ASSOCIATION
Onhopedic nurses hold education day. 12Ap
TURNBALL. Martha
Protective isolation unit. Montreal General Hospital. 26Au
TL'RNBULL. Sharon
Bk. rev.. 53N
UNION OF NURSES OF ALBERTA
Separate collective bargaining body for Alberta. I3JI
UNITED NATIONS
World Environment Day — June 5. 1977 (Hanna) E. 3Je
UNITED .STATES
A Canadian grad goes to the Slates (Zin) 460c
UNIVERSITY OF ALBERTA
New appointments. I60c
UNIVERSITY OK BRITISH COLUMBIA. SCHOOL OF
NURSING
Marilyn D. Willman appointed director. -S2Mr
UNIVERSITY OF NEW BRUNSWICK
Announces changes in nursing program, I2F
UNIVERSITY OF TORONTO. ENVIRONMENTAL AND
OCCl RATIONAL HEALTH UNIT
Health happenings in the news. 13Ja
UNIVERSITY OF TORONTO. FACULTY OF MEDICINE
Appointments. 48Ja
INIVERSITY OF VICTORIA
Focuses on elderly. I lOc
UNIVERSITY OF WESTERN ONTARIO
[>ean of Nursing addresses Seneca College Education Day, 1 5Mr
M Josephine Baherty resigned as dean. Faculty of Nursing. 5 1 My
UPRICHARD. Muriel
Director, School of Nursing, UBC retires. 52Mr
— V —
VANDEWATER, Deborah
Laryngectomee leaflet, 48Au
VANCOUVER GENERAL HOSPITAL
Reorganizes nursing depailment. 8N
VENEREAL DISEASE
Ontario PHN's hold second open forum. 12Ja
VERMETTE, Dorla
St. John Ambulance Investiture. I4D
VICTORIAN ORDER OF NURSES
Appoints financial adviser (port) I lOc
Future for VON despite budget cuts, 7J1
Ruth Mellor, appointed Regional Director for Ontario, 49N
WALLINGTON, Marjorie
Awarded RNAO Fellowship, 48N
WALSH. Bernadetle
One gentle man . . (port) 56Ap
WARD, Wendy
Protective isolation unit, Montreal General Hospital. 26Au
WAREHAM, Peggy
Representatives — to the 1977 ICN Congress. 5 1 My
WARKENTIN, Eleanore
Programmed learning, 30My
WASSON, Dorothy
NBARN scholarship, 48Ja
WATSON. Ina
Bk. rev.. 48JI
WATSON. Pamela Gaherin
People with temporary colostomies (Wood) 28N
WEARING. Joan Irene
Awarded a $3,000 scholarship, JOS
WELLER. Stella
Especially for you. nurse. 20My
WESTERN PACmC
Nursing around the world (Chung) 45Au
WESTWOOD, Catherine Ann
A comparative study of the self-acceptance of suicidal and non-
suicidal youths, A. 43Je
WHAT'S NEW
40Je. 42 Jl
WHELAN. Glenys A.
Provincial representative. Newfoundland. CCCN, 52Mr
WILKINSON, Maude
Four score and ten. 260c. 13N. I6D
WILLIAMS. Joann K.
Practical guide to preventing neonatal heat loss (Lancaster) 28^
WILLMAN. MarUyn D.
Director of the School of Nursing. UBC. 52Mr
WILSON, Jane
Bk. rtv.. 54N
Treasurer. CCCN. 52Mr
WINBKRG. Mona
Listening does help (Hobson) 40S
WOMEN
New horizon for nursing. Part 2. Nursing practice around
world, 40Au
Women in ambulance services. lOJe
WOOD, Robin Young
People with temporary colostomies (Watson) 28N
WOOD, Vivian
In Women of action 1876-1976, I4D
WOODS. Carol
Awarded RNAO Fellowship. 48N
WORDEN, Jane
Caring for the forensic patient (port) 2IJa
WORKSHOPS
See Congresses
WORLD FEDERATION FOR MENTAL HEALTH
Draws 2100 concerned professionals (Zilm) lOOc
WORLD HEALTH ORGANIZATION
Thirtieth World Health Assembly in Geneva. Switzerland, 7
WORLD WAR I
Four score and ten (Wilkinson) 260c. I3N
WORTHINGTON, Uura
Things that go bump in the night. 190c
WRIGHT, Mae
Honorary member, NWTRNA. I4D
— XYZ —
YARMOUTH REGIONAL HOSPITAL
Idea exchange; well woman and health awareness clinic (Doc
5IAu
YOGA
Especially for you (Weller) 20My
YOUNG. OUve June
Assistant professor. University of Alberta. 160c
YTTERBERG. Lorea
Director. Medical Nursing. VGH (port) 8N
YUKON
Federal transfer health services. 9D
ZILM, Glennis
World Federation for Mental Health draws 2 1 00 concerned pr'
sionals. lOOc
ZIMMERMAN. Anne
Professional responsibility. 40Au
ZIN. Katherine
A Canadian grad goes to the States. 460c
tHo eamaMam
MBWBmSO
January 1977
ES7607615935
-MRS eC MCCUE
58 HAR^»ER AVE N APT 3
CTTAWA ONT
KlY
White Sister works haidest
Msihen you d
i •
Style 48505 — Dress
About $23.00
Style 8560
Wardrober
About $35.00
(Skirt not shown)
You work hard enou^ without having to worry about
how much your uniform can take.
And that's the real beauty of the WardrcA)er
by White Sister. It consists of a jacket, skirt ai
pants that all work beautifully together, like:
outfits for the price of one. Easy-care "Royali
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Looksgreat with little ironing. White or Robin
blue. Royale's newest colour. Size 6-16. $35
White Sister also has a dress uniform made
Available at leading
if the same fabric. We've paid special attention
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Size 3-15. $23.00
When you want hard-working unif^ms
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tH» eawBadinwB
wBnmme
January 1977
The official journal of the Canadian
Nurses Association published
monthly in French and English
editions.
Volume 73, Number 1
^^^^^^^^^^^^^B
input
4
News
8
Names
48
Peter: An Intant with a
Myelomeningocele
Judith M. Hendry
15
Books
50
Sexuality and the Disabled
Elizabeth Finch
19
Calendar
55
Caring for the Forensic Patient
Jane Warden
21
Library Update
56
The Nurse Continuum Perspective
Arlee D. McGee
24
Abortion Counselling
Bonnie Easterbrook, Beth Rust
28
The Tip of the Iceberg
Jackie Barber
31
The Taxman Cometh
Mike Grenby
36
Crossword Puzzle
Maria Rubilie Glenn
39
Challenging the Status Quo
Heather F. Clarke
40
Hospitalization and
Personality Change
Gertrude M. l^ke
44
Idea Exchange
Lynda Ford
46
Lifestyle, according to Health and
Welfare Canada, is "staying in
shape or getting fit through regular
physical activity or it's going to seed ....
it's getting out and doing something
enjoyable or being bored." Our
cover photo (Courtesy Canadian
Government Travel Bureau)
illustrates a form of physical activity
that is becoming increasingly popular
with people looking for more exercise
... skiing.
The views expressed in the arlicles
are those of the authors and do not
necessarily represent the policies of
the Canadian Nurses Association.
ISSN 0008-4581
Indexed in International Nursing
Index, Cumulative Index to Nursing
Literature. Abstracts of Hospital
Management Studies, Hospital
Literature Index. Hospital Abstracts.
Index Medicus. The Canadian Nurse
IS available in microform from Xerox
University Microfilms. Ann Arbor.
Michigan, 48106.
The Canadian Nurse welcomes
suggestions for articles or unsolicited
manuscripts. Authors may submit
finished articles or a summary of the
proposed content. Manuscripts should
be typed double-space. Send original
and carbon. All articles must be
submitted for the exclusive use of The
Canadian Nurse. A biographical
statement and return address should
accompany all manuscripts.
Subscription Rates: Canada: one
year, S8.00: two years. Si 5,00,
Foreign: one year, S9,00: two years,
S17.00. Single copies: Si, 00 each.
Make cheques or money orders
payable to the Canadian Nurses
Association,
Change of Address: Notice should be
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registration number, in a provincial/
territonal nurses association where
applicable. Not responsible for
journals lost in mail due to errors in
address.
Postage paid in cash at third class rate
Montreal, P,Q, Permit No, 10,001.
- Canadian Nurses Association
1977,
Canadian Nurses Association,
50 The Driveway. Ottawa, Canada,
K2P 1E2.
The Canadian Nurs« January 1977
Porspeetivi?
Usually the start of a new calendar
year brings with it an almost
Imperceptible rise in spirits. Somehow
we always expect things to be a little
better in the 1 2 months ahead. This
year, however, as the world struggles
to recover from an economic
downturn, many people are having
trouble being optimistic about what
1977 has in store. Among these
people who find their expectations
suddenly and drastically curtailed are
the members of the Class of 76 —
upwards of 150,000 young persons
who graduated last year from
Canadian universities, community
colleges and other post-secondary
institutions. The former editor of
Canadian Labour, Roy LaBerge,
writing in the September issue of the
Labour Gazette, describes the
employment prospects of this group
as "possibly the worst facing any
graduating class since the 1930's
Depression." Along with the
Economic Council of Canada and
Statistics Canada, he holds out little
hope of improvement in the situation
until the 1980's. His observation that
"almost everywhere graduates in
education, nursing, and several other
health professions are having trouble
finding professional openings
because of government spending
cutbacks" is not news to nurses. Nor is
it much consolation to realize that job
prospects are also bleak for
accountants, scientists, architects,
architectural draftsmen, metallurgists,
biochemists, corporate planners and
market researchers, among others.
Nor to read that most universities
report "poor" to "non-existent" job
prospects for Ph.D's. On page 10 of
this issue, you can read what some of
the provincial nurses' associations
have to report on the current scarcity
of nursing positions in their
jurisdictions. Subjective opinions on a
scattered regional basis are not an
accurate way to measure
under-employment but one would
have to agree with LaBerge when he
suggests that, at the very least,
Canada is not tapping the potential
ability of many graduates.
Nurses, in common with
members of other occupational
groups, invest many years and
thousands of dollars in preparation for
a career. When oversupply of
manpower, personnel cuts and
reduced turnover make it impossible
for many of them to find jobs,
questions inevitably arise about the
quantity and quality of public
manpower planning.
The problems inherent in
attempts to achieve a balance
between supply and demand for
professional and skilled manpower,
are numerous and extremely complex,
involving as they do wage rates,
lengthy lead times, basic forces of
economic expansion and educational
planning, (Manpower policies must be
coordinated with other public policies,
including immigration, regional
development and science policy.
It is not enough to simply adjust
the enrolment in the educational
institutions in which nurses are
prepared, "Short run" solutions are
not the answer. Dorothy Kergin,
well-known Canadian nurse educator,
summed it up this way when she
addressed delegates to the recent
national conterence on the
professions and public policy; "Before
manpower planning in the health field
can be carried out with any
confidence, we must have a national
and provincial consensus on what
kind of health system we are going to
have and how much we are willing to
pay for it." She suggested that we
begin by deciding on the most
effective way of dividing our limited
resources among primary care
services provided by a
multi-disciplinary team, solo medical
practitioners, and highly specialized
institutional services. She went on to
cite a recent study that showed how
one ambulatory medical clinic, by
changing its traditionally organized
services, was able to cut costs by
$32,500 per 1 ,000 patients per year
simply by complementing physician
services with care by nurse
practitioners.
What are the assumptions behind
our present nursing manpower
forecasts? Does the answer to better
utilization of our precious human and
financial resources not lie in
fundamental changes within our
health care system — changes that
involve allocation of authority and
responsibility, methods of
reimbursement and organization of
delivery of services? Something to
think about as we enter 1 977, isn't it?
— M.A.H.
Herein
These days, as Alice pointed out, one
must run very fast simply in order to
stand still. This month CNJ
celebrates the first anniversary of its
new format by updating its cover
design. We hope you approve. Why
not drop us a line to let us know how
you feel about it?
"Shared labor" is becoming an
increasingly common occurrence in
Canadian hospitals and even homes.
Next month' author Linda Leonard
describes the reactions of 20
husbands she interviewed shortly
after they attended the delivery of their
latest offspring. "The Father's Side: a
different perspective on childbirth" will
offer nurses a little more insight into
this aspect of their attempts to provide
family-centered care.
A numtjer of hospitals in Canada
admit patients for therapeutic
abortions. How are the needs of
these patients for support and birth
control counselling being met? This
month author Bonnie Easterbrook
describes the role of nurses in a
unique counselling and support
program available to patients admitted
to Toronto General Hospital for
therapeutic abortions.
Also this month, author Arlee McGee
shares her thoughts on what nurses
can do to improve their relationships
with co-workers and' indirectly,
contribute to the growth of the
profession "The Nurse Continuum
Perspective," which begins on page
24, is for every nurse who wants to
understand herself and the people
she works with a little better
Editor
M, Anne Hanna
Assistant Editors
Lynda Ford
Sandra LeFort
Production Assistant
Mary Lou Downes
Circulation Manager
Beryl Darling
Advertising
Gerry Kavanaugh
CNA Executive Director
Helen K, Mussallem
I
ssment
lealth
lotion
iroush the
Cife Span
OK
LASl>R.M<JRV
Thsrs
1^ the ncu;cst in treatment, focts, diogriosis-
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52328. HANDBOOK OF PSYCHIATRIC
EMERGENCIES/ MANUAL OF PSYCHIATRIC
THERAPEUTICS. Two eminently practical working
guides that provide the best of current knowledge on the
clinical management of psychiatric complications rjf2
count as one Book. $18.95
42750. DRUG INTERACTIONS. Third EditJon.
Philip D. Hanslen. Pharm. D. Clinical significance of
drug-drug interactions and drug effects on clinical
laboratory results Softbound. $11.50
60432. MANUAL OF MEDICAL THERAPEUTICS
(21st Edition)/PROBLEM-ORIENTED MEDICAL
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...Plus guidance in reaching a diagnosis based on
symptoms. ^oiXboani.The 2 counl as one book. $17.90
55875. INTERPRETATION OF DIAGNOSTIC
TESTS. Jacques Wallach. M.D. A practical guide to
more than 906 laboratory tests— instantly tells you what
results signify, what normal values are. $8.95
55850. INTENSIVE CARE. John Joakim Skillman.
M.D. el al. Spells out just about every development that
could occur at any time with the seriously ill — and how
to handle it Counts as 2 of your 3 books $25.00
37665. CHILD HEALTH ENCYCLOPEDLA. The
Boston Children's Medical Center and Richard I.
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42985. THE DYNAMICS OF HEALTH CARE. 2iid
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60422. MANUAL OF CLINICAL PROBLEMS IN
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43260. ECG DUGNOSIS: Self Assessment. Edward
A. Chunii. M D and Donald K. Chung^M.D. Remark-
ably illuminating manual containing 200 actual tracings
and diagnosis for each. Softbound. $13.50
64985. NURSING AND THE LAW. 2nd Edition.
Edited by The Health Imk Center and Charles J. Streiff.
Attorney-at-Law . Completely covers the nurse's rights
under the law. nurse-to-patient, nursc-to-employer and
nurse-to-community relationships. $15.00
37300. CARE OF THE CRITICALLY ILL. 2nd Edi-
tion. Stephen M. Ayres. M.D. el al. From basic
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THROUGH THE LIFE SPAN. Two important books
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55820. INTENSIVE AND REHABILITATIVE
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MEMBERSHIP BENEFITS • In addition to get-
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that Selection may be returned at Club expense.
37240. CARDIAC EMERGENCY CARE. Edited by
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38420. CLINICAL INTERPRETATION OF
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mation on diagnostic procedures, telling how they are
chosen, evaluated, performed and interpreted, $12.95
72960. PSYCHOTROPIC DRUGS. Nathan S. Kline.
M.D. el al. A manual for emergency management of
drug overdose superbly geared to nelp you deal expertly
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35911. BEHAVIORAL CONCEPTS AND THE
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JECTS FOR CRrnCAL CARE NURSES. Two prac
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35760. BEHAVIOR AND ILLNESS. Rulh Wu. R.N.
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patient, drawn from the experiences of nurses. $9.65
The Nurse's Book Society 6 3ap
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The Canadian Nurse January 1977
The Canadian Nurse invites your
letters. All correspondence is subject
to editing and must be signed,
although the author's name may be
withheld on request.
Input
Nursing's true spirit
Thank you for your September
article — Mary Berglund, Backwoods
Nurse. In this day of increased
emphasis on better salaries, working
conditions, unions, strikes, etc., it's
refreshing to know that the true spirit of
nursing still remains alive in the hearts
of people such as Mary Berglund.
Her story of dedication and
unselfishness was appreciated by us
and we are grateful for the privilege of
having known Mary Berglund through
the interpretations of a most sensitive
author — Ingrid Bergstrom.
— Francis Ward, Halifax, N.S., Sybil
Cameron, Middleton, N.S.
Emergency nursing
This is to point out the special
interest arising from your r,-ticle on
Understanding the Patient in
Emergency that appeared in the
October 1976 issue.
Having some experience in the
emergency ward, I have noticed the
accuracy of your thinking on the lack of
communication that exists between
nurses and patients who are being
taken care of in the emergency ward.
Too often, the rapidity with which we
must take care of a patient prevents us
from noticing his state of anxiety and
dismay.
We give too much importarice to
the physical treatments that must be
administered promptly and we neglect
the psychological and emotional
aspects that have nevertheless an
important therapeutic value.
On rereading this article, I have
resolved to increase the human
contact I have with patients in the
emergency ward, as well as with the
members of their families. For me, the
emergency ward is the ideal place to
work; this is the area that I feel most
happy in and for this reason I really
appreciate anything that can help my
work — particularly with the patients
themselves.
— Marie-Marthe Souliere-Roussel,
Centre-hospitalier Sacre-Coeur, Hull,
Quebec.
Our mistake-
In the article Emergency Care of
the Acute Ml in the November issue of
The Canadian A/urse, the dosage for
Xylocaine should read: Xylocaine drip
I gm/500 ml. We apologize for our
typographical error!
Single parenting
I have just read the November
issue of The Canadian Nurse and
again am proud of the credible articles
this magazine presents to us. I am
informed and touched with each issue
but I am writing now in response to the
article Operation Communication by
Sharon Bala. I commend her integrity
in accepting and searching for the vital
aid, essential to the healthy
development of so many of our
children who, these days suffer loss.
I am the mother of six — three
girls, three boys (five my own — one
adopted) who was left to "raise,
develop, and nurture " these children
1 1 years ago when the youngest was
three years of age. I know the personal
trauma and realize the damage that
can be done along the way. It is not
easy but the biggest growth in a
human being is the realization that you
have worked and achieved the
development of your children. I am
reaping this reward now as I see my
family as individual, stable and most
exciting people!
— Margaret Troyer, (nee Graham),
M.S.N., Ottawa, Ontario.
"Upside-Down" readers
I would like to compliment you on
your questionnaire, (Oct., 1976) as an
attempt to view the problems inherent
in nursing ... We need to know how our
colleagues feel on various issues. I
would like to see questionnaires on
issues such as the input nurses want
to have as far as health care cutbacks
etc. , which focus on political concerns.
It seems that nursing is so politically
detached at the present time — such
questionnaires may stimulate us to
focus on meaningful issues again.
Vancouver, British Columbia.
I am very pleased to see such an item
in our professional journal. At times I
feel that The Canadian Nurse is
written solely for and by the 'upper
crust' of nurses .... For the floor
nurses, the nurses who work shift, I
congratulate you for your efforts and
look forward to seeing the results of
the questionnaire.
Etobicoke, Ontario.
...Would like to offer my
cor 'jratulations to all the people
involved in getting this magazine off
the ground, and for the much-needed
improvement in the last year...
...this questionnaire shows great
initiative, and I hope the results will
have some effect on the thinking of the
health profession. If The Canadian
Nurse continues to improve, it will rival
the best this continent has to offer.
I hope this isn't just another survey —
it's high time some eoncrete efforts
were made to aid all night nurses.
Thank you. I enjoyed this -
more of these.
Lennoxville, Quebec.
- let's have
I found your questionnaire very good,
except that it seemed to take for
granted that people do not like working
nights, as shown by certain
questions...
Editor's note: To these and all the
hundreds of other readers who took
time to contribute, not only through
the questionnaire, but through their
letters, many thanks. See also this
month's Idea Exchange on page 46.
Quality or equality of life
... I wish to express my concerns
about some recent medical trends ...
We work together in one ward to
terminate a life before birth — most of
the time, a healthy one. At the same
time, in an adjacent ward, we
concentrate on saving a sick,
handicapped premature baby who
may need several surgical
interventions before ever sitting on his
mother's lap.
At least one Canadian hospital
has switched from saline to
prostaglandin abortions. This way, the
baby is usually born alive, appears
normal for the pregnancy stage, but
too small to survive. This was
upsetting to the staff witnessing the
abortions and some nurses left their
jobs. The hospital then chose to inject
blue dye before the abortion. The
nurses are now less upset because
babies are blue when born (aborted)
and look less like candidates for life.
Where are our standards? We have
abortions so that only "wanted
babies " are born, so that their "quality
of life" is assured. But what if the
wanted baby, one day, becomes ill, or
proves to be a "difficult child. " Do we '
still want him? ]
Am ! sure that I am a useful J
citizen; am I wanted by my family? ]
Maybe not, yet I hope nobody decides
to terminate my life just because
someone doesn't want me around any
longer. I am a Registered Nurse, but 1
mostly, j
— A concerned citizen of Canada,
(name withheld).
O.R. experience invaluable i
As head nurses and supervisors |
at a hospital in Eastern Ontario, we are I
concerned about the lack of .
knowledge and skills in relation to the j
basic principles of aseptic technique |
found in todays student nurse or new ;
graduate. These remarks in no way j
reflect on the capabilities of the i
instructor or the caliber of the student: !
the students are knowledgeable, alert, I
eager to learn and they too seem [
concerned.
We feel that O.R. experience is ■
invaluable and will reflect on the whole \
future of the nurse, no matter what ;
field she chooses to follow. There is I
just no place where this can be truly ]
learned except right in the atmosphere I
of the operating room, not just
standing with your arms folded, but
listening, learning and above all
actively participating.
Please, before it is too late, put
operating room nursing back into the |
curriculum and let us train interested
nurses who could become future staff
nurses or supervisors in our operating
rooms.
— O.R. Supervisor, Hospital,
(name withheld). ;
Our new look
...I have truly enjoyed the last I
three issues of The Canadian Nurse j
(September, October and November) i
and I wanted to let you know. My i
outlook and interest in The Canadian ■
Nurse is changing. |
— Cheryl L Sutton, R.N., Victoria, j
B.C.
Just a short note to commend you
on the great improvement in your
articles. I used to just leaf through The I
Canadian Nurse ... now, each month "
provides a new learning experience. '•
Keep up the good work.
— Dianne Brown, lie des Chenes,
Manitoba.
Designer s Choice.
Because good clothing is an investment.
Here is one of the wisest investments
you can make in a uniform — The Wardrober.
Why? Because it's a jacket. It's a skirt.
It's a pair of pants, which you can mix and
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Wardrober.
But the beauty of it is more than skin
deep. Because it's made of "Royale
Pristine", 100% polyester textured warp
knit. You can wash it. And it needs little
ironing to look great! Take white, pink, or
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When you want a good investment,
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A
UMITEO
EDITION
Available at leading specialty or department stores across Canada.
The Canadian Nurae January 1977
I II put
Dtscrimination still exists
The Advisory Council on the
Status of Women would like to take
this opportunity to remind nurses that
every province in Canada now has
human rights laws to protect its
citizens against discrimination, but the
federal government continues to delay
passage of human rights legislation
that has been promised since 1973.
The Council points out that, as a result
of this failure to act, discrim ination can
affect you and members of this
association. For example:
If You Are a Member of a
Minority Group, it means that
services and accommodation can be
denied to you because of your race or
color.
If You Are an Older Worker, it
means that employers under federal
jurisdiction — such as banks,
insurance companies, airlines and
telephone companies — can legally
refuse to hire you because of your
age.
If You Are a Member of a
Religious Group, it means that
services and accommodation can
legally be denied to you because of
your religion.
If You Are a Woman, it means
that you can be denied
accommodation, services,
emptoyment, or equal opportunity for
advancement. It also means that your
emptoyer can legally provide smaller
pension and insurance benefits for
you than for male employees.
Governments react to pressure
from the public. If you, and thousands
of people from across Canada, write to
urge passage of human rights
legislation, the government will act.
You can help by writing today to
Justice Minister Ron Basford, House
of Commons, Ottawa, KIA0A6, with a
copy to your member of parliament.
(No postage required).
Sample Letter
I strongly urge quick action by the
government to pass the federal
human rights act. I am a member of
the Canadian Nurses Association
and I object to the fact that
discrimination on the basis of race,
color, religion, age, sex and marital
status is still legal under federal law.
— Yvette Rousseau, Chairman,
Advisory Council on the Status of
Women, Ottawa.
Jobs for the older nurse
There seem to be no job
opportunities for nurses 50-60 years
old that would permit us to maintain
our competency within the limits of our
strength due to aging. For example,
twinning' could be made available.
Income tax incentives alone make this
attractive. We can handle four hours'
work and still have the satisfaction of
involvement. With health care budget
cuts, administration should be
interested in this idea.
Our experience here and
overseas makes us valuable.
Responsibility is water off a duck's
back' to us. Disease has changed very
little ... neither has basic treatment,
nor understanding of the patient, nor
hospital procedures.
We can cope. Doctors are often
our age and so are many patients.
Rapport is good. We are good house
mothers. Often we are mothers and
grandmothers. We can handle
problems. The years have provided
the answers.
Often we are given night duty.
Aging leaves us needing less sleep
but makes adjusting difficult. On
changing shifts we have the dubious
pleasure of a few days of no sleep.
I know our younger graduates
need work but the job picture changes
quickly . Throughout the whole n ursing
spectmm, I would like to see such job
opportunities provided.
— Rita Bitten, R.N., Victoria, B.C.
Did you know ...
The nursing staff of St. Joseph's
Hospital in Hamilton, Ontario has
developed instructional manuals for
diabetic patients. The manuals,
entitled An Instructional Aid for the
Adult Diabetic and So You Have
Diabetes (A Paediatric Diabetic
Manual) are intended to reinforce the
individual teaching provided for
diabetic children and adults. Copies of
the manual are $1.00 and are
available from:
Department of Nursing, St. Joseph's
Hospital, 50 Charlton Ave. East,
Hamilton, Ontario. /-8/V 1Y4.
Not just an aide
I am one of many Nurses' Aides in
Canada. We are responsible for our
guests in every respect: their health
habits, cleanliness, comfort,
contentment. We must be observant
because we must report to our head
nurse, so she will know what has been
going on during that shift. RN's, R NA's
both have their special magazines and
books: they have their conventions
and unions, but what do we have?
Nothing. We have no say in hospital
decisions, we have no books, or
magazines. We are a forgotten part of
the nursing profession. How many
mental and nursing homes would
have to close down for lack of staff if it
were not for Nurses' Aides?
I wonder if the professionals and |
the men and women on the board of ■
directors ever think that perhaps we i
have a home to keep up, food to buy, |
bills to pay. Maybe our pay check is
the only one coming in.
Wearenof just Nurses' Aides, we '
are the bridge between the RN's,
RNA's, doctors and the patients. We
are the ones the patients or guests rely |
on, ask things of, depend on. We ,
would like to feel that perhaps
professionals could try to see the i
importance of the work that we do, and |
accept us as a necessary part of the '
nursing profession, r\o\ just an aide.
— (Name withheld), Cumberland
County, N.S.
Moving, being married?
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The Canadian Nurse January 1977
A^OWS
Health educators examine
alternatives to current system
Health science programs must
ctiange radically to provide health
care workers with the kind of
education they need to promote and
adapt to changes in society's use of
their services. This theme dominated
the discussion at the Health
Educators' Meeting during the 6th
Annual Meeting of the Association of
Canadian Community Colleges, held
in Ottawathis November. The session
centered around the problem of
"Decreasing Enrollment — the
Dilemma of Health Science
Programs. "
In confronting the question of
whether health educators have a
moral responsibility to decrease
enrollment in response to decreasing
need, Jenniece Larsen, chairman of
the Allied Health Department at Grant
MacEwan College in Edmonton,
pointed out that we must distinguish
between real health needs and
artificial or created needs which
depend on the economic climate or on
government priorities. In our society
health standards are measured in
terms of the number of doctors,
hospitals and hospital beds, not in
terms of home care, nutrition and our
approach to geriatrics, and health
programs tend to reflect this bias, she
said. She suggested that a better
question health educators might ask
themselves is "Do we have a
continuing need for nurses whose
expertise is in the hospital? "
Larsen said that "health
programs are too restricted in their
focus if education is matched to
specific job needs in society," and
proposed that what is needed is a
broad-based education system that
provides graduates with the
perspective to assess where needs
are and the flexibility to change and
work where they are needed. She
added that health care v;orkers also
need to develop political skills to be
able to lobby more effectively for shifts
in government emphasis to where
health needs really are.
Dr. Sheila Thompson, Director of
Health Services at Douglas College in
New Westminster, B.C., also
addressed herself to the need for
alternatives in discussing how
education can change the utilization of
its graduates. She compared our
approach of relying heavily on
credentials to the Chinese approach
where effort is spent identifying people
with the qualities needed to perform a
job well and then training tfiem to do
that job and only that job. One problem
with the credential approach is that we
screen out many students who may
have a high proportion of the personal
qualities necessary to be a good nurse
by requiring that they be able to
understand and learn things they will
never use on the job. One way of
overcoming this problem is to develop
a core curriculum for all health care
workers which would provide them
with the knowledge they can use at
one level and also with the base to go
on to higher levels of specialization. If
this system were adopted, continuing
education would have a greater and
greater role to play in career mobility,
she said. The ideal would be a
situation in which a licenced practical
nurse with several years experience
could move up the ladder to higher
levels of specialization without starting
over again, by taking courses to
upgrade her knowledge and skills. At
tfie same time she would be given
credit for her experience.
Thompson proposed an
alternative health care system in
which clients would consult a
paraprofessional, someone less
trained than a doctor, for their basic
needs, and tie referred to a specialist if
necessary. For this kind of team
cooperation, medical workers must be
trained together, she said.
To deal with problems like this
that are related to health education in
the community colleges, the ACCC
set up a Health Education Resource
Committee three years ago. One
continuing problem that has been
addressed by the committee and
taken up by a Joint Committee of
health educators from ACCC and
AUCC (the Association of Universities
and Colleges of Canada) is the
question of accreditation. This
cooperation has resulted in a major
proposal to Health and Welfare
Canada for an independent national
Council on Accreditation of Health
Science Educational programs.
ICN welcomes
student nurses
The International Council of Nurses
has announced that special
accommodation for student nurses
will be available during the 16th
Quadrennial Congress, May 30 to
June 3 in Tokyo. The Olympics
Memorial Youth Centre has been set
aside for the use of student nurses
during the meeting.
To be eligible, students must be
enrolled in an approved school of
nursing in this country. Registration
forms for students are available from
the Canadian Nurses Association and
must be signed by the president or
executive director of the CNA.
The student nurse Congress
registration fee, as stated on the
registration form, is U.S. $30. before
March 1, 1977 and U.S. $50. from
March 1-31, 1977. No registrations will
be accepted after March 3 1 , 1 977 and
there is a cancellation fee of U.S. $20.
Testing Service Committee
Approves Blueprint
The Canadian Nurses Association
Committee on Testing Service hcis
placed its stamp of approval on a
blueprint for a comprehensive
examination that will eventually
replace the RN's now written by
nursing graduates across Canada.
The blueprint for a comprehensive
exam, to be made available in both
French and English, is the work of an
eight-member CNATS committee set
up by the Testing Service in 1975.
Myrtle Kutschke, Blueprint
Committee chairman, and Michelle
Chariebois, committee member,
presented the committee's final report
to the Committee on Testing Service
(COTS) at a meeting at CNA House in
mid-November. COTS members
voted unanimously to accept the
blueprint.
The next step in the development
of the comprehensive exam will be the
convening of committees to write
objectives for the blueprint. These
objectives will form the basis for
devetopment of test items. Four
objectives committees have already
been appointed for each language.
Eric G. Parrott, Director of Testing
Service, says that the first meeting of
these committees is scheduled for
January 24-29, 1977, with other
meetings to follow in February and
March.
Nurses to complete
new health forms
The National Council of the Giri
Guides of Canada has approved a
new Health Evaluation form for Girl
Guides attending activities in Canada
and the United States which may be
completed by a registered nurse with
provision made for referral to a
physician if necessary. The request
for a health assessment form which
could be signed by a registered nurse
came to the Canadian Nurses
Association from the National Camp
Commissioner of the Girl Guides of
Canada in November 1975, The
disease-oriented evaluation report
used at that time was felt to be too
detailed and required the signature of
a physican, which during the busy
summer months was difficult to obtain.
In response to the request from the
GGC, the Canadian Nurses
Association formed a committee of
nurses skilled in health assessment
and subsequently developed a
concise health evaluation form
designed for total health assessment.
Only essential information required by
a registered nurse in completing a
health evaluation was included.
This form which must be
completed three days before a Girl
Guide attends camp or other activity
will be in circulation by early spring.
NBARN supports
provincial consultant
In psychiatric nursing
The New Brunswick Association of
Registered Nurses has pledged full
support for improving standards of
mental health and psychiatric care in
New Brunswick. The Association's
Council voted in November to request
government support for a provincial
consultant in psychiatric nursing, and
called on all groups concerned to work
together in upgrading standards.
The action was taken after
reviewing a report on the six-month
advanced course in psychiatric
nursing held earlier this year. Twelve
nurses graduated from the course,
which was co-sponsored by the
NBARN and the Department of
Health.
NBARN president Simone
Cormier said that the Council agreed
with the Reports major
recommendation for a nurse at the
government level to upgrade
psychiatric nursing in Nevi Brunswick.
Such an appointment would maximize
the positive strides taken in the field of
mental health, particularly over the
past few years, she said. Because
patients with psychiatric disorders are
being treated in their own
communities through such programs
as community mental health clinics,
psychiatric units in general hospitals,
and discharge of patients from the
lairge provincial institutions to foster
homes, there is a need for a nurse at
the government level with expertise in
mental health/psychiatric nursing
care. Cormier said, "We see this as a
priority in the total scheme of providing
improved services for psychiatric
patients. "
Did you know...
An experimental treatment for
multiple sclerosis will be tried out on
eight patients in Toronto soon. The
patients, who are under 35 years of
age, who have had MS less than five
years, and who are experiencing an
acute relapse, will be given protein
injections. If these patients are not
helped, the experiment will end, but if
results are encouraging, 17 other
patients will receive the treatment
before evaluation of the experiment.
McGill Research Unit to study
community health nursing
The Research Unit of the School of
Nursing, McGill University, has been
awarded a National Health Research
and Development Award for the
funding of a Demonstration Project
involving the establishment of a
community health nursing service.
The project, tocated in a middle
income suburban community of
Montreal, is directed toward the
development and maintenance of
family health in a primary care setting.
Some unique features of this
setting differentiate it from existing
experiments in community health
centers. For example, it will serve a
middle income group as opposed to a
disadvantaged sector; it will provide a
nursing service supported by
community development and
information services; physicians will
not be located within the center but will
be utilized whenever medical
consultation and/or referral is
required; emphasis will be placed on
the workshop natu re of the setting — a
place in which people — individuals,
families and groups, will come to work
on and learn to deal with problems
related to health.
As they provide care, in
collatKiration with McGill School of
Nursing, the nurses involved in the
project will be exploring, learning and
demonstrating new ways of nursing
families and a community toward
health. In addition, emphasis will be
placed on the development of a design
for evaluation.
The Research Unit at the McGill
School of Nursing has only recently
been established and has four nurse
researchers, seven researchers from
other disciplines and a number of
research assistants on staff. Besides
this community health project, the Unit
is also investigating tfie learning of
health behavior in children.
Development of the Research
Unit in nursing and health care permits
the School of Nursing to offer graduate
nurses the opportunity to prepare
themselves as researchers at the
Master's level. The program is two
years in length and financial support of
up to $5,000 per year is available
through the Research Directorate of
Health and Welfare Canada.
CNA executive director
receives
Ren Honorary
Fellowship
A Canadian was among ten nurses
elected by the Royal College of
Nurses of the United Kingdom to
receive official recognition during the
College's Diamond Jubilee Year.
Helen K. Mussallem, executive
director of the Canadian Nurses
Association, was the only nurse from
outside the United Kingdom to receive
an Honorary Fellowship from the
College in a special ceremony in
London, England on November 24
chairman of the committee on
fellowships, read the citations and
presented the insignia and scrolls of
Fellowship or Honorary F<>::owship to
the recipients. The citation to Dr.
Mussallem described her as
"Canada's most distinguished nurse
in her generation" and pointed out
that: "She can equally well be
described as a nurse of the world, so
generous has she been in accepting
overseas assignments under the
aegis of the World Health
Organization and of other
governmental and non-governmental
bodies, also in responding to
individual calls from the profession in
various countries wishing to benefit
from her vast knowledge of nursing
The occasion marked the first
time in the 60-year history of the
College that it exercised its power to
confer Fellowships and Honorary
Fellowships in recognition of
exceptional contributions to the
advancement of the art and science of
nursing. The Honorary Fellowship
awarded to Dr. Mussallem was
conferred by the College in
recognition of "her work at
international level in advancing
nursing education and high standards
of nursing practice."
Winifred E. Prentice, immediate
past president of the Ren and
education and deep understanding of
the nursing process."
Above, left to right, Catherine
Hall, Ren executive secretary, Helen
Mussallem. and Winifred Prentice are
pictured following ceremony. Eligibility
for consideration for Fellowships
requires nominees to be members of
the College, actively engaged in
practice. Honorary Fellowships are
awarded to Ren members who have
retired from practice or to nurses who
have made an exceptional
contribution to the advancement of
nursing at the international level but
are not eligible for Ren membership.
The Canadian Nurse January 1977
\e\Y.S
Coast-to-coast reports indicate
few nursing positions available
Eight months ago, in May 1976, The
Canadian Nurse conducted an
informal survey of CNA member
associations throughout Canada in an
attempt to obtain a national overview
of the nursing manpower situation in
the various jurisdictions. At that time,
we reported that the general picture
was one of tightening up in
employment prospects, with poc(<ets
of serious unemployment becoming
apparent in several centers. In
anticipation of another wave of
graduates entering the employment
picture within a few months, CNJ has
attempted to up-date information
presented at that time. Here is what
spokesmen for the various
provincial/territorial member
associations have to report:
Newfoundland
Almost all of the 1 976 graduates from
Newfoundland Schools of Nursing
have nursing positions (fewer than ten
do not have jobs). Most of the smaller
hospitals across the province are
staffed as budgets permit, but
hospitals or nursing stations in
approximately six to eight more
remote areas of Newfoundland and
Labrador still require experienced
nurses. Officials in hospitals outside
the larger centers report much less
difficulty this year in obtaining nursing
staff. There are several nurses listed
with the Canada Manpower offices
across the province.
A total of 30 nurses are presently
listed as required by employers. Most
require experienced nurses and most
are needed in the smaller areas, and
in extended care facilities. Many of the
part-time positions have been filled by
full-time personnel. Openings are
available for public health nurses in a
few areas.
Most Schools of Nursing did not
decrease enrollment of nursing
students this fall (to any degree) but
immediate consideration will have to
be given to this.
New Brunswick
As far as job vacancies and nursing
manpower are concerned, the
saturation point reached in the spring
continues to exist. As a result, the
in-migration of out-of-province (mainly
Ontario) nurses experienced earlier
this year has decreased.
There are a substantial number of
nurses across the province looking for
employment through Canada
Manpower, and hospitals and
agencies employing nurses continue
to enjoy a period of adequate staffing.
Nova Scotia
In August we had 359 new graduate
nurses. As far as we can determine,
167 of these are now employed
— most in Nova Scotia but some in the
States.
In June of this year we conducted
a survey of all our R.N.A.N.S.
members who said that they were
unemployed at the time of registration.
Considering those on U.I. benefits, our
Placement applicants, the
unemployed new graduates and those
who appear to be unemployed as of
the June survey, we estimate close to
800 unemployed nurses in the
province. The vacancy situation is not
very good. We only have two
vacancies in hospitals and nursing
homes in the month of September.
Before the restrictions were imposed
on the hospitals last January, we cou Id
expect approximately 40 vacancies
monthly in the metro area. This year
nurses are hanging on to their jobs
and as a result, we are not sure if this
figure will remain the same.
We do expect approximately 80
new jobs next spring when two new
hospitals and two new nursing homes
open. However, one of the hospitals
employing approximately 50 nurses
expects to close.
Ontario
The employment situation for nurses
in Ontario has not changed drastically
from an oversupply situation.
The R.N.A.O. Referral Service
officially began operation on October
1 , 1 976 and the first survey to over
1,100 agencies employing nurses
indicated that there were 135
positions available . Of these
positions, 30 were part-time and 44
were anticipated openings. General
hospitals listed 62 positions — 34 at
the management level and 28 in
specialty units where special
preparation was required. There were
very few openings in Public Health or
educational facilities. Many of the
part-time positions were listed in
Nursing Homes and Homes for the
Aged. The majority of available
positions were clustered within the
larger cities of Ontario.
A survey conducted by the
Ontario Hospital Association in June
1976 shows that of 1,193 hospitals
reporting, there were 208 R.N.
vacancies. However the openings
were in specialty areas and/or
requiring nurses with special
preparation.
Canada Manpower Centre's data
indicates that in July 1976, of 1,560
employees laid off from hospitals,
70% were registered nurses. A
program to assist the employers and
employees was initiated with some
success. They have found that most
employees do not have the mobility to
move to other jobs in other areas, and
that where the number unemployed is
high — is also an area or city with few
or no nursing job opportunities.
In terms of the approximately
3,200 new graduates from the College
of Applied Arts and Technology,
success rate in finding jobs varies
from college to college. In
mid-summer the number with jobs
ranged anywhere from 7 to 50
percent, and roughly half of the
positions accepted were in the United
States.
Prospects for the next few
months do not appear to be any
different. The province is awaiting the
court s decision on the hospital
closures, and announcement of
government policy on financing for
1976.
Manitoba
We know that some of the new
graduates who wrote CNATS exams
in August are not employed and that
for each general staff position, there
are many applications. We also have
several administration positions and
positions in specialty areas not yet
filled.
A more detailed report will be
available following establishment of
our referral service.
Alberta
Employers state that the turnover rate
of registered nurses is beginning to
pick up slightly. Vacancies, however,
are being filled from within the health
agencies, as part-time and casual
employees move into permanent
positions. Applications for
employment in most situations are
adequate, the exception being in the
north of the province. A dearth of
nurses exists where expertise is
required, both in education and
experience. The primary need is
Intensive Care personnel.
Saskatchewan
It is difficult to know accurately the
supply of nurses in Saskatchewan at
this time. A brief survey was done at
the end of September and we found 83
new graduates unemployed at that
time. Some of the employed had
employment in areas other than
nursing. Like other provinces, we
believe that some nurses have left and
others will be leaving to take nursing
positions in the United States.
Many nurses who have come into
the province from other countries have
had difficulty in passing the
registration examinations.
Consequently some of these are now
unemployed and are having difficulty
in finding suitable employment.
Northwest Territories
In the N.W.T. there are very few jotis
open. Most hospitals (Inuvik, Hay
River, Yellowknife, Frobisher, and Ft.
Smith) seem to be able to meet their
requirements with ease. The Federal
government also has very few
openings in the Nursing Stations. The
nurses required for the Stations must
have experience and/or additional
preparation (i.e. Nurse Practitioner
Course).
We generally fill our staffing
requirements with applications
on-hand from interested persons. Few
of the hospitals advertise for staff. We
did feel that the number of applicants,
with good references and with
experience has increased over the
last few months. Many are from
Ontario where the impact of closed
hospitals must be being felt.
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The Canadian Nurse January 1977
\ew.s
MARN sets up referral service
The Manitoba Association of
Registered Nurses has set up a
referral service for RN's to assist both
nurses seeking employment and
employers seeking nursing staff.
Health agencies in the province
are providing the Manitoba
Association of Registered Nurses with
up-to-date listings of staff vacancies.
Registered nurses looking for work
who contact the MARN office will be
given a list of vacant positions, and
may then apply directly to the agency
of choice.
The referral service is not a
placement service and
recommendations are not provided
either to the nurses or to the employer.
The decision to apply or to hire is left to
the nurse or the agency. A list of
several full-time nursing positions
outside of the city of Winnipeg is now
available.
Nurse heads N.W.T.
Public health association
Janet Lindquist, R.N., who is Nursing
Consultant for the Northwest
Territories Health Insurance Service
was recently elected the first president
of the N.W.T. Branch of the Canadian
Public Health Association. The first
meeting of the branch, with Dr. Ken
Benson, national president of the
Canadian PublicHealth Association in
attendance, was held immediately
following the Twelfth Annual Meeting
of the N.W.T. Hospital Association in
Hay River, N.W.T. on November 24
and 25, 1976. The theme of the
meeting was "The Community Health
Center' and in conjunction with the
main session, seminars in Nursing,
Housekeeping and Dietary Services
were held.
Guest speaker at the Nursing
Seminar was Beverly Rinneard of the
Scarborough Centenary Hospital in
Toronto who presented information on
the Bedside Audit and its relationship
to nursing standards to about 20
nurses from Yellowknife, Hay River,
Ft. Smith, Ft. Simpson and Ft. Rae.
She also discussed the use of the
Friesen concept as implemented in
her hospital and gave assistance to
the Hay River hospital which is in the
process of implementing the Friesen
Concept in the new Health Center.
Ontario PHN's hold
second open forum
Sexually transmitted diseases,
diseases of the jet age, home births
and the need for more nursing
research were the four issues that
occupied the attention of more than
100 of Ontario's public health nurses
at a recent day-long seminar in
Toronto. The occasion was the
second open forum for public health
nurses sponsored by the Registered
Nurses Association of Ontario.
Speakers included Elaine Hykav*^
(above) of the Ontario Ministry of
Health; Christina Butler (below) of the
Victorian Order of Nurses of
Metropolitan Toronto: Gail Wright of
the Ontario Ministry of Health and
Joyce Kinslow of the Etobicoke Health
Unit. Chairman for the event was
Margaret M. Boone.
Photos courtesy Suzanne Emond,
Notice of Annual Meeting of the
Canadian Nurses Association
In accordance with By-law Section 44, notice is
given of an annual meeting to be held 31 March
1 977, commencing at 09:00. This meeting will be
held at the Chateau Laurier Hotel, Ottawa,
Ontario. The purpose of the meeting is to conduct
the business of the Association.
Ordinary members of the Canadian Nurses
Association are eligible to attend the annual
meeting. Presentation of a current
provincial/territorial membership card will be
required for admission. Students of nursing are
welcome as observers. Proof of enrolment in the
school of nursing will be required for admission .
Helen K. Mussallem, Executive Director,
Canadian Nurses Association.
International authorities to address
ICEA conference on the family
Anthropologist Ashley Montagu heads
the list of speakers scheduled to
address the Fifth Canadian Regional
Conference of the International
Childbirth Education Association in
Edmonton in June. The meeting is
sponsored by the Edmonton
Childbirth Education Association.
Concerned professionals and lay
persons from all across Canada, the
northwestern U.S.A. and Alaska are
expected to attend to obtain
information and insight to help them in
their own fields.
The theme of the conference is
Nurturing the Family. The program will
incorporate findings from medicine,
mental health, sociology, and many
other fields to form an integrated
approach to the care of the normal
childbearing family.
Program participants Include, in
addition to Montagu, who is the author
of "Touching " and "Life Before Birth ':
Niles Newton, behavioral scientist
specializing in the psychological
aspects of child-rearing and
reproduction; Elizabeth Bing, author,
childbirth educator and co-founder of
the American Society for
Psychoprophylaxis in Obstetrics;
Agnes Higgins, executive director of
the Montreal Diet Dispensary; and
Wilma Marshall of La Leche League,
Edmonton.
Topics to be discussed during the
meeting include: early parenting; the
role of the health care administrator in
delivering family-centered care;
overview of modern obstetrical
practice; drug use; high-risk mothers;
breastfeeding; meeting the needs of
native people; temperament of
babies: obstetrics and the teenager;
the advisability of adoptees tracing
their natural parents.
Lawyers, sociologists, doctors,
nurses, and psychologists are among
the professionals expected to
participate in the conference.
ICEA is an interdisciplinary
organization, founded in 1960,
representing a federation of groups
and individuals, both parent and
professional, who share a genuine
interest in parent education and
family-centered maternity care.
The Edmonton Association was
founded in 1967 and joined the
International Association in 1974.
Resolutions for Annual Meeting
Members who wish to submit resolutions to the
Canadian Nurses Association annual general
meeting (31 March 1 977) are asked to send them
to CNA House by 1 February 1977 to ensure
distribution .
Helen K. Mussallem, Executive Director,
Canadian Nurses Association.
Code of Ethics
implemented in Quebec
After two years of intensive work and
of consultation between members of
ttie Order of Nurses of Quebec and the
Office des professions, nurses in the
province of Quebec now have their
own Code of Ethics. The Code was
conceived as an effective instrument
to enable the Order of Nurses of
Quebec to fully assume its role as the
protector of the users of all nursing
care services in Quebec. It came into
effect at the end of September last
year.
The following is a list of the
principal subjects dealt with in the
document;
• duties and obligations towards
the public
• duties"and obligations towards
clients
• integrity
• availability and diligence
• liability
• independence and disinterest
• professional secrecy
• accessibility of records
• determination and payment of
fees
• derogatory acts
• relations with the Order and other
members of the Order
• contribution to the advancement
of the profession.
The Order of Nurses of Quebec
invites readers who would like to
obtain a copy of its Code of Ethics or
wish to know more about its contents,
to contact:
Monique Foisy, Public Relations
Officer. ONQ, 4200 Dorchester West,
/Montreal. Que. H3Z 1V4.
Health happenings
in the news
An American city — Washington. D.C.
— has become the first in North
America to record a higher number of
legal abortions than births among its
residents over a 1 2-month penod. The
human resources department of the
city of Washington reports that a total
of 9.819 abortions were performed in
1975. compared with 9.746 births.
About 85 percent of the total number
of abortions were paid for by the
government Medicaid program for low
income persons (7,417) or were
performed without charge at the
city-operated D.C. General Hospital
(1,082).
A statistician at the London School of
Hygiene and Tropical Medicine
estimates that the risk of death from
high blood pressure for women using
oral contraceptives, compared with
non-users, is 5-to-1. For all
cardiovascular diseases, the ratio is
3-to-1.
Dr. Valerie Beral. author of the
study indicating a stronger than
suspected link between the
contraceptive pill and diseases of the
heart and blood vessels, bases her
findings on an examination of
morbidity statistics for 21 nations
provided by the World Health
Organization.
She found that as the availability
of the pill rose, so did deaths due to
cardiovascular disease in women
aged 1 5 to 44. Dr. Beral estimates that
as many as 200 additional annual
deaths per million from heart and
blood vessel diseases among women
in this age group may stem from use of
the pill.
Vaccination of native people in the
North West Territories against swine
flu got underway several weeks ahead
of centers in the south because of the
special threat the disease poses in the
North. Native people, according to the
territories'chief medical officer, Dr.
F.J. Colvill, were isolated and not
affected by the 1918-19 outbreak of
swine flu and, also, "have historically
been vulnerable' to respiratory tract
infections such as influenza which is
frequently followed by lung
complications.
"Northern natives lack protective
antibodies to help fight off the
disease," Dr. Colvill said. He added
the limited hospital capacity in the
region would require "mass
evacuations should an epidemic of
any magnitude develop."
The vaccine is being made
available at nursing stations and
health units throughout the N.W.T.
While the federal Advisory Council on
the Status of Women calls existing
birth planning programs
"inadequate" and recommends more
government spending on family
planning information and services, the
federal government has been cutting
back expenditures in this area.
According to members of the advisory
council, comprehensive temHy
planning must become "a matter of
high prionty " for federal and provincial
governments, a matter important
enough to justify increased use of
public funds.
the Department of Health and Welfare
says that the budget for printing and
distribution of information has been
cut. that staff has been reduced, and
that budgets for training and research
projects in Canada have not
expanded according to the increase in
the number of projects.
A new Environmental and
Occupational Health Unit is to be set
up within the Faculty of Medicine of the
University of Toronto. The goal of the
unit will be the solution of a wide range
of health problems caused by
environmental pollution and the
effects of industry on the employee.
The focus will be on research,
education, information and
consultative services.
An Oncology Nursing Society, of
special interest to nurses concerned
with the variety of modalities of
treatment of cancer patients, is now
operating in the greater Montreal area.
The Society is open to all nurses in the
province of Quebec.
Its primary goals are:
• to promote quality care for cancer
patients
• to act as a support group for one
another in cancer nursing.
Officials include; Jennie E.
MacDonald. RN, head nurse,
Oncology Day Center, Royal Victoria
Hospital, (president); Frances
Murphy. RN, head nurse. Montreal
Neurological Hospital,
(vice-president): Heather Dorsey. RN,
head nurse. Royal Victoria Hospital,
(secretary); Elizabeth Scott, RN,
chemotherapy nurse. Queen Mary
Veterans' Hospital, (treasurer).
Society president. Jennie E.
MacDonald, points out that ttie
Quebec group is anxious to offer
assistance to nurses in Ottwr
provinces who would like to form a
similar society. The group also invites
applications from interested nurses in
Quebec who have not yet joined the
Society to contact the president c/o
the Royal Victoria Hospital, 687 Pine
Avenue West, Montreal, Quebec,
H3A tAI.
M.Sc. (Applied) offered to
non-nurses
The Kellogg Foundation has awarded
a grant to the School of Nursing,
McGill University, to fund a
new 3-year program offered to
non-nurses holding a B.A. or B.Sc.
degree and leading to a Master's
degree in Nursing.
The first year is a qualifying year,
in which students are provided with
experiences fundamental to the
practice of nursing. The two final years
are in the regular M.Sc. (Applied)
program, in which a broad nursing
base is developed and refined. Nurse
licensing examinations are written
toward the end of the third year.
Further information about the
program may tie obtained by writing
to: McGill University, School of
Nursing, Masters Program, 3506
University Street, Montreal, P.Q.
The Canadian Nurse January 1977
*r> ^c**;
Style 814 Pantsuit
Polyester Textured Warp Knit
White - Blue - Yellow - Ice Mint
Suggested Retail $28.00
11
78 KING ST. WEST
ORONTO, ONTARIO M5V 1N6
PHONE 364-01 25
i/leicci
1 2 ABITIBI PLACE BONAVENTIJ|
MONTREAL, QUEBEC
LEPHONE
Judith M. Hendry
PETER:
an infant with a
myeiomeningocele
Myelomeningocele is a
congenital defect that
occurs in as many as
three of every 1,000
children born. The
problems facing the
infant with this
condition and his
family are illustrated in
this case study of one
nurse's experience in
caring for Peter and in
supporting his family.
"Is the baby normal?" This is often the first
question a mother will ask about her newtxDrn
child. In the excitement of the event, how
difficult it is to have to tell the parents that their
baby is not alright — that he has a serious
defect.
Peter was the firstborn son of
twenty-two-year-old parents. As with any
young couple, they had been anxiously
awaiting the birth of their baby and had
received no warning that their baby might not
be normal. Peter was born with a severe
midlumbar myelomeningocele which
extended from the second to the fifth lumbar
vertebrae. Immediately following his birth, he
was transferred by ambu lance to The Hospital
for Sick Children, Toronto for better evaluation
of his condition. His mother stayed in hospital
for a week before she was able to visit him.
Specific nursing interventions were
Implemented based on a systematic
assessment of Peter's physical status and his
parents' coping abilities.
Peter
Physical Assessment
Only a few hours after his birth, Peter arrived
on the surgical infant area where I was
working. He was in no apparent distress
although he had mild peripheral cyanosis. His
vital signs were within normal limits; his pupils
were equal in size and reacted briskly to light.
Although his head was not enlarged (a
circumference of 35 cm), it was significantly
moulded and the fontanelles were large and
soft. He had a strong, lusty cry.
On examination, his skin was soft, clear
and pink. The myelomeningocele was covered
by a thin membrane and was oozing a small
amount of serosanguinous drainage.
Rooting, sucking and grasping reflexes
were present. When I stroked Peter's cheek,
he struggled to turn his head towards me. He
displayed a good grasp reflex with his fingers
but his lack of response to the pinprick test
below the level of the second lumbar vertebra
indicated that there was no apparent motor or
sensory function in his lower extremities. The
hip flexor muscles had some tonus but the
abductors and extensors of the hip were
paralyzed, causing flexion, adduction and
lateral rotation deformities of the hip and
extension of the legs. A slight rectal prolapse
indicated poor tonicity of the anal sphincter. He
was able to void a good stream of urine
spontaneously, but his bladder was not
emptying completely and retained
approximately 10 cc of urine. Peter also had
bilateral clubfeet with calcaneous,
equinovarus and "rocker bottom" deformities.
Treatment
Less than 12 hours after his birth, after a
thorough medical/ surgical assessment of his
condition, Peter underwent surgery for repair
of the myelomeningocele. Under general
anesthetic, the membrane was excised
exposing the neural plaque. The meninges
were sutured over the plaque in the midline,
and lateral skin flaps were raised and sutured
over the meninges. Postoperatively, Peter's
condition was stable and he was nursed prone
with a dry elastoplast dressing over the
incision.
Associated Problems '~"\
Approximately 80-90% of infants with ^
myelomeningocele develop hydrocephalus.'' ^ \
Tension or fullness of the fontanelles and
increasing head size are early indicators of the
increased intracranial pressure associated
with this condition in infancy.
Signs of Increasing intracranial
Pressure in Infancy
• tense or bulging fontanelles
• restlessness, irritability
• lethargy
•drowsiness
• increasing head circumference
•sutures palpably separated
• vomiting
•sluggish, unequal response of pupils to light
•decrease in apical rate
Thus, it was important to check the tension of
the fontanelles, pupillary reaction and level of
consciousness when taking Peters vital signs.
His head circumference was assessed daily
by placing the tape measure snugly around his
head from the occiput to the frontal region just
The Canadian Nurse January 1977
FIGURE 1 myelomeningocele
?^
vertebral
spinous -
process
vertebral body
spina!
cord
-intervertebral disc
CSF — ^-
skin
coccyx ',-
sacrum
A. LONGITUDINAL SECTION
C S F -^■■^■■z-
tr.insversi
of ihe
-nienibrtiiw
— neural pUiqiie
■vertebrnl
lamina
\/ertebrnl
body
TRANSVERSE SECTION
Mveiomeningr>cele is a severe
3ess9S to fu;
gating an inco uia
feti J 2 A sac. cc ' the outer
i-)inal
ny
ilated
Aliened iri
This defect results in motor and
:■ where the
^ 'here is
e of
;er with
lol and
i is
■^^
lid and
anal
Among
.,,...,,„ ,^.. ingocele,
there is a high incidence o\^
hydrocephalus.
i'.'.Tsdliui ; III ;
complete incc
urine. In > '
located ^
Usually, surgical treatment is
done as soon ; "n
to decrease th-. d
? the care oi the infant. The
^,. -H.^^o tor these children has
improved considerably over the past
ten years due to better neonatal
surgical techniques.^
Illustrations courtesy of Shirley Mohyudden
above the eyebrows. There were no signs of
increasing intracranial pressure until three
weeks postoperatively, when the
circumference of Peters head increased from
35 to 39 cm. The fontanelles became full and
bulging and the sagittal sutures were widely
separated. Also at this time, he began vomiting
small amounts after each feeding.
For the second time in three weeks, Peter
had surgery. To control the developing
hydrocephalus, a ventriculoperitoneal shunt
with a Pudenz' pump was inserted (see
Figure 2.)
Nursing Care
One of the most important nursing
observations on Peter's return to the ward was
the assessment of his neurological status. He
was observed carefully for signs of increasing
intracranial pressure in order to detect a
possible malfunction of the shunt.
Positioning Peter comfortably was a
challenge. He appeared to be most
comfortable in the prone position with his head
to the left side and a folded diaper placed
between his legs. This position prevented
pressure on the myelomeningocele incision,
controlled the flexion, adduction and
subluxation of the hips, and prevented
pressure on the skin over the Pudenz pump.
Since Peter was unable to lift his head due to
its increased weight, the nursing staff turned
his head every two hours to the right side for
10-20 minutes to prevent stiffness of the
sternocleidomastoid muscles.
The skin around the ear was massaged
with cream each time his head was turned to
prevent skin breakdown. Other areas such as
the elbows, knees and feet were also
massaged frequently to facilitate the
circulation of nutrients and the removal of
waste products by the bloodstream. To
enhance this process and to prevent stiffness
and contractures, the upper extremities were
exercised through their full range of motion.
Extending Peter's arms well above his head
was especially helpful in preventing shoulder
stiffness. Because of his lower limb paralysis,
it was important that Peter's legs and feet be
exercised gently. This was done with extreme
caution since the bones of these infants tend to
be fragile and rough handling can cause
fractures.^ Approximately 2-3' of flexion was
achieved with passive exercise of the knees.
Passive foot exercises included dorsiflexion,
plantarflexion, eversion and inversion.
Since Peter could not yet be held or
cuddled and his condition necessitated that he
lie in a prone position, the nursing staff utilized
every opportunity to provide him with
sensory-motor stimulation and "people
contact." Thus, exercise periods, for example,
would be turned into a game where the nurse
established eye-contact, and talked to and
played with Peter. This provided some visual
and auditory stimuli which otherwise were
limited to those in his hospital room. Playing a
radio or a wind-up music box provided variety
in sound stimulation as did singing and talking
to him. A bright red rattle suspended from the
crib rail at eye level provided him with another
lo peritoneal shunt
PUDENZ PUM^ IN SITU
Pudenz
pump
shunt
tubing
peritoneal
cavity
^brain
right lateral
ventricle
3rd ventricle
unihi,
developmental stimulus.
Peter had difficulty in taking all his formula
while in the prone position. We found it best to
feed him every three hours rather than every
four hours and give him one ounce of formula
less each time to increase his fluid and caloric
intake. Placing my left hand under the infant s
upper chest, neck and head helped to raise
him sufficiently to facilitate feeding. Stroking
his cheek and massaging the muscles used in
sucking also helped to improve his swallowing.
The use of a small-holed nipple prevented
Peter from swallowing excessive amounts of
air. After each ounce of formula, I stopped and
gently rubbed Peter's back for a few minutes
while keeping his head and chest slightly
elevated.
As soon as the repaired
myelomeningocele was well healed, Peter
could be held during his feedings. This not only
provided variety, stimulation and security for
him, but was also conducive to improved
integumentary and respiratory status.
Due to the level and extent of his
defect, Peter had a neurogenic bowel and
bladder. Sacral nerve involvement interrupted
the reflexes essential for micturition and
affected the levator ani and external anal
sphincter musculature causing decreased
tonicity of the anal sphincter.
Elimination of urine was facilitated by the
Crede maneuver (application of suprapubic
pressure over the bladder).^ This was
accomplished by standing at the foot of the crib
and grasping the infant's hips with both hands
so that the thumbs extended along the
buttocks and pointed toward the infant s head.
The bladder was compressed firmly between
the first two fingers and the spine. Pressure was
maintained until the flow of urine ceased.
Although Peter voided spontaneously between
bladder expressions, this procedure was
repeated every two hours in order to prevent
incomplete emptying and subsequent urinary
tract infections. A folded diaper under the chest
and upper atxlomen and a small disposable cup
under the perineal area facilitated the collection
process. After each expression, the amount and
characteristics of the urine were observed and
recorded accurately and the perineal area was
cleaned thoroughly.
With a neurogenic bowel, constipation
can occur easily due to a lack of normal
contractile tonus in the lower bowel and
rectum. It was important that Peter not become
constipated because it could result in
compression of the peritoneal end of the
ventriculoperitoneal shunt and eventually
cause it to block. Therefore, the characteristics
and amount of stool were carefully recorded.
Members of the health team including
physiotherapist, social worker, public health
nurse, and hospital nurses met as a group to
plan for Peter s care and discharge. Realistic
goals were established early in order to ensure
that potential problems were not overlooked.
For Peter, these goals were to:
take 90 cc at each feeding
have adequate daily output of urine and
stool
remain free of infection
sit in a baby seat
go home with his parents.
For Peter's parents, the agreed upon goals
were to:
feed Peter
hold him
bathe him
express his bladder
disempact his rectum
exercise his extremities
pump ventriculoperitoneal shunt if
necessary
know early signs of intracranial pressure
know adequate inputs and outputs
know appropriate stimulation for him
feel confident in cahng for him.
The Canadian Nurse January 1977
The public health nurse provided a liaison
between the hospital and the home and helped
to communicate these goals to the nurse in the
community.
Peter's Family
Helping parents face and cope with the reality of
a newborn child with a severe defect is a difficult
task but one which is of utmost importance.
Peter's parents had not anticipated the birth of an
abnormal infant and they felt grief for the healthy
baby they had expected and guilt that they might
have done something wrong to cause the
defect. 8 3 During the first week after Peter's
birth, neither parent came to see him. His
mother was still in hospital in the postpartum
unit and his father was torn between visiting
his wife or Peter who was in a different
hospital. He decided to spend his time with his
wife because she was upset and he thought
she needed his support.
Seven days after their baby was born,
they came together to visit Peter for the first
time. Both parents were anxious and
concerned about their baby's condition but
expressed this in very different ways. Peter's
mother tried to deny the severity of his
condition and stressed to her husband how
'healthy' and 'happy' Peter looked. Although
she had been told about Peter's paralysis, she
"normalized" his immobility by saying, "He's
such a good baby. He never squirms. He
seems to be contented to lie in that position all
the time." Peter's father was very quiet during
his first few visiis and looked away each time I
approached him. Because nis first language
was Greek, he seemed to be unsure of his
ability to share his concerns. An interpreter
helped a great deal to clarify things for him and
to make him feel more comfortable. One day,
when talking to a physician he became very
angry stating that his son's defect was all the
doctor's fault." This was the first time he had
verbally expressed any of his feelings about
Peter's condition.
Building up a relationship based on trust
between the nurse and the parents was an
essential beginning in helping them cope with
their new situation. To accomplish this, I
answered their questions honestly and gently,
and demonstrated, by my frequent presence, my
acceptance of them and their baby.
It was heipfu I to can Peter oy name and to
refer to "you and Peter " as a unit, when I talked
with the parents. This simple intervention
assisted them in linking themselves with their
child in their planning for their tuiure. By
example, I encouraged them to touch Peter, to
play with him, and to sing and talk to him.
These "parenting" activities were difficult for
them, however, because tney were afraid of
"harming" their baby. I tried to emphasize
Peter's healthy behavior as much as possible,
for example, taking all of his feeding;
gradually, the parents were able to touch Peter
while talking and playing with him. This
behavior as well as the parents' questions
about Peter's feeding patterns indicated that
they were ready to learn some techniques
about caring for their baby.
In my initial interviews with the family, I
discovered that the parents' knowledge of
baby care was limited. Both parents were the
youngest in their families and neither had any
experience holding, bathing or feeding an
infant.
Our teaching-learning sessions were
directed towards meeting the goals set by the
health team, and began with informal
demonstration-discussions of Peter's feeding
behaviors, and moved the next day into
supervised feeding periods initiated by the
mother. Sympathetic and understanding
teaching and positive feedback about
successes assisted her in gaining confidence
in her own mothering abilities.
The parents had many new skills to learn
before they would be ready to care for Peter at
home. These included how to hold and bathe
Peter, how to detect early signs of intracranial
pressure, express his bladder, disempact his
rectum, determine adequate intake and
output, exercise his extremities and position him
appropriately.
Each learning need or problem was
assessed by the nursing staff in a systematic
manner by being alert to verbal and nonverbal
cues from the parents and evaluating their
developing knowledge base, skills and
readiness to pursue the task. For example, I
noticed that Peter's mother tightened her facial
muscles while she was expressing Peter's
bladder. When I asked her about this, she said
that she felt tense and worried about the
procedure. By placing my fingers over hers
and pressing down on the bladder with her,
she was able to judge the pressure required to
empty the bladder and felt more confident
about doing this task.
With practice, both parents gained skill in
assessing Peter's problems and in performing
the techniques necessary in his care. Before
Peier'sdiscnarge, they felt they cou Id carr/out
the basic daily tasks required. They will still
have to adjust their usual daily activities to
include this rigorous regimen without
redirecting their goals completely when they
take Peter home.
Concern for the Future
For this family there will be many future
concerns and stressors. There are still many
questions they may want answered (i.e. How
can we provide Peter with appropriate
stimulation as he develops? What type of
schooling would be most appropriate for him?
How can we heip ni.r, rlna playmates?) The
community nurse with the help of the public
health nurse from the Society for Crippled
Children can provide guidance to assist the
parents to prepare for problems associated
with Peter's development. At the present time
there is no special equipment required for
Peter's care. As he grows, he will probably
require special carts for mobility, wheelchairs,
braces, orthopedic shoes and urinary
appliances. The public health nurse in
collaboration with other members of the health
team can assist the family to adapt to each
new situation.
Peter will be further assessed in the
combined spina bifida clinic at the Ontario
Crippled Children's Centre. Then he will have
ongoing assessments (i.e. urological,
orthopedic, physical medicine and
neurological) at three to six-month intervals as
needed.
The family was also referred to the Spina
Bifida Association which promotes the welfare
of individuals with spina bifida and their
families and provides support through a group
approach to problem-solving.
Summary
Caring for a child with a myelomeningocele is
not a task that one person can accomplish on
his own. An interdisciplinary team approach,
early parental involvement in the baby's care,
a thorough knowledge of community
resources, and parental understanding of the
long range implications will greatly influence
and affect Peter's early years. With support
from both professionals and relatives and
friends, it is hoped that they will develop a
positive attitude to this challenge and continue
to demonstrate their love and concern for
Peter.*
Judith M. Hendry (R.N., Hospital for S/c/f
Children, Toronto; B.Sc.N., University of
Toronto; M.Sc./V., University of Western
Ontario) is presently a lecturer at the
University of Toronto, Faculty of Nursing. She
prepared this paper while working on a
surgical infant area at the Hospital for Sick
Children in Toronto.
References
1 Kapila, Leela. Surgical aspects. Nurs. Times
69:6:172-174, Feb. 8, 1973.
2 Downey, John A. Ttie child with disabling
illness: principles of rehabilitation, by ... andNielsL.
Low. Toronto, Saunders, 1974. p. 132,
3 Kapila, op. cit.
4 Waechter, Eugenia H. The birth of an
exceptional child. A/urs. Forum 9:2:202-216, Feb.
1970.
5 Lavoie, Donnajeanne. Spina Bifida:
immediate concerns ... long terms goals, by ... et al.
Nursing 73 3:10: 43-47, Oct. 1973.
6 Bonine, Gladys N. The myelodysplastic child
and home care. Amer. J. A/ors. 69:3:541-544, Mar.
1969.
7 Colliss, Virginia. Nursing care. Nurs. Times
69:6:174-175, Feb. 8, 1973.
8 Bradley, Rachel. A spina bifida baby. Nurs.
Times 68:5:145-147, Feb. 3, 1972.
9 Hill, Margaret L. The myelodysplastic child:
bowel and bladder control, by ... et al. Amer. J. Nurs.
69:3:545-550, Mar. 1969.
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In recent years much literature and discussion
has centered on hunnan sexuality. Society has
pried into, questioned, evaluated and
generally exposed to public view, many areas
of human sexual needs and behavior that were
once considered taboo. Ideally, this kind of
scrutiny leads to increased knowledge about
what it means to be fully "human."
For the handicapped person, the journey
towards a better understanding of his/her
sexual potential has been a little slower in
getting started. Ignorance about the sexual
feelings of the handicapped person has kept
the subject shrouded in embarrassment and
silence but attitudes are changing. Workshops
and conferences being held in centers across
Canada are one means of increasing
communication among health care workers
and the disabled, This ensures that better sex
education and counselling is available as well
as providing a means of improving public
education and understanding of the disabled
person and his needs.
An example of this type of conference was
the one held some time ago at the Royal
Ottawa Hospital and co-sponsored by
Algonquin College in Ottawa and SIECCAN
(Sex Information and Education Council of
Canada). The three-day conference, entitled
'Sexuality and the Disabled,' brought together
health care workers and physically disabled
persons in a relaxed and accepting
atmosphere to consider human sexuality in its
broadest sense and to study the more
particular difficulties experienced by the
disabled in the expression of their sexuality.
The tone for this Ottawa workshop was
set during the opening address by Beverley
Thomas, Executive Director of Planned
Parenthood British Columbia. Beverley is a
quadriplegic who twenty years ago sustained
a spinal cord injury as a result of a diving
accident. With a mixture of gentle humor and
-candid self -disclosure, she opened the doorto
the forbidden area of sexuality and made it
possible for those present to begin taking a
long, hard look at their own values and beliefs,
as well as the taboos, myths and
misconceptions surrounding sexuality in
general and sexual practice in particular. She
told her audience:
/ don't want to be the odd guy out. We're
people and that's important. Because I have
to wheel to get from here to there is nobody's
business but mine. But we do have to pick up
some people on the way who will share that
experience with us — we have to find those
people who will love us for ourselves, and not
worry about those who can't ... in any
experience where you are trying to create
trust, you have to take risks.
By being together in both large and small
groups, those at the workshop were able to
exchange information, opinions and
experiences with one another. For example,
participants engaged in some value
clahfication strategies which allowed them to
look in some depth at their own attitudes
towards sexuality. In order to understand what
this exercise involved, imagine yourself in a .
small group setting. You are given a small card I
on one side of which is written a general |
statement about sexuality. You are asked to i
respond to the statement. Then turning the i
card over, you are asked to respond to a more !
specific statement. You may elect to pass if I
you wish and no one may interrupt you until !
you finish. Suppose your first statement is:
Physically handicapped children should I
be given opportunities to develop their own
sexual feelings realizing that they may not get I
these opportunities as other children do. \
More than likely you are able to comment
on the statement with a fair degree of ease.
But, how about the reverse side?
'Your 13-year-old niece tells you that a I
close girlfriend, who is unable to use her !
hands, has asked for assistance in i
masturbating because she wants to find out '
how it feels. She asks you if you think it would ;
toe OK."
This is not quite so easy. Although some ,
participants thought the whole exercise too' -
academic, it did permit those unaccustomed to
speaking freely about sexual matters the i
freedom to do so in an atmosphere that was i
accepting and nonjudgmental. This attitude \
was an outstanding feature of the conference. '
No one felt pressured to talk about their own
sexual experience if they did not wish to do so.
In group sessions, participants ^ •
considered sexuality in its broadest sense.a .
well as examining the importance of ^
establishing meaningful relationships —
"How I view myself as a man or a woman?" j
— "How can I express my masculinity or
femininity in ways acceptable to myself and my
partner?"
One gentleman, who has multiple
sclerosis and is confined to a wheelchair,
shared the following; .
My sexuality consists of more than my \
genitals. For many of us here, they don't work \
anymore. Touching and holding someone I i
care for is important to me. Why, I can have a
spiritual orgasm just looking into my partner's ]
eyes! ]
I
A woman participant recounted her !
determination to look just as attractive and i
feminine as any other woman:
By golly, when I went out to the Queen
Elizabeth (theatre) and for dinner, I was going
to wear a long dress just like anyone else, I .
was going to get there, I was going to wheel ,
up to that table and I was going to ask the
waiter to cut my meat. I
i
This kind of sharing not only provided
much needed encouragement to other |
disabled people but also helped to dispel the j
misconception that sexuality is synonymous '
with sexual intercourse. As McRae and
Henderson state:
The Canadian Nurse January 1977
Sexuality has many modes of expression,
ranging from tfie baking of an apple pie for a
loved one to shiaring one's body. Sexual
behavior Is a private affair between partners,
having variable significance depending upon
the psychologic, physical and social
environment of the moment. '
A variety of discussion groups centered
on the specific problems experienced by
individuals with different physical disabilities or
dysfunctions. Knowledge related to sexual
activity for people with pain and joint stiffness,
speech and communication disorders,
spasticity, muscle weakness and immobility
was shared by the participants who were
encouraged to choose the group best suited to
their needs. Resource people for each group
included a leader having special knowledge of
the particular disability and a facilitator to
provide support and promote meaningful
interaction tietween members,
A panel discussion, "Growing Up with a
Disability and Learning to Live with a
Disability," was presented by four disabled
people who shared where they "were at" in
terms of their own sexuality and how they got
there. The courage and determination of these
people who shared some of the most intimate
and what, for most of us, would be devastating,
experiences in their lives was greatly admired
by the audience.
Conference Outcome
Effective workshops and conferences
have a tendency to raise more questions than
ihey answer and this one was no exception.
The final sessions were devoted to formulating
the questions and common concerns of the
participants into meaningful
recommendations. A total of 22
recommendations were accepted for
circulation to provincial and federal
government agencies, health care and
residential agencies, and health education
institutions within the Ottawa area.
Participants agreed that;
• directors and supervisors of health and
residential facilities should
— allow self-governing by the disabled
persons in all non-medical matters,
— provide appropriate facilities, such as a
furnished room with adequate privacy for
personal use by residents on request.
• an ombudsman (priority to a disabled
person) should be appointed to be the liaison
between the associations of the disabled and
the government (federal and provincial).
• all in-patients and out-patients should be
given instructions about the effects of drugs on
their sexuality.
• a sexual therapy team should be
identified within all Rehabilitation units in
Ontario.
• subsidized transportation should be
made available to the disabled to allow for
socialization.
• disabled children should be integrated
with other children throughout the general
school system.
• all educational programs for health care
professionals (including inservice) should
provide courses in sexuality, and sexuality and
the disabled.
• institutions and places of care (i.e. active
treatment hospitals, chronic hospitals and
homes for the elderly) should allow individuals
to express their right to privacy and support the
individual's dignity in this expression.
To devise strategies for implementing
these and other recommendations for change,
a core group of thirty-five people from the
workshop continue to meet and evaluate their
progress. They anticipate that through public
education and a better understanding of
human sexuality the needs of the disabled in
the expression of his sexuality will be met.
Nursing Implications
During the course of the conference,
participants became increasingly aware of the
significance of the observation by one of the
workshop organizers that:
The fundamental Issues relating to
human sexuality encompass personal value
systems, life-styles, self-image and
communication mode as well as how people
In relationships act toward each other ^
Acceptance of the idea that these words
apply, not just to the patient — theotherguy —
but also to nurses themselves, carries with it
several important implications among them:
• Our sexuality is not out there somewhere,
it is an integral part of our total being. It is not
just something we do privately. It is our
confirmation of ourselves.
• Until we are comfortable with our own
sexuality, we cannot help anyone else. Being
comfortable for some may simply mean that
when a patient broaches the subject of
sexuality, you, his nurse, can honestly say, "I
find it difficult to talk about intimate matters of
this nature, but I know it is important to you and
I will put you in touch with someone who can
help you with this concern,"
• We don't all have to be counsellors on
sexuality but we do have a responsibility to our
patients.
An individual who undergoes an
alternation in body image is certainly going to
have concerns regarding his sexuality. The
nurse, in helping her patient through the
rehabilitation process, can encourage the
patient to take the initial risks required in trying
out his "new image" as he relates to his friends
and loved ones, and in making new
acquaintances. Some individuals have to
learn to love all over again.
This demands a lot of courage as well as a
great deal of support from the health care
worker most closely involved, the nurse.
Therefore, we must become as
knowledgeable and as comfortable as
possible in this whole area if we are to be of
help to the disabled person.*
References
1 MacRae, Isabel. Sexuality and irreversible
health limitations, by ... and Gloria Henderson. Nurs.
Clin. North Am. 10:3:587-597, Sep. 1975.
2 Personal communication with Trudy Brown,
Nursing Inservice Co-ordinator, Royal Ottawa
Hospital.
Bibliography
1 Lief, Harold I. Sexuality — knowledge and
attitudes, by ... and Tyana Payne. Amer J. Nurs.
75:11:2026-2029, Nov. 1975.
2 Neubeck, Gerhard. Sex and awareness. In
Ways of growth, edited by Herbert A. Otto and John
Mann. New York, Grossman, 1968.
3 MacRae, Isabel. Sexuality and irreversible
health limitations, by ... and Gloria Henderson. Nurs.
Clin. North Am. 10:3:587-597, Sep. 1975.
4 Sedgwick. Rae. Myths in human sexuality.
Nurs. Clin. North Am. 10:3:539-550, Sep. 1975.
5 Smith, Jim. Sexuality and the severely
disabled person, by... and Bonnie Bullough, Amer. J.
Nurs. 75:12:2194-2197, Dec. 1975.
6 Zaiar, Marianne. Human sexuality: a
component of total patient care. Nurs. Digest
3:6:40-43, Nov./Dec. 1975.
Elizabeth Finch (R.N., Toronto General
Hospital: B.N., M.Sc.( Applied) McGIII
University) is the coordinator of nursing
inservice education at the Royal Ottawa
Hospital, Ottawa, Ontario. While attending the
conference, "Sexuality and the Disabled, "
she was struck by the open and sincere
sharing of feelings by the participants who
earned "our undying respect, admiration, and
gratefulness. Beverley Thomas, for example,
who gave the opening address is without a
doubt a remarkable, vibrantly alive woman."
"It took an enormous amount of courage
and 'sheer guts' for these people to share
some of the most Intimate and what for most of
us would be devastating experiences In their
lives. "
To those nurses who feel embarrassed
discussing the topic of sexuality, Finch adds,
"When you are overcome by these feelings,
look at your patient who knows more about
embarrassment, fear and vulnerability than
most of us could ever Imagine."
M
a supportive approach
to individuals in conflict
with society.
Jane Warden
Three years ago, when I moved to the Forensic
Unit of the institution where I worl(, the only
I thing I knew for sure about the patients there
was that, at some point in their lives, they had
all come into conflict with the law and had
been subject to judicial process. Since then, I
have cared for many of these patients and
come to appreciate some of the problems
involved in their rehabilitation.
The need for nurses in this area of
psychiatry is growing as the need for more
facilities for the assessment and treatment of
these patients becomes increasingly obvious
in our society. It is my hope that this personal
account of my experiences and observations
will spark a corresponding interest among
other nurses. --- ■-
The Forensic Inpatient Unit of the Clarke
Institute of Psychiatry in Toronto can handle a
maximum of 22 patients — 19 male patients,
three females. Since most of these patients
are remanded to our custody, the doors of the
unit must be kept locked. The unit provides
both assessment and treatment. Assessment
is at the request of the courts, on behalf of the
defence attorney, crown attorney or judge.
Most patients are remanded for from 30 - 60
days but staff may request an extension or ask
to have the patient returned to custody before
the designated time is up.
Assessments may be pre-trial — i.e. the
person has been charged with an offence but
not yet tried, or pre-sentence — i.e. the person
has been convicted of an offence and an
assessment requested, usually to aid the
judge in dispensing an appropriate sentence
to a suitable institution.
Assessment
Thirty to 60 days Is obviously not a very
long time in which to do a thorough
assessment and therefore the staff must work
quickly to discover all the relevant information.
Along with routine blood and urine tests, an
E.E.G. is usually done to rule out brain
dysfunction that could have some bearing on
the person committing the offence with which
he is charged. Extensive psychological testing
is carried out and detailed histories are taken
by the doctor and added to information
gathered by other staff involved with the
patient.
Staff-patient contact varies from person to
person and ranges from group therapy to
one-to-one interactions with staff, but
evaluation of the day-to-day social dealings
with co-patients is probably our best tool for
assessment. We see examples of many
psychiatric illnesses, but most patients are
labelled as having "personality" or "character"
disorders. In texttxiok terms, they are
individuals whose behavior is amoral and
I anti-social, whose actions are impulsive, H
irresponsible, and serve immediate interest
with little or no feeling of guilt or anxiety and
without concerns for the legal or social
consequences of their act.
Each written report submitted to the court
on the completion of an assessment is
compiled by the doctors from information
gathered by team members, including the
nurses, social workers, psychologists,
occupational therapists, and the doctor
himself. The report contains information such
as whether the person is fit to stand trial, based
on whether he is certifiable under the Mental
Health Act 1967, whether he understands the
nature of the charges and the possible
implications and consequences, whether at
that point in time he is able to follow court
proceedings and advise his lawyer.
22
The Canadian Nurse January 1977
appropriately, and whether he understands
the meaning of the oath to be taken in c»urt.
A more personal assessment of the patient's
personality is also outlined and
recommendations are made for treatment, either
in a psychiatric facility or in an appropriate
institution in the penal system.
Treatment
Along with assessments, the unit accepts
some patients for psychiatric treatment.
Re-admission of former patients for "crisis
intervention " is not uncommon. Sometimes
the court recommends that one of our patients
who has had an assessment be returned for
treatment instead of incarceration. There is
another group of patients who after serving
some part of their sentence may be returned to
the unit on a parole basis — i.e., by serving the
remainder of a sentence in close contact with
an agency that provides rehabilitation to the
community. Our rehabilitation program has
extended to include patients now considered
"sane" and released from the Hospital for the
Criminally Insane in Penetangueshene,
Ontario as ready to re-enter society.
On the Job
My nursing experience on the forensic
unit began when I requested a transfer after
several openings became available. The idea
of working with "criminals" was intriguing and
it was probably this curiosity that led me to
apply.
The first two weeks went by as if in a
dream. I recall sitting in the nurses' station
reading charts and trying to fit the "charges"
with the faces that occasionally appeared.
That was, and still is, an impossible feat.
I learned very quickly that each of these
patients is an individual. Initially, most struck
me as "nice guys," it was difficult for me to
connect an individual with, for instance, a
brutal rape, an armed robbery, or even
murder. This tendency to stereotype and
prejudge is one that 1 had to overcome; as very
often it caused me to be less than objective in
my approach to these patients. I came to the
conclusion that I was doing myself and my
patients an injustice. I soon realized that each
patient has district needs peculiar only to him.
The team approach helps to maintain this
objectivity by a system of effective
communication between members and by
providing necessary feedback and even
conflicting opinions.
As we get to know our patients, problem
areas begin to surface. Our unit is often their
last contact with "society" before a long period
of incarceration. Sometimes a patient is
making a last attempt to get help after years,
often a lifetime, of problems. For many
patients, it is too late. They must face the legal
consequences of their deeds, and their
J
chances for rehabilitation in the prison system
are slim. Often, patients have agreed to this
assessment period merely to get a "good
report, " in the hope that the judge will allow
them to go free on bail or to receive probation,
a shorter sentence or even acquittal. They
believe that if they are "good" and attend all
the activities available they will receive a
favorable report. They soon learn that this is
not the case.
After the staff has prepared the
groundwork, the patient can either start
working in groups and on a one-to-one basis
with his staff, including at least two primary
nurses, or he can sit back and openly admit to
little or no motivation. We try to get the patient
to make this decision himself but this is not
easy for a person who has always avoided
accepting responsibility for his actions.
The therapeutic milieu we try to attain on
our unit is based on trust ... a small word with
enormous connotations. Some of these
patients have never trusted anyone, much less
a stranger, in the form of a nurse (who is after
all, an authority figure). As staff, we are
constantly tested with statements like — "You
don't really care about me. This is just your,
job." We try to respond in an honest,
straightforward and consistent manner.
Openness and honesty on the patient's part
are also stressed. Using a give-and-take
approach, sharing a little of ourselves and
expecting the same in return, we try to
establish a therapeutic relationship with each
patient.
I share my expectations with him in the
hope that he will begin to take the
responsibility upon himself to set some
realistic goals, and understand his personal
limitations. Often he needs a great deal of
guidance and support in these areas, but the
nurse-patient relationship can be such that he
will accept these from her.
In working with the forensic-type patient, it
is important to refrain from setting goals that
are beyond his reach or imposing rigid,
middle-class values . Instead, I try to set what I
would consider easy goals so that positive
gains are achieved and recognized by the
patient relatively quickly, thereby helping him
to acquire the self-confidence he so
desperately needs.
We must carefully examine the
socio-economic background of each
candidate for rehabilitation and then also
consider how much of his life has been spent in
institutions. We must be careful not to
automatically assume that he can function in
our society. Realizing this, I try to be sensitive
to the needs of a patient to learn what I would
consider an elementary task, like using a
telephone or operating a vending machine,
try to make the patient aware of this
understanding early in our relationship.
Good rapport, mutual understanding and
trust make it possible for the patient to be less
threatened in admitting his need to be taught
and protect his pride and self-esteem from
further damage. This supportive,
non-threatening approach to teaching simple
life-skills can be expanded into more
complicated areas like interpersonal and
social relationships. It is a slow and difficult
process, but often it can lead to the roots of
serious problems of depression, alcoholism or
inadequacy that may, in turn, result in
difficulties with the law.
At first, I found it difficult to understand the
unconscious desire of some patients to return
to jail. Usually these people have a history of
repeated institutional admissions, ranging
from orphanages to maximum security
institutions. They have come to believe that
prison will accept them and provide the
security they so desperately need when
society will not. In many cases, this is a fact. It
is not unusual, for instance, to see one of our
patients receive probation after assessment
and return to us for rehabilitation. He begins to
learn how to live a decent life, he finds a job
and a place to live. He is discharged and seen
on a regular out-patient basis. Then, suddenly,
he is up on another charge, for no apparent
reason. (Viore often than not, he is just not
ready to cope with the everyday hassles of life,
and the institutional environment offers him a
secure alternative to coping. Douglas was a
patient like this ...
Case History
Name: Douglas H.
Age: 25
Birthplace: SmalKown, Manitoba
Present Charge: Break and Enter, Two Counts.
This patient was admitted for a 60 day assessment
at the request of the trial judge prior to sentencing.
Over the past ten years, he had been in jail many
times on various charges. Invariably, he was under
the influence of alcohol when he committed his
offences. Previous psychiatric contact was nil.
Familial history revealed an alcoholic father and a
mother who died when he was four years old. Doug
spent four years in various homes in the community
and then was adopted by a paternal uncle and his
wife. While he was well provided for physically, his
emotional needs were not adequately met,
especially after the birth of a stepsister.
Doug's real father introduced him to alcohol use
when he was 12 years old. It would appear that in
these formative years, he was confused and torn
between identifying with his real father and his
stepfather, as his adult model. He was still in close
contact with his father and two brothers in the small
community where they lived and alcohol was his way
of relating to his "real family. "
Doug was a shy, introverted teenager who used
alcohol for courage and confidence in social
situations. By 16, his dependency was
uncontrollable and he needed money to support it.
His first conviction was at age 1 5 and for the next ten
years he progressed from county jails to the federal
penitentiary, with only brief periods out on the street.
While in prison he relates a considerable use of
alcohol in the form of Illegal "moonshine " made by
the inmates, so his dependence was never really
interrupted through incarceration.
Assessment
When Doug arrived on our unit, he presented as
a suspicious and quiet individual, unsure of the
reasons for his admission and mistrustful of staff and
patients alike. With a long history of incarceration
this is not an unusual response: as nurses, we are
confronted repeatedly with patients who question
our motives in trying to establish a relationship. The
self-esteem of these patients is often so low that they
see no reason for our concern.
Since Doug seemed unable to trust anyone,
consistency of staff and a non-threatening approach
were very important. He was encouraged to become
involved in all the groups available including a
closed insight-oriented group. Psychological testing
revealed little pathology other than a tendency
toward hypomania and impulsivity. A series of
EEC's revealed some permanent organic
dysfunction due to chronic use of alcohol.
Nevertheless, he showed many resources,
intellectual and emotional, that he could use if
motivated to do so. The prognosis remained
guarded due to his long history of alcoholism. Doug
himself admitted to a problem in this area though
and expressed a desire for help with his problem.
During his 60 days on the unit, Doug proved to
be a warm, caring individual, with a capacity for
insight, and the ability to form interpersonal
relationships with staff and patients. Team members
felt that treatment could result in his eventual
rehabilitation back into the community and
recommended probation. The judge concurred and
Doug received a sentence of two years probation.
Doug felt his drinking problem was the result of
his background and it would appear that alcoholism
was a symptom of early deprivation, identity
confusion, low self-esteem and contact with a
lifestyle condoning extensive use of alcohol, typical
of the community where he grew up. His self-esteem
improved remarkably as the result of feedback from
patients and staff about the positive aspects of his
personality. His general popularity on the ward
resulted in his serving on patient committees and he
became an appreciated as well as productive group
member. The peer group support he received was
important but the genuine caring that the staff
demonstrated was probably more important
because we were role models for him. Doug's
motivation to change was very high.
Treatment
After sentencing, he was supposed to continue
in group and individual therapy for approximately
two months to facilitate further growth and improve
his self confidence so that he could seek
employment and live in the community.
Treatment for Doug's alcoholism was
discouraging. It was important that he transfer his
dependency on alcohol to a healthy dependency on
the unit, especially after discharge when he would
need a great deal of support but this was not easy
since he regarded any dependency, especially on
women, as a weakness. Doug knew that continued
alcohol abuse would mean more brain damage and
possible return to prison. Intellectually he was able
to say that he had to stop drinking. Emotionally, he
had to discover for himself whether he could control
his drinking rather than stop. On his first pass , he
returned to the unit quite drunk. In this condition, he
was angry, verbally abusive, aggressive and
objectionable. His memory of this behavior was
almost nil and when confronted with it, he was
frightened enough to agree to begin treatment with
Antabuse. This continued for about a month but he
regarded this medication as a crutch and preferred
to be independent. Since regaining his self-respect
was extremely important to him the staff did not force
the issue.
Release
Eventually, Doug returned to the community.
Through employment counseling and much
searching on his own, he found a good job and was
well-liked by his fellow employees. Out-patient
follow-up, in the form of supportive psychotherapy
with two of the nurses who were his primary staff,
was continued on a weekly basis for three months.
Then, he was charged with assault following a
drinking incident in a tavern. Because the charge
involved a breach of probation, the judge sentenced
him to the penitentiary.
Should we regard Doug's treatment as a
failure? Where did we go wrong? Did we waste a lot
time and energy on a hopeless case? I would have to
answer "NO ' to all of these questions. I feel that
Doug benefited immensely from our program. I think
that loneliness and situational depression, leading to
an increasing use of alcohol again after discharge
were the cause of his "downfall." He admitted that
drinking was his only way to socialize. Apparently his
ability to be independent was limited and I feel this
was due mce *o his io"g ^^'stcy o*
institutionalization than to any failure on our part.
Although Doug ended up back in prison. I feel
sure he will maintain the gains he made and be able
to use these once he is released again. He definitely
learned a great deal by his mistakes and he was
certainly aware that he had to take responsibility for
his own actions. As nurses, we cannot feel
responsible for this so-called failure and, as a team,
we can use cases like Doug's and countless others
to learn from and discover new and different ways
of dealing with future patients.
Summary
Invariably, we spend many, many hours
vk^orking with "antisocial behavior" problem
patients before we see even a small amount of
progress. I try to maintain a degree of
perspective with each individual patient. I have
learned to cope with temporary defeat and
discouragement. Eventually, a substantial
number of our patients do make it. There may
be crisis-intervention admissions or another
prison term intervening, but often this is just
part of the learning process. What seems like a
tiny step forward to us, is often really a giant
step for the patient and the trial and error
process really does work in the long run.
At first, many of our patients appear to be
beyond our help. I am amazed, however, when
I think of the number of them that we have
almost given up on who suddenly do a
complete about-face and begin to work
themselves on their problems.
In this job, I am constantly learning new
techniques, new theories, new approaches. I
have made some mistakes but I have also
learned to periodically reassess my old values
and adapt some of them to meet the needs of
the patients and the unit. In short, my work with
forensic patients has been a rewarding
experience; through it, I have achieved personal
growth beyond my original expectations. ♦
Jane Warden, R.N., author of Caring for the
Forensic Patient, worked on the Forensic Unit
of the Clarke Institute of Psychiatry in Toronto
for almost four years before writing this article.
She points out that her observations are
based entirely on personal opinions and her
experience on the Unit, developed in
consultation with co-workers. A graduate of
Peterborough Hospital School of Nursing,
Peterborough, Ontario. Worden joined the staff
of the Clarke Institute in 1971. After 1 5 months on
the Child and Adolescent Unit, she transferred
to the Forensic Unit where she remained until
recently.
She is now working as a home care worker
with the East f^etro Children and Youth Services
Department of the City of Toronto. In this position
she says she deals with "potentially
forensic-type patients, " treating the entire family
along with the child.
The Canadian Nurse January 1977
The Nurse Continuum Perspective
Author's preface:
This personal expression of attitudes and opinion is
not meant in any way to indicate issues of nursing
education, nor to reflect on the quality of nursing
care in any specific area. During the 26 years that I
have been involved, either directly or indirectly, with
nurses, many of my friends and associates in both
Canada and the United States have voiced their
concern over the status of nursing. This article is the
result of their comments, as well as my own
personal experiences in the area of nurse-nurse
relationships.
I note, also, the contribution of Dr. W.B.W.
Martin, Department of Sociology, University of New
Brunswick. Dr. Martin, who is the author of The
Negotiated Order of the School (MacMillan
Company of Canada Limited 1976) delivered the
series of lectures on small groups that helped to
pinpoint the interpretation of nurse-nurse
associations described below.
Hopefully, readers of The Canadian Nurse will
recognize that this perspective is not stereotyping,
for the notion of a continuum suggests that there is
constant opportunity for change. It is never too late
to alter our behavior patterns. That is the whole
meaning behind the Nurse Continuum Perspective.
I his article is unique in the fact that it is not
based on past studies; it does not include
statistics or references, nor does it have a
bibliography. It is, quite simply, a description
of one nurse's ideas about the interaction
between members of the nursing profession
at this particular point in time.
It is the author's contention that it is not
systems, governments or other disciplines that
are the greatest barriers to the progress of
nurses in the field of health care. The initial and
most common barriers are, in fact, other
nurses. Negative nurse-nurse interactions
can be, and often are, a definite deterrent to
change. Until this fact is accepted and dealt
with appropriately nurses may continue
forever on a weary continuum of stress.
Listening, sharing, encouraging
and understanding are too often
missing from nurse-nurse
relationships. .,.^,.
We can accept the fact that nurses are
persons who should care about other people.
What we cannot seem to accept is the fact that
nurses should also specifically care about
other nurses. In our rush to reach a desired
personal or professional level — in the
constant struggle to cope with nursing
problems — we frequently overlook the
importance of the human qualities that are vital
to the survival of good working relationships.
Listening, sharing, encouraging and
understanding are too often missing from
nurse-nurse relationships. This failure to find a
common ground and establish lines of
communication stifles and inhibits efforts to
negotiate and compromise. In the end, talks
break down, impetus is lost and change
becomes impossible.
In an attempt to open the lines of
communication between nurses and to create
greater understanding, the author has devised
a simple but dynamic tool that offers some
handy landmarks in recognizing the difficulties
inherent in nurse-nurse relationships. The
Nurse Continuum Perspective proposes three
broad groupings of attitudes with varying
degrees of compliance measured along a
sliding scale between the two extremes. At
one end of this continuum is the
"Institutionalized Nurse" — who gives every
indication of being a ligid, non-flexible,
immovable object. Her position in the health
care field seems relatively stable largely
because, although she is verbally active, in
actuality she strongly resists change. The
contribution to nursing that the
Institutionalized Nurse is capable of making is
limited and almost never fully realized.
She feels secure and comfortable only with
well-established habits and routines: change
represents a threat. In reacting to new
situations, she often attempts to inflict her
present notions and unchanging values upon
other nurses.
The Institutionalized Nurse feels
secure and comfortable only with
well-established habits and
routines.
Examples of the Institutionalized Nurse
are familiar to all of us. A classic one is the
nurse who stifles the creativity of other nurses
with her deference to authority or constant
compulsion to rigidly adhere to unimaginative
procedure and maintain the status quo.
At the other end of the continuum is the
"Polemic Nurse" who has rejected the
bureaucratic system and constantly creates
turmoil and stress by means of negative
feedback. She seems incapable of making
The Institutionalized Nurse
The Nurse Continuum Perspective
The Kinetic Nurse
The Polemic Nurse
Strategies
Tactics
Rigid
Non-flexible
Hinders Change
Stifles Creativity
Gives Negative Feedback
Causes Stress
Discourages
Progress for Nurses
Status quo
State of Constant Confusion
constructive criticism and is noted for being
picky over trivia — particularly while others are
attempting to concentrate on the real issues of
patient care. The Polemic Nurse presents a
hazard to those around her because of the
discouragement she causes among her
associates. Polemic Nurses smother
enthusiasm with their negative and hostile
attitude and, unfortunately, co-workers who
are exposed to this are inclined to give up in
despair.
The Polemic Nurse subjects her
co-workers to an unending stream
of carping criticism directed
against "the system" or the people
she works with.
It seems strange that an occupational
group that utilizes the concept of rewards to
shape behavior, somehow overlooks the use
of positive reinforcement in the patterning of
behavior in other nurses. (After all, other
people besides Brownies like Brownie points!)
Negative feedback discourages and
depresses its recipients and tx)th
Institutionalized and Polemic Nurses seem to
display a definite skill in this area.
Somewhere in the center of the
Continuum is the Kinetic Nurse. She is the
individual who continually tries to handle
day-to-day situations in a creative and
growth-producing manner; ultimately she is
responsible for most of the improvements and
advancements within her profession. Kinetic
Nurses are pulled back and forth on the
Continuum according to the frequency of their
encounters and involvement with their
Institutionalized and Polemic colleagues. This
back and forth movement depends upon how
skilled the Kinetic Nurse is in devising
strategies and tactics for coping with these
other two kinds of nurses. The maneuvers she
is forced into often cause loss of valuable
'emotional' time and may cause the Kinetic
Nurse to adopt some of the negative
characteristics of the other two groups.
Periodically, many nurses feel compelled
to "play the game " in order to obtain
professional advancement or even survive.
Kinetic student nurses may be confronted by
an Institutionalized instructor. They recognize
the passive role they may have to adopt to
receive a favorable evaluation and they
suppress their creative techniques
accordingly.
"Playing the game " may also occur in other
work situations. The Kinetic Nurse often finds it
necessary to strive for approval of the
Institutionalized and/or Polemic Nurse but, at
the same time, has difficulty in maintaining the
acceptance of her nursing peers. There is
constant dissonance in this type of working
situation and little opportunity for progress.
Both Institutionalized and Polemic
Nurses, if they obtain supervisory positions,
are often guilty of inhibiting Kinetic Nurses
from expressing their true feelings. When this
occurs, the profession is prevented from
establishing better understanding among its
The "I Win - You Lose" attitude of
many nurses defeats progress
within the profession.
members and with other disciplines. All nurses
must feel free to share their honest concerns
within their own professional group.
As a result of the polarizing effect of the
Nurse Continuum Perspective, all three
groups of nurses tend to adopt an "I win — you
lose" attitude towards their fellow workers. In
this kind of nurse-nurse relationship there can
be no opportunity for compromise. Nursing
issues remain unchanged and problems
remain unsolved. Nurses cannot afford to be
static; ttiey must be dynamic and since
Institutionalized and Polemic Nurses
encourage stagnation and apathy, progress
depends on the efforts of the Kinetic Nurse.
Readers will recognize that one
inadequacy of the Nurse Continuum
Perspective is the emphasis it places on the
negative aspects of nurse-nurse interactions.
Positive aspects do exist: how else could
nursing have moved forward to its present
position in the field of health care?
The Nurse Continuum Perspective is
meant to present more than a philosophic
viewpoint; it also has a pragmatic value. It
applies to all nurse-nurse interaction and all
areas of nursing. It gives each of us the chance
to honestly rate our own position on the scale
and, eventually, to assess one another's faults
and merits in an objective and constructive
fashion.
Nurses at all levels must develop the
capacity to understand each other; they must
make a concerted effort to work things out
through compromise. They must encourage
and support one another. A great deal remains
to be accomplished in nursing but none of this
will be realized if we fragment our resources
and dilute our strengths.
"All things must change and we must
change with them." If Kinetic Nurses can
confront and negotiate with the initial barriers,
(Polemic and Institutionalized Nurses) and at
the same time succeed in obtaining the
cooperation of these nurses in working
together for the common good, then ideas can
be shared and individual efforts encouraged.
With these kinds of nurse-nurse relationships,
progress in nursing will be measured in leaps
and bounds.*
Arlee D. McGee, R.N., B.N., describes the '
Nurse Continuum Perspective, as "simply a '
means of providing food for thougtit in this
area." She observes that, although a great
deal has been written and talked about \
concerning nurse-patient interaction and also
the doctor-nurse game, articles about
nurse-nurse relationships are conspicuous by
their rarity— even though this is a very
significant area. '
l^cGee recently completed her post -
basic nursing degree at University of New '
Brunswick School of Nursing in Fredericton i
after an absence from the classroom that j
lasted over two decades. She is a graduate of ;
Victoria Public Hospital School of Nursing in i
Fredericton and received a diploma in \
psychiatric nursing from the University of ]
Western Ontario in London. |
She was instrumental some time ago in i
starting a Home Visiting Teaching Program for
developmentally handicapped children in ,
York County, N.B.,and this year she designed I
and taught a course for attendants working in '
alcoholism detoxification centers.
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The Canadian Nurse January 1977
A New Role for Nurses
abortion
counselling
••••••••••••••••••••••••••••••••••••••
It is very easy, and erroneous to view the issue of
abortion in simplistic general terms. The problem of
unwanted pregnancies is multilayered; approaches
to it are feeble, haphazard, and lacking in
understanding. Inconsistent media and
medical information, sexual politics,
women's sexual needs and random,
one-dimensional family-life
education classes are only a
few of the factors
involved.
I Bonnie Easterbrook (R.N.) is a
graduate of the Toronto General
Hospital School of Nursing in
Toronto. She has worked as a
counsellor with Planned Parenthood
in Toronto and San Francisco, and
was a team leader for a
Community Outreach project
through Planned Parenthood of
Toronto in 1972. In 1973,
Easterbrook helped to organize a
teen conference 'Sex Seminar A to Z'
for Planned Parenthood of Toronto.
In 1974 she was an R.N.A.O.
delegate to the Ontario Conference
sponsored by the Family Planning
Division of Health and Welfare
Canada.
I Beth Rust, (R.N.), the author's
co-worker on the counselling team,
is a graduate of Wellesley School of
Nursing, Toronto. She is a past
board-member and volunteer
counsellor for A.C.C.R.A., and
Planned Parenthood of Toronto and
has had 5 years training and
experience in family-life counselling
with the Toronto Institute of Human
Relations. Rust was also a
participant in a summer program at
the Institute for Sex Research at the
University of Indiana.
For the past two and a half years, nurses at the
Toronto General Hospital have been involved
in the education and counselling of therapeutic
abortion patients within the
gynecological/obstetrical service. It really
began in 1 972, when Nancy Snelgrove, a staff
nurse in gynecology at T.G H., recognized the
need for counselling and support of
therapeutic abortion patients. Up until that
time, very little contraceptive counselling had
been offered to them.
With the support of the nursing
department at T.G.H., Nancy Snelgrove
developed a program that involved visiting all
abortion patients pre- and post-operatlvely.
During these visits, she spent time discussing
contraception with patients according to their
needs, dividing her eight-hour shift between a
regular patient assignment and the
counselling of abortion patients. Gradually,
she expanded her counselling role, and
became the nurse-counsellor for all women
admitted for therapeutic abortions.
We have been subjected to
intense, rigidly defined sex-roles and
unrealistic expectations for both men
and women. Our attitudes are a
culmination of many years of covert
and overt sexual conditioning.
Two registered nurses now share in the
counselling of patients admitted to T.G.H. for
therapeutic abortions. Beth and myself both
work in this capacity for four hours a day. an
arrangement found beneficial to us because of
the intensity inherent in abortion counselling,
because of the necessary repetition of basic
information, and because of the importance of
a fresh and enthusiastic approach to individual
patient's problems and anxieties each day. We
work individually, although we have close
contact with each other in our work.
Beth and I visit all women admitted to
T.G.H. on an in-patient basis for either suction
D & 0 or second trimester saline injection.
Most women prefer to have a D & C under
general anesthesia, while a small number
have the procedure done in the out-patient unit
with the help of a local anesthetic. (The
out-patient unit is separate from our ward.)
The doctor determines which procedure is
most suitable for the patient.
Our initial visit with the patient occurs on
her admission to the nursing unit. At this time,
we explain how the abortion will be done. We
encourage the patient to express her fears so
that we can help to clear up any mistaken
ideas she may have about the procedure. We
also invite questions from the patient and her
partner or parents.
It is our experience that most patients
have not been informed about what is going to
happen to them, particularly it they have been
referred to our service by a private physician.
IVe live in a society thai sexualizes
everything from shoelaces to
toothpaste. On the one hand, it is a
society whose media urge women to be
sexy: paradoxically, it is a society thai
doesn't accept sexuality as a normal
healthy part of whole human beings.
Our sexual conditioning is, to say the
least, confusing.
Their apprehension about the atKirtion itself is
often compounded by the fact that they feel
little regard has been paid to their emotional
state at a time of intense personal crisis.
During this visit, Beth and I attempt to find out if
the woman has any support from her family,
husband or boyfriend, so that we can help her
to work out her feelings about their reactions to
her decision. Quite often the fact of an
unwanted pregnancy, or the decision to have
an abortion forces the patient to question her
perceptions of the relationship she has had
with her partner. She may find herself alone at
a time when most in need of acceptance and
comfort.
Women are asking for good
alternatives to the birth control pill for
contraceptive purposes. The pill
cannot cover the span of a woman's
reproductive years. The combination
of birth control foam and the condom
is one extremely effective method for
preventing pregnancy but requires the
man's cooperation as well.
In preparing the patient for the procedure
involved in the abortion, we tell her about the
use of the laminaria tent. This device is used at
T.G.H. to cause slow dilation of the cervical os
in order to minimize cervical tissue tear and
shorten the time necessary for general
anesthesia in the operating room. The
laminaria tent is inserted by a doctor on the
evening before the abortion to begin dilation of
the cervix. Occasionally, menstrual-like
cramps occur. The tent is mads of
compressed seaweed, and resembles a small
stick when it is inserted in the cervix. It is
removed prior to the suction D & C.
Often when procedures and the rationale
behind them are explained fully, the patient
can relax within the hospital setting with less of
the unknown' to fear. This may be the first time
the patient has any feeling of acceptance and
support for her decision. When the patient's or
couple's questions have been answered, we
tell her that we will see her after the abortion
and on the morning of her discharge from the
hospital.
Patients admitted for suction D & C come
into the hospital on the afternoon or evening
prior to the abortion. They have the abortion on
the following day, and are not discharged until
the morning of the third day, when we have a
group discussion.
Our group meeting entails the discussion
of after-care instructions, birth control
methods, self-examination and the dynamics
of male-female relationships. Prior to the
group meeting our emphasis is on supporting
the patient and establishing a trusting
relationship with her. We consider this to be of
Importance because women admitted for
abortions are often defensive and suspicious
when they reach the hospital door — far too
often they have been sutiijected to the
dogmatic postu rings of doctors, clergy and
friends regarding their decision to have an
abortion.
The onus has always bean on
women to assume responsibility for
birth control. But women must not be
confused about their sexuality; they
must understand enough about
themselves to be able to assert
themselves and demand responsibility
from their male partners.
Beth and I are also involved in counselling
women admitted for second trimester
abortions by intra-amniotic saline injection.
This method is used for women who are at
least 1 7 weeks pregnant, and requires that the
patient remain in hospital for four to five days.
As the patient having a saline injection is in the
hospital for a longer period of time, we have
more time to help her to work out her feelings
about her decision. And this extra time is often
beneficial.
Many of the women admitted for a second
trimester abortion have had great difficulty in
reaching a decision about what to do. The
reason that a woman's actions are delayed
may often be attributed to the fact that she has
weighed her decision with painstaking care to
We hear so much adverse publicity
about thepill, and hesitate to use it. It is
difficult to feel secure when five
doctors give five different answers to
our questions about side effects.
choose the best of alternatives available to
her. Some women have abortions at this stage
of their pregnancy due to delays and
misassessment by the doctor. Most of the
Author Bonnie Easterbrook (standing) and '.
herco-worker, Bett} Rust in their office at the j
Toronto General Hospital. \
patients admitted for second trimester salinaj
injections have in fact sought medical help
immediately after they missed their second
period. The patient may feel hostile towards |
her partner and/or men in general, a situation '
aggravated if her partner has abandoned her. '•
Beth and I wear street clothes during our'
working hours, a fact that helps many women
feel more comfortable in talking to us. Very few I
women refuse to participate in our group I
discussions. There are however, exceptions.
Often an okJer woman via II prefer a one-to-one'
discussion with Beth or myself, feeling very
strongly that she should have known better.' i
Other women may feel intimidated by groups '
— the patient and partner may feel much freer;
to discuss contraception when they are atonal
with us. Our program is flexible enough for
improvisation and in such circumstances, we
talk together in the privacy of the patient's
room.
Most patients are pleasantly surprised by i
the group support that evolves during the I
meeting. Our patients are usually between the i
ages of 17 and 26. of varied ethnic !
backgrounds and religious persuasions. The j
group decides what direction their discussion
will take while Beth and I act as resource j
persons. In the meetings, we discuss a whole
gamut of topics related to women's health
issues. We cover simple female anatomy and
physiology, after-care instructions to follow the j
atjortion, birth control methods and their
efficacy rates.
The Canadian Nurse January 1977
After-Care Instructions for Patients Having Therapeutic Abortions*
1. Bleeding similar to menstruation will continue for seven
days or less; watch if this bleeding is heavier and followed by
severe cramps, backache and nausea.
2. Take your temperature for five to seven days, and if it is
elevated for 24-48 hours and associated with the above
symptoms, contact your family physician or come to the
Emergency Department.
• Do not take tub baths until bleeding stops: showers and
sponge baths are permitted. Do not douche or go swimming
until bleeding stops.
• Do not use tampons until your next period — use sanitary
pads.
• Do not have intercourse until you have stopped bleeding
— preferably wait until you have had one normal period.
3. Strenuous exercise should be avoided for at least one
week as It may cause further bleeding.
4. If your doctor has prescribed medication to prevent
bleeding expect a few cramps and clots.
5. Due to hormonal changes, some women will experience
depression or their breasts may be sore and perhaps leak.
Wear a supporting bra and reduce fluid intake. Most
important, realize it is a normal response and it will pass.
6. If you are going to take birth control pills, please begin
taking them the first day you get home, according to
directions in the instruction booklet.
7. In about one month's time, return to your doctor or to our
clinic for a checkup.
8. If you have any problems within the next few weeks and
wantto talk them over, please phone us. (1 1:00 a.m. is a good
time for phoning). Leave a message if you cannot contact us
and we will call back.
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All Canadian nurses, nursing students, and
members ot their families are invited to
participate in a unique tour to ttie ICN
Congress and beyond . ,
T0KYQ
for the excitement o( the ICN Congress
(or mystery and exotica
tor tropic sun and reiaxalion
THIS IS THE KIND OF
SPECIAL SERVICE YOU GET:
Roundtrip jet transportation; deluxe accom-
modations -TOKYO 6 nights, HONG KONG
4 nights: HONOLULU 3 nights; American
breakfast daily; all transfers between airports
and hotels; shuttle bus service between ICN
Congress/ Hotel; orientation tour in each city:
welcome reception in Hong Kong: flower lei
greeting in Honolulu; Special farewell
Hawaiian banquet.
JOIN US
May 27 June 10. 1977
from Vancouver $995' + '5% lornps/iaxes
Special low add-ons from other Canadian
cities; single rooms available at additional cost
This unique study tour sponsored by
TtttR*9istttr«d Nurses' TX7
As»ociation of Ontario V
m co-operation with Protessiona'
Travel Consultanis Ltd Toronto
^—^-^-^
Pleasi
Name
Address
City
Information on the.iCN Nurses Orient Tour
_Proi/ince .
_Code_
Clip and mail to: Professional Travel Cor^ltants Ltd
I
330 Bay Street. Suite 1 iM, Toronto, Ontario M5H 2Sgr -^»s . /
Part of our discussion deals w/ith female
sexuality — our goal here is to detnystify the
topic and help women to feel comfortable with
themselves and their bodies. This discussion
continually reveals to Beth and I just how
frightened women are to be open and
accepting of their bodies. We deal with the
topic in a frank and open manner — we talk
about self-examination of the genitals, the
vagina, the clitoris and its responsivity. Often
this discussion represents the first time
approval and encouragement has been given
to self-examination. We emphasize the
importance of honest, gutsy communication
between couples regarding sexual feelings,
and the responsibility of both partners for birth
control. In this couple of hours, we hope to
stimulate an expression of opinions and
questions, and the beginnings of awareness.
The groups themselves provide positive
feedback to our efforts — patients often relate
their appreciation of our counselling and
support to their doctors, who in turn tell us
about it.
Beth and I make every effort to talk to
interns and residents on the gyn/obs service
about our counselling program to help create
some awareness and understanding of the
problems women confront when they have an
abortion. We also contribute to the staff
development program for our own gyn/obs
departmental staff nurses. *
We are entitled to learn and
discover our sexual selves throughout
our lifetimes. Our sexuality must be
given positive value by our society.
References
Boston Women's Health Book Collective Our
bodies, ourselves. Rev. 2ed. New York, Simon &
Schuster, 1976.
Recommended reading: Walters, Wendell W.
Compulsory parenthood: the truth about abortion.
Toronto, McClelland & Stewart, 1976.
Keeping up-to-date with new techniques and new ideas in her profession requires that the nurse
continue to learn long after she has left school. Staff development programs provide an opportunity
to do this in a structured, formal way within the hospital setting. But formal learning programs can be
made more effective by using some of the techniques that adults use to learn on their own every day.
The I ip of the Iceberg-
Staff development and the universe of adult education
®
Jackie Barber One of the thorniest problems confronting
staff and administrators at individual hospitals
today Is the issue ofinsen/ice education. How
much? how? for whom? are questions that
administrators face in organizing staff
development programs, and they may feel
their problems are compounded by the
ambivalent reactions they get from nurses.
l\Aany staff nurses feel that their
professionalism is dependent on keeping up
with advances In medical technology,
learning new techniques and expanding their
awareness, and are eager to participate in
any learning experiences that are available.
Other nurses seem to be completely
uninterested in going to any more classes
once they have finished school. The attitudes
of head nurses toward staff development,
whether they are willing to make work
schedules flexible enough to encourage
participation and what provision they make for
nurses to use and share new knowledge with
others, also determine the success of
inservice education programs.
Hospital educators are faced with these
and many other considerations in their
attempts to plan successful education
programs. To make the learning experience
more valuable to individual nurses that
participate, and thus to the hospital that gives
them, it is helpful to look at some general
principles of adult education.
The Magnitude of Adult Education
When adults learn, they do so in a variety
of formal and informal ways. Formal education
takes place in a classroom, lecture hall or
conference room. It is directed by a teacher,
lecturer, group leader or resource person.
Formal education can be quantified. You can
count the number of people who attend class,
the number of hours spent in the classroom
and the numberof right and wrong answers on
the final examination.
Many books have been written about
formal adult education, and about how to
ensure that maximum learning takes place in a
formal setting. Perhaps one of the most helpful
of these books is The fvlodern Practice of
Adult Education. ^ by Malcolm Knowles.
There is no denying that much valuable
leaming can take place in a well-structured
formal setting, but most adult leaming takes
place informally. Allen Tough, in his book 7^e
Adult's Learning Projects. ^ proves
conclusively what we all have suspected, that
adults learn a great deal on their own, with a
little help from their friends and the local
librarian. It is a fascinating book and of great
importance to adult educators.
The universe of adult education can be
likened to an iceberg. The tip is what we see —
the workshops, conferences, lectures,
seminars, courses — but below the waterline
is where the majority of adult education really
takes place.
Hospital educators are like solitary
fishermen, sailing the North Atlantic in small,
fragile boats. Worrying about the tip of the
iceberg is formidable enough without
concerning themselves with what lies below
the waterline. And yet, many facets of the
unseen part of the education iceberg can be
used to increase the quality, quantity and ease
of formal hospital education. The books
mentioned above, by Knowles and Tough,
give some very practical guidelines.
LIPPINCOTT
:W<
LIPPINCOTT'S NO-RISK GUARANTEE
You may wish to take advantage of LIPPINCOTT'S GUARANTEE OF SATISFACTION.
We will gladly send you any book on 15-day approval. Upon subsequent examination of the
book, if you are not completely satisfied, you may return the book to us without obligation.
Also, you can save delivery charges by enclosing payment with order — the same return
privilege is guaranteed.
MANUAL ON CONTROL OF INFECTION
IN SURGICAL PATIENTS
Altemeier, Burke, Pruitt and Sandusky
Provides up-to-date information for the control in liospital
practice.
Lippincott 280 Pages Illustrated 1976 $16.00
TEXTBOOK OF MEDICAL SURGICAL
NURSING, 3rd Edition
Brunner and Suddarth
Tliis leading text is outstanding in its depth of scientific
content and in the practicality of its application.
Lippincott 1156 Pages Illustrated 1975 $19.75
The most useful nursing book ever!
THE LIPPINCOTT MANUAL OF
NURSING PRACTICE
Brunner and Suddarth
This now famous ready reference puts virtually all of nursing
right at your fingertips!
Lippincott 1473 Pages Illustrated 1974 $21.50
PATIENT CARE GUIDELINES FOR THE
FAMILY NURSE PRACTITIONER
Hoole, Greenberg and Pickard, jr.
This is the ideal pocket reference for all professionals engaged
in the delivery of primary health care.
Little, Brown 339 Pages 1976 $7.95
CLINICAL PROTOCOLS: A Guide for Nurses
and Physicians
Hudak
This manual of clinical guidelines fits conveniently into the
pocket of a lab coat.
Lippincott 461 Pages 1976 $8.75
MASSACHUSETTS GENERAL HOSPITAL
MANUAL OF NURSING PROCEDURES
Department of Nursing Massachusetts General Hospital
Little, Brown 389 Pages Illustrated 1975 $8.95
A GUIDE TO PHYSICAL EXAMINATION
Bates, Hoekelman, and Wabnitz
A cornerstone' for any teaching program in primary health
care.
Lippincott 375 Pages Illustrated 1974 $18.75
PRINCIPLES AND PRACTICE OF
INTRAVENOUS THERAPY, 2nd Edition
Plumer
includes technological advances in intravenous equipment
and techniques, and the latest findings on asepsis and hazards
of contamination.
Little, Brown 348 Pages
Paper, $6.95
Illustrated
Cloth, $10.95
1975
CARE OF THE ADULT PATIENT: Medical-
Surgical Nursing, 4th Edition
Smith and Germain
Provides an authoritative basis for understanding the patient's
therapeutic regimen, including surgery, drugs, nursing inter-
vention and rehabilitation.
Lippincott 1229 Pages
Paper, $16.95
Illustrated
Cloth, $21.75
1975
THE DYING PATIENT: A Supportive Approach
CaughitI
Written specifically for the many hundreds of thousands of
practicing nurses who care for the critically ill and dying
patients, this sympathetic and practical book offers compas-
sionate solutions to the difficult problems they encounter.
Little, Brown 228 Pages 1976 $6.95
CARDIAC ARRHYTHMIAS:
Practical ECG Interpretations
Mangiola and Ritota
Provides clear and authoritative information for the inter-
pretation of cardiac arrhythmias.
Lippincott 215 Pages Illustrated 1974 $22.00
To order any of these outstanding booths simply return the
INTERPRETING CARDIAC ARRHYTHMIAS:
A Basic Guide
■]c Far land
\ beginning text that assumes no prior knowledge of cardiac
rrhythmias, this book provides a systematic method
NURSING CARE OF THE GROWING FAMILY:
A Maternal —Newborn Text
Pilliteri
Provides prospective and practicing nurses with the most
authoritative up-to-date information available on maternal
976 S15.00
I and emotional
Is, and provides
ternity nursing.
976 S14.75
ving good staff-
1976
patient and implement a plan of nursing management.
Lippincott 488 Pages Illustrated 1975 S15.75
HANBOOK OF CRITICAL CARE
Berk, Sampliner, Artzer and Vinocur
Outlines in step-by-step detail the diagnostic methods and the
specific therapy necessary to treat critically ill patients effec-
tively and efficiently.
Little, Brown 574 Pages Illustrated 1976 S12.50
EMERGENCY-ROOM CARE, 3rd Edition
Eckert
Bringing together the expertise of 29 specialists in all aspects
of acute care, the expanded edition of this well-known
manual is a must for all professional personnel working
on the emergency-room team.
Paper, $5.95
Cloth, 511.50
MANUAL OF DIAGNOSTIC PROCEDURES
FOR PATIENT TEACHING
Sky del I and Crowd er
Clear directions on what to tell patients to expect, in order
to spare them unnecessary anxiety.
Little, Brown 248 Pages 1976 S6.95
DYNAMICS OF PROBLEM ORIENTED
APPROACHES: Patient Care and Documentr.tion
Walter, Pardee and Molbo with 16 Contributors.
Challenges the nurse to explore the development of the
problem-oriented approach in a clinical situation.
Lippincott 206 Pages 1976 S6.75
Little, Brown 459 Pages
Paper, $12.50
Illustrated
Cloth, $17.50
1976
TEXTBOOK OF ORTHOPAEDIC NURSING,
2nd Edition
Roaf and Hodkinson
"This is a book to be included in the library of all schools of
nursing, where its clearly written text and wonderful sel-
ection of illustrations will make the learning or orthopaedics
so very much easier and mor enioyable."
—Nursing Mirror
Biackwell 592 Pages Illustrated 1975 $18.50
■t paid order card with your selections marked.
Representing in Canada:
). B. Lippincott Company
Biackwell Scientific Publications
Little, Brown and Company
Springer Publishing Company, Inc.
J. B. LIPPINCOTT COMPANY OF CANADA LTD.
Serving the Health Profession in Canada Since 1897
75 Horner Ave., Toronto, Ontario M8Z 4X7
LIPPINCO
MANUAL ON CON-
IN SURGICAL PAT
Altemeier, Burke, Pruit\
Provides up-to-date infon
practice.
Lippincott 280 Pages|
TEXTBOOK OF M
NURSING, 3rd Edit
Brunner and Suddarth
This leading text is outstanding in its deptn o
content and in the practicality of its application.
Lippincott 1156 Pages Illustrated 1975 $19.75
The most useful nursing book ever!
THE LIPPINCOTT MANUAL OF
NURSING PRACTICE
Brunner and Suddarth
This now famous ready reference puts virtually all of nursing
right at your fingertips!
Lippincott 1473 Pages Illustrated 1974 $21.50
PATIENT CARE GUIDELINES FOR THE
FAMILY NURSE PRACTITIONER
Hoole, Greenberg and Pickard, Jr.
This is the ideal pocket reference for all professionals engaged
in the delivery of primary health care.
and techniques, and the latest findings on asepsis and hazards
of contamination.
Little, Brown 348 Pages
Paper, $6.95
Illustrated
Cloth, $10.95
1975
CARE OF THE ADULT PATIENT: Medical-
Surgical Nursing, 4th Edition
Smith and Germain
Provides an authoritative basis for understanding the patient's
therapeutic regimen, including surgery, drugs, nursing inter-
vention and rehabilitation.
Lippincott 1229 Pages
Paper, $16.95
Illustrated
Cloth, $21.75
1975
Little, Brown
339 Pages
1976
$7.95
THE DYING PATIENT: A Supportive Approach
Caughill
Written specifically for the many hundreds of thousands of
practicing nurses who care for the critically ill and dying
patients, this sympathetic and practical book offers compas-
sionate solutions to the difficult problems they encounter.
CLINICAL PROTOCOLS: A Guide for Nurses
and Physicians
Hudak
This manual of clinical guidelines fits conveniently into the
pocket of a lab coat.
Lippincott 461 Pages 1976 $8.75
MASSACHUSETTS GENERAL HOSPITAL
MANUAL OF NURSING PROCEDURES
Department of Nursing Massachusetts General Hospital
Little, Brown 389 Pages Illustrated 1975 $8.95
Little, Brown
228 Pages
1976
$6.95
CARDIAC ARRHYTHMIAS:
Practical ECG Interpretations
Mangiola and Ritota
Provides clear and authoritative information for the inter-
pretation of cardiac arrhythmias.
Lippincott 215 Pages Illustrated 1974 $22.00
To order any of these outstanding books simply return the
INTERPRETING CARDIAC ARRHYTHMIAS:
A Basic Guide
^c Far land
V beginning text that assumes no prior knowledge of cardiac
rrhythmias, this book provides a systematic method of
arning to evaluate an ECG strip.
pringer 128 Pages 1975 S5.25
THE PATIENT IN THE CORONARY
CARE UNIT
weetwood
Written primarily for the CCU nurse in the community
Hospital, where lack of elaborate monitoring apparatus means
^he nurse must rely on clinical skill and iudgement for
detecting critical changes in the patient's condition.
Springer 465 Pages Illustrated 1976 S13.95
CARDIOSURGICAL NURSING CARE: Under-
standing, Concepts and Principles for Practice
\phow
Cardiovascular surgical nursing is presented in terms of
If) the "why" tor nursing intervention; 2) the "what to do"
I-i.e., nursing actions to solve the patients physiologic
|problems and 3) the "how"— suggested nursing procedures.
springer 386 Pages 1976 SI 2.50
THE PRACTICE OF EMERGENCY NURSING
Cosgriff and Anderson, with 31 Contributors
Will enable the emergency department nurse to assess the
patient and implement a plan of nursing management.
Lippincott 488 Pages Illustrated 1975 $15.75
HANBOOK OF CRITICAL CARE
Berk, Sampliner, Artzer and Vinocur
Outlines in step-by-step detail the diagnostic methods and the
specific therapy necessary to treat critically ill patients effec-
tively and efficiently .
Little, Brown 574 Pages Illustrated 1976 S12.50
EMERGENCY-ROOM CARE, 3rd Edition
Eckert
Bringing together the expertise of 29 specialists in all aspects
of acute care, the expanded edition of this well-known
manual is a must for all professional personnel working
on the emergency-room team.
Little, Brown 459 Pages
Paper, SI 2.50
Illustrated
Cloth, SI 7.50
1976
TEXTBOOK OF ORTHOPAEDIC NURSING,
2nd Edition
Root and Hodkinson
"This is a book to be included in the library of all schools of
nursing, where its clearly written text and wonderful sel-
ection of illustrations will make the learning or orthopaedics
so very much easier and mor enjoyable."
—Nursing Mirror
Blackwell 592 Pages Illustrated 1975 S18.50
paid order card with your selections marked.
NURSING CARE OF THE GROWING FAMILY:
A Maternal —Newborn Text
Pilliteri
Provides prospective and practicing nurses with the most
authoritative up-to-date information available on maternal
and child care.
Little, Brown 445 Pages Illustrated 1976 $15.00
MATERNITY NURSING, 13th Edition
Reeder
Integrates nursing assessment of both physical and emotional
factors, applies evaluation and diagnostic skills, and provides
thorough coverage of current concepts in maternity nursing.
Lippincott 706 Pages Illustrated 1976 $14.75
NURSING CARE OF CHILDREN, 9th Edition
Waechter, Blake and Lipp
Organized by age groups, from infancy to adolescence,
with emphasis on physical and psychosocial growth, devel-
opment, and health care planning for each age.
Lippincott 834 Pages Illustrated 1976 $17.95
STAFF-PATIENT COMMUNICATION
IN THE HEALTH SERVICES
Peltchinis
Discusses the elements and means of achieving good staff-
patient rapport.
Springer 1 76 Pages 1976
Paper, S5.95 Cloth, $11.50
MANUAL OF DIAGNOSTIC PROCEDURES
FOR PATIENT TEACHING
Sky del I and Crowd er
Clear directions on what to tell patients to expect, in order
to spare them unnecessary anxiety.
Little, Brown 248 Pages 1976 S6.95
DYNAMICS OF PROBLEM ORIENTED
APPROACHES: Patient Care and Documentrtion
Walter, Pardee and Molbo with 16 Contributors.
Challenges the nurse to explore the development of the
problem-oriented approach in a clinical situation.
Lippincott 206 Pages 1976 $6.75
Representing in Canada:
|. B. Lippincott Company
Blackwell Scientific Publications
Little, Brown and Company
Springer Publishing Company, Inc.
J. B. LIPPINCOTT COMPANY OF CANADA LTD.
Serving the Health Profession in Canada Since 1897
IS Horner Ave., Toronto, Ontario M8Z 4X7
The Canadian Nurse January 1977
^ Key Elements in Adult Education
The key elements of informal adult
education are: usefulness, relatedness,
control, involvement, other people and
support. All of these elements are built right
into the adults informal education and yet they
can also be incorporated into the formal
setting.
Adults are busy people with many
responsibilities. They are inclined to spend
their time and energy learning only those
things that they consider to be of use to them. It
is the responsibility of the hospital educator to
find out from the staff just what skills and
knowlege would be useful. Knowles does quite
a thorough job of outlining methods for gaining
this needed information. Once the educator
knows what learning the staff considers useful,
she can plan a program that they will attend
eagerly. Occasionally the educator has a
learning program in mind that she considers
useful for staff; then she must do a "selling
job." If the staff can readily see where the new
learning will make their jobs easier or more
satisfying, they will consider it useful to attend
the program and learn.
Adults also tend to be practical people
who put a lot of stock in their own past
experiences. Their informal education builds
from what they already know, toward what
their experience tells them is a desirable goal.
If what we want them to learn can be seen to
relate directly to their own past experience and
knowledge and to their future goals, it is much
more likely that they will learn willingly and
quickly. If the topic is one that the learners
consider useful, it is probably related to their
experience and goals, but even then their
whole learning experience can be spoiled by
the use of language and examples that they
can't relate to or don't understand. It is often
worthwhile to take the time to have learners
verbalize relationships and applications as
they see them.
When an adult learns informally, he has a
great deal of control over the situation. He
decides what the subject matter will be, what
learning methods and tools will be used, how
quickly the learning will proceed, and when he
has achieved his learning objectives. In a
classroom setting, the learner frequently
relinquishes all of this control to the teacher.
CWS5e5
Lectures
sem\nars
conferences
workshops films
courses panels
reading studying
thinking wdtchin^Tv
discussintj tvlrh otlieri
Jolng some personal project
vjorklnq on comm rTrecs
bclon.]inij to a snuJij qroup
p;'ck;'ii I someone's brains
5olvin^ a new protlem working
witli a new person ^errin^ feedback
da'di} experiences and observations
yormd Educamn
-Vy^
Inhrmai
Lducavion
The educator who feels secure in her role can
return much of the control in the formal
learning situation back to the learners.
Depending on the nature and breadth of the
topic, the learners can decide what sections
they will study, how long they will spend on
each section, how many practice sessions
they will need, what teaching methods they
prefer, and even the method and content of
evaluations.
Some adults feel most comfortable when
the teacher has all the control, but more and
more adult learners wish to influence the
content and nature of their formal learning
experiences. As adults, they are accustomed
to being in control of their learning and, by
exercising some of this control in the
classroom, they are increasing, for
themselves, the usefulness and relatedness of
the learning.
The more involved a learner is in the
learning situation, the more likely she is to
thoroughly absorb and efficiently utilize the
learning. There are three major areas where
learners can become involved in their own
formal learning — the content, the process,
and the problem.
If the staff has been consulted about what
content, knowledge or skills would be useful to
them, they have a sense of involvement with
the learning program before they even come to
class. Once inside the classroom, they need to
become directly involved with the content.
When we teach skills, we allow ample time for
learners to handle the equipment and practice
the skills, but too often we overiook the
importance of the "hands-on" experience
when the content of the program is knowledge
or ideas. Learners need time to grapple with
new knowledge, debate ideas, draw
analogies, and relate what is new to what they
already know.
The education process is another area
where hospital staff can become involved. If
their opinions about teaching formats and
methods are solicited, and their suggestions
employed, they have a vested interest in
making the educational experience
successful. If they feel that they have a
responsibility for assisting each other in
learning, they tend to work harder to avoid
letting their co-workers down. Regular
evaluations of the content and process by
learners, small group discussions, and
The Canadian Nurse January 19/ r
jroup-leaming or problem-solving projects
osfer the sense of involvement and
■esponsibility.
Involvement with a real-life problem that is
)f importance to people is perhaps one of the
nost meaningful of all learning experiences,
homas^ eloquently argues in favor of the
eaming value of membership in task forces,
ommittees and other groups that voluntarily
;ome together to achieve a specific goal or
solve a certain problem. Hospital educators
night want to seriously consider the
3ducational value of staff involvement in
arious hospital committees.
Tough discovered that in informal
Jducation, almost every learner uses four or
ive other people to help with each learning
roject. The people used are friends,
icquaintances, colleagues, family members
md neighbors. They act as resource people in
jjanning the learning, selecting the learning
ool, providing information, evaluating the
eaming, stimulating further learning, and
offering support and encouragement. In other
/vords. the adult learner, when learning
nformally, uses not just one "teacher" but
several. Interaction with other people,
ndividually or in groups, seems to be an
essential part of the adult education process.
Many adult learners who would eagerly
set out to learn anything from astronomy to
zoology in an informal manner, resist going to
formal education settings, and resist learning
once they get there. Perhaps childhood
experiences within the school system have left
them feeling that they cannot learn, or cannot
learn anything useful, in a classroom. They
may be afraid — afraid of the content, the
teacher, or their own learning abilities.
Learning itself is fraught with anxieties and
discouragements.
When an adult learns on his own, he
builds in a support system. Friends, family
members and "that nice librarian ' are used as
sources of support and encouragement. In
staff development education classes, the
learner is cut off from these supporting people.
Co-workers and superiors may be supportive
or they may be non-supportive, even hostile,
toward the learneror the learning program. It is
the educator's responsibility to help learners
build support networt<s within the class and in
the work area.
Q\ The Support Network for
Adult Learners in Hospitals
The building of a support system is such
an important part of a successful staff
development program that it deserves more
attention here. It is this system that
encourages staff to continue learning and
enables them to use their new knowledge in
the work environment.
A pleasant, relaxed atmosphere in the
classroom is the first step toward dispelling old
fears about formal education. Course content
that the learners know, in advance, is going to
be useful, and related to their needs and goals
can eliminate a lot of resistance to learning. A
teacher who genuinely likes the leamers and
talks in language they understand, without
being condescending, can increase
considerably the learners' estimation of their
own abilities to master course content. The
educator becomes a primary person in the
learners support networi<. Other people in the
class form the ribs of the network. Small and
large group discussions, and projects done in
pairs or in groups, are conducive to the
formation of the classroom support networks
that are essential for the effective absorption,
understanding and use of new learnings.
Too often educators see people eagerly
and happily learning in the classroom, but
have "that sinking feeling" that once the
learners return to the wortcplace all will be lost
because of a lack of support "out there."
Having staff members come to class in pairs or
small groups from each area can help develop
a support network back at work, but it is
essential that the learners have support from
key people in the work environment. The
educator's and the learners' superiors and
co-wort<ers must not only be in favor of the
program, but must also be involved, in some
way, in the planning, process and evaluation of
the program. If staff development programs
are to be effective, what the educator does
outside of class can be more important than
what she does in the classroom.
Just as it is easier to avoid hitting the
iceberg if we know what is below the waterllne,
hospital educators can plan better staff
development programs if they understand
what adults do on their own to continue
learning. The educator who spends the time
and effort incorporating these elements into
her program not only answers many of those
questions educators must ask themselves
when planning a program, but is already well
on the way to providing a rich and rewarding
experience for leamers on their terms. ^
Jackie Barber. B. Sc. N. , M. Ed. . author of "The
Tip of the Iceberg," is an independent adult
educator living in Toronto, Ontario, whose
present positions include those of
co-ordinator and instructor, Continuing
Education Division, Centennial College of
Applied Arts and Technology, consultant and
instructor, Nursing Resource Centre, and
counsellor and educational consultant.
Central Abortion Referral. Education
Services. Toronto.
She is a graduate of Atkinson School of
Nursing, Toronto Western Hospital, and
received her B.Sc.N.. from University of
Western Ontario, London, and her A/f. Ed. from
the Ontario Institute for Studies in Education.
Barber observes that "although nurses
involved in staff development make up only a
small percentage of CNJ readers, they are
constantly searching for new ideas and for
support in lonely positions. '"
References
1 Knowles, Malcolm S., The modern practice of
adult education: andragogy versus pedagogy.
Association Press. New York, 1970.
2 Tough, Allen. The adults learning projects: a
fresh approach to theory and practice in adult
learning. Toronto. The Ontario Institute for Studies
in Education, 1971.
3 Thomas. A.. "Studentship and Membership,"
The Canadian Association for Adult Education,
Toronto.
The Canadian Nurse January 1977
Mike Grenby
1
A sharp eye can go a long way toward making
this time of year considerably less taxing for
you. For if you can spot the deductions which
people miss most often, you can be dollars
ahead when you fill in your income tax return.
I'm going to summarize here a number of
points to help you cut your tax bill. I suggest
you circle the points which specifically apply to
you. (I've indicated where and how Quebec
income tax law differs from the federal rules).
Then clip this article and refer to it when you
prepare your return, supplementing the
information here with the guide which
accompanies the return.
""" " Make sure you fill in the basic
personal details correctly. If they don't
correspond to the information on previous
years' returns, the computer will get upset and
interminably delay any refund. Also, incorrect
marital status or age information can affect
your deductions.
If you got married last year, the
marriage date is important. For it's the
spouse's net income while married that
counts.
Example: If you were married on Dec. 1 0,
your net income for 1976 — while married —
might be only about $500. So your spouse can
claim almost the whole married exemption for
you.
If you earn more than your spouse, then
you will probably claim the married exemption.
■"""" Declaring all your income is
important. If you forget, chances are the
income tax department won't. You'll eventually
get a back tax bill, complete with interest and
perhaps penalties.
Other income includes scholarships and
bursaries over $500. and alimony if received
pursuant to a written agreement or court order.
If you're self-employed, phone or write to
your nearest district taxation office for form
T-2032 (in Quebec, this form is TP-1 and
should come with the return), or you can draw
up your own statement to attach to your return.
A single person can claim the
"equivalent to married exemption"
($1 ,830.— Quebec, $1 ,900) for a
dependent.
Example: A single mother could use her
youngest child for this exemption; she'd save
the others for the child exemption section,
where greater age means a greater claim. (In
Quebec, the child exemption is only for
children 16 or older).
The parent claiming the child
exemption must declare the family
allowance as income. (This does not apply in
Quebec).
Here again, if the child has earned some
money, use the net income (after deductions
like tuition, union dues, registered home
ownership and retirement savings plan —
RHOSP and RRSP — contributions, Canada
Pension Plan and Unemployment Insurance
Commission payments) when calculating the
child exemption.
The annual deadline for completion of income tax returns is
fast approaching. So that you can be sure that you're not
"shelling out" more than necessary, The Canadian Nurse is
pleased to offer readers some tips from a recognized
authority in the field of money management.
6
8
9
If you were enrolled in an eligible,
full-time course last year, you can claim
$50. a month for every named month,
irrespective of the number of days.
Example: You were enrolled from March
31 to June 3. You can claim four months —
March, April, May and June — even though
only 64 days were Involved.
This is one of the transferable deductions,
so if there's a student in your family, you could
benefit.
If the student doesn't need to use the
deduction, any other person claiming the
student as a dependent (you might be claiming
your spouse, child, parent, etc.) can use this
deduction. (Not in Quebec).
Another transferable deduction is the
interest-dividend deduction: the lesser of
the actual amount or $1,000.
So if your grossed-up dividends (actual
dividends times four-thirds) plus interest come
to $400, for example, you claim $400. If the
total were $1,200, you'd claim $1,000.
And if one spouse has interest or dividend
income but little or no other income, the other,
higher-income spouse may be able to use the
transferred deduction.
One accountant I talked to felt that in the
"employee expense" section, a nurse
worthing as an employee might also be able to
claim the cost of uniforms and other necessary
equipment such as a stethoscope as "other
allowable expenses." Keep receipts to bacl<
up this claim, in case it is allowed — although
income tax officials I talked to disagreed with
the accountant on this.
If you had more than one employer
last year, chances are you over-
contributed to CPP (In Quebec, QPP) or
UIC. There's a place on your return to make
this calculation.
10
11
12
13
14
15
You must have an official receipt for
any RRSP or RHOSP contribution before
you can deduct it, and if you contribute in
January or February, you probably won't get
the receipt until March or even April.
If you have a refund coming without the
contribution, go ahead and file your return.
Then when your receipt arrives, send it off with
a note asking the tax people to include this
deduction.
gS Tuition fees over $25 paid to the
same institution can be claimed by the
student. This is in addition to the transferable
education deduction mentioned earlier.
i.i^ To claim child care payments, you
must include the name, address and social
insurance number if possible of the person
you paid. You must have receipts on file but
needn't submit them.
i If you moved more than 25 miles to a
new job last year — and this includes a
student moving to take up a first job — you can
deduct all expenses connected with the move
for which you were not reimbursed.
And don't forget the commission when
you sold your home. If you did forget this in the
past, you can ask to liave your return
reassessed; depending on your tax official,
you might be able to go as far back as the 1 973
tax year.
All expenses (except commissions)
related to investments are deductible. Don't
forget safety deposit box rental and the
interest paid on the instalment or payroll
deduction plan to buy Canada Savings Bonds.
I Alimony is deductible only if
payments are made pursuant to a written
agreement or court order.
If you've marked some of these points but
still feel unsure about preparing your own
return, consider paying around $25. —
although the fee could be as low as $1 0. — to
have a professional do the job for you.
Ideally, pick somebody with an
accounting background and most important,
somebody who will be around all year. This
contact with a professional could also help you
with your general personal finances, not only
taxation.
If you do your own return, your local
district taxation office offers free answers to all
questions. Unfortunately, this information is
not binding: at worst, you could get three
different answers to the same question from
three different people.
So if a large deduction is at stake in a fairly
complex matter, always realize that you might
get an assessment notice disallowing it and
don't spend your rebate until you actually get it.
The Canadian Nurse January 1977
Recommended reading:
• Some 1 5 different income tax department
booklets, available free by phone or mail from
your local taxation office.
• David Ingram's Guide to Income Tax In
Canada and Thomas Ferguson's What to Do
When the Taxman Comes, both International
Self-Counsel Press Ltd.; around $3. each.
• Preparing Your Income Tax Return, by
Lachance and Eriks: CCH Canadian Limited;
around $6.
• Check your library or bookstore for other
titles; several of the CCH income tax titles are
in French, too. *
Copyright
M & M Creations Ltd.,
585 Hadden Drive,
West Vancouver, B.C.
V7S 1G8 (Tel: 926-9936)
If you have any questions on your
personal finances involving
investment; insurance, banking,
credit or any other such matters'
write to me c/o The Canadian
Nurse.
While I cannot reply
individually, I will answer as many
questions in this column as space
allows.
Letters must be signed, but
only your initials will be used if you
so request
Mike Grenby whose tips on preparing your
income tax return appear above, is on the staff
of the Vancouver Sun, lectures and appears
regularly on both loc^' ; ■;(■ ' ,-' - nal radio and
television, and has done ju^.^'.dmg v/orkfor
the federal government.
He is the author of a nationally Sy ; ■ dicated
column that he says he writes "to help
ordinary people understand, manage and gei
the most from their money. " Last year, he
received the Toronto Press Club and the
Royal Bank of Canada's National Business
Writing Award for "the best business column
in Canada."
A graduate of the University of British
Columbia and Columbia University Graduate
School of Journalism, he is the author of "Mike
Grenby's Guide to Fighting Inflation in
Canada" (International Self-Counsel Press
Ltd.). He and his Australian-born wife, Mandy,
who is a nurse, live with their son, Matthew, in
West Vancouver.
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Crossword
Puzzle
Maria Rubilie Glenn
For those who have been doing the clinical
wordsearch puzzles, here is a new slant — a
crossword puzzle of nursing and medical
terms. If you have difficulties, all the words and
their definitions are taken from Borland's
Illustrated Medical Dictionary, Philadelphia,
W.B. Saunders Co., 1965. Answers on page
38.
DOWN
2. To throw off, as waste matter, by a normal
discharge.
3. The expansive superior portion
of the hip tx)ne.
4. A disease caused by infection of the
lungs. It is marked in initial stages
by symptoms resembling those
of pulmonary tuberculosis, with erythema
nodusum. The disease may progress to
a generalized form.
5. Combining form meaning new or
strange.
6. Recurrence of an action or
function at regular intervals.
7. Removal of all foreign matter and devitalized
tissue in or about a traumatic or other lesion.
8. Roentgenography of the vein or veins.
9. A band of tissue that connects
bones or supports viscera.
10. Referring to the eye.
12. Division into two tiranches or site
where a single structure
divides into two.
16. A wheal or pomphus.
1 8. Device by which different parts of an
apparatus or instrument are
connected.
19. A combining form meaning
relationship to tears.
21. A condition of diminished
carbon dioxide in the blood.
22. That portion of the body which
lies between the thorax and
the pelvis.
24. Acronym for common bile duct.
26. A circular area of different
color surrounding a central
point.
27. A prefix signifying above,
beyond or excessive.
28. A glyceride existing in
butter or liquid fat with an
acrid, bitter taste.
29. Combining form denoting
relationship to milk.
31. Any spasmodic movement or
twitching.
33. A constricted portion, such as
the part connecting the head and
trunk of the body, or the constricted
part of an organ, as of the uterus
or other structures.
34. A circular or rounded flat plate
or organ.
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— -J
ACROSS
1. A quantity to be administered at one
time, such as a specified amount of
medication.
4. A skin cancer of a moderate degree of
malignancy.
8. A membranous fold in a canal or
passage, which prevents the reflux
of the contents passing through It.
10. Excision of one or both testes.
11. A word meaning not malignant.
13. A unit of heat.
14. A test for vision determining if
the subject Is binocular or monocular.
Named after a physiologist In Leipzig,
(1834- 1918).
15. Material or fact on which a
discussion or an inference is based,
(singular).
1 7. The tough white supporting tunic
of the eyeball.
20. An instrument for measuring the
eye, especially one determining its
refractive powers and defects by
measuring the size of the images
reflected from the cornea and lens.
21. The inability to walk due to a
defect of coordination.
23. Small transverse lines caused by
increased density of the bone, seen
in x-rays at the metaphysis of
growing bones and due to temporary
cessation of growth.
25. The act of drawing toward a
center or median line.
26. A word meaning to touch, adjoin or
border upon.
28,
29.
30,
32.
35.
36.
37.
38.
39.
A sign indicating a definite zone
of dullness with absence of the
respiratory sounds In hydatid disease of
the lungs. Named after an Australian
physician, (1832-1904).
Color hue between white and black.
Another term for Phimosis.
A ringlike or circular structure.
(Plural).
A litter for carrying the sick
or Injured.
A compound that reacts with a
base. Sour, having properties
opposed to those of the alkalies.
Abnormal concretion occurring within
the animal body and usually composed
of mineral salts, (plural).
A quality of being marked by stripes,
a streak or scratch.
The anterior aspect of the head
from the forehead to the chin inclusive.
Author's Note
Maria Rubilie Glenn came to Canada in 1 965
from the Philippines after receiving her basic
nursing education. She has worked as a
general duty nurse and as an OR nurse at
various hospitals before completing her
B.Sc.N. at the University of Alberta,
Edmonton. She states: "I find crossv^ord
puzzles an excellent way to learn new words. I
hope that the readers of The Canadian Nurse
will enjoy and benefit from solving this
particular puzzle just as much as I enjoyed
developing it."
40
The Canadian Nurse January 1977
CM [flGi
the Status Quo:
the nurse's role in health care delivery planning
Heather F. Clarke
i\!iir5inij Involvement ConririMum
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"Nurses have already made concrete
suggestions about ways of responding to
the needs: home care, use of the public
health nurse, ... etc .... What is needed is
an unbiased assessment of alternative
services in terms of their relative low cost,
effectiveness and social importance. This
will require a concerted and imaginative
effort by the consumers of care, the health
workers and government. Nurses are
willing to enter into such a partnership. "'
Thus the Canadian Nurses Association
has supported the necessity for nurses to
get involved in health care planning and
challenged other parties to recognize
nursing input. The real challenge,
however, is whether nurses will rise to
their responsibility in health care planning
with the energy and commitment
necessary \omake significant input.
For most nurses, involvement in the
planning of health care services is still a
new concept. Traditionally we have been
taught to accept the role of implementor of
medical and administrative decisions
and, until recently, were content to stay in
that role. The nurse's responsibility for
planning and evaluation of health
services was rarely mentioned because,
officially, only medical services existed.
Today, however, more and more nurses
are concerned that their professional
responsibilities go beyond direct nursing
care to cooperating with others in the
planning, implementation and evaluation
of health care delivery. From their unique
perspective, nurses are beginning to
challenge the status quo of the health
care system, to get elected to hospital
boards, and to agitate for the changes
they regard as necessary to focus health
care delivery on the total needs of the
client rather than the goals of
professionals (ie. physicians).
The kind of adaptive planning that
has been used in the past is outdated and
ineffective; the need today is for positive,
innovative, developmental planning. The
modern health care system must put its
emphasis on health maintenance and
prevention, increase its capacity to locate
those at high risk, and identify groups
requiring preventive and long-term care.
#
In their struggle to achieve wider recognition and more responsibilities, nurses have been breaking
into areas from which, in the past, they have been excluded. One of these is the field of health care
planning. In The Canadian Nurse, March 1976, Bernadet Ratsoy described a strategy the individual
nurse could use to promote her own ideas for change. Here, Heather Clarke outlines the role of the
nurse in health care delivery planning and the part played by the RNABC Committee on Health Care
Delivery in promoting nursing participation in this area.
Because nurses represent the largest
group employed in health care delivery
and are closely associated with the
consumers of existing services, their
participation is needed for effective
management of the community's total
health care resources, for improved
communication between the providers
and consumers of services, and for better
distribution and quality of health care
services. Thus our involvement must
include not only planning for the nursing
component of health services but for
those services in their totality.
To become involved to this extent in
health care planning, we must change our
conservative attitudes and recognize that
our responsibility is to the client, not only
to the system. We must accept the
challenge and responsibility for defining
our roles in broad, functional terms rather
than narrow and task-oriented ones. The
preoccupation of nursing with its own
problems must give way to a closer
collaboration with others, with extensive
participation in the community health care
planning process.
In B.C., for example:
• nurses have been elected to hospital
boards in their community;
• in one region a nurse has been
appointed to the Union Board of Health;
• nurses were included in advisory
committees to the new
Matemal-Child-Pediatric Health Care
Complex;
• nurses have become part of an
Interdisciplinary team approach to
community services that involves the
integration of social work and health
services. These changes would not have
happened without the work of individual
nurses who were fonward-looking,
committed to their cause, and not afraid of
the hard work involved to make their goal
a reality. It was only through insistence,
pressure, follow-up, time and energy that
even such small victories were won. (See
Ratsoy, The Canadian Nurse, f^arch
(1976). 2
To further promote the effective
participation by nurses at the policy- and
decision-making levels of both elected
and appointed bodies which affect health
care delivery, the RNABC Board of
Directors established the Committee on
Health Care Delivery in March 1975. At
the 1975 RNABC Annual Meeting
delegates and participants identified
deterrents to nursing involvement in
health care delivery, the four most
significant being apathy, lack of
confidence, lack of knowledge and
training, and the traditionalism of the
health care system. Suggestions for
change involved personal, professional
and educational committments. Although
Committee members were interested in
studying these concerns and developing
specific objectives, they first had to
answer a number of questions: how do
we initiate involvement; how much input
should we have; who should be involved;
and what are the priorities?
During the year of its existence, the
Committee on Health Care Delivery
studied issues and made
recommendations to the RNABC Board of
Directors to:
• communicate with federal and
provincial governments indicating the
Committee's terms of reference and
commitment to active involvement in
health care planning;
• examine the internal committee
structure of the RNABC, emphasizing the
need for coordination;
• support nursing responsibilities at
the IXth International Conference on
Health Education by participation and
financial support, and
• promote recognized formal nursing
input to hospital boards by a change in
hospital bylaws.
Many other issues were identified but
again, priorities had to be set.
The model of involvement (see
diagram) the Committee used to promote
nursing input in health care planning can
best be illustrated by taking the case of
changing hospital bylaws. The first step,
or minimal level of involvement, is
information sharing. This is an essential
precondition for participation, since it is
the only way of ensuring that intelligent
choices are made. Each nurse must be
informed about the current situation, past
experiences and alternative solutions —
in short, she must know what she is
talking about. The Committees concern
for formal, recognized nursing input to
hospital boards meant that each member
had to be knowledgeable about the
present situation, the results of any
previous studies and government
reaction, and the strategies and
alternatives used in other provinces. We
studied the hospital bylaws, shared
information and came up with a
recommendation.
The second level of involvement,
consultation, is built upon information. Is
the informed nurse consulted when
planners are making investigations and
recommendations? Is she/he visible to
the planners? Because those involved in
planning are still frequently unaware of
nursing expertise and interest in
becoming involved, we had to present our
recommendation on bylaw changes to the
RNABC Board of Directors and get their
support to present a brief and
recommendations to the Minister of
Health. At the same time, nurses
concerned with health care planning in
the community and RNABC officials
joined committee members in a series of
activities that served to increase our
visibility. These included; submitting
petitions of concern to the government
and indicating willingness to become
involved in planning (eg. regarding
cutbacks in Home Nursing Program);
submitting letters of concern and
resolutions to the RNABC Board of
Directors requesting action: issuing press
releases and statements regarding
controversial health issues.
Involvement at the first two levels is
relatively passive and it is usually up to the
discretion of the bureaucracy or
physicians whether they will take nursing
interests seriously. As nursing
involvement becomes more pronounced
and active, however, there will be a
movement toward negotiation. This is a
bargaining situation between planners
and decision-makers, demanding a
greater degree of equality. In our society
The Canadian Nurse January 1977
this Stage is largely a political process.
Can we persuade government to adopt
our ideas or change their stand? Can we
get the hospital bylaws altered to include
formal nursing input to hospital boards? In
our case, the brief requesting a change in
hospital bylaws was presented to the
Minister of Health and his Deputy
Ministers. They agreed in principle to the
change, suggesting we return with
alternative methods after discussing them
with the medical and hospital
associations.
Negotiation leads to the next level of
involvement, participation in the
decision-making process. This has been
graphically described by Bernadet
Ratsoy( Ttie Canadian Nurse, March
1976) in her article about the steps she
took to promote the implementation of a
Family-Centered Matemity Health Unit in
her hospital.
Only after the nurse has progressed
through the other levels of involvement
and established credibility as a planner of
health care delivery will she reach the
strongest form of participation in planning
and decision-making, the Veto. At this
stage the nurse has attained enough
respect in her field that a recommendation
by her withholding support for a certain
aspect of the plan is accepted by other
planners as reason enough to alter the
plans.
Successful planning is based on
policy and strategy as well as on coherent
gathering and organization of reliable
data. Nurses, then, must rely on their
political abilities as well as their
professional knowledge and skills in order
to influence the world in which they live. In
general, nurses have lacked political
consciousness. We have had the
potential for power, in fact, we have had
power, but we have not used it effectively.
The potential power lying unused and
dormant in our profession is colossal.
Writing m Nursing Outlook, JoAnn Ashley
noted that "...nursing has, and always has
had, power; it is essentially a social
phenomenon and its power derives from
society's recognition of nursing as an
essential service. The problem lies in the
ways in which nurses have used,
misused, and abused their power (or
failed to use it at all) and in the system in
which nursing developed and is now
practiced."^
Power and freedom must always be
taken. They are nevergiven to oppressed
groups. Part of the problem lies within
nursing itself, as Dorothy Hall stressed in
her address to the RNABC Annual
Meeting in May 1 975: "One of the reasons
we have been excluded from planning is
because we may never have indicated
that we wanted 'in.' Where we have done
so and continued to be excluded, we have
perhaps failed because we lacked an
alternative strategy or because we have
not been prepared either to persist or
insist.""
Success in politics depends on
commitment and energy, clear goals,
thoughtful planning and a sense of humor.
Nurses must arrive at the conclusion and
conviction that it is morally right for them
to seek power, freedom and recognition.
A clear presentation of our motives is
essential, devoid of the confusion,
misconceptions and fears that so often
accompany efforts to attain these goals.
Whether it is bedside care, service
planning and control, or teaching, nurses
are already involved in decision-making.
Even if by default, we cannot escape
certain actions that ultimately make
services available to some and deprive
others. It is time we started to recognize
that as nurses we have a dual
responsibility; as citizens and as health
care professionals. We must stop being
passive about health care planning and
participate directly, in a planned, strategic
way, armed with knowledge, experience
and commitment. *
References
1 Canadian Nurses Association
Communiquette Ottawa, Feb. 25, 1976.
2 Ratsoy, Bernadet. Shaping a new future.
Canad. Nurse 72:3:40-41, Mar. 1976.
3 Ashley, Jo Ann. About power in nursing.
hJurs. Outlook 21:10:637-641, Oct. 1973.
4 Hall, Dorothy C. Nurses in health
planning; an international overview. Address
delivered at the Annual Meeting of the RNABC,
Penticton, May 1975. Summary. RNABC
News 7:4:12-13, Jul. 1975.
Bibliography
1 Ashley, Jo Ann. Power, freedom and
professional practice in nursing. Superi'. Nurse
6:1:12-14, 17, 19 passim, Jan. 1975.
2 Flaherty, Josephine. The presidential
address. RNAO News 29:1:5-7, Jun./Jul.
1973.
3 Gilchrist, Joan M. The nature of nursing
in the health care structure. Nurs. Papers
5:3:3-13, Dec. 1973.
4 Klein, Rudolf. Nofes towards a tiieory of
patient involvemerjt Ottawa, Canadian Public
Health Association, 1974.
5 Scott, Jessie M. The changing health
care environment; its implications for nursing.
Amer J. Pub. Health 64:4:364-369, Apr. 1 974.
6 Simmons, H.J. Community health
planning — with or without nursing? Nurs.
Outlook 22:4:260-264, Apr. 1974.
Heather F. Clarke is herself an active
promoter of progress on the nursing front.
She was involved In the Expanded Role
of the Nurse Program of the University of
British Columbia, is a member of the
Board of Directors of Vancouver Planned
Parenthood and of the Social Planning
and Review Council of B.C. (SPARC)
and was resource person for the IXth
International Conference on Health
Education held recently in Ottawa. She
was chairman of the Health Care Delivery
Committee of the Registered Nurses
Association of B. C. and of the program
committee for the 1975 RNABC annual
meeting. Her present position is Nursing
Consultant to Community Human
Resources and Health Centres In B.C.
and World Health Organization (WHO)
Consultant to the University of Iceland
School of Nursing.
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The Canadian Nurse January 1977
ii^
^#^1
if
CHANGE: RECOGNITION
VITAL TO
NURSING
CARE
Gertrude M. Lake
m
&
r/
'^
¥
/
Hospital nurses sometimes forget that
adults as well as children face the thought
of hospitalization with something less
than unbridled enthusiasm. For most
patients, the hospital is, at best, an
unfamiliar environment full of stressful
situations.
Patients often endure mild stress
brought on by their illnesses long before
they must have hospital care. Healthy
people who fall ill unexpectedly suffer
almost as much from a loss of self-esteem
as they do from their physical ailments.
This triggers such reactions as morbid
self-pity and hostility directed at nearly
everyone they encounter.
Subtle personality changes begin
almost at the moment the former
"healthy" person is forced to become
dependent on others for assistance.
Everyone knows how the common cold
can turn a once sunny disposition sour. It
is not surprising, then, that hospitalization
can produce dramatic personality
changes. Nurses who recognize these
■\
'i>r*>
>f
changes and understand why they
happen, are in a position to take
appropriate measures which will reduce
emotional stress as much as possible.
There can be little doubt that nursing care
which takes into account patient
personality change is essential to the
speedy recovery of the sick.
People who try to ignore an illness,
often become angry when they must
accept the truth. For almost a year
Howard put off having a
hemorrhoidectomy. Finally, one of his
co-workers told him he was grumpy and
he knew he had to do something. The pain
had increased to the point where it was
affecting his work and his relationship with
his co-workers. When he accepted the
inevitable, he reacted by cursing the fates
and indulging in self-pity.
John was in no position to "find the
time to be sick." He was in agony with an
inflamed appendix. His only thought was
to get instant help to relieve the pain.
Because it was impossible to perform
miracles, he became hostile towards the
nurses. When relief finally came he
regained his self-control and was able to
accept the reassurances of the nurses.
Although their experiences were in
marked contrast, tx)th men displayed the
same reaction — anger — at the outset.
Eventually anger will begin to subside as
hospitalized patients enter an adjustment
phase.
The importance of a good nurse-patient relationship cannot be overstated. John and Howard could
lave been very difficult patients if their nurses hadn't taken the trouble to figure out why they behaved
;he way they did.
Dependency
During this stage, patients see
themselves as passive recipients of help,
laving given up their normal rights over
their own bodies. They feel helpless,
completely dependent on nurses for
everything. In the acute phase of an
illness patients must have an abiding trust
in those looking after them. If the trust is
broken, emotional and physical setbacks
Eire highly probable.
At this point during his hospital stay,
Howard began to worry about what he
perceived as inconsistencies in his
ursing care. His anxiety took such a hold
over him that he was unable to question
the nurses.
A flippant reply to a question from
John had similar consequences. When
old that a nurse could not help him
because it was time for her to go home,
John felt his legitimate concerns were
being ignored. It took him many days to
get over the incident: this would not have
happened if the nurse had merely advised
lim that her replacement would look after
lis needs.
Recovery
Later, patients begin to feel they are
participating in their recovery.
Howard showed an interest in
learning about necessary diet changes.
John made less frequent requests for pain
relievers.
At this stage, however, patients are
still a long way from regaining confidence
in their abilities to look after themselves.
Both Howard and John felt the nurses
were neglecting them, an indication their
ailments still dominated their
personalities.
Because normal life styles are
altered, hospitalization tends to break the
continuity of life. The bed, food, room,
people, smells and routines are not like
home. Family members can often provide
help to bridge this gap by bringing "home"
to the hospital. A few personal
possessions, such as photographs of the
patient's family, news about happenings
at home, and even a little home cooking
may help the patient maintain his sense of
personal identity.
It is important that nurses know how
patients react to the hospital scene so that
they can work with them to set health
goals. Because this involves the patients,
they have a greater sense of control over
their situations.
Nurses should only get involved in
areas where patients cannot help
themselves. The ultimate aim is to create
a process which allows patients to play a
greater part in helping themselves.
However, at this point they are still mainly
in a receiving position.
Getting Involved
Nurses could alleviate much of the
initial trauma t^r patients and reduce their
own workload if they became involved as
soon after admission as possible.
The nurse-patient relationship is the
first step in helping patients. In varying
degrees nurses must reach out to patients
and establish workable systems of
communications. Essentially, patients
should feel they have the right to ask
questions and that nurses will respond.
To return to John and Howard for a
moment, their involvement in nursing care
helped them to learn what was expected
of them and how they could help
themselves increase their understanding
of treatment plans. All this was necessary
in the battle to regain their
self-confidence.
Both nurses and patients must be
honest and concerned about the effects of
hospitalization. Young nurses should not
be reluctant to consult more senior nurses
in order to answer patient questions. The
student nurse who was answering
Howards questions, for example, often
turned to experienced nurses for the
answers. Howard found this reassuring
as he felt the nurse was giving him
accurate and valuable data and had a
genuine interest in his well-being. Howard
expressed a lack of concern from the
"higher up " nurses who were more
interested in running the ward, and were
not available to help the patients. The
nurse needs to have a relationship that
indicates her receptiveness to the patient.
She needs to feel comfortable with him,
not pass judgment, and be honest to
herself about her own biases. She must
listen to the intent of communication —
not just the words she hears, but also the
nonverbal messages.
Finally, openness is extremely
important. Patients should be
encouraged to express their feelings, to
let the nurses know what is bothering
them, even though it may not be directly
related to a medical problem.
In an era when many people feel
alienated by an impersonal society,
nursing should once again emphasize the
value of establishing meaningful human
relations as an integral part of medical
care. *
Author Gertrude Lake of Bum aby, B.C. (R.N.,
B.S.N., M.S.N.,) is program co-ordinator for
tfie first year of nursing for Registered Nurses
and Registered Psychiatric Nurses at the
British Columbia Institute of Technology. She
was responsible for the integration of mental
health nursing concepts and skills into the
BCIT program before becoming co-ordinator.
Lake is a graduate of the University of British
Columbia and received her M.S. A/, from the
University of California, San Francisco
l\^edical Center. She describes this article as
"the beginning of my organization of my
beliefs concerning nursing assessment" and
says: "I fully believe that assessment for
emotional components in patient behavior
and in illness need not be complicated, nor
time-consuming. Nursing needs to identify a
select assessment tool which includes critical
components that will lead to identification of
problems that are emotional or have
emotional overtones. "
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The Canadian Nurse January 1977
Names and Faces
Eliane Lacroix, French translator at
the Canadian Nurses Association, is
retiring after 13 years of service.
During her stay at CNA, she has been
solely responsible for the translation of
many articles in L'infirmi6re
canadienne and all the official
documents, annual reports, position
papers and minutes of CNA meetings
into the French language. Her
translation abilities have been utilized
by the library and information Services
at CNA as well as by many
French-speaking nurses in Canada.
Before coming to Ottawa, Lacroix
worked for the purchasing division of
the French interim government in
Washington, the French Embassy in
New York and until 1963, for the
French official tourist board in
Montreal. She will be greatly missed
by her colleagues who value her
integrity, dedication, experience and
sense of humor.
Henriette Gravelle, formerly with
the Council on Social Development,
replaces Lacroix as CNA translator
and Jacques Paris takes on the
position of re visor of translation.
Marlene A. Grantham (R.N.,
Atkinson School of Nursing, Toronto
Western Hospital; P.H.N. , B.Sc.N.,
University of Western Ontario; M.Sc.
(Admin.), McGill University) has
recently been appointed Director of
Nursing Service, Victoria General
Hospital, Halifax, Nova Scotia.
Leaving her position as Regional
Director of the VON, she brings a
variety of clinical and community
health experience to her new
appointment.
Grace Batchelor has been appointed
Co-ordinator of Continuing Education,
Division of Community Health by the
University of Toronto, Faculty of
Medicine. Batchelor holds a B.Sc. in
biophysics from McGill University and
a Master of Health Services
Administration from the University of
Alberta. She has previously worked as
a research associate in the
Department of Clinical Epidemiology
and Biostatics at the McMaster
University and as a health consultant
with Systems Dimensions Ltd.
Jeff A. Bloom has joined fhe staff of
the Division of Community Health,
Faculty of Medicine at the University of
Toronto. Bloom will be secretariat of
the Primary Care-Outreach Project
Commrtiee, a multi-faculty task force
working on developing a
demonstration model of a multi-faculty
primary care unit with involvement
from the five health science faculties
and the School of Social Work.
Previously, Bloom was the
Evening Administrator at Belleville
General Hospital, Belleville, Ontario.
Norah A. O'Leary (R.N., Toronto
General Hospital School of Nursing;
B.Sc.N., M.Sc.N., University of
Toronto) has recently been appointed
Nursing Consultant, Health
Consultants Directorate, Health
Programs Branch of Health and
Welfare Canada. When asked to
comment on her new position, she
stated, "Its primary objective is the
improvement of the delivery of nursing
care in institutions. This objective is
met in a variety of ways. The Nursing
Consultant acts as a member of a
multidisciplinary team which assesses
and makes recommendations for
improvement in the areas of
organization, administration,
operation and patient care delivery in
an individual hospital. Consultative
services are offered to provincial
authorities, and through them to
individual Nursing Service
Departments. There is an opportunity
to participate on federal-provincial
working parties developing standards
for various hospital departments. A
function which I perceive as very
important is to facilitate
communication between nursing
groups throughout the country."
O'Leary is President of the
Ontario Lung Association Nurses
Section and is past assistant
professor. School of Nursing,
Lakehead University in Thunder Bay,
Ontario.
Phyllis Craig (B.Sc.N., M.H.S.A.,
University of Alberta) has been
appointed a full-time researcher with
the Edmonton Local Board of Health.
She says "Administration and
research in health disciplines should
be interrelated. The research program
need not be large, but at least
decisions are based on some
statistical findings."
Craig's nursing career has
included two years with Health and
Welfare Canada at Nonway House,
Manitoba; short-term nursing
assignments in Australia; and work as
a public health nurse and nurse
practitioner in Alberta. Her recent
studies in health services
administration were in part supported
by the Canadian Nurses Foundation.
Anne Dykstra (R.N., Brantford
General Hospital, Brantford, Ontario)
recently arrived, with her family, in
Solo, Indonesia to join MEDICO, a
service of CARE. She will conduct
in-service training sessions for
Indonesian student nurses and
nursing staff from outlying district
hospitals. She was previously
assigned to Malawi as a volunteer for
CUSO.
New Appointment
Iris Passey of Vancouver is
representing the RNABC on the
Forensic Nursing Committee of the
Registered Psychiatric Nurses'
Association.
Awards
The New Brunswick Association of
Registered Nurses has awarded
$4500. in scholarships to students
enrolled in university nursing
programs.
At the Master's level, Dorothy
Wasson, R.N. at McGill University
receives $1500., and Cheryl Doiron
R.N., enrolled at the University of
Ottawa receives $500.
At the Baccalaureate level,
Carole Estabrooks at the University
of New Brunswick, Kathryn Suttle, at
Dalhousie University, and Nicole
Girouard at the University of
Moncton, receive $500. scholarships.
The annual Muriel Archibald
scholarship was awarded to
Columbienne Bernard, at the
University of Moncton and Paula
Quinn at the University of New
Brunswick.
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L.
The Canadian Nurse January 1977
Books
Barriers and Facilitators to
Quality Health Care, by
Madeline Leininger (ed.).
Philadelphia: F.A. Davis Co.,
1975.
Approximate price $9.60
Reviewed by Colleen Stainton,
Assistant Professor, Faculty of
Nursing, University of Calgary,
Calgary, Alberta.
"Health care is an
expected, essential, and important
societal imperative in our culture." So
says Madeline Leininger at the
beginning of her chapter in this
interesting book. While most of the
content deals with the health care
system in the United States during the
past two decades, the bool< provides
some thought-provoi<ing reading for
health professionals in other
countries.
Various authors examine major
issues and generate some common
themes among the ban-iers and
facilitators of health care. Barriers
tend to be identified as: poor planning:
lack of coordination and cooperation
among the rapidly increasing numbers
of health care professionals;
inefficient use of economic and
manpower resources; and changing
consumer demands. Some facilitators
suggested are: communication and
coordination of the professionals;
improved health team education;
improved health policy leading to
more primary, ambulatory care
facilities; and changes in the role
of the health professionals.
The chapters are arranged
logically, beginning with an historical
review of the last decade by Loretta
Ford, who focuses on health
manpower use and changes needed.
The next chapter by John Bryant, an
Associate Dean of Medicine,
examines Health Care Trends and
Nursing Roles, and provides some
comments highly relevant to current
planning in both education and service
in nursing. He makes interesting
suggestions for dealing with some oi
the problems in health manpower
resources, and discusses nursing as
an important profession in providing
the answers to these problems.
A chapter by a dental professor
outlines the strengths and
weaknesses of dentistry as part of the
health team, especially in the area of
prevention and early diagnosis of
medical problems. Nancy Keller, a
doctorate nurse with a private nursing
practice, discusses the facilitators and
barriers to this type of health care
delivery. She adamantly supports the
view of the nurse in the extended role
as a "client-extender" vs. a
"physician-extender."
Dr. McCormack, a health care
planner, in a chapter entitled "Public
Policy and Medical Care Evaluation"
examines the organizational structure
of the health care system in the U.S.A.
and the evolution of public policy. He
evaluates the response of the
professions and makes a strong plea
for peer review as a means to ensure
quality. Then, Drs. Saward and
Greenlick in "Health Policy and the
HMO," (Health Maintenance
Organization) comment on the effect
of the prepaid medical programs
established in the U.S.A. in 1965 and
end the chapter with a plea for more
medical research in the area of health.
These chapters clearly detail for the
reader the current health care delivery
system in the U.S.A. and strenuously
evaluate It.
The final three chapters are
focused on predicted and tested ways
of improving the present system.
Madeline Leininger describes health
care behavior from an anthropological
perspective in a fascinating chapter
entitled, "Health Care Delivery
Systems for Tomorrow: Possibilities
and Guidelines," strongly advocating
an open system and consumer choice
of the type of health practitioner
appropriate to their health needs.
The book concludes with two
chapters by Canadian authors. The
first is about the nurse practitioner
program at McMaster University and
is written by Walter Spitzer and
Dorothy Kergin. The famous Southern
Ontario Randomized Trial of nurse
practitioners in doctors' offices is
described by WO. Spitzer, MA.
Yoshida and B.C. Hackett in the final
chapter.
It is notable that the profession of
Social Work is not represented in the
list of authors.
The book was edited with an
impressive advisory board of nursing
leaders and a group of special
consultants from dentistry, pharmacy,
nursing and medicine. It is a book that
would be a useful reference for those
studying health care administration
and policies. It documents needed
changes in focus of health care
delivery from curative to preventative
care. The nurse practitioner is strongly
supported as a logical means of
providing this type of care.
Health care research is alluded to
on occasion in this book but one would
expect it to be mentioned more often
as a facilitator and for some stress to
be placed on interdisciplinary health
care research.
The book, while only 118 pages
long, is heavy reading. The
highly-qualified authors have taken
considerable care to document the
content of their chapters. Extensive
bibliographies follow most chapters.
This text provides information of
use to faculty and those in graduate
programs in all health professions. It
would probably have somewhat
limited use by undergraduate students
but should be available to them. The
extensive index is an excellent
reference on special or specific areas
covered by the several authors. I
would recommend it as a good
reference for all those holding office in
professional associations, for the
library holdings of all professional
faculties and schools, and certainly for
those serving on special action
committees studying the health care
delivery system in any country.
Correction
In November, credit for reviewing
Freedom to Die: Moral and Legal
Aspects of Euthanasia by O. Ruth
Russell, was mistakenly given to
Harriett Hayes, Director of the Miss
A.J. MacMaster School of Nursing.
The review was in fact written by
Sharron Woodworth, Instructor, The
Miss A.J. MacMaster School of
Nursing, Moncton, New Brunswick,
MOSBY
TIIVIE5 iviirTnon
When you're talking about
adaptability in nursing
education, you're talking
about new Mosby texts. . .
• authoritative
• up-to-date
• clinically-oriented
Comprehensive new texts for your classes
A New Book!
MATERNITY CARE:
The Nurse and the Family
This humanistic new text can help you prepare your
students to function as competent and sensitive
maternity nurses in today's changing society.
Information is clearly presented in a logical manner,
following the chronologic order of conception,
pregnancy, birth and parenthood. Superbly illustrated
with more than 650 original drawings and
photographs, this text includes plans for nursing
intervention based on diagnostic, therapeutic and
educational objectives. Chapters examine such
diverse topics as: infertility, contraception, genetics,
legal aspects of maternity nursing, etc. Highly
accessible information, emphasis on the human
dimension, quality drawings and photographs - these
are the elements that make this text uniquely
significant in the literature of maternity nursing!
By Margaret Jensen. R.N., M.S.; Ralph C. Benson. M.D.; and
Irene M. Bobak, R.N., M.S. April. 1977. Approx. 832 pages,
BV2" X 11", 659 illustrations. About $13.15.
New 2nd Edition!
ADULT AND CHILD CARE:
A Client Approach to Nursing
This comprehensive text has been significantly revised
to include more information on pathophysiologv and
assessment techniques. Focusing on the patient as
client, it retains an integrated approach to adult and
child care organized according to human needs, with
emphasis on nursing care. The text has been expanded
by more than 50%, with 72 tables and more than 1 00
new illustrations. You'll find major revisions in the
chapter on fundamental processes of illness, and new
material on: the pathophysiology of cancer,
assessment techniques for congenital anomalies,
pathophysiology of inflammations, and tables on
cancer-treating drugs and nursing actions. The chapter
on sexual roles includes new material on nursing
assessment of breast cancer and venereal disease, and
a new section on rape.
ByJanet Miller Barber. R.N.. M.S.: Lillian Gatlin Stokes. R N .
M.S.: and Diane McGovern Billings. R.N.. M.S. March. 1977.
2nd edition, approx. 1,024 pages, 8" x 11", 738 illustrations.
About $18.85.
MOSBY
TIMES MIRROR
The Canadian Nurse January 1977
ADMINISTRATION & EDUCATION
New 3rd Edition! THE FOUNDATIONS OF
NURSING: As Conceived, Learned, and Practiced in
Professional Nursing. By Lillian DeYoung, R.N.,
B.S.N. E., M.S., Ph.D.; with 4 contributors. This
updated text provides students with the most current
information on responsibilities, opportunities, and
changes in professional nursing. Thought-provoking
chapters cover patients' rights, human rights, abortion,
euthanasia, death and dying, institutional licensure vs.
individual licensure, and the problems of transition
from student to practicing nurse. March, 1976. 316
pp., 43 illus. Price, $9.40.
New 2nd Edition! REVIEW OF LEADERSHIP IN
NURSING. By Laura Mae Douglass, R.N., B.A., M.S.
Thoroughly updated and revised, this new edition
reflects contemporary thinking and practices for
nursing management in all current systems of health
care. It offers students the necessary leadershipskillsto
function in formal and informal settings and in a
variety of relationships. New material covers
management of nursing service and changes that
nurses can effect. March, 1977. Approx. 160 pp.
About $6.25.
A New Book! QUALITY ASSURANCE PROGRAMS
AND CONTROLS IN NURSING. By Doris I. Fiaebe,
R.N., Ph.D. and'R. Joyce Bain, R:N., Ed.D. In a single
volume, the authors provide an in-depth guide to
existing evaluation systems used in nursing
administration. Based on systems and management
science concepts, the book examines six quality
assurance programs: P.O.M.R., care plans, rounds,
histories, audit, and client evaluation. Organizational
structure, processes, leadership, and motivation are
discussed as controls (QAC) for implementing quality
assurance programs. -July, 1976. 175 pp., 58 illus.
Price, $6.60.
MANAGEMENT FOR NURSES: A Multidisciplinary
Approach. Edited 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. This
collection of selected readings provides practical
information on management and organization
theories in nursing. Each ofthe three sections contains
material relevant to the organization asa whole and to
the individual in a leadership or management position.
You'll find details on structure, personnel, and
economic factors. 1976, 292 pp., 24 illus. Price,
$9.40.
CRITICAL CARE
New 3rd Edition! CRITICAL CARE. By Zeb L. Burrell,
jr., A.B., M.D., F.A.C.P. and Lenette Owens Burrell,
R.N., B.S., M.S.N. The new updated edition of this
classic text (formerly titled INTENSIVE NURSING
CARE) reviews all aspects of critical care, with
increased emphasis on physiology. Using an
organ-system organization, the text covers the
anatomy and physiology, clinical findings,
pathogenesis, and treatment for each critical care
problem discussed. This edition features more material
on: psychosocial aspects; shock; physiology ofthe
respiratory, cardiovascular, and renal systems; plus
two new chapters on the Gl system and hepatic failure.
April, 1 977. Approx. 424 pp., 1 61 illus. About $12.35.
• authoritative
• up-to-date
clinica lly- oriented
IVI05BY
TIMES MinnOR
'«".^-'
MEDICAL/SURGICAL
A New Book! ENDOCRINE PROBLFMS [N
NURSING: A Physiologic Approach. By Judith
Amerkan Krueger, R.N., M.S. and lanis Compton Ray,
R.N., M.S. Providing students with a physiologic basis
for care of patients with endocrine disorders, this new
text studies all aspects of the endocrine system.
Discussions cover proper functions and mechanisms
of dysfunctions, diagnostic procedures and
pharmacologic treatments. You'll find chapters on the
gonads, pancreas, parathyroid, and the thymus and
pineal glands. August, 1976. 175 pp., 41 illus. Price,
$6.60.
A New Book! LIFTING, MOVING, AND
TRANSFERRING PATIENTS: A Manual. By Marilyn /.
Rantz, R.N., B.S.N, and Donald Courtial, R.P.J. , B.S.
This new handbook photographically depicts the
safest and easiest methods of patient handling and
transfer. Beginning with the fundamental principles of
patient transfer, basic body mechanics, and bedside
body mechanics, the manual then provides
instructions for the transfer of patients with special
problems or injuries. January, 1 977. 148 pp., 250 illus.
Price, $7.30.
PHARMACOLOGY
New 13th Edition! PHARMACOLOGY IN NURSING.
By Betty S. Bergersen, R.N., M.S., Ed.D.; in
consultation with Andres Goth, M.D. Now available in
a new 1 3th edition, this leading text outlines current
concepts of pharmacology in relation to clinical
patient care. Written by a nurse for nurses, the text
features updated discussions on mechanisms of drug
action, indications, contraindications, 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. February, 1976. 766 pp., 100 illus. Price,
$14.20.
New 4th Edition! THE ARITHMETIC OF DOSAGES
AND SOLUTIONS: A Programmed Presentation. Bv
Laura K. Hart, R.N., B.S.N., M.Ed., M.A., Ph.D.
Updated and expanded, this new 4th edition can help
students develop skills in calculating dosages and
solutions. Arranged in a logical, programmed format,
the guide allows students to proceed at their own pace
and master practical problems they might encounter in
daily work. New information is included on the
calculation of children's dosages, insulin dosages and
intravenous flow dosages. January, 1977. 82 pp., 9
illus. Price, $6.05.
M05BV
TIMES ivimnon
A New Book! CDNICAL LABORATORY TESTS: A
Manual for Nurses. By Marcella M. Strand, B.S.N.,
R.N. and Lucille A. Elmer, B.S. in M.T., M.T.tA.S.C.P.).
Designed for quick reference, this new manual
provides important information to help your students
learn to transcribe physician's orders, explain tests to
patients, collect or supervise the collection of
laboratory specimens and understand written
laboratory reports. Selected concepts from physiology,
basic nursing, and medical-surgical nursing are
included. March, 1976. 126 pp. Price, $5.55.
New 4th Edition! NURSING CARE OF PATIENTS
WITH UROLOGIC DISEASES. By Chester C. Winter,
M.D., F.A.C.S. and .Alice Morel, R.N. The new edition
of this popular text examines current concepts of
urologic disease and related nursing management.
Four new chapters highlight this edition: urologic
examination and diagnostic tests; urologic equipment
and its care; urinary ostomy care and appliances; and
the cystoscopy suite and urologic out patient care.
Outlines precede each chapter for easy reference.
January, 1977. Approx. 384 pp., 217 illus. About
$11.05
• Up-to-date
clinically-oriented
• authoritative
Wth 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. An effective self-teaching guide, this
concise workbook relates mathematics to common
solutions and dosages, and provides information
essential to proper calculation, preparation, and
administration of drugs. Updated throughout, this
edition places more emphasis on the metric system
and includes many new problems. The totally
rewritten appendix contains drug standards and legal
regulations, metric doses and apothecary equivalents,
dosage rules for children, and more. 1 976, 1 76 pp., 1 1
figs. Price, $7.10.
% ■■ ^^i
r^
'<^'
i
The Canadian Nurse January 1977
Mas BY
TiiviES rvimnon
PSYCHIATRIC NURSING
A \eu Book! THE PROBLEM-ORIENTED
PSYCHIATRIC INDEX AND TREATMENT PLANS. By
Monte I. Meldman, M.D.; Gertrude McFarland, R.N.,
M.S.: and Edith Johnson, B.A. This pacesetting new
book explains how to standardize psychiatric
treatment and improve the delivery of psychiatric care.
The book helps all members of the mental health team
formulate goal statements and treatment plans.
Prevention, diagnosis, treatment, and rehabilitation
are integrated into a comprehensive plan for care of
the individual and his family. July, 1976. 212 pp., 88
illus. Price, $7.90.
clinically-oriented
• up-to-date
• authoritative
PRACTICAL NURSING
New 4th Edition! TOTAL PATIENT CARE:
Foundations and Practice. By Dorothy F. Johnston,
R.N., B.S., M.Ed, and Gail H. Hood, R.N., B.S., M.S.
Fully updated and expanded, this important text
encompasses all areas of medical-surgical nursing.
The authors offer in-depth information on principles,
techniques, and specific guidelines for nursing care of
patients with diseases and disorders of various body
systems. This new edition includes new material on
pathophysiology, microbiology, pathology,
intravenous solutions, shock, blood, cardiac
monitoring, and a new chapter on death and dying.
February, 1976. 630 pp., 311 illus. Price, $11.85.
New 5th Edition! STRUCTURE AND FUNCTION OF
THE BODY. By Catherine Parker Anthony, R.N., B.A.,
M.S. and Irene B. Alyn, R.N., Ph.D. Now available in
hard cover or paperback, this popular text presents
fundamental information on body structure and
function. It clearly indicates the relationship between
normal and abnormal structure, and links normal
anatomy and physiology to various laboratory tests,
treatments, and nursing procedures. New chapters
discuss cells, organs, systems, and tissues;
fluid-electrolyte balance; and acid-base balance.
April, 1 976. 21 2 pp., 1 07 illus. Price, $8.35 (H); $6.05
(P).
New 4th Edition! MEDICAL-SURGICAL NURSING:
Workbook for Practical Nurses. By Dorothy F.
Johnston. R.N., B.S., M.Ed, and Gail H. Hood, R.N.,
B.S., M.S. An ideal companion to the above text, this
practical workbook carefully follows the text chapters
and presents hypothetical clinical problems for
students to solve. New key features include: expanded
vocabulary, additional discussion questions, and
extended chapter introductions. February, 1976. 208
pp., 18 illus. Price, $6.05.
MOSBV
TIMES MIRROR
THE C V MOSBY COMPANY. LTD.
86 NORTHLINE ROAD
TORONTO. ONTARIO
M4B 3E5
Calendar
February
Orthopaedic Nursing Education
Day sponsored by the Toronto Area
Interest Group of the Orthopaedic
Nurses Association. To be held on
Feb. 1 6, 1 977 in The Sheraton Centre,
Toronto, Ontario. For Information
:ontact: Heather Reuber, 392 Paisley
3lvd. West, Mississauga, Ontario.
Motivation for Nurses a conference
to be held In Calgary, Alberta on Feb.
'7-18. 1977. For Information contact:
^•vision of Continuing Education,
niversity of Calgary, Calgary,
■^'berta, T2N 1N4.
Communicating through
Objectives — a one-day conference
'or management and supervisory staff
0 be held Feb. 8 In Toronto, Ont.;
March 8 In (Montreal, P.O.: and March
0 in Vancouver, B.C. For Information
contact: Practical Management
Associates, P.O. Box 751, Woodland
Hills, Ca. 91365.
March
Recent Advances in Cardio-
vascular Nursing to be held on
March 2-4, 1977 in Sasltatoon,
Sasl<atchewan. Fee: S45.00. For
information contact: Norma J. Fulton,
Director, Continuing Nursing
Education, Room 411. Ellis Hall.
University of Saskatchewan,
Saskatoon, S7N OWO.
American Operating Room Nurses
24th Annual Congress to be held on
March 20-25. 1 977 at Anaheim
Convention Center, Anaheim,
California. For Information contact:
AORN Congress Department, 10170
E. Mississippi Ave., Denver, Colo.
80231.
Audiometry and Hearing
Conservation in Industry to be held
on March 22-24, 1977 at the
Rensselaer Polytechnic Institute,
Troy, New Yorl< In cooperation with
Albany Medical Center Hospital. For
further Information contact: Office of
Continuing Studies, Rensselaer
Polytechnic Institute,
Communications Center 209, Troy,
New York, 12181.
Job of Supervision — a one-day
conference to be held on March 9 in
Vancouver, B.C. and on March 31 In
Toronto, Ont. For information contact:
Practical Management Associates,
P.O. Box 751. Woodland Hills, Ca.
91365.
April
Registered Nurses Association of
Ontario Annual Convention to be
held at the Royal York Hotel In
Toronto, on April 28-30, 1977. For
Information contact: RNAO, 33 Price
St., Toronto, Ontario. M4W IZ2.
The Nurse Administrator's Role in
Implementing a Quality Assurance
Program in any Health Agency. To
be held on April 4-6, 1 977 In Harrison
Hot Springs, B.C. For Information
contact: Jo-zAnn Wood, Continuing
Nursing Education. 1st Floor,
Instructional Resources Centre. The
University of British Columbia.
Vancouver, B.C. V6T 1W5.
Ninth Annual Meeting of the
American Association of
Neurosurgical Nurses to be held In
Toronto, Ontario on April 24-28, 1 977.
For Information. conlacV.The
American Association of
Neurosurgical Nurses, Business
Office. 428 East Preston Street,
Baltimore. Md. 21202.
National League for Nursing 25th
Anniversary Convention and
Exhibition to be held on April 24-27,
1977 In Anaheim, California. For
information contact: National League
for Nursing. 10 Columbus Circle, New
York, New York 10019.
May
Alberta Association of Registered
Nurses Annual Convention to be
held on May 3-6. 1977 in Calgary,
Alberta. For further information
contact; Alberta Association of
Registered Nurses. 10256 — 112th
St.. Edmonton, Alberta, T5K 1M6.
Manitoba Association of
Registered Nurses Annual Meeting
will be held at the University of
Brandon, Brandon. Manitoba on May
15-17, 1977. The theme of the
meeting will be related to Standards."
For Information, contact: Manitoba
Association of Registered Nurses,
647 Broadway. Winnipeg. Manitoba,
R3C 0X2.
Registered Nurses Association of
British Columbia Annual Meeting to
be held on May 11-13, 1 977 at the
University of British Columbia In
Vancouver. For Information contact:
RNABC, 2130 West 12th Ave.,
Vancouver, B.C.. V6K 2N3.
Saskatchewan Registered Nurses'
Association —Sixtieth Annual
Meeting to be held at the Hotel
Sas(<atchewan, Regina,
Sasi<atchewan on May 11-13,1977.
For Infomation contact:
Saskatchewan Registered Nurses'
Association, 2066 Retallack Street,
Regina, Saskatchewan. S4T 2K2
New Brunswick Association of
Registered Nurses Annual Meeting
to be held May 31 , June 1 -2. 1 977 at
Campbellton, New Brunswick. For
information contact: New Brunswick
Association of Registered Nurses.
231 Saunders Street, Fredericton,
N.B., E3B 1N6.
Tenth Communicating Nursing
Research Conference to be held In
Denver, Colorado on May 4-6, 1977
For information contact: WICHE,
Nursing Research Development
Program, P.O. Drawer P, Boulder,
Colorado 80302.
Director of Labor Relations Service
Applications are invited for the newly created position of
Director of Labor Relations Services at Canadian
Nurses Association, Ottawa.
Applicants must have had at least five years' experience
in labor relations as well as knowledge, experience and
interest in nursing and national organizations.
The successful applicant will be required to establish
and direct a labor relations service which includes
collection and analysis of data, preparation and
distribution of information and development of relevant
educational programs. Fluency in English and French
an asset.
Interested applicants are asked to submit, in
confidence, their curriculum vitae before the end of
January 1977 to:
Chairman, Selections Committee
Canadian Nurses Association
50 The Driveway
Ottawa, Ontario
K2P 1 E2
The Canadian Nursa January 1977
Library Update
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 by
letter giving author, title and item
number in this list.
If you wish to purchase a book,
contact your local bookstore or the
publisher.
Books and documents
1 . Aguilera, Donna C. Intervention en
situation de crise; th^orie et
m6thodologie, par.. .at Janice M.
Messick. 2 6d, St-Louis, tVlosby, 1 976.
168p.
2. American Nurses' Association.
Professional development in
psychiatric and mental health
nursing, Kansas City, Mo., c1975.
99p.
3. — . Affirmative Action Task Force.
Affirmative action: toward quality
nursing care for a multiracial society.
Kansas City, N/lc, c1976. 53p.
4. — . Affirmative action programming
for the nursing profession through the
American Nurses' Association, by
Janice E. Ruffin in conjunction with
members of the...Ethelrine Shaw...et
al. Kansas City, Mo., c1975. 55p.
5. — . Biennial Convention, 49th, San
Francisco, June 9-14, 1974. Special
interests — common goals: House of
Delegates reports 1972-1974,
Kansas City, Mo., American Nurses'
Association, c1974. 126p.
6. L' Association des InfimniSres
Enregistr6es du Nouveau-Brunswick.
Standards du service du nursing.
Fredericton, 1976. 6p.
7. Bechtel, Jody. Emergency: a core
curriculum for continuing education in
emergency care, by...et al. Lincoln,
Nebraska, Cardiac Respiratory
Services, Bryan Memorial Hospital,
1975. 75p.
8. Boroch, Rose Marie. Elements of
rehabilitation in nursing. St. Louis,
Mosby, 1976. 31 6p.
9. Braden, Carrie Jo. Community
health: a systems approach, by.. .and
Nancy L. Herban. New York,
Appleton-Century-Crofts c1976.
178p.
10. Chabner, Davi-Ellen. The
language of medicine: a worktext
explaining medical terms.
Philadelphia, Saunders, 1976. 582p.
1 1 . Charron, K. Education of the
health professions in the context of
the health care system: the Ontario
experience. Paris, Organization for
Economic Co-operation and
Development, 1975. 70p.
1 2. Da Cruz, Vera. Bailli^re's
midvirives' dictionary, by... and
Margaret Adams. 6 ed. London,
Baillidre Tindall, c1976. 303p.
13. Delivering family planning
information and services. Winnipeg,
Dept. of Family Studies, University of
Manitoba, 1975. 2v.
14. Drainville, Marie-Claire. Cah/er-de
terminologie medicate. Montreal,
Renouveau P6dagogique, c1976.
207p.
15. Ehrenreich, Barbara. Sorci^res,
sage-femmes et infirmidres; une
histoire des femmes et de la
medecine, par...et Deirdre English.
Montr6al, Las Editions du
Ramua-M6naga, c1976. 78p.
16. Falconer, Mary W. Patient studies
in pharmacology: a guidebook.
Philadelphia, Saunders, 1976. 147p.
1 7. — . Trait6 de pharmacologie,
par...et al. Montreal, HRW, c1976.
692p.
18. Frankel, Robert. Radiation
protection for radiologic
technologists. New York,
McGraw-Hill, c1976. 150p.
19. Froebe, Doris J. Quality
assurance programs and controls in
nursing, by.. .and R. Joyce Bain. St.
Louis, Mosby, 1976. 161 p.
20. Gagn6, Robert M. Les principes
fondamentaux de I'apprentissage;
application d I'enseignement, traduit
par Robert Brian et Raymond Paquin.
Montreal, HRW. c1976. 148p.
21. Godfrey, Simon. L'6preuve
d'effort Chez I'enfant. Montr6al, HRW,
C1976. 199p.
22. Hull, E. Quizzes and questions for
nurses. Book A. Medical nursing and
paediatric nursing, by. ..and B.J.
Isaacs. London, Baillidre Tindall,
C1976. 152p.
23. — . Quizzes and questions for
nurses: Book B. Surgical nursing and
geriatric nursing, by. ..and B.J. Isaacs.
London, Baillidra Tindall, c1976.
147p.
24. Jameson, Robert Morpeth.
Management of the urological
patient, by...K. Burrows and Beryl
Large. Edinburgh, Churchill
Livingstone, 1976. 249p.
25. Jones, Maxwell Shaw. Maturation
of the therapeutic community: an
organic approach to health and
mental health. New York, Human
Sciences Press, c1976. 169p.
26. King's Fund Transatlantic
Seminar of Nurses, 2nd May.. .1972.
Nurses and health care. Collected
papers edited by Eliiabath Lucas.
London, King Edward's Hospital Fund
for London, 1976. 112p.
27. Klaus, Marshall H. Maternal-infant
bonding; the impact of early
separation or loss in family
development, by. ..and John H.
Kennell. St. Louis, Mosby, 1976.
257p.
28. Krueger, Judith Amerkan.
Endocrine problems in nursing: a
physiologic approach, by. ..and Janis
Compton Ray. St. Louis, Mosby,
1976. 165p.
29. Lewis, Lucile. Planning patient
care. 2ed. Dubuque, Iowa, Brown,
C1976. 209p.
30. Milbank Memorial Fund.
Commission. Higher education for
public health: a report of the Milbank
Memorial Fund Commission. New
York, Prodist, 1976. 218p.
31. National League for Nursing.
Biennial Convention, New Orleans,
May ^e-22,^975. Ethnicity and health
care. Papers... presented during an
open forum... at the NLN Convention
in May at New Orleans, Louisiana.
New York, National League for
Nursing, c1976. 55p. (NLN
Publication no. 14-1625)
32. — . Sfafe organization planning
for home health care.
Papers... presented during an open
forum... at the NLN Convention in May
1975 at New Orleans, Louisiana. New
York, National League for Nursing,
C1976. 47p. (NLN Publication no.
21-1629)
33. Nelson, Ruben F.W. The illusions
of urban man. Ottawa, Ministry of
State for Urban Affairs, available from
information Canada, 1976. 76p.
(Urban prospects no. 8)
34. Or7e strong voice, the story of the
American Nurses' Association,
compiled by Lyndia Flanagan. Kansas
City, Mo., American Nurses'
Association, c1 976. 692p.
m
35. Open Curriculum Conference, 4,
New Yori<, Sept. 22-23, 1975.
Proceedings. Edited by Lucille Notter.
A project of the NLN Study of the Open
Curriculum in Nursing Education. New
York, National League for Nursing,
C1976. 122p. (NLN Publication no.
19-1627)
36. Ordre des InfirmiSres et Infirmiers
du Qu6bec. Commentaires et
recommandations du bureau.
Montreal, 1976. 51 p.
37. Patient care guidelines for family
nurse practitioners, edited by Axalla J.
Hoole, Robert A. Greenberg and C.
Glenn Pickard. Boston, Little, Brown
and Co., c1976. 339p.
38. Piggott, Juliet. Queen Alexandra's
Royal Army Nursing Corps, edited by
Lt. General Sir Brian Horrocks.
London, Leo Cooper, c1975. 105p.
39. The psychiatric nurse as a family
therapist, edited by Shiriey Smoyak.
New York, Wiley, c1975. 251 p.
40. Psychiatric nursing 1946 to 1974:
a report on the state of the art,
compiled by Florence L. Huey. New
York, American Journal of Nursing
Co., 1975. 61 p.
41. Reeder, Leo G. Handbook of
scales and indices of health behavior,
by.. .Linda Gordon Ramacher and
Sally Gorelnik. Pacific Palisades, Ca.,
Goodyear, c1976. 540p.
42. Respiratory technology: a
procedure manual, by Doris L.
Hunsinger et al. 2ed. Reston, Va.,
Reston, c1976. 437p.
43. St. John Ambulance. Safety
oriented first aid; a multi-media
programme for Canadian schools,
colleges and universities. Ottawa, St.
John Priory of Canada Properties,
C1976. 1v. (various pagings)
44. Scherer, K. First survey of nurse
practitioners and associated
physicians methodological manual
and final report, by.F. Fortin, W.O.
Spitzer and D.J. Kergin. Hamilton,
Ont., McMaster University, Faculty of
Health Sciences, 1 976. 252p.
45. Scott, Joseph W. Woman, know
thyself. Thorofare, N.J., Slack, c1976.
399p.
46. Turabian, Kate L. A manual for
writers of term papers, theses, and
dissertations. 4 ed. Chicago,
University of Chicago Press, c1973.
21 6p.
47. United Nations. Development
Programme. Reports 1975. New
York, 1976. 88p.
IP-
48. Varney, Glenn H. Management by
Objectives. Chicago, II., Dartnell,
C1971. 167p.
49. Wachstein, Jennifer. Anaesthesia
^ and recovery room techniques. 2ed.
London, Bailli6re TIndall, c1976.
150p. (Nurses' aids series)
50. Weiss, Curtis E. Communicative
disorders, a handbook for prevention
artd early intervention, by. ..and Herold
S. Ullywhite. St. Louis, Mosby, 1 976.
289p.
51. Werther, William B. Labor
relations in the health professions: the
basis of power — the means of
change, by. ..and Carol Ann Lockhart.
Boston, Little, Brown and Co., c1976.
255p.
52. World Health Organization.
I Multinational study of the international
migration of physicians and nurses:
country specific migration statistics.
Geneva, 1976. 392p.
53. — . Regional Office for Europe.
Use of operational research in
European health services: report on a
Working Group convened by the...,
Sofia, 7-n July 1975. Copenhagen,
1976. 68p.
Pamphlets
54. American Association of Industrial
Nurses. The student nurse in industry:
guide to use: the industrial medical
department as a clinical setting for the
student. New York, c1 958, 1971. 11 p.
55. — . A guide for developing
grievance processing skills. Kansas
City, Mo., n.d. 1v. (various pagings)
56. American Nurses' Association.
Guidelines for short-term continuing
education programs for college and
university health nurse practitioners: a
joint statement of the Divisions on
Community Health t^ursing Practice
and Psychiatric and Mental Health
Nursing Practice of the American
College Health Association. Kansas
City, Mo., 1975. lip.
57. — . Guidelines for short-term
continuing education programs
preparing adult and family nurse
practitioners: a statement of the
Division on Community Health
Nursing Practice of the American
Nurses' Association. Kansas City,
Mo., C1975. 8p.
58. — . Commission on Nursing
Education. Standards for nursing
education. Kansas City, Mo., cl975.
45p.
59. College of Nurses of Ontario.
Statements re policy on special
procedures for registered nurses,
nursing and technical personnel.
Toronto, 1975. 9p.
60. Conference Internationale du
Travail. 61 e session. Gen6ve, juin
1976. Compte rendu provisoire,
annexes. L'emploi et les conditions
de travail et de vie du personnel
infirmier, septi^me question d I'ordre
dujour. Gen6ve, Bureau international
du Travail, 1976. 36p.
61. Freese, Arthur S. Understanding
stress. New York, Public Affairs
Committee. c1 976. 20p. (Public affairs
pamphlet no. 538)
62. Hodgeman, Karen. Adaptations
and techniques for the disabled
homemaker. by. ..and Eleanor
Earpeha. 4ed. Minneapolis, Mn.,
Sister Kenny Institute, 1976. 30p.
(Sister Kenny Institute, Rehabilitation
Publication no. 710)
63. Intemational Labour Conference,
61st session, Geneva, June 1976.
Provisional record: appendices:
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The Canadian Nurse January 1977
Librartj rpdate
Employment and conditions of work
and life of nursing personnel. Seventh
#em on the agenda. Geneva,
International Labour Office, 1 976.
32p.
64. New Brunswick Association of
Registered Nurses. Nursing service
standards. Fredericton, 1976. 6p.
65. Nurse's role in blood component
transfusion procurement. Bethesda,
Md., National Institutes of Health,
1975. 27p. (DHEW Publication no.
76-759)
66. Ozimek, Dorothy. Relating the
open curriculum to accountability in
baccalaureate nursing education.
Kevi York, National League for
Nursing, c1976. lOp. (NLN
Publication no. 15-1631)
67. The primary care nurse in the
hospital emergency department A
loint brief to the Government of
Ontario from the Ontario Hospital
Association, Ontario Medical
Association, College of Nurses of
Ontario, Registered Nurses of
Ontario, College of Physicians and
Surgeons of Ontario. Toronto, 1975.
1v (various pagings)
68. The Provincial Council of Women
Of Manitoba. Ad hoc committee on
rape. Brief on rape. Winnipeg, 1 975.
20p.
69. Rogers, Peter D. Influenza alert; a
self-instructional unit. Philadelphia,
Davis, C1976. 21 p.
70. Saskatchewan Registered
Nurses' Association. Continuing
education for nurses in
Saskatchewan: policies, procedures,
standards for approval. Regina,
Sask., 1976. 6p.
71. Taunton, Roma Lee.
Characteristics of short-term
continuing education pediatric nurse
practitioner /associate programs
existing September 1974 — June
1975, by ...and John M. Soptlck.
Kansas City, Mo., American Nurses'
Association, c1976. 18p.
72. Wright, Leora R. A report on the
advanced course in mental health
and psychiatric nursing, Nov. 1, 1975
— Apr. 30, 1976. Fredericton, New
Brunswick Association of Registered
Nurses, 1976. 28p.
Oovernment documents
Canada
73. Advisory Council on the Status of
Women. Report 1975/76. Ottawa,
1976. 32p.
74. Le bureau de la Coordonnatrice,
Situation de la femme. La femme
canadienne. 26d. Pr6par6 par
Recherches et D6cisions Qu6bec
Limit6e, Toronto. Ottawa, 1 976. 278p.
75. Conseil consultatif de la situation
de la femme. Rapport 1975/76.
Ottawa, 1976. 32p.
76. Health and Welfare Canada.
Health Protection Branch. Alcohol
problems in Canada: a summary of
current knowledge. Ottawa, 1 976.
67p. (Its Technical report series no. 2)
77. — . Selected nutrition teaching
aids. Ottawa, Information Canada,
C1976, 62p.
78. Intemational Development
Research Centre. Low-cost rural
health care and health manpower
training; an annotated bibliography
with special emphasis on developing
countries. Ottawa, c1975. 2v.
79. Labour Canada. Occupational
safety and health: a bibliography;
selected holdings of technical library,
accident prevention division. Ottawa,
Supply and Services Canada, 1 976.
144p.
80. Office of the Co-ordinator, Status
of Women. Women in Canada. 2ed.
Prepared by Decision Mari<eting
Research Ltd. Ottawa, 1976. 256p.
81. Pariement. Chambre des
Communes. Comit6 permanent de la
sant6, du bien-dtre social, et des
affaires sociales. L'enfance maltrait6e
et n6glig6e. Ottawa, 1 976. 90p.
82. Pariiament. House of Commons.
Standing Committee on Health,
Welfare and Social Affairs. Child
abuse and neglect. Ottawa, 1976.
90p.
83. Sant6 et Bien-6tre social Canada.
Direction g6n6rale de la protection de
la sant6. Service 6ducatlfs.
Documentation sur I'hygi^ne
alimentaire. Ottawa, Information
Canada, c1976. 67p.
84. Secretary of State. The
organization and administration of
education in Canada. Ottawa,
Minister of Supply and Services
Canada, c1976. 21 9p.
85. Travail Canada. S6curit6 et
hygidne professionnelles;
bibliographie; choix de volumes de la
bibliothdque technique, division de la
pr6vention des accidents. Ottawa,
Approvisionnements et Services
Canada, 1976. 144p.
United States
86. Division of Nursing. Graduation
and withdrawal from RN programs; a
report of the nurse career-pattern
study, by Lucille Knopf. Bethesda,
Md., 1975. 130p. (DHEW Publication
no. (HRA) 76-77)
87. — . High school seniors' attitudes
and concepts of nursing as a
profession, by Melvin H. Rudov,
Maurice T. Wilson and Karen F.
Trocki. Bethesda, Md., 1976. 167p.
(DHEW Publication no. (HRA) 76-35)
88. — . SuA'eys of public health
nursing 1968-1972 prepared by
Division of Nursing in cooperation
with the Association of State and
Territorial Directors of Nursing.
Washington: U.S. Dept. of Health
Education, and Welfare, Public Health
Service, Health Resources
Administration, Bureau of Health
Manpower, Division of Nursing; tor
sale by the Supt. of Docs., U.S. Gov't.
Print. Off., 1976. 337p. (DHEW
Publication no. (HRA) 76-8)
89. Interagency Conference on
Nursing Statistics. Abstracts of
studies; health manpower
references. Bethesda, Md., U.S.
Public Health Service, 1975. 30p.
(DHEW Publication no. (HRA) 75-24)
Studies deposited In CNA
Repository Collection
90. KIrstine, Myrtle Lav'ma. A study of
health and related needs of senior
citizens in two housing complexes,
conducted in the regional
municipality of York. Newmarket,
Ont., Yort< Regional Health Unit, 1976.
86p. R
91. Leonard, Linda Gaye.
Husband-father's perceptions of
labour and delivery. Vancouver,
1975. 165p. (Thesis — British
Columbia) R
92. Pelletier, Julia M. The effects of
continuity in nurse-patient
assignment among a selected group
of preoperative aortocoronary bypass
patients. Toronto, 1 976. 125p. (Thesis
(M.S.N.) — Toronto) R
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this
patient
needs
your help
When patients need private duty
nursing in the home or hospital,
they often ask a nurse for her
recommendation. Health Care
Services Upjohn Limited is a re-
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The Canadian Nurse January 1977
Alberta
British Columbia
Employment Opportunity — Athabasca Health Unit No. 1 8 requires
a Senior Public Health Nurse for the Athabasca Office. B.Sc qualifi-
cation preferred and experience essential. Salary range varies accor-
ding to qualification and experience Apply immediately to V.
Markowski, Admrnistrative/Secty.. Box 1140. Athabasca. Alberta
TOG 080 Phone 1-403-675-2231
General Duty Nurses for modem 35-bed hospital located in south-
ern B.C. s Boundary Area with ■excellent recreation facilities- Salary
and personnel ooiraes m accoraance with RNABC, L-omfortable
Nurse s home. Apply Director of Nursing, Boundary Hospital, Grand
Forks. Bntish Columbia, VOH 1H0.
British Columbia
Ontario
Head Nurse — Psychiatric Unit — Position requires a R.N. with
psychiatric training and experience in Ward Management. The unit is
16 beds with 6 day care units. It is a new unit opening in January or
February of 1 977. The position becomes available November 1 . 1 976.
Salary according to RNABC contract. Apply in wnting to: The Director
of Nursing. Mills Memonal Hosp.tal, 2711 Tetrault Street, Terrace,
British Columbia. V8G 2W7.
Registered and Graduate Nurses required for new 41-bed acute
care hospital, 20C miles north of Vancouver, 60 miles from Kamloops.
Limited furnished accommodation available. Apply Director of Nurs-
ing. Ashcroft & District General Hospital, Ashcroft, Bntish Columbia
Registered Nurses with psychiatnc training or expenence. for nev>'
psychiatnc unit opening January or February 1977. Salary according
to RNABC contract. Please apply m wntmg to The Director of Nursing,
Mills Memonal Hospital. 271 1 Tetrault Street, Tenace. Bntish Colum-
bia. V8G 2W7
General Duty Nurses for modern 41-bed hospital located on the
Alaska Highway. Salary and personnel policies m accordanc^ with
RNABC, Accommodation available m residence. Apply: Director ot
Nursing, Fort Nelson General Hospital, P.O. Box 60, Fort Nelson,
British Columbia, VOC 1R0,
Director ot Nursing for generalized public health program with invol-
vement in teaching at university level and partidpalion in community
research projects. Education to level of Master s Degree applicable to
public health nursing and several years expenence in the service field
in supervisory capacity. Salary negotiable and commensurate with
these requirements. Usual fnnge benefits. Apply to: Miss F. Abbotts,
Secretary. Board of Health, Borough of East York Health Unit, 550
Mortimer Avenue, Toronto. Ontano. M4J 2H2.
Quebec
Registered Nurse required for co-ed children s summer camp in the
Laurentians (seventy miles north of Montreal) from tate June until late
August 1977. Call (514) 487-5177 or write; Camp MaroMac. 5901
Fleet Road, Hampstead, Montreal, Quebec, H3X 1G9.
Saskatchewan
General Duty Nurse required for 8-bed hospital in Edam, Saskat-
chewan Expenence preferred and references needed. To start De-
cember 1. 1976, with salary according to S.U.N. Apply to: Director of
Nursing, Lady fulinto Union Hospital, Box 178. Edam, Saskatchewan,
SOM OVO.
MANIT
DEPARTMENT OF
HEALTH AND SOCIAL DEVELOPMENT
The School of Nursing
Selkirk Mental Health Centre
is offering a
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 dL^ration
September through May and includes
theory and clinical experience in hospitals
and community agencies, 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 15/77 to: Director of
Nursing Education, School of Nursing,
Box 9600, Selkirk, Manitoba R1A 2B5
V*3f81^
McGILL UNIVERSITY
SCHOOL OF NURSING
GRADUATE PROGRAM IN NURSING — MASTER OF SCIENCE (APPLIED)
This program has been designed to prepare clinicians and researchers for the expanding function of nursing in our rapidly developing
health care services.
OPTIONS AVAILABLE
OPTION A
CLINICAL NURSING PRACTICE
OPTION B
RESEARCH IN NURSING AND HEALTH CARE
Graduates will be prepared to incorporate either option within careers in the Teaching of Nursing or the Development and
Management of Nursing Service.
ADMISSION REQUIREMENTS
Either a Baccalaureate degree in Nursing comparable to B.Sc. (N) or B.N. from McGill; or Baccalaureate degree comparable to B. A. or
B.Sc. offered at McGill
LENGTH OF PROGRAM FURTHER INFORMATION FROM:
2 years for those with nursing degrees Director, School of Nursing
3 years for those with non-nursing degrees Master's Program
3506 University Street
LANGUAGE OF STUDY: English Montreal, P.Q. H3A 2A7
United States
Registered Nurses — Hospital openings available for new graduates
and ex perienced nurses (R.N.s). Wilting to re- locate 10 United States.
No charge to \he applicants. We arrange everything for you ' ' Please
contact: Miss Shore (416) 449-5883.
Come South! Sunshine, warmth & beaches — mild winters. We
represent hundreds ot clients that are seeking Canadian nurses to join
their slafi Third nation entrants need not apply. These situations are
vaned. and income levels are excellent, up to S14.000 (U.S.) tor
ICU/CCU supervisors. Si 3.500 for shift supervisors and Si 2.000 for
generaJ duty staff nurses. Some situations may require Slate licen-
sure exam, however, most are available without examination. One
year commitment, round-tnp Air Fare, housing assistarKe and Visa
H-1 application assistance ts provided Our fee is paid also — you
have no obligation whatsoever. For complete details, send your re-
sume with photograph and full particulars, to Medical Search, 3274
Buckeye Road. Atlanta. Georgia 30341
Registered Nurses — Hurley Medical Center is a well equipped,
modern, 600-t>ed leaching hospital ottering complete and specialized
services for the restoration and preservation of the community s
health. It also offers orientation, in-service and continuing education
(or employees It is involved in a building program to provide better
surroundings for patients and employees We have immediate ope-
nings for registered nurses m such speaalty units as Cardio- Vascular,
Operating Rooms, Nurseries, and General Medtcal-Surgtcai areas
Hurley Medical Center has excellent salary and fringe benefits Be-
come a part of our progressive and well qualified work force Today.
Apply. Nursing Department. Mr. Garry Viele. Assocate Director of
Nursing, Hurley Medical Center, FInt, Michigan 48502 Telephone
(313) 766-0386
Nurses — RNs — Immediate Openings in Rortda & Arkansas — If
you are Expenenced or a recent Graduate Nurse we can offer you
positions with excellent salaries of up to Si 160 per month plus all
benefits Not only are there no fees to you whatsoever for placing you.
but we also provide complete Visa and Licensure assistance at also
no cost to you Write immediately for our application even if there are
other areas of the US. that you are interested in We will call you upon
receipt of your application in ordef to arrange for hospital interviews,
Windsor Employment Agency Inc. PO, Box 1133. Great Neck. New
York 11023. (516-487-2818).
Hospital Affiliates
International Inc.
NURSING
CAREERS
United
States
Hospital Affiliates International, ttie leader
in tfie field of hospital management, has
over 70 hospitals in operation or under
construction in 23 States.
On-going opportunities exist for Canadian
citizens who have graduated from an
accredited Canadian School of Nursing,
Openings exist in all clinical areas.
If you are considering working in the
United States, and have an interest in
associating yourself with one of our
hospitals, please contact our Canadian
representative who will be pleased to
discuss your specific needs. All enquiries
will be treated in confidence and should
be directed to:
DOW-CHEVALIER
SEARCH CONSULTANTS
365 Evans Ave.. Toronto M8Z 1K2
416-259-6052
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 Medical 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,
wfi would like you on our staff.
Interested qualified applicants should
apply to the:
Director of Nursing
Montreal Children's Hospital
2300 Tupper Street
Montreal, Quebec. H3H 1P3.
McMASTER UNIVERSITY
SCHOOL OF NURSING
Nurse faculty members required for the
1977-78 academic year for a School of
Nursing, within a Faculty of Health
Sciences. The School is an integral part of
a newly developed Health Sciences
Centre where collatKirative relationships
are fostered among the various health
professions and clinical appointments
can be arranged. Requirements: Masters
or Doctoral degree, with clinical specialist
preparation or experience and/or
preparation in teaching preferred, in adult
health, medical-surgical or pediatrics.
Application, with a copy of curriculum
vitae and two references to:
Dr. D. Kergin
Associate Dean (Nursing)
Faculty of Health Sciences
McMaster University
Health Sciences Centre
1200 Main Street West
Hamilton, Ontario
L8S4J9
Come
grow
with us
University of Kentucky
Medical Center —
a progressive tertiary care center
oriented toward service, teaching
and research.
We offer-travel and moving
allowance-salary commensurate
with experience and
education-three weeks paid
orientation-three weeks
vacation-10 holidays-sick leave
benefits-paid tuition
benef its-inservice and continuing
education-professional freedom
and growth.
Write to:
Mrs, Dorothea Krieger
Assistant to the Director for Staffing
Department of Nursing
UNIVERSITY HOSPITAL
University of Kentucky
Lexington, Kentucky 40506
Name
Address
City
State Zip
Degree
Date of Graduation
An Equal Opportunity Emptayer
The Canadian Nurse January 1977
Director School of
Nursing
Reporting directly to the Executive
Director, assumes the responsibility for
the organization and administration of
ongoing accredited diploma nursing
programs.
Qualifications:
• Appropriate (blasters Degree
preferred, but applicants possessing a
Baccalaureate in Nursing will be
considered.
• Previous experience in the
administration of an accredited nursing
education program a necessity.
Please forward, in confidence, a
complete resume of experience and
qualifications including expected
salary to:
Mr. T.I. Bartman
Executive Director
Misericordia General Hospital
99 Cornish Avenue
Winnipeg, Manitoba R3C 1A2
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, September
Limited to 8 participants
Applications now being accepted
For further information, please wr'He
to:
Co-ordinator of In-service Education
Foothills Hospital
1403 29 St. N.W. Calgary, Alberta
T2N 2T9
University of Ottawa
School of Nursing
Positions available for the 1977-78
academic year in;
• Medical-Surgical Nursing
• Maternal and Child Nursing
• Psychiatric Nursing
• Community Nursing.
Master's degree in clinical specialty and
teaching experience required. Preference
will be given to bilingual candidates.
(French and English). Salary
commensurate with preparation.
Send curriculum vitae and references to:
Dean
School of Nursing
University of Ottawa
770 King Edward Avenue
Ottawa, Ontario
K1N6N5
I
Head Nurse
The Position:
Directing an active 40 bed surgical unit
with opportunity for future advancement.
The Person:
Should have a Baccalaureate degree with
a clinical specialty and/or administrative
experience.
The Hospital:
Central Alberta location in an expanding
regional hospital.
The City:
30,000 population half way between
Edmonton and Calgary and close to the
best in skiing and recreation centres.
Please send complete resume to:
Director of Personnel
Red Deer General Hospital
Red Deer, Alberta
T4N 4E7
Operating Room
Supervisor
Applicant must have a thorough
knowledge and training in current
operating room management and
procedures including personnel
selection, good communication and
interpersonal relationship sl<ills.
Baccalaureate degree required.
Please apply, forwarding
complete resume to:
Director of Personnel
St. Joseph's Hospital
London, Ontario
N6A 4V2
Head Nurse
with preparation and/or
demonstrative competence in
Psychiatric Nursing and
Management functions, required for
Head Nurse appointment. To be
responsible for participation in the
organization, initiation, and the
management of a New Psychiatric
In-patient Unit.
Please apply, forwarding
complete resume to:
Director of Personnel
Stratford General Hospital
Stratford, Ontario
N5A 2Y6.
Registered Nurses
and Certified Nursing
Assistants
Required for 340 bed Level IV Hospital.
Must be eligible for Saskatchewan
registration.
Salary in line with neighbouring provinces
and under review.
For details apply to:
The Personnel Department
Souris Valley Extended Care Hospital
Box 2001
Weyburn, Saskatchewan
S4H 2L7
University Faculty
Applications are invited for the position of
Assistant or Associate Professor of
Community Health Nursing in a basic
University program enrolling
approximately 200 students.
A Master's degree and expertise in
practice are required. Preference given to
candidates with graduate preparation
and/or experience in Maternal Child
Nursing. Teaching experience in a
university program is desirable.
Candidate must be eligible for registration
in Ontario.
Salary commensurate with qualifications.
Apply in writing giving curriculum
vitae to:
Dr. E. Jean M. Hill
Dean and Professor
School of Nursing
Queen's University
Summerhill
Kingston, Ontario K7L 3N6
Clinical Specialist
Nursing
We require the services of an articulate,
dynamic nurse with a Master's Degree
and a Major in Medical-Surgical nursing.
We are a 300 bed Hospital Complex on
the verge of a major expansion. We are
close to fine recreational and cultural
areas.
The nurse in this position will work closely
with our Medical Staff, Administrative
Staff and Staff Nurses to further develop
patient centered projects. The salary and
benefits are based on the qualifications
and experience of the applicant.
For further information about this
opportunity, please forward a
complete resume to:
Director of Personnel
Red Deer General Hospital
Red Deer, Alberta
T4N 4E7
can go a long way
...to the Canadian North in fact!
Canada's Indian and Eskimo peoples in the North
need your help. Particularly if you are a Community
Health Nurse (with public health preparation) who
can carry more than the usual burden of responsi-
bility. Hospital Nurses are needed too... there are
never enough to go around.
And challenge isn't all you'll get either — because
there are educational opportunities such as in-
service training and some financial support for
educational studies.
For further information on Nursing opportunities in
Canada's Northern Health Service, please write to:
Medical Services Branch
Department of National Health and Welfare
Ottawa, Ontario K1A0L3
Name
Address
City
■ ^ Health and Well?! c
Canada
Prov.
Sante et Blen-etre social
Canada
m c
MEDICINE HAT COLLEGE
Nursing Instructors Required
IF YOU HAVE THE FOLLOWING PERSONAL
QUALITIES:
• are imaginative, creative, interested in professional growth and
development
• like working with students and like to teach
• are not afraid of hard work
• are satisfied with nothing short of excellence
• are interested in earning good salary
IF YOU HAVE THESE QUALIFICATIONS:
• a Baccalaureate or Masters Degree in Nursing
• several years of practical field experience
IF YOU ARE INTERESTED IN A NURSING
PROGRAM:
• that is student centered, promotes self-paced learning
• that is open to creative change and experimentation
• that aims to graduate nurses that are current, {and responsible)
and have the capacity for growth
Apply to:
Mr. C.L. Dick
Vice President
Medicine Hat College
Medicine Hat, Alberta
T1A 3Y6
The Canadian Nurse January 1977
Director of Nursing
Dryden District General Hospital
Dryden District General Hospital is a 75 bed accredited
hospital located in the Town of Dryden, population 7,000, area
served 15,000. Dryden is midway between Winnipeg and
Thunder Bay on the Trans-Canada highway in the midst of the
Patricia Tourist Region. Transair provides twice daily jet flights
to Toronto and Winnipeg.
Many cultural and recreational opportunities are available to
residents of and visitors to the community.
Experienced applicants with a university degree will be given
preference but experience in a supervisory capacity in a larger
hospital will receive consideration. Employees benefits are
generous, salary is negotiable. Employment is available
immediately.
Please write or telephone to:
Administrator
Dryden District General Hospital
Dryden, Ontario Phone: 807-223-5261
Index to
Advertisers
January 1977
Abbott Laboratories
Cover 4
Burroughs Wellcome & Company (Canada) Limited 43
The Canadian Nurse's Cap Reg'd
59
Connaught Laboratories Limited
26, 27
Designer's Choice
5
East African Travel Consultants
57
Equity Medical Supply Company
59
Health Care Services Upjohn Limited
59
Frank W. Horner Limited
47
L'eggs Products International Limited
49
J.B. Lippincott Company of Canada Limited
32,33
The C.V. Mosby Company Limited 51 , 52
, 53, 54
The Nurse's Book Society
3
Professional Travel Consultants Limited
30
Reeves Company
7
W.B. Saunders Company Canada Limited
11
The Uniform Shop of Peterborough Limited
45
Uniforms Registered
14
White Sister Uniform Inc Covers 2, 3
Advertising
Gerry Kavanaugh
The Canadian Nurse
50 The Driveway
Ottawa, Ontario K2P 1 E2
Advertising Representatives
Richard P. Wilson
219 East Lancaster Avenue
Ardmore. Penna. 19003
Telephone: (215) 649-1497
Gordon Tiffin
2 Tremont Crescent
Don Mills, Ontario M3B 2S1
Telephone: (416) 444-4731
Member of Canadian
Circulations Audit Board Inc.
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The Canadian Nurse February 1977
SOME STYLES ALSO AVAILABLE IN COLORS . . . SOME STYLES 3y2-12 AAAA-E, ABOUT 25.95 to 34.95
For a complimentary pair of white shoelaces, folder showing all the smart Clinic styles, and list of stores selling them, write:
THE CLINIC SHOEMAKERS • Dept. CN-2, 7912 Bonhomme Ave. • St. Louis, Mo. 63105
^H» eainadian
nmmme
February 1977
The official journal of the Canadian
Nurses Association published
monthly in French and English
editions.
Volume 73, Number 2
^^^^^^^^^^^^^^^1
Input
6
Calendar
8
News
10
Idea Exchange:
Education in the
Electronic Age
Manuel Escott
15
Books
50
The Father's Side:
A Different Perspective
on Childbirth
Linda Leonard
16
Library Update
52
Nursing ttie Acutely Psychotic Patient
Janet Berezowski
23
Frankly Speaking
Patricia McMeekan
26
Singing, Signing, Smiling
MaryDean Samanski
28
Accountability:
A Professional Imperative
Muriel A. Poulin
30
Reproduction and
the Test Tube Baby
L. Pakalnis, J. Makoroto
34
The Self-Care Unit:
A Bridge to the Community
Patricia Barrington
39
Care of the Rape Victim
in Emergency
Sandra LeFort
42
fvlrs. B. and Me
Heather Sprout
46
These days, fathers are getting In on
the act at every stage of the growth
and development of their offspring as
this month's cover photo illustrates.
On page 16, author Linda Leonard,
describes the reaction of some fathers
to their participation in the events
leading up to and including the birth of
their children. Cover photo by Miller
Services Limited.
The views expressed in the articles
are those of the authors and do not
necessarily represent the policies of
the Canadian Nurses Association.
ISSN 0008-4581
Indexed in International Nursing
Index, Cumulative index to Nursing
Literature, Abstracts of Hospital
Management Studies, Hospital
Literature Index. Hospital Abstracts.
Index Medicus. The Canadian Nurse
IS available in microform from Xerox
University Microfilms. Ann Arbor.
Michigan, 48106.
The Canadian Nurse welcomes
suggestions for articles or unsolicited
manuscripts. Authors may submit
finished articles or a summary of the
proposed content. Manuscripts should
be typed double-space. Send original
and carbon. All articles must be
submitted for the exclusive use of The
Canadian Nurse. A biographical
statement and return address should
accompany all manuscripts.
Subscription Rates: Canada: one
year. S8.00: two years. Si 5.00.
Foreign: one year, S9.00: two years,
Si 7.00. Single copies: Si. 00 each.
Make cheques or money orders
payable to the Canadian Nurses
Association.
Change of Address: Notice should be
given in advance. Include previous
address as well as new, along with
registration number, in a provincial/
territorial nurses' association where
applicable. Not responsible for
journals lost m mail due to errors in
address.
Postage paid in cash at third class rate
Montreal, P.O. Permit No. 10,001.
• Canadian Nurses Association
1977.
i£Jp Canadian Nurses Association.
•S" 50 The Driveway, Ottawa, Canada,
K2P 1E2.
The Canadian Nurse February 1977
FtM'.spiK'iive
Of all the "helping professions,"
nurses must be among the most
keenly aware of the toll that poverty
exacts in terms of our vital human
resources. Every day, in the people
we care for, we see the effects of
dietary deficiencies, under-nutrition
and all the other deprivations
associated with life below the poverty
line. We recognize that a link exists
between malnutrition and anemia, low
resistance to infectious diseases,
mental retardation and mental illness.
We know also that the deprivations
arising from a marginal existence
present a special threat to certain of
our patients — the very young, the old,
the disabled and the expectant
mother. We have read that studies of
the children of the poor (Montreal,
1969) prove that half of them show
signs of emotional problems and that
almost one third of them exhibit
symptoms of malnutrition, retarded
growth (height and weight) and
psycho-motor retardation.
The poor, in fact, survive in an
environment that almost prohibits
mental and social well-being and has
an even more disastrous effect on
their physical health. A representative
of the Canadian Medical Association
has estimated that "the 20 percent of
the population that are poor suffer
something like 75 to 80 percent of
major illnesses."
It is now more that five years
since the Senators who travelled
across Canada listening to the poor
and studying their submissions, tabled
their report , "Poverty in Canada." In
this, they acknowledged the existence
in Canada of "an ugly sub-culture
within society" whose inhabitants
generally receive inferior educational,
medical, cultural and information
services and whose children, "the
most helpless victims of all, find even
less hope in a society whose
social-welfare system from the very
beginning destroys their dreams of a
better life."
Since then, as the Economic
Council of Canada points out, the
poverty gap has widened. Between
1 965 and 1 974, according to the ECC,
the only group to increase its share of
total pre-tax income was the top 40
percent of families and individuals.
The share of tUebottom 40 per cent of
families and individuals in fact
decreased from 16.2 percent in 1965,
to 14.9 percent in 1974.
When the Poverty Committee
submitted its report in 1971, the
principal recommendation of its
members was for acceptance by
Canada of the right of all of its citizens
to an adequate minimum income. The
Senators saw implementation of a
Guaranteed Annual Income as the
first and most crucial step in a
comprehensive program to combat
poverty in Canada in the Seventies.
Political and social acceptance of the
GAI would, they believed, depend on
the extent to which'Canadians and
their elected leaders recognized some
form of income maintenance as a
viable alternative to the chaos of the
existing welfare system.
The future of the Canadian social
security system is still up in the air. A
blue-ribbon task force with
representatives from both the
departments of Health and Welfare
and Finance is currently studying
possible changes in the tax system to
provide a guaranteed income for the
two million working Canadians who
live in poverty. The proposed system
could be expanded later to cover all
Canadians who now depend upon the
welfare system for much of their
income.
Iloroiii
Editor
M. Anne Hanna
Assistant Editors
Lynda Ford
Sandra LeFort
Production Assistant
Mary Lou Downes
Circulation Manager
Beryl Darling
Advertising
Gerry Kavanaugh
CNA Executive Director
Helen K. Mussallem
Canada's Minister of Health and
Welfare has indicated that he
considers some form of supplement
program for the working poor and a
support program forthose who cannot
work "inevitable." The question now is
"when?" It would seem the time is ripe
for this kind of fundamental and
long-delayed shakeup in our
approach to promoting the health and
well-being of our fellow-Canadians.
— M.A.H.
How long is it since you made
your first hesitant attempts to apply the
nursing skills you had learned in a
classroom to the care of your "very
own patient?" Every nurse has
memories — some bitter, some sweet
— about herfirst real patient. We think
that, no matter how long its been,
Heather Sproul's story about Mrs. B.
will strike a familiar chord for all our
readers.
In our society, the victim of a rape
is often the victim of bureaucratic,
unfeeling medical and judicial
systems as well. In hospitals, the
treatment given to a woman who has
been raped often leaves a great deal
to be desired, especially in the area of
emotional care. This month, Care of
the Rape Victim in Emergency on
page 42 provides some guidelines for
those nurses who deal with rape
victims.
Is the fetal monitor an expensive
and risky toy, or a means of reducing
North America's alarmingly high
perinatal mortality figures? Next
month, author Ellen Hodnett
investigates what researchers have to
say about the use of fetal monitors in
assessing fetal health just prior to
delivery.
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A
uMrrEO
EDITION
Available at leading department stores and specialty shops across Canada
The Canadian Nurse February 1977
The Canadian Nurse invites your
letters. All correspondence is subject
to editing and must be signed,
although the author's name may be
withheld on request.
Input
Appropriate clinical content
I share the conviction, stated in
the last paragraph of "Perspective,"
(October, 1976), that to be
professional we need a special body
of knowledge and skills that only
members of our occupational group
possess. Because nursing is a
practice discipline, it follows that the
development and communication of
appropriate clinical content is a
mandatory activity for nurses. I
therefore expected you to request
clinical articles on the etiology,
incidence, signs, symptoms and
treatment of phenomena which
nursing practitioners manage
independent of other disciplines.
However you request articles that
derive from a medical rather than a
nursing classification scheme, i.e.
cancer, arthritis, dermatology. Most of
the data you solicit, i.e., etiology,
incidence, signs and symptoms of a
disease, are already available in
medical journals. A simpler version of
that knowledge is contained in the
journals for persons working in the
physician's assistant role.
Thus I must ask: What are your
criteria for classification of a clinical
nursing article? Would you be
interested in receiving clinical articles
that deal with nursing diagnoses that
reflect patient situations that arise
because the person has a disease
state but that do not use a medical
classification scheme for
identification? For instance, I do work
with patients who have cancer. I need
an understanding of this disease
process as it relates to my patients'
coping with both the disease and the
medical regimen. My major skills and
knowledge as a nurse focus on
helping these persons and their
families to: manage their fears of
death; adapt to changes in body
image that come from treatment and
disease progression; and manage the
experience of pain and changes in
their activities of daily living that
ensue. Persons who have the disease
label called cancer' may experience
any or all of these phenomena but so
will patients suffering from other
diseases. My understanding of these
phenomena comes from the research
and theory of many disciplines and
articles on these nursing concerns
and cannot be discussed under
categories such as the 'dermatology
patient.'
I also consider the management
of client situations in which there is no
disease state present appropriate
clinical content tor the discipline of
nursing. Would articles on this topic be
included or excluded in your
inventory?
— Jessie Mantle, R.N., London,
Ontario.
The editor replies:
Our request for clinical articles
based on a medical classification
scheme is largely an historical
accident; the most common complaint
we receive about deficiencies in
editorial content is the absence of
"clinical articles like the ones in
the American nursing journals." In our
attempt to analyse the journal over the
past five years in response to this
criticism, we grouped published
articles according to disease states.
There was no intent to "put down"
nursing diagnoses. We do feel,
however, that in order to be complete,
a clinical article should provide nurses
with enough information about the
pertinent etiology, incidence, signs,
symptoms etc. of a disease state to
serve as a handy review. Our feeling is
that this knowledge is useful in
developing the larger concerns that
you mention — such as helping
patients and their families to adjust,
adapt, manage etc.
- M.A.H., Editor.
Essential or non-essential?
As a Public Health Nurse I am
experiencing anger and frustration.
For years we have been docile
handmaidens, reluctant to speak out
against those changes that seem to
have caused only deterioration in the
health field. I feel our government and
our communities need to be educated
about our role as public health nurses
in a growing society. Health care costs
have increased; too often I have been
told that the reason lies in the high
salaries of registered nurses.
If public health nursing were used
to its fullest potential, it could definitely
reduce the cost of health care. I have
read that those employed at the Liquor
Control Board are classified as
providing "essential services"; public
health nurses are not.
As members of a community,
preventive medicine should be
foremost in our minds. The public
health nurse functions as a
coordinator, counsellor, nurse, and
teacher of health-related topics. We
are involved with every age group, in
the schools, homes, hospitals and
places, of employment.
If our doctors utilized our
services, many of the patients that
arrive in their offices could be seen by
a public health nurse. If, after she
assessed the situation, she felt a
doctor should be consulted, then a
referral would be made. Immunization
should be looked after by the health
agencies, not by a doctor who should
be utilizing his time in a different
manner. Mothers should be
encouraged by the doctors to contact
the public health nurse if they are
concerned about feeding and care of a
child. If the problem is one that
requires the doctor's expertise, then
an appointment could be made to
have the child seen. Family planning
and birth control clinics should be well
attended — why should a
gynecologist see patients who could
be taught at these clinics?
A comment has been made that
we are too highly specialized for what
we do. My reply to that comment is —
since we are well trained to cope as
members of the health team, then
direct added responsibilities towards
public health nurses rather than to a
highly paid, overworked group.
- Mrs. Vi Krmpotich, R.N., P.H.N.,
Sault Ste. Marie, Ontario.
Curing career cramp
As a group, nurses now have
considerable security and a trend
toward complacency is
understandable. We have achieved
considerable gains in terms of
remuneration but from a personal or a
professional standpoint, a monetary
definition of success isn't quite
sufficient. Success is almost
impossible to define but a working
answer would be that we are a
success as individuals and as a
profession if we get to do what we
perceive to be our work. This would
seem to involve determining what our
work is, but need not be a
once-and-for-all decision; the many
roles of nursing are still evolving.
Following the Boudreau
Committee report there was animated
discussion of this point. Almost every
issue of The Canadian Nurse carried
reports of pilot projects where nurses
were attempting new patterns of
practice. It's fashionable today to say
that nurses are overpaid, but the other
side of that statement is that nurses
are underutilized. Yet, the basis for
professional expansion has been
afforded us in the flexibility evident in
deciding what responsibilities for
patients a nurse may undertake.
Pilot projects are clearly
necessary, but often when the novelty
wears off one feels that the new range
of practice is confined to the area
where the pilot project was
undertaken. It has not spread to other
areas or institutions. Of course there is
conflict inherent in what must be done
for the patient — how it should be done
and by whom. The old hierarchical
values tell us conflict must be avoided
at all costs, and yet conflict can be
productive and even fun. In any case,
it's not possible to eliminate it entirely
from organizations. Attempts to avoid
it block our development and lead to
career cramp. The Pickering Report
indicates that the public are affording
us the chance to enlarge our practice.
We cannot expect to continue
doing things in the old familiar way.
What is needed now is that each nurse
deliberately attempts to improve and
expand her own performance to fill the
void between expensive medical care
and those patient needs that can be
handled by the nurse. This grass roots
effort seems one way of increasing our
productivity and testing our ability and
acceptability. The present level of our
remuneration carries a responsibility
to demonstrate our increased worth to
our employers and the community.
— Gabrielle Monaghan, R.N.,
Belleville, Ontario.
Wrong subject!
Notice of my dissertation was
published in the December issue of
the journal . My name was recorded as
Haliburton, John C.
John Haliburton is my cousin and
is currently doing research on
changing manure to gas at the
University of Manitoba, Winnipeg.
My topic is evaluation of the new
curriculum in the nursing school.
Would you please make the
appropriate corrections.
— Jane C. Haliburton, Ed. D., Director
of Education, Yarmouth Regional
Hospital, Yarmouth, N.S.
M05BV
TIMES Minnon
The v/^ell in! oriived sttideivt
becomes a competent ivurse.
New 3rd Edition!
NUTRITION AND DIET THERAPY
Continuing to provide a person-centered approach to
nutrition, the new 3rd edition of this widely acclaimed
text emphasizes the role of nutrition in public health, the
basic health care specialties, and the clinical manage-
ment of disease. Discussions cover social science prob-
lems and human needs as well as scientific principles
and clinical applications. This new edition features new
and revised tables; a new section on behavioral ap-
proaches to weight control; a new section on P.O.M.R.
for weight control; and expanded material on minerals
in the body. The author challenges some old ideas and
ritualistic practices, including food faddism, and pre-
sents only the most current clinical methods of care.
Students will find details on care for many specific
disorders along with helpful study aids — diagrams,
summary glossaries, cross-references, and questions and
outlines.
By Sue Rodwell Williams, M.P.H., M.R.Ed., Chief, Nutrition Pro-
gram, Kaiser-Permanente Medical Center, Oakland, California;
Instructor, Human Nutrition, Chat)ot College, Hayward, Califor-
nia; Field Faculty, M. P. H.— Dietetic Internship Program and
Coordinated Undergraduate Program in Dietetics, Uni-.ersityof
California, Berkeley, Calif. March, 1977. 3rd edition, approx. 720
pages, 7" x 10", 134 illustrations, including original drawings
by George Strauss. Atxjut $13.40.
New 3rd Edition! NUTRITION AND DIET THERAPY:
A Learning Guide for Students. By Sue Rodwell
Williams, M.P.H., M.R.Ed. March, 1977. Approx. 196
pages, 7 1/4" x 10 1/2", 1 illustration. About $7.10.
Rely on new
Mosby texts to
supplement your
instruction
on vauious facets
of effective patient
cau'e.
MOSBV
TIMES MinnoR
New 8th Edition!
PRINCIPLES OF MICROBIOLOGY
Thoroughly updated and revised, the new edition of this
popular text continues to offer comprehensive coverage
of the basic principles of microbiology. Authoritative
and well-written discussions explore: essential con-
cepts, procedures for study, production of infection;
preclusion of disease; pathogens and parasites; and
public welfare. Students will especially appreciate the
clear presentation of laboratory methods, rules for
specimen collection, and review exercises. This new edi-
tion features a revised section on cancer; and expanded
sections on tuberculosis, hepatitis, antibiotics, and
allergies. Other highlights include the newest
procedures for cellular immunity, the most recent in-
formation on purification of sewage, and revision of the
tables on immunization requirements. Thirty-four new
illustrations and eleven new tables have been added.
By Alice Lorraine Smith, A.B., M.D., F.C.A.P., F.A.C.P., Pro-
fessor of Pathology, The University of Texas Health Science
Center at Dallas, Texas; formerly Assistant Professor of Mi-
crobiology, Department of Nursing, Dominican College and St.
Joseph's Hospital, Houston, Texas. April, 1977. 8th edition, ap-
prox. 736 pages, 7" x 10", 341 illustrations. At)Out $15.70.
New 4th Edition! MICROBIOLOGY LABORATORY
MANUAL AND WORKBOOK. By Alice Lorraine
Smith, A.B., M.D., F.C.A.P., F.A.C.P. April, 1977.
Approx. 192 pages, 7 1/2" x 10 1/2", 46 illustrations.
About $7.25.
The Canadian Nurse February 1977
Calenclar
March
Call for Research Papers for
Workshop on Research
Methodology in Nursing Care to be
held in Ottawa, Ontario, on 9, 10, 11
November 1977. Workshop theme:
Management of methodological
problems encountered in research in
nursing care. Attendance by invitation.
Papers which describe methodo-
logical problems encountered are
invited from nurses conducting
research in nursing care. Initial
inquiries regarding preparation of
papers accepted until 15 f\/larch 1977;
completed submissions must be
postmarked not later than 20 April
1977. For information contact: Marion
Ken, Research Officer, The Canadian
Nurses Association, 50 The Driveway,
Ottawa. Ontario, K2P 1E2.
Writing Workshop for Nurses to be
held in Toronto on March 3-4, 1977.
Fee: $50. Contact: Dorothy Brool<s,
Chairman, Continuing Education
Programme, Faculty of Nursing, 50
St. George Street, Toronto, Ontario,
M5S lAI.
The Nurse Practitioners'
Association of Ontario Annual
Workshop to be held at the
Sunnybrook Medical Centre, Toronto
on March 10 and at McMaster
University, Hamilton on March 11,
1 977. For information contact: fJlegan
t^cCullough, 32 Chelvin Drive,
Georgetown, Ontario L7G 4P9.
Budgeting for the Head Nurse and
Coordinator to be held March 14,
1977 in Calgary. Fee: $20. Contact:
The Division of Continuing Education,
University of Calgary, Calgary,
Alberta, T2N 1N4.
Nursing Assessment: Keystone to
Care Planning to be held March
23-25 , 1977 in Calgary, Alberta. Fee:
$51 . For information contact: The
Division of Continuing Education,
University of Calgary, Calgary,
Alberta, T2N 1N4.
Annual Meeting of the Canadian
Nurses Association, 31 March 1977,
Ottawa. Contact: The Canadian
Nurses Association, 50 The Driveway,
Ottawa, Ont, K2P 1E2.
April
Registered Nurses Association of
Ontario Annual Convention to be
held at the Royal York Hotel in
Toronto, on April 28-30, 1977. For
information contact: RNAO, 33 Price
St., Toronto, Ontario, M4W IZ2.
Interviewing for Nurses to be held
April 4-6, 1977 in Lethbridge, Alberta.
Fee: $55. Contact: Division of
Continuing Education, University of
Calgary, Calgary, Alberta, T2N 1N4.
Leadership In Nursing, to be held
April 13-15, 1977 in Lethbridge,
Alberta. Fee:$55. Contact: D/ws/on of
Continuing Education, University of
Calgary, Calgary, Alberta, T2N 1N4.
Symposium on Coping with Cancer
to be held at the Royal York Hotel,
Toronto, Ontario on April 24-26, 1 977.
Topics to be discussed include:
cancer prevention, screening for
cancer, helping the newly diagnosed
patient, palliative care and other
related topics. Contact your provincial
nurses' association for details and
registration forms.
The Director of Nursing and Clinical
Nursing Research, to be held in
Toronto on April 21-22, 1977. Fee:
$50. Contact: Dorothy Brooks,
Chairman, Continuing Education
Programme, Faculty of Nursing, 50
St. George Street, Toronto, Ontario,
M5S lAI.
May
Twenty-Second Annual
Convention of the American
College of Nurse-Mldwives to be
held May 2-4, 1 977 at New York City's
Statler Hilton Hotel. For information
contact: American College of Nurse
Midwives, 100 Vermont Avenue,
N.W., Suite 1210, Washington, D.C.
Cardiology '77 — Fourth Annual
Seminar on Advanced Intensive
Cardiac Care to be held on May
16-18, 1977 at the Par1< Plaza Hotel,
Toronto, Ontario. For information,
contact: Conference and Seminar
Services, Number College of Applied
Arts and Technology, Box 1900,
Rexdale, Ontario tJI9W 5L7.
Eleventh Annual Symposium on
Intrauterine Development and Fetal
Management to be held on May 5-7,
1 977 at the Cross Keys Inn, Baltimore,
Maryland. For information, write: Dr.
John W.C. Johnson, Dept. of
Gynecology and Obstetrics, The
Johns Hopkins Hospital, Baltimore,
Maryland 21205.
Alberta Association of Registered
Nurses Annual Convention to be
held on May 3-6, 1977 in Calgary,
Alberta. For further'information
contact: Alberta Association of
Registered Nurses, 10256 — 112th
St., Edmonton, Alberta, T5K 1M6.
Manitoba Association of
Registered Nurses Annual Meeting
will be held at the University of
Brandon, Brandon, Manitoba on May
15-17, 1977. The theme of the
meeting will be related to "Standards."
For information, contact: Manitoba
Association of Registered Nurses,
647 Broadway, Winnipeg, Manitoba,
R3C 0X2.
Registered Nurses Association of
British Columbia Annual Meeting to
be held on May 11-13, 1 977 at the
University of British Columbia in
Vancouver. For information contact:
RNABC, 2130 West 12th Ave..
Vancouver, B.C., V6K 2N3.
Saskatchewan Registered Nurses
Association — Sixtieth Annual
Meeting to be held at the Hotel
Saskatchewan, Regina,
Saskatchewan on May 11-13,1977.
For information contact:
Saskatchewan Registered Nurses
Association, 2066 Retallack Street,
Regina, Saskatchewan, S4T 2K2.
New Brunswick Association of
Registered Nurses Annual Meeting
to be held May 31 , June 1 -2, 1 977 at
Campbellton, New Brunswick. For
information contact: New Brunswick
Association of Registered Nurses,
231 Saunders Street, Fredericton,
N.B., E3B 1N6.
Cancer Nursing Update - 1977.
Progress, Problems and Prospects
to be held in St. Louis, Missouri on
May 9-10, 1977. For information,
contact: Sidney L. Arje, M.D., The
American Cancer Society, 777 Third
Avenue,- New York, 10017.
June
Registered Nurses Association of
Nova Scotia Sixty-Eighth Annual
Meeting to be held at the Isle Royale
Hotel, Sydney, Cape Breton, on June
23-24, 1977. Theme: Crisis in Care.
For information contact: Frances M.
Moss, 6035 Coburg Road, Halifax,
N.S. B3H 1Y8.
Fifth Canadian Regional
Conference of the International
Childbirth Education Association
sponsored by the Edmonton
Childbirth Education Association on
June 28-30, 1977. Theme: Nurturing
the Family. Participants include
Ashley Montagu. For further
information contact: Mrs. Pat Walker,
Information Officer, ECEA, 15 Glacier
Crescent, Sherwood Park, Alberta,
T8A 2YI.
8th Annual Meeting of the Canadian
Association of Neurological and
Neurosurgical Nurses to be held at
the Loews Concorde Hotel in Quebec
City on June 14-16, 1977. Contact:
Ms. Beth Cook, 59 Warren Road,
Toronto, Ontario. M4V 2R9.
Annual Meeting of the Canadian
Society of Allergy and Clinical
Immunology to be held in Hamilton,
Ontario on June 16-18, 1977. For
information contact: Executive
Secretary, Canadian Society of
Allergy and Clinical Immunology,
1390 Sherbrooke Street West,
Montreal, Quebec.
1977 Annual Canadian
Physiotherapy Congress to be held
on June 1 0-20, 1 977 at the Edmonton
Plaza Hotel, Edmonton, Alberta. For
information, write: Yvette D. Claveau,
Publicity Chairman, 1977 C.P.A.
Congress, 5507— 115th Street,
Edmonton, Alberta T6H 3P4.
Multi-Disciplinary Burn
Management Seminar to be held at
the Misericordia Hospital in
Edmonton, Alberta on June 19-20,
1977. For further information contact:
Mr. Ken Mark, Director, Rehabilitation
Medicine, Misericordia Hospital,
16940 — 87th Avenue, Edmonton,
Alberta T5R 4H5.
MOSBV
TIMES rviinnon
CRITICAL CARE
2nd Edition! DECISION MAKING IN THE COR-
ONARY CARE UNIT. By William P. Hamilton, M.D.
and Mary Ann Lavin, R.N., M.S.N. , M.S.(H.S.A.)
This important 2nd edition can help you prepare stu-
dents to make necessary decisions in the CCU. General
principles and practical techniques for care of patients
with cardiac pain, irregular pulse, and low blood pres-
sure are carefully described. Actual coronary care situa-
tions illustrate each problem — providing relevant
clinical experience. A new chapter discusses patient
education. 1976, 168 pp., 126 illus. Price, $7.10.
2nd Edition! A COMMONSENSE APPROACH TO
CORONARY CARE: A Program. By Marielle Ortiz
Vinsant, R.N.. B.S.; Martha I. Spence, R.N., B.S.,
M.N.: and Dianne Chapell Hagen, R.N., B.S. This pro-
grammed book reviews all major problems associated
with acute myocardial infarction. New material
discusses hemodynamic monitoring and drug therapy
for shock and heart failure. 1975, 244 pp., 439 illus.
Price, $8.35.
New 2nd Edition! HIGH RISK NEWBORN INFANTS:
The Basis for Intensive Nursing Care. By Sheldon B.
Korones, M.D. This important new edition can inform
your students of the most up-to-date advances in peri-
natal medicine and nursing care of the high-risk infant.
Explaining the "why's" behind many specific proce-
dures, Dr. Korones emphasizes an understanding of
intrauterine antecedents. A new chapter on thermo-
regulation adds to the value of the revision. June, 1976.
280 pp., 113 illus. Price, $11.50.
AlATERNAUCHILD
A New Book! PEDIATRIC NEUROLOGIC NURSING.
By Barbara Lang Conway, R.N., M.N. This new text
can alert students to the signs of pediatric neurologic ab-
normalities. It first presents a clear account of
neurologic physiology; then offers informative discus-
sions on normal neurologic development; and assess-
ment techniques for testing children with learning disa-
bilities, emotional disturbances, and hyperkinesis. Feb-
ruary, 1977. Approx. 416 pp., 102 illus. About $15.25.
A New Book! MATERNAL-INFANT BONDING: The
Impact of Early Separation or Loss on Family Develop-
ment. By Marshall H. Klaus, M.D. and John H.
Kennell, M.D. ; with 3 contributors and 8 critical com-
mentators. This timely book focuses on the earliest
physical and sensory relationship a baby develops with
his parents; the factors that enhance or inhibit this proc-
ess; and the effects of this relationship on the growth of
the family. August, 1976. 275 pp., 49 illus. Price, $9.40
(H);$6.60 (P).
M05BY
TIMES Minnon
2nd Edition! THE PEDIATRIC NURSE PRACTITION-
ER: Guidelines for Practice. By Fernando ]. deCastro,
M.D., M.P.H., F.A.A.P., F.A.P.H.A.; Ursula T.
Rolfe, M.D., F.A.A.P.,: and Janice Ko cur Drew, R.N.,
B.S., P.N. P.; with 3 contributors. Provide your stu-
dents with a current guide to ambulatory pediatrics with
the help of this text. Discussions examine the entire pro-
cess of assessment and treatment, including many speci-
fic clinical problems. Some of the new material covers
hematology, neonatology, parasitology, and school
health. 1976, 220 pp., 8 illus. Price, $6.85.
A New Book! ASSESSMENT AND MANAGEMENT
OF DEVELOPMENTAL CHANGES IN CHILDREN.
By Marcene L. Erickson, R.N., B.S.N. , M.N. This well
illustrated new book provides a systematic approach to
developmental screening and assessment of infants and
pre-school children. It carefully shows how to use many
specific assessment tools and how to plan the manage-
ment of behavioral problems caused by developmental
changes. July, 1976. 280 pp., 161 illus. Price, $8.95.
New 2nd Edition! FAMILY PLANNING EDUCATION.
By Charles William Hubbard. M.P.H., M.A. The new
2nd edition of this popular book offers a concise presen-
tation of four areas of sexuality: contraception, abor-
tion, sterilization and venereal disease. It features a new-
chapter on psychosocial aspects of birth control and
new information on risk factors of various contracep-
tive methods, counseling, and the "new" venereal
diseases. January, 1977. 258 pp., 47 illus. Price $6.25.
The Canadian Nurse February 1977
A^ews
Drug ad watchdog
assumes
responsibility
Canada has become one of the first
countries in the western world to
introduce a preclearance program for
pharmaceutical advertising directed
towards the health professions. The
newly created Pharmaceutical
Advertising Advisory Board (PAAB)
which will coordinate the prog ram was
federally incorporated as a non-profit
organization in January 1976. The
Board brings together representatives
from the health professions of
medicine and pharmacy, the
Association of Medical Media, the
Canadian Advertising Advisory Board,
the Consumers Association of
Canada and the pharmaceutical
industry. The Board's functions will
include the preclearance of
advertising of pharmaceuticals, the
establishment of criteria for the
approval of proposed advertising and
the administration of program policy.
The permanent Chairman of the
advertising preclearance program is
Dr. I.W.D. Henderson FRCS(C). Dr.
Henderson is a Fellow of the Royal
College of Surgeons (Canada) and a
widely-known specialist in clinical
pharmacology in Canada. He is
presently chairman of Clinical
Research and also of the Pharmacy
and Therapeutics Committee at the
Ottawa General Hospital, and
associate professor in the Department
of Surgery and Pharmacology at the
Faculty of Medicine, University of
Ottawa. He also serves as a
consultant to the Health Protection
Branch of Health and Welfare Canada
and is a member of the Advisory
Committee on Proprietary and Patent
Medicines. Dr. Henderson is current
chairman of the Canadian Medical
Association Sub-Committee on
Pharmacotherapy, and represents
both CMA and L'Association des
m6decins de langue frangaise du
Canada on the Steering Committee
for the proposed Canadian Drug
Formulary Service.
He replaces Ley Smith, president
of The Upjohn Company of Canada
who served as interim chairman
during the formative stages of the
Board and guided the development of
the advertising preclearance program.
A.V. Raison assumes the position
of Commissioner of Pharmaceutical
Advertising. He will be responsible for
the review of submitted advertising
according to a Code of Advertising
Acceptance established by the Board.
A panel of recognized experts from the
health disciplines across Canada will
advise the Commissioner on technical
questions and artDitrate in cases of
differing opinion. Raison takes on this
position following over 15 years as
editor for the periodicals of the
Canadian Pharmaceutical
Association.
The program, which became
effective in January 1977, will initially
apply only to prescription drug
advertising, the bulk of which appears
in tradejournals. Eventually the PAAB
hopes to extend its jurisdiction to
over-the-counter drug advertising
which comprises approximately 25
percent of drug advertising in journals.
Since the Canadian Advertising
Advisory Board along with the Health
Protection Branch of Health and
Welfare Canada reviews the
advertising of over-the-counter
proprietary medicines, the PAAB will
not become involved in drug
advertising that is directed to the
public via radio, television or popular
magazines. Its prime aim is to "ensure
that the content of prescription drug
advertising to the health professions
continues to serve the ultimate
interests of the patient."
Since the program is not
mandatory, its success hinges jointly
on the cooperation of pharmaceutical
manufacturers to submit proposed
advertising copy to the Commissioner
for approval and upon the trade and
professional media to accept only
approved advertisements. The final
responsibility for publication rests with
the media. The cooperation of the
health professions and other
advertisers in referring enquiries and
complaints to the Commissioner is
also vital.
Initial funding of the program was
provided by the pharmaceutical
industry, the professions of medicine
and pharmacy and the trade and
professional media. Preclearance
fees for full disclosure, reminder and
institutional advertisements will be
charged to advertisers to finance the
continuing operation of the program.
Implementation of the program
will commence with the preclearance
of an estimated 300 to 400 new journal
advertisements in both languages,
annually. After several months, other
forms of communication will be
phased in. Preclearance will require a
maximum of 30 days.
Better qualified
personnel
would benefit aged
The quality of life for the aged, in
institutions and in the home, could be
improved if those who care for them
were properly prepared, according to
the Nova Scotia Association of
Registered Nurses. "The practice of
permitting personal care workers to
perform beyond their preparation is
unsafe for the aged and represents a
legal hazard for both employer and
employee."
The warning is contained in a
position paper "Personnel Required to
Meet the Needs of the Aged," issued
by the Registered Nurses Association
of Nova Scotia as part of a continuing
program to improve care of the aged In
that province.
The paper, prepared by a special
committee appointed by the RNANS
Executive, observes that, if aged
persons have health problems which
necessitate nursing care, whether in
their own home, or in an institution,
this care should be given by registerec
nurses or certified nursing assistants
While recognizing that there are many
needs of the aged wh ich can be met b^
homemakers and/or personal care
workers, the RNANS is concerned
about the varying quality of courses t(
prepare this type of personnel and th(
proliferation of uncoordinated trainim
programs.
As a result of these concerns, th<
Registered Nurses Association
believes that there is a need for the
appointment of an individual or a
group to study the need for
homemaker servicesfor the aged, ani
that there should be collaboration witl-
existing serv/ices to develop a
coordinated plan, organized on a
regional basis, with regional directors
Guidelines for Homemakers for
the Aged and for Personal Care
Workers, are included with the
Position Paper.
Did you know...
• 40% Of Canadian men and 47'
of Canadian women have fitness
levels classified as fair or low.
• Canadian women, with teenage:
and 20-29 year olds rated the lowes
are less fit than men.
• Cardiovascular fitness declines
steadily from the age of 8, stabilizini
at a very low level, only in late
adolescence.
• Over half of the adult Canadiar
population is overweight, and those
who are fat eat the same number c
calories as those of normal weight.
• 40% of Canadians watch more
than 15 hours of TV every week.
• Only 20% of Canadians engag
in some form of physical activity sue
as walking for pleasure, jogging,
hiking or other exercise.
• Canada's medical care bill
increasedfrom 2 billion dollars in 19f
to more than 7 billion dollars now —
rise of some 14% per year.
MOSBY
TIMES ivimnon
Mosby texts supplemeivt your instructioiv
on vairious facets of effective patient caire.
PHARMACOLOGY
New 6th Edition! BASIC PHARMACOLOGY FOR
NURSES. By ]essie E. Squire, R.N., B.A., M.Ed, and
Jean M. Welch, R.N., A.B., M.A., B.S.N.ed. Updated
to include the most current drug data available, this
vocational nursing text presents basic information on
drug administration, source, purpose, route, side effects
and contraindications. New information includes in-
travenous therapy, physiology, techniques and nursing
responsibilities. April, 1977. Approx. 360 pp., 58 illus.
About $7.30.
A New Book! CALCULATING DRUG DOSAGES: A
Workbook. B\/ Ruth K. Radcliff, R.N., M.S. and Sheila
]. Ogden, R.N., B.S. This new workbook can help stu-
dents learn the necessary math to safely and accurately
calculate drug dosages. After a pretest to determine each
student's needs, the text discusses general mathematics
and all the essentials required for dosage calculation.
January, 1977. Approx. 224 pp. About $8.35.
13th Edition. PHARMACOLOGY IN NURSING. By
Betty S. Bergersen, R.N., M.S., Ed.D.; in consultation
with Andres Goth, M.D. Written by a nurse for nurses,
this leading text outlines current concepts of pharma-
cology in relation to clinical patient care. It features
comprehensive, well-organized discussions on drug ac-
tion, indications, side effects, toxicity, and safe thera-
peutic dosage range. Two new chapters explain antimi-
crobial agents and drug effects on sexuality and fetal
development. 1976, 766 pp., 100 illus. Price, $14.20.
A New Book! HANDBOOK OF PRACTICAL PHAR-
MACOLOGY. By Sheila A. Ryan, R.N., M.S.N, and
Bruce D. Clayton, B.S., Pharm.D. This practical hand-
book conveniently summarizes dosage, action, usage,
possible side effects and interactions of more than 80
commonly used single-entity drugs. Categorized
according to their primary action, drugs are arranged
alphabetically by generic name within each chapter, and
indexed at the end of the book. January, 1977. 252 pp.,
2 illus. Price, $7.30.
2nd Edition! THE COMPOSITION AND FUNCTION
OF BODY FLUIDS. By Shirley R. Burke, B.S.N. ,
M.S. N.Ed. This new edition can provide students with a
sound understanding of general principles of body
fluids. Examining the relationship of body fluids to
health and the consequences of typical defects in the
regulatory system, the text carefully explains cell func-
tion, extracellular fluid, fluid balance, and acid-base
balance. A new chapter on blood clotting adds to the
value of this revision. 1976. 128 pp., 21 illus. Price,
$5.25.
New 2nd Edition! BODY FLUIDS AND ELECTRO-
LYTES: A Programmed Presentation. By Norma Jean
Weldy, R.N., B.S., M.S. Using a step-by-step ap-
proach, this practical self- teaching manual presents
basic principles of normal body fluids and electrolytes,
common abnormalities, and clinical applications. The
section on "Electrolyte Imbalance" has been con-
siderably revised with new material on potassium im-
balance and new, updated questions. Summaries and
review questions conclude each chapter. March, 1976.
130 pp., 24 illus. Price, $5.80.
A New Book! NURSE-CLIENT INTERACTION: Im-
plementing the Nursing Process. By Sandra J. Sundeen,
R.N., M.S. ; Can Wiscarz Stuart, R.N.. M.S.; Elizabeth
DeSalvo Rankin, R.N., M.S.; and Sylvia Parrino
Cohen, R.N., M.S. Emphasizing the importance of in-
terpersonal communication, this unique text presents
psychodynamic and sociological principles relevant to
the nursing process— the emergence of the self, the help-
ing relationship, stress, etc. April, 1976. 214 pp., 38 il-
lus. Price, $7.90.
FUNDAMENTALS
TIMES Minraon
The Canadian Nurse February 1977
\e\\H
Nurse to direct Information Centre
at Hospital for Sick Children
A plan now in the finalization stage for
a Medical Information Centre for the
Hospital for Sick Children in Toronto is
a comprehensive attempt to answer
many common public and in-hospital
needs. The new department will
provide services in an organized way,
services including triage, poison
information, channels for medical
consultation, public advisory
information, and family physician
feedback.
Gail Funger, an experienced
nursing instructor in the Emergency
department at HSC, will direct the
Medical Information Centre in these
functions. She explains that most of
these needs have been met in the past
in a haphazard way, that people
requiring information quickly had to
make many calls or visit many
departments before reaching the
appropriate source of help. She also
explains specifically what the services
offered by the new department will
mean to those that require them:
• Triage — Triage is defined as
sorting out or setting priorities, and
refers to the placement of patients
an-iving at the Medical Information
Centre without an appointment. The
patient will see an experienced nurse
at the centre, who will judge whether
he should be seen in emergency or in
one of the out-patient clinics. The
patient and his parents can receive the
attention and support of the nurse, and
the delay and anxiety inherent in
wandering from one department to
another is avoided. The nurse s
decision regarding placement will be
final. No patient she directs to
emergency will be rerouted back to
out-patients, causing delay and
anxiety for the patient and his parents.
• Poison Information —
Establishment of the Medical
Information Centre at HSC will allow
calls for poison information to be
referred directly to specially trained
nurses (with a medical backup
consultant) who are prepared to
handle difficult calls. HSC has
Canada's largest poison information
center. The establishment of the
Medical information Centre will make
related information more directly
available, and will free emergency
• Medical Consulting Services —
Community doctors requiring
specialty consults will be able to call
the Medical Information Centre. The
nurses there will tie knowledgable in
fielding such calls to the appropriate
HSC consultant.
• Public Advisory Service —
Many calls to the emergency
department at HSC are from
concerned parents who want to know
from a reliable source how to care for
their sick child. Nurses at the centre
will be able to answer public enquiries
or to refer the callers directly to a
qualified person, avoiding an
unnecessary and anxiety-provoking
delay for the parent in receiving
information. This service will also
relieve some of the pressure on the
emergency department and ensure
follow-up of the patient and parents.
• Family Physician Feedback —
Staff in the Centre will ensure that
contact is made with a patient's family
physician if he is admitted to HSC from
the emergency department.
The Medical Information Centre
is expected to open this Spring, and
will be located just inside the Gerrard
Emergency Entrance.
UNB announces
changes
in nursing program
The University of New Brunswick has
announced curriculum changes in its
three-year baccalaureate program for
nursing students. The changes
according to Carolyn Pepler,
associate professor of nursing and
curriculum chairman for the faculty of
nursing, are in line with evolving
circumstances of modem health care.
"The first change is an emphasis on
promoting health as opposed to
treating illness", she said. Education
in the health sciences traditionally
centered on the study of symptoms
and treatment of known diseases. The
new curriculum stresses the nurse's
role in promoting healthy lifestyles and
preventing illness, she pointed out.
The second alteration in the
curriculum Is a switch from the study of
nursing as it relates to locale and/or
medical specialty to a focus on the
nursing functions in any setting. This
means that instead of talking about
surgical nursing, public health nursing
or psychiatric nursing, they will talk
more about the nurse's work of
comforting, preventing trauma,
providing therapy, counselling, and so
forth, says Prof. Pepler.
The third modification is an
increased emphasis on the
problem-solving approach to nursing
and learning. Since the modem nurse
deals more with complex situations
than clearly -defined diseases and
cures, she will have to be flexible and
innovative in her approach.
During their firstyearthe students
will be looking at themselves and
those around them to develop their
skills in observation and data
collection. They will attempt to modify
their own health habits and will be
studying the theory of change in that
context.
In their interactions with patients,
the first year students will concentrate
on the comforting and protecting
functions of the nurse, under the new
program.
The new curriculum will be
expanded year by year as this year's
freshmen move through their
program. Prof. Pepler pointed out that
though they will not participate in the
complete new program, the current
upper classes in the nursing faculty
are being exposed to many of the
underlying concepts and some of the
classwork.
In the second year the students
will expand their nursing to include the
therapeutic role and the role of the
health teacher, and will begin to give
attention to the patient's family, she
said.
The third year program, building
on a coursewori< foundation, will
involve the students in more teaching
and counselling.
In their final year, the nursing
students will develop the role of the
nurse as collaborator and advocate.
The collaborative situation is one in
which the nurse may have the primary
contact with the patient, and wori<s
with doctors, other health agencies
and with social agencies for the
patient's care and welfare.
Health happenings
More than 1 00 babies with congenital
malformations are born each year in
Canada as a result of their mothers
developing rubella during the first
three months of pregnancy.
Despite the availability of
effective vaccines, infectious
diseases are still among the four
leading causes of hospitalization
among children. 'Parents tend to think
that communicable diseases are a
thing of the past and neglect to
immunize their children, " according to
child health consultant, Shirley Post in
an article in the December issue of
Canadian Consumer. Dr. Post points
out that Canadian children spent a
total of almost 500,000 days in
hospital in 1971 (latest available
figures) as a result of infectious
diseases. See also, "Communicable
Diseases and Immunization" by L.
Cranston, The Canadian Nurse,
January, 1976.
A paper entitled "Living with the dying:
use of the technique of participant
observation," published in the Dec.
18, 1976 issue of the Canadian
Medical Association Journal makes
interesting reading for nurses as well
as members of the medical
profession. One interesting sidelight is
the observation of the effects of
hospitalization on a well 31 -year-old
man.
M., a medical anthropologist,
conducted a study to observe the kind
of care given to patients in the
Palliative Care Unit of the Royal
Victoria Hospital in Montreal. As a
pseudopatient in the Palliative Care
Unit, he was surprised to find that he
began to experience symptoms of
illness. The study reports, "Once on
the unit, he identified closely with
these sick people and became weaker
and more exhausted. He was anorexic
and routinely refused to take a
shower. He sat exhausted in a chair.
He experienced increasing pain, a
constant ache in his left leg together
with numbness and restless nights
during which family members of other
patients commented sympathetically
on his 'moaning and groaning.' M.
himself was not aware of this
nocturnal behavior."
11
ry^'^ft »/^ ^r,^
MOSBY
TIMES MIRROn
3rd Edition! CREATIVE TEACHING IN CLINICAL
NURSING. By Jean E. Schweer, R.N., B.S., M.S. and
Kristine M. Gebbie, R.N., M.N. This exciting text ex-
plores the concept of creativity as an integral part of
clinical nursing education. Focusing on the latest
developments in the field, the book examines a wide
variety of teaching .pproaches, technological advances,
and educational communication media. 1976, 224 pp., 3
illus. Price, $8.35.
New 2nd Edition! ELEMENTS OF RESEARCH IN
NURSING. By Eleanor W. Treece, R.N., B.A.. M.Ed.,
Ph.D. and James W. Treece, Jr., B.R.E., B.A.. M.A.
The 2nd edition of this successful text discusses every
step of the research process in clear, non-technical
language. This revision features updated examples; and
new discussions on systems analysis, critiquing, opera-
tional definitions, in addition to other pertinent
material. January, 1977. Approx. 352 pp., 66 illus.
Price, $8.35.
ADMINISTRATION
& EDUCATION
POLITICAL DYNAMICS: Impact on Nurses and Nurs-
ing. By Grace L. Deloughery, R.N., Ph.D. and Kristine
M. Gebbie, R.N., M.N. This stimulating text presents a
general overview of the political process, and examines
specific health care legislation programs and proposals.
The authors show nurses how to become a force that
can influence legislation and how to have an equal share
in health care decisions. 1975, 246 pp. Price, $11.30.
THE PROBLEM-ORIENTED SYSTEM IN NURSING:
A Workbook. By Beth C. Vaughan-Wrobel, R.N.. M.S.
and Betty Henderson, R.N., M.N. This first-of -its-kind
workbook presents the problem-oriented system as a
theoretical and practical basis for comprehensive health
care management. The authors provide simple, effective
guidelines to help nurses collect data, identify patient
problems, develop plans for nursing care, and evaluate
progress. 1976, 164 pp., 19 illus. Price, $6.85.
PSYCHIATRIC NURSING
A New Book! REVIEW OF PSYCHIATRIC NURSING.
By Donna Conant Aguilera, R.N., Ph.D., F.A.A.N.
This informative text provides an overview of current
concepts and practices in mental health nursing. Con-
cisely written essays cover such topics as: ego function
and mental status examination; psychiatric emergen-
cies; maladaptive behavior; and crisis intervention.
January, 1977. 172 pp. Price, $5.80.
<
TIMES MIRROR
THE C. V. MOSBY COMPANY, LTD.
86 NORTHLINE ROAD
TORONTO. ONTARIO
M4B 3E5
The Canadian Nurse February 1977
Metamucil
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Available as Metamucil Powder and
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ursing education may be just waking up to the fact that we live in
n electronic age where students need to become involved in their
ducation. Children raised on the instantaneous communication
f television become adults who demand the experience of film
Bther than being the passive recipients of printed or spoken
words. The Nursing Education Media Project is Ontario's answer
to the need to develop greater familiarity with audiovisual aids for
use in nursing education. Films such as "Don't Cry for David"
attest to the fact that, although still in its infancy, the organization
is gaining in confidence and creativity ...
Idea Etvchaiige
1
Education in the Electronic Age
Manuel Escott
he Nursing Education Media Project (NEMP)
5 a unique project to educate Ontario nursing
Bachers in the use of audiovisual techniques
ind to produce and distribute audiovisual
naterial. As such, it has attracted the interest
)f nursing agencies throughout Canada and
he United States. The product of a decade in
vhich visual teaching has become as
mportant as the book or the lecture, NEMP
equires the highest degree of co-operation
rom its participants: Ontario's 22 community
idleges, the Registered Nurses Association
)f Ontario, the College of Nurses, and the
Ontario Educational Communications
\uthority (OECA), the the province's
jward-winning public broadcasting sen/ice.
^yerson Polytechnical Institute in Toronto,
and the University Nursing Programs are
ictive observers.
NEMP costs between 545,000 and
f 550,000 a year to operate. The money comes
..rom the agencies taking part.
Until afew years ago, the creation of such
a project would have been difficult. Only a
nandful of nursing schools, mainly in the
Digger cities and towns, had access to
audiovisual equipment. Nor was there any
Dverall program of instruction in its use. All of
that changed when the schools were absorbed
into the community college system, each of
which had a media resource center.
Community college officials and health
science experts assessed the situation and
foresaw the danger of wasteful duplication in
increased audiovisual production. They also
realized that there was a lack of production
expertise and that material covering many
critical subjects such as obstetrical and
neuropsychiatric nursing was frequently
inappropriate and/or out-of-date.
Initially, a series of exploratory meetings
were held to determine the feasibility of the
media project and map out its structure.
Marilynne Seguin, a health science media
consultant and former nursing teacher,
travelled throughout Ontario for six months,
talking to college officials about priorities and
available facilities and personnel. The result
was the creation of NEMP, a multi-faceted
cooperative with Ron Keast, of OECAs Media
Division, as chairman.
NEMP has four basic objectives:
• to identify teaching-learning resources for
nursing education;
• to produce and distribute instructional
packages of audiovisual material;
• to educate nursing teachers in the use of
audiovisual techniques — videotape, 16 mm
film slides, editing, production:
• to distribute quality work done by one
NEMP member to all other members.
Of equal importance is the ongoing
evaluation of materials for college use and the
identification of subjects for new productions
and agencies that can assist NEMP.
NEMP holds seminars and workshops
throughout the province of Ontario. These are
designed to use the know-how and facilities of
OECA and the college and university resource
staffs, plus guest authorities in many fields, in
teaching nursing educators about AV
techniques. For example, workshop delegates
discuss, design and produce learning
packages to be evaluated in the final phase of
the workshop. Any faculty with a
communications problem — whether visual or
print — can call in a member of the project
resource team to help.
Although still very much in its infancy,
NEMP appears to be gaining in confidence
and creativity. Its agencies have produced
dozens of works on a wide range of topics,
from "Care of a patient in a Stryker Frame" to
"Oral Medication." All productions —
videotapes or slide tapes with written material
— are distributed to colleges through OECA.
The project's most ambitious effort to date
is "Grieving Due to Loss of Body Image: Don't
Cry for David, " a two-part videotape on the
rehabilitation of a young athlete whose leg is
amputated. The tape is accompanied by two
learning activity packages that include print
material, slides and audiotapes.
Eight pilots, the first of a series of over 20
presentations on ethics, and a series on law,
are in the planning stage. According to
Marilynne Seguin, both the law and the ethics
series are in response to a demand by nursing
faculties. The productions are designed to
illustrate problems rather than to answer all
questions. Seguin says that the problems find
resolution through discussions following the
production.
Another major production — "Charge:
Incompetence, a Mock Hearing of the
Discipline Committee of the College of Nurses
of Ontario" is a 68-minute videotape produced
at McMaster University in Hamilton, Ontario. It
enacts a disciplinary hearing based on an
actual case.
"This production should be of major
educational value," says Seguin. 'Lawyers tell
us that nurses tend to treat complaints against
them lightly and sometimes don't even bother
to respond to complaint notifications. Then, of
course, they're shocked to find that their right
to practice is jeopardized. Often, they have a
very plausible explanation for their actions but
have not fully communicated these factors. "
The ethics series attempts to define a
highly controversial area where a nurse's
personal morality can conflict with the law or
other authority. What patient information, for
example, should remain confidential? What is
the nature of a nurse's responsibility to herself,
her patient and the health team on which she
works? Under which circumstances can she
refuse to give treatment? The series will also
deal with many other issues, including
euthanasia, abortion, truth and lying, and
organ transplants.
How effective has NEMP been thus far?
"It has a great potential, but it's a little too early
to assess it fully " says Fred Habermehl, the
Health Sciences Director of Niagara College,
Welland. 'Some of the first productions were
too long, but this is changing."
"The law and ethics series will have a major
impact when they're distributed. Nursing
faculties find it difficult to get a handle on these
subjects. The films should give us specific
illustrations of the problems encountered."
'What we can say are effective, are the
seminars and wori<shops. These are
invaluable in teaching faculties how to use
visual media properly."
Manuel Escott has been a journalist for the
last 24 years. A feature writer for the Toronto
Star for seven years, and foreign
correspondent with Reuters in the Middle
East and West Africa, Escott has been a
freelance writer since 1972.
■w
^i^C^TadiaT^
urse Feoruary 1977
Recent emphasis on family-centered maternity care is a step in the direction
of recognizing the father's role in childbirth. Because he has been neglected
for so long little is known about his feelings during the experience. This
review of a study of husbands' perceptions of labor and delivery, and their
reactions to nursing care draws important implications for the prenatal
preparation of couples and for their care within the hospital.
The
father's
side
Linda Leonard
Since the advent of modem health care the
husband-father has received little attention
during the childbirth phase of the life cycle.
Although he "plants the seed" and shares
many experiences with the expectant mother
during pregnancy, until recently he has been
excluded from the event. Now, however, it
seems that most husbands are present for all
or a portion of the labor, and an increasing
number are requesting to attend the delivery of
their child.
A new emphasis in the hospital on
"family-centered care" seems to indicate
official acknowledgement that the husband's
presence at birth and participation throughout
his wife's hospitalization is valuable for the
father and for the new family. Yet despite this
trend we are still very ill-informed about the
thoughts and feelings of this family member
during the birth process. If we aspire to provide
care that is truly family-centered, we must find
out more about the husband's reactions and
needs during his involvement in childbirth.
This article is a summary of the results of a
study which focused on the reactions of 20
husband-fathers to labor and delivery. More
specifically the study probed the husbands'
thoughts and feelings about the experience,
their perceptions of their role during labor and
delivery, and their thoughts about nursing
care.'
a different PERSPECTIVE
on childbirtli
n
The Study
The study took place in a family-centered
maternity unit which has approximately 1 ,1 00
births annually. Twenty Caucasian. Canadian,
or British-born husbands were interviewed
between 13 and 107 hours after delivery of
their infant. They were between 22 and 40
years of age and had some formal education,
ranging from 8 to 23 years. All attended
prenatal classes and the labor, eighteen
attended the bi rth (one father did not intend to
be present, the other was unable to attend
because of fatigue). Seventeen were fathers
for the first time; three were fathers for the
second time. All deliveries were per vagina
and resulted in a healthy newborn of at least
thirty-seven weeks gestation.
Interviews with husbands were
conducted using an interview schedule which
employed rating scales, open-end and
fixed-alternative questions. No wives were
present during the interviews.
The husbands responded
enthusiastically to being interviewed and
many began the interview with no prompting
from the researcher, continuing to talk for 45 to
90 minutes.
Findings
Events prior to labor and delivery
All but one of the husbands had decided to
participate in childbirth by the early third
trimester of pregnancy and half had made the
decision before or when pregnancy was
diagnosed. Only seven fathers expressed
anxiety and uneasiness about attending labor
and delivery, and their concerns were allayed
dunng prenatal classes.
Most of the husbands wanted to
participate because they felt their wives
needed them. Typical comments were: "I
wasn't going to let her go through that alone "
and 'It's the least I could do for her. " Less
popular reasons for taking part were to share
the experience together and to have the
opportunity to see the labor and birth.
Reactions to labor and delivery
On a rating scale ranging from -4 (excellent
experience) to -4 (very bad experience) most
husbands viewed labor as a slightly positive
experience (mean-i- 1.6) and delivery as a
moderately positive experience (mean +
2.26). They described the labor as
"meaningful," 'valuable, ' "a necessary evil,"
and viewed it as a period of helplessness for
The Canadian Nutse February 1977
them and a time of pain for tlieir wives. The
majority described delivery as a period of
progress, a time of pain relief, and a time of
exhilaration tempered with worry about
possible complications for the baby.
The fact that labor was rated lower than
delivery may be partially explained by
exploring prevailing North American attitudes
towards pain and the male role in society. The
relatively passive role of the husband as
protector and supporter during labor and
delivery runs counter to the North American
image which stresses the ability to take
charge, to be in control and to solve problems. ^
His role as supporter and protector is
particularly emphasized during labor because
analgesics must be used judiciously. This is
one time when North Americans cannot get
the immediate relief from pain that they are
used to seeking, 3 and for this reason the
husband may feel especially helpless when he
cannot see any positive results of his efforts to ■
give encouragement and support. Thus, his
effectiveness will likely influence his view of
labor and his self-esteem. Delivery, on the
other hand, is a period when pain-relief is
offered, health team members relieve the
husband of many of his functions and, finally,
the sight of the emerging baby signifies the
end of the laboring experience.
During the first and early second stage of
labor the husbands tended to direct their
emotional and intellectual energy almost
solely towards their wives, noting their
behavioral responses to pain, pelvic pressure
and to the husbands' attempts to give support.
Many tried to look for indicators that their wives
were progressing in labor.
During these early stages, many
husbands could not remember thinking about
the baby. One father revealed "There was
nothing I could do forthe baby. My wife was the
one who needed me." Those few husbands
who indicated a high focus on the baby
admitted that they were concerned about
whether the baby was getting enough oxygen
and whether it would be normal.
In the late second stage of labor the
husband's focus changed; he was still
concerned for his wife but was now caught up
in the fascination of the delivery. Many
admitted that it was only then that the baby
became a reality. Several said that some of the
delivery room procedures, such as
administration of anesthesia with long needles
and performance of the episiotomy, made
them feel "queasy" but that they were able to
overcome the feeling. The birth of the baby
brought about a high focus on the infant as well
as on themselves. The completeness and
general health of the baby were paramount in
their thoughts. They needed to know that the
baby was "all there" and there were no
anomalies. Reassurance that the color, cry
and respirations were satisfactory was equally
important, and was noted by the fathers
independent of whether the baby was given a
high or low Apgar rating. Few husbands made
reference to their wives during this period and
not one described his wife's reactions to the
baby at birth.
The birth appeared to be an infinitely
personal experience for the majority of the
men. Dur[ng the interview, some fathers were
unable to find the words to describe their
feeling at the time of the birth but kept
struggling to do so. Several, as they recounted
the birth, had tears in their eyes and noted "It
was the best experience I've had in my life." A
minority displayed a flat affect and related the
birth and their feelings in a monotone. "I didn't
feel anything," and "It was okay, I guess " are
quotes from two new fathers. Another
intimated that he was disappointed in his
emotional reaction to the birth, stating that
"Some people get off on seeing their child born
... I didn't." Similar expenences have been
described by Greenberg and Morris.''
Role During Labor and Delivery
Most of the husbands saw their role during
iabor as that of providing support,
encouragement and physical care to their
I ves. For this reason many chose not to leave
eir wives during the experience, even for rest
or nourishment. Of those who did take a break,
some expressed guilt at seeking this relief
nen their wives were unable to do so. Others
oted that it was worse to be separated from
eir wives than to be with them.
Most felt that they had helped their wives
a great deal during labor and attributed their
success to the prenatal class instruction and to
the labor-room nurses At the same time they
needed to confirm their success with their
wives. Those who had not discussed the
success of their role with their wives tended to
believe that they were of very little help.
There were periods during the labor in
which the husbands were not able to help their
wives. They had difficulty coping with their
wives' pain and loss of control during
transition . Some said that they lost control and
that this was precipitated by their wives'
reaction to the contractions, the diagnosis of
fetal distress, and/or extreme fatigue of ttie
husband.
In a question concerning the father's right
to attend the bi rth of his child, most felt strongly
that itwas their right. A smallergroup believed
that it was not their right but said they would
still like to be present. The husbands
spontaneously noted that if their presence in
any way jeopardized the health of their wives
or babies, or interfered with the health team
members' performance, they would accept the
decision not to be present at delivery.
Many health team members have
expressed concern about
husband-attendance during the birth of a sick
or malformed baby. In response to a
hypothetical question, nineteen fathers said
they would prefer to be with their wives during
the birth of a potentially unhealthy baby. They
felt that they did not want their wives to be with
strangers during this time and that they would
be able to share their grief together.
Perceptions of Nursing Care
When asked what aspects of nursing care
were helpful or not helpful to their wives and
themselves during labor and delivery, the
husbands focused on five categories:
• the attitudes and responses of the nurses
• inclusion of the husband in the experience
• assessment and explanation of labor
events
• contact with the nurse other than for
assessment
• physical care of the woman in labor.
The nurses' attitudes and responses
which were identified as helpful were
"friendly," 'kind," "cheerful," "thoughtful," and
"interested." Many husbands obsen'ed that
the nurses cared about their wives and that the
nurses' attitudes were significant in
establishing their own confidence. Their
perceptiveness and vulnerability during labor
is illustrated by one husband's reaction to
some nurses laughing outside the labor room:
"I can appreciate that you have to laugh in
a place like this but when they didn't
stop... I kept looking at my wife in pain and
thought my God, what can they find so
funny?"
Most of the husbands did not expect
the nurses to go out of their way to include
them in the bi rth experience, but when they did
it seemed to leave a very positive impression.
Helpful gestures of the nurses, such as
qp
m^;mmmmm^^mmff^9m
bringing coffee or j uice to the fi usband while he
was at his wife's bedside and "spelling hinn off "
for short rest periods, were seen as indicators
that he was accepted by nursing staff.
Husbands also appreciated the nurses'
explanations and demonstrations of progress
made by their wives. Several objected to being
asked to leave during pelvic examinations, an
observation also made by Jordan, ^ while a
small number welcomed the break away from
their laboring spouses.
The assessment of the mother and baby,
and explanation of the results was a perceived
weakness in nursing care. Husbands felt there
was a need for more frequent and accurate
assessment, particularly during the transition
phase and the second stage of labor. Several
husbands echoed the sentiments and
displeasure of these three men: "I knew that
she was going fast. I had to go out and get the
nurses a few times... they could have
anticipated how quickly she was progressing;"
"There was panic at the end;" and "I could
have ended up delivering the kid myself."
Husbands apparently needed to have
human contact during this emotional and
fatiguing experience and welcomed contact
with nurses other than for assessment
purposes. One husband described a nurse as
exceptional;
"She'd say that she would bring such and
such in 15 or 20 minutes and then she
would. You knew that you only had to go
for 15 minutes, not forever, before she'd
come back. "
Many fathers said they knew the
nurse was outside the labor room and that
all they had to do was ask her to come.
However, they were reluctant to summon her
because, as one father stated, "She probably
couldn't do anything anyway." Several fathers
indicated that they saw the nurse as much as
they wanted and appreciated being left 'to do
our own thing."
A large majority of the husbands praised
the care given to their wives in the form of
backrubs, assistance with position and
breathing, and provision of analgesic
medications and clean laundry. Problems in
this aspect of nursing care centered around
acquiring satisfactory pain relief for their
wives.
Implications for Nursing
If nursing hopes to promote optimal family
Linda Leonard (B.Sc.N. and M.Sc.N.,
University of British Columbia) has worlied in
labor and delivery rooms and in psychiatry.
She is now teaching in the Baccalaureate and
Graduate programs at the University of British
Columbia School of Nursing.
functioning, we must take responsibility for
helping the husband-father to achieve
satisfaction from and feel effective in his role in
the birth process. The results of this study
indicate some specific ways that the nurse can
achieve this goal, although one must be
careful in making generalizations from such a
small and specific study.
The nurse involved in teaching prenatal
classes should be aware that her attitude
regarding husband-participation in labor and
her confidence in the expectant father is highly
influential. The teacher's confidence and
reassurance seems to benefit those men who
are undecided and uneasy about participating
in labor and delivery. Husbands asked that
more emphasis be placed on helping both
parents cope with the pain of labor; many felt
betrayed by their instructor, who left them with
the impression that labor is uncomfortable but
not necessarily painful. Pertiaps a discussion
regarding attitudes to pain as well as feelings
and behaviors elicited by seeing someone
else in pain would benefit husbands. It might
also be appropriate to coach husbands in how
to recognize behaviors that their wives
indicate are emotionally and physically
supportive.
The nurse caring for the couple in labor
and delivery can do a great deal to make the
experience a positive and satisfying one for
the husband. First, she must recognize that
husbands are highly sensitive during this
period to the nurse's attitudes and responses
to the couple. The nurse's expressions of
warmth and caring, and her efforts to include
the husband convey acceptance to him and
foster his ability to help his wife function.
At the beginning and as labor progresses,
it is important for the nurse to assess the
specific role the father hopes to play in labor
and delivery, as well as the kind and amount of
contact the couple wants with the nurse. She
must be aware that the husband is more likely
to need her presence, even if he doesn't
specifically request it, during the active phase
of labor, during periods of ineffectual progress,
and when he is tired. Permitting the husband to
stay with his wife as much as the couple
desires, e.g., during pelvic examinations, and
being available to "spell the husband off" for
rest-breaks from time to time also help to
relieve the stress of the situation. To maintain
the husbands confidence the nurse may also
identify the ways in which the husband is being
supportive of his wife. Although
communicating to the couple regarding the
progress of labor is a fundamental principle of
care, results of the study indicate that it needs
to be re-emphasized. The health status of all
infants born, independent of the Apgar rating
should be interpreted to couples.
During the postpartum period it is
essential that those who care for the family be
alert to husband-wife-infant interaction and to
their desire to communicate their reactions
and feelings.^ The nurse should encourage
couples to review the labor and delivery, and
their performance, as soon after delivery as
possible, and to verbalize questions and
concerns about the experience. This may be
done with the nurse on an individual basis or
she may bring together a small group of new
parents to discuss their common experience.
In our recent emphasis on
"family-centered care " we have begun to
accept the father's role in childbirth. We still
have a long way to go, however, to fully
understand his needs and perceptions during
this experience. This study of fathers'
perceptions of labor and delivery, while taken
from a small sample, offers nurses some
insight into how they can help the expectant
and new father. Whatever specific actions the
nurse takes to convey her acceptance, care
and support to the expectant father, it is clear
that this neglected family member needs to be
given much more attention to make the
experience of childbirth as rewarding and
positive as it can be. *
References
1 Leonard, Linda G. "Husband-Father's
Perception of Labour and Delivery," MSN Thesis,
U.B.C. School of Nursing, April 1975.
2 Benson, Leonard. Fatherhood: A sociological^
perspective. New Yort<: Random House, 1968.
p. 21. .
3 Zborowski, Mark. "Cultural components in
response to pain" in A Sociological Framework for
Patient Care. ed. Jeanette R. Folta and Edith S.
Deck. New York. Wiley, 1966. p. 259.
4 Greenberg, Martin and Morris, Norman.
"Engrossment: The Newborn's Impact Upon the
Father," American Journal of Orthopsychiatry.
44:4:521 July 1974.
5 Jordan, A. Doreen. '"Evaluation of a
Family-Centred Maternity Care Hospital Program,
Part I: Introduction. Design, Testing," JOGN
Nursing. 2:1:17, January, February 1973.
6 Rising, Sharon S. "The Fourth Stage of
Labour: Family Integration," American Journal of
Nursing. 74:5:870, May 1974.
Note: a bibliography is available on request from
CNA Library Sen/ices.
Benaxyl LotkMi 20%
proven effective '
in treatment of cutaneous ulcers
BEFORE AFTER
Left: ulcer of right greater trochanter, 14 cm in diameter, with
undercutting of superior border to 3 cm. Right: full healing after
8 months therapy with benzoyl peroxide.
Benzoyl peroxide, a powerful organic
oxidizing agent, was applied topically
according to a carefully developed
technique to cutaneous ulcers of
different types. The healing time was
shortened greatly by the rapid
development of healthy granulation
tissue and the quick ingrowth of
epithelium.
Exceptionally large pressure ulcers
with deep cavities, undercut edges
and sinus tracts were successfully
treated, as were stasis ulcers of long
duration resistant to all other therapy.
There were only 13
treatmfent failures
among the 133
cases.^
Available only from Stiefel
STICFIL o
FCXJNDED 1847
TM trademark
STIEFEL LABORATORIES (CANADA) LTD.,
Montreal, Canada H4R 1E1
Reference: ' Pace, WE: Treatment of cutaneous ulcers with benzoyl peroxide. Can Med
Assoc J 115:1101, 1976
iNon
- O T 1 O N
'.ZOYL PEROXl
■"; U S.P-j
^
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NURSING
THE ACUTELY
PSYCHOTIC
p/1
-1"
-:\
■r-\
IJ J
L. -
- --
1.
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--
Janet B. Berezowsky
The acutely psychotic patient poses a special threat
within the general hospital setting because staff is
frequently unaccustomed to dealing with such behavior.
Management of these patients can be effectively
achieved by using appropriate measures to reduce the
anxiety of the patient, staff, other patients and visitors.
Here, Janet Berezowsky outlines the nursing
interventions necessary to deal with the acutely
psychotic patient and the steps that can be taken to
reduce the anxiety of those around him.
Acutely psychotic patients are being seen more and more often in
the general hospital setting. Yet frequently the staff who must cope
with them have had little or no experience in dealing with this type of
patient. The bizarre and often threatening behavior of the psychotic
can be very frightening both to staff and to other patients; its
occurrence in the hospital presents major management problems.
The central problem in coping with the acutely psychotic patient
is anxiety — anxiety of the patient, anxiety of the staff and anxiety of
other patients and visitors. If the anxiety of the patient is dealt with by
using appropriate medications and nursing interventions, psychotic
behavior can be controlled within 24 hours of admission, and
symptoms can be greatly reduced within a week. The anxiety of staff,
visitors and other patients, while it may seem less immediate than
that of the acutely psychotic patient, is still an important factor.
Reducing the anxiety of those surrounding the patient minimizes the
threat not only to those involved but to the psychotic patient himself.
The Canadian Nurse February 1977
The Patient
The patient experiencing a psychotic episode, brought to
hospital frequently under pressure of family or police, is certainly
expressing anxiety. He is frequently hallucinating and preoccupied
with unreasonable and bizarre fears. He may be physically
aggressive or acutely suicidal. The psychotic patient /7as lost
control, control of his ability to relate effectively to the demands of his
reality situation, control even of the decision to seek medical help.
He will often attempt to assume control in the only way he can — to
leave the hospital.
Because the situation presents itself in such an immediate and
extreme manner, nursing interventions must be guided by certain
priorities:
• Explanation of intent: The first and most essential therapeutic
maneuver is to take control for the patient. It is important that the
patient be provided with an explanation of his experience; that is be
informed that he is having difficulty controlling his behavior and his
thoughts, and that for the present this responsibility will be assumed
by the treatment team. A brief explanation of the treatment plan
should be given, his cooperation should be requested and the staff
should proceed to take control. Staff must take care to do this in a
caring rather than a punitive fashion since the patient is particularly
sensitive to punitive approaches at this time and is easily provoked
to "fight or flight."
Although the plan to take control is usually conveyed to the
patient by the treatment team in the emergency room, when the
patient is transferred to an in-patient unit it is desirable for at least
one member of the assessment staff to accompany the patient and
to relate the plan to unit staff in the patient's presence. The intent of
hospital staff will be reinforced if the assessment team remains in the
unit initially and assists unit staff to assume control by administering
medications, removing street clothing and, if necessary,
re-explaining to the patient the plan originally made in emergency.
• Administration of medication: The most commonly used
medications are antipsychotics, but antidepressants and
barbiturates may be added to this regime. The initial medication
should be given I.M. or I.V. in a dosage large enough to quickly
sedate the patient. The actual dosage will depend on the patient's
age, body weight, the intensity of psychotic symptoms, and the
previous use of such medications, but nurses should be familiar with
appropriate dosages. Liquid medication may be more acceptable to
the patient, but pills should not be considered since there is little
assurance that the patient will actually swallow them.
If a choice of liquid or I.M. medication is to be offered, both
should be prepared so that, should the liquid be refused, staff can
immediately proceed to give the medication intramuscularly.
Medication should be presented to the patient in the privacy of his
room, (or cubicle if the patient is still in emergency), and staff should
block the patient's most likely routes of escape by standing between
him and possible exits. The patient should be informed of the plan
and requested to cooperate.
It is likely, however, that the patient will attempt to resist the staff
at this early stage of treatment. In this event, staff should be
prepared to use force in administering medication. All those involved
should remove glasses, watches and rings which could be broken or
damaged and might inflict injury to the patient in a struggle. The staff
member who has the best relationship with the patient should be in
charge, to speak to the patient, give direction to the staff and
administerthe medication. The presence of at least three to six staff
members is necessary for safety, and very often this show of force is
sufficient to reduce the likelihood of a struggle. If only one or two staff
members attempt to medicate the patient, he will likely struggle and
staff and patient may be injured. More than six staff members
intensify the patient's anxiety and may precipitate a struggle.
To administer medication, staff members should move in close
to the patient. Often when patients realize that argument or
discussion will not alter the intent of the staff, they will accept liquid
medication without struggle. At least one member of the staff should
remain with the patient until the medication takes effect.
Such behavior of the staff clearly conveys that they are in
control and, when this procedure is used, patients rarely resist after
the first three or four doses of medication. In any event the above
approach should be used until the patient willingly accepts
medication.
Regular administration of medication every 4 hours for the first
48-72 hours is usually essential. Since the antipsychotic effect of the
phenothiazines takes about five days to develop and the
mood-elevating effect of most antidepressants takes even longer,
the sedative effect of these medications will be the initial means of
control. The patient should be drowsy but care must be taken to be
sure his level of consciousness has not been severely depressed
and that his vital signs following assisted mild exercise are
satisfactory. If the patients blood pressure is very low (less than
80/50) it is preferable to withhold medication for an hour or so and do
passive exercises with him, dangling his legs over the side of the bed
and assisting him to walk about in his room. In determining the safety
of administering the next dose of medication, the nurse should be
certain that the patient can be roused, that he responds to pain and
that his hand grips are moderately firm. An increase in psychotic
symptoms, particularly visual hallucinations, probably indicates
toxicity. Very close observation of the patient is essential at this
stage of treatment.
Once the patient requires waking in order to administer each
dose of medication through the night, it is usually safe to give the
sametotalamountof medication in a q.i.d. regime. Within 5 to 7 days
the dosage can usually be reduced.
• Removal of street clottiing: To tell a patient that we want him to
remain in hospital and allow him to keep his street clothing gives him
a very ambiguous message. Once the initial dose of medication has
begun to take effect, the patient should be requested and assisted to
change into hospital pyjamas. Asking him to disrobe before being
sedated frequently increases his anxiety because he may fear a
sexual assault.
All street clothing should be taken from the patient and locked,
and visitors should be supervised to be certain they are not bringing
clothing to the unit for him . If the patient is kept in hospital pyjamas he
will be easily identified if he attempts to leave the hospital and he can
be returned without necessarily involving public or police assistance.
• Dally nursing care: Once the patient's immediate needs have
been met the emphasis of nursing care shifts to his daily physical
and emotional needs while he is in hospital.
In treating the acutely psychotic patient it is essential that
adequate fluid intake be maintained ( 1 500-2000 ml/24 hr). This can
usually be accomplished by offering oral fluids regularly, as often as
q1 h. The patient should not be left to make the decision whether or
not to drink, but should be informed that he will be assisted to drink.
The nurse should position him, put the fluid to his mouth and direct
him to swallow. An elevated temperature or symptoms of toxicity are
common signs of inadequate hydration. The consistent and caring
attitude of the staff in meeting this basic need will facilitate the
development of a trusting relationship.
Acutely psychotic patients tend to prefer water, juices, and
simple sweet foods which require a minimum of chewing or
preparation before eating. Because of their reduced activity,
together with the side effects of medication and an erratic eating
pattern prior to admission, psychotic patients frequently develop
constipation. They should be questioned several times a day,
assisted to the toilet regularly, and provided with laxatives p.r.n. until
they are able to resume activity and diet patterns which will prevent
such complications.
The acutely psychotic patient should be given a low bed or
mattress on the floor to reduce the possibility of injury due to falls.
Regular exercise penods, where the patient is assisted in passive
exercises by one or two staff members, should be arranged to
prevent respiratory and circulatory complications (hypostatic
pneumonia and hypovolemic shock). The patient's vital signs
(temperature, pulse, respiration and blood pressure) should be
monitored before each dose of medication. Because the
anticholinergic effect of medications increases the risk of damage to
mucous membranes, regular mouth care is essential. Regular
bathing, turning and positioning, and massaging of pressure areas is
also very important to prevent breakdown of the skin. Smoking
should be controlled and supervised. The patient should tie informed
priorto each nursing intervention, so that he does not perceive it as
an assault. All of these attentions, which form the basis of good
nursing care, help to convey to the patient that the staff is concerned
about him and is looking after his needs. This knowledge that the
staff is in control serves to reduce the patient's anxiety and increases
his feelings of safety and security.
The patient should be provided with a quiet, restful environment
free of distracting noises, activity and objects. A locked room is a
poor solution unless staff are with the patient continuously: the
feeling of being abandoned will only increase the patient's anxiety. In
an unlocked room, frequent regular visits to provide reality
orientation and basic physical care soon allay the patient's anxiety
and enable him to cooperate with the treatment plan. Reality
orientation should include calling him by name and telling him your
name, that you are a nurse, that he is in hospital, explaining your
immediate nursing intervention, telling him the date and time of day
and any other significant information such as doctor visits or family
visits. Expression of psychotic ideas should be responded to with
kindness. It is important to acknowledge that you understand the
ideas or feelings which he expresses and to describe reality clearly
and simply. Discussion and arguments serve only to strengthen the
patient's psychotic ideas. A limited numberof consistent staff should
work with the patient in this phase of treatment in order to keep reality
relatively simple for him, and to develop a therapeutic relationship
which is essential for a successful outcome in the convalescent
phase.
Anxiety Surrounding the Patient
Particularly when the acutely psychotic patient is first brought to
hospital, his behavior is likely to cause anxiety in those around him.
In order to deal effectively with the patient and create a therapeutic
environment, it is essential that this anxiety be minimized.
Anxiety of the nursing staff can be greatly reduced by careful
application of the approaches described above and by effective
teamwork. The nurses who care for acutely psychotic patients
frequently require the assistance of their colleagues to provide
adequate, safe nursing care and to ensure even temporary relief
from this demanding regime. New staff should never be designated
to care for such acutely disturbed patients until they have had an
opportunity to observe and assist in the regime. Detailed teaching
and supervision should be provided until staff are comfortable and
able to make safe judgments and provide skilled care to these
patients.
Physician-nurse teamwork centers around two points; the
physician's reinforcement of the treatment plan to the patient, and
the provision of adequate medication orders to prevent further
uncontrollable psychotic behavior. The physician who is defining the
treatment plan should present it to the patient initially, and reinforce
it frequently. This may be done verbally or by actually assisting with
specific interventions such as the administration of medication or
electrotherapy.
The availability of sufficient immediate assistance to deal with
possible crises is essential. Crisis situations should occur
infrequently once this regime has been established. When they do
they are usually due to failure to obtain adequate medication orders,
failure to use the medication ordered, or failure to provide very close
supervision until continual control is established.
Anxiety of other patients, relatives and visitors can be reduced
by giving them simple, factual information about the patient and the
means by which the staff are maintaining control, and by ensuring
that they are not left alone with the acutely psychotic patient. Fear of
unpredictable, uncontrolled assaultive behavior is intense for the
uninformed single observer. If a struggle is anticipated, it is
advisable for nursing staff to remove other patients and visitors from
the area and for at least one staff member to stay with the patients
who have been removed. Simple, factual explanations should be
provided in a calm, concerned manner.
Family members should be encouraged to maintain contact
with the patient during the acute phase. Their visits should be short,
supervised and facilitated by nursing staff. Explanations of the
treatment plan as it proceeds should be provided regulariy for family
members and for other patients on the unit. This helps greatly in
maintaining a therapeutic milieu for other patients in the setting.
Conclusion
The suggestions above for dealing with acutely psychotic
patients center around the problem of anxiety. They are intended to
help staff in a general hospital who are frequently unaccustomed to
dealing with acutely psychotic behavior but who are being
confronted with this type of patient more and more often in their daily
routines. In order to deal appropriately with what often threatens to
become a crisis situation, nurses can develop the skills to deal
appropriately with these patients and to reduce their anxiety and
the anxiety of those around them. ^
Janet B. Berei^wsky (R.N., B.S.N.. B.A.. University of
Saskatchewan) was head nurse of the psychiatric unit at the Royal
Alexandra Hospital, Edmonton, Alberta at the time that she wrote
"Nursing the Acutely Psychotic Patient. " She had previously
worked as a staff nurse, head nurse and clinical Instructor in psy-
chiatry. Since then she has returned to school and is working
towards her M. Sc. In Family Studies at the University of Alberta.
^m^immmme-^mrm^mr
SpeaiSing
SoWou^anf
a (BomeBacS
L. Patricia R. McMeekan
There are many clich6s in nursing by which the profession
sells itself short. How many times have you heard the
following:
• "At least nurses will always be needed."
• "Once a nurse, always a nurse."
• "A nurse is also a teacher."
Fallacy number four is one that has only recently
appeared on the scene. It goes like this: "To teach nursing is a
nice way to get back into nursing." The implications of this
statement are cause for alarm and concern.
In the institution where I work there are many part-time
clinical teachers. In advertising for these positions the
necessity for recent active nursing experience is always
stipulated. In spite of this, almost one third of the telephone
enquiries I have received about these jobs in the past two
years have begun along lines like this:
Enquirer: Hello, I am interested in your advertisement for
part-time (or even fuil-time) teachers. I have been out of
nursing for 5 (10 or T 5) years, and I feel that this would be a
nice way to get back into it
Recipient: What have you been doing during the last five years?
Enquirer: Oh, bringing up my family, which is a good experience
with which to help students, don't you think?
Recipient: We require the teachers, especially the clinical ones,
to have recent experience. What type of nursing was your
specialty?
Enquirer: / worked in a doctor's office (or Obstetrics, or Public
Health, or something somewhat specialized). I graduated
12 years ago from the 'good old three year program. ' Surely
you are not saying that all this experience is of no value.
This type of conversation is a composite of many, but
the theme has been very similar ... that to have nursed at all is
sufficient preparation for teaching it.
I suggest that nurses who are contemplating re-entry
into the profession by the "back door" of teaching, would do
well to ask themselves the following questions:
1 Assuming that the majority of nursing students are
between 1 7 and 20 years of age, how do I regard young
people in this age range ... as children, or as 'becoming
adults'?
2 How do I feel about students as a group ... are they
basically trustworthy or untrustworthy? At what point on the
growrth and development continuum do I expect to find them?
3 What sort of person am I ... do I need direction and
structure, or am I self-directed and flexible?
4 Am I willing (and able) to spend a lot of home and/or
family time on the preparation, study, marking of papers and
the myriad of other tasks that are part of teaching?
5 What is my concept of teaching ... standing on a dais in
front of a class handing out information or as a nurse watching
a student carry out a procedure? (In a cynical vein, many
perceive the latter as the teacher standing with arms folded).
6 How do I perceive the learner ... as passive and
receiving, or active, participative and challenging?
7 Should a learner evaluate himself, or should / be telling
him?
8 Could a learner evaluate me ... could I accept it if it were
negative?
9 Should the learner make mistakes, or does that mean
that my teaching was poor or unsuccessful?
1 0 How well do I remember the principles of teaching and
learning ... or did I ever learn them?
In Reality Shock, author Marlene Kramer identifies a
-jroup of people found in nursing schools. These are the
afera/ Arabasquers who have achieved very well as nursing
tudents but are frustrated as registered nurses, feeling that
ley are unable to carry out the level of care which they have
Deen taught. So, they become nursing teachers!!!
Occasionally a registered nurse with considerable expertise
n recent nursing care feels that she would like to share this with
nursing students. Undoubtedly, a person with such a background
could provide excellent learning experiences for students.
However, the teaching of nursing requires more than the
ability to demonstrate care. The teacher, in any field, should
be able to cope with self-direction in the use of her time.
Nurses have a particular problem in transferring from the
traditionally highly structured service setting to an
environment of considerable flexibility. In a nursing school,
even small items such as coffee breaks (except while in the
clinical area) are highly individual and are planned by the
teacher herself. Other than scheduled classes and interviews,
the timing of the teacher-work is up to the teacher. If the
would-be teacher is a dependent person, to an extent, and
prefers a fair degree of predictability in the day's work, then
J he/she should re-examine his/her goals.
If these goals include teaching the students all the things
which you were not able to do as a registered nurse, then the
students will soon get the message that nursing education is
an exercise in futility. They will learn little about the
combination of idealism and reality that is essential for
adequate performance as a professional registered nurse.
If your goals include conveying to the students how
unfortunate they are not to have had a three- year program in a
hospital school ... think again! Forty years ago nurses in
Canada endorsed two facts:
• Education should not be paid for with service.
• Education should be conducted mainly in educational
institutions.
Today, finally, this dream has become reality and yet
some of us continue to behave as though the concept were a
new one. The two-year program was justified by experiment
starting in 1948, and has been functioning increasingly
effectively since 1960, producing beginning' graduates, not
'finished' ones. Their potential, in many instances untapped, is
many times greater than that of the so-called better'
three-year programs. It is a well-known fact that persistent
enforcement of behavioral expectations eventually produces
that behavior. The graduates of today are being "boxed into"
an inferior position by the unproved expectation that they will
be poor practitioners. Registered nurses in the service areas
are not alone in conveying these sentiments: as teachers, we
convey them too, indirectly perhaps but the students hear
such statements as: "If only I had more time to teach you
properly" of 'Of course, spending so much time on arts
courses lessens your time for nursing," and so on.
If you really would like to teach nursing, give serious
thought to your philosophy of nursing education. Do you want
a nurse who knows just that ... or do you want a nu rse who has
the kind of broad knowledge base that enables her to
understand other people's problems as well as to solve her
own personal and professional problems.
I am not condemning the old' programs: I feel that, to be
proud of one's training and to be defensive in the face of
change are two different things. I am very proud of the training
that I received (and it was training !) but that does not mean that
I must blind myself to the possibility that anything better could
be developed. *
The author of this month's Frankly Speaking, Patricia
McMeekan, B.Sc, M.Ed., is assistant director of
nursing at Sheridan College School of Nursing in
Mississauga, Ontario. She bases these observations
on her experience in nursing education in that province
and also on the assumption that "clinical teaching,
especially in the diploma nursing program, occurs
mainly In the hospital setting. "
THE UNIFORM SHOP
TWO STORES
TO SERVE
ALL YOUR
UNIFORM NEEDS
BRAMPTON
160 MAIN ST. S.
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PETERBOROUGH
441 V2 GEORGE ST. N.
Frankly Speaking is intended as a forum for nurses
who want to speak out on issues that may influence
the future of nursing practice, research,
administration or education. Guest columnists
from time to time will be members of the Board of
Directors of your national professional association.
If you have an opinion or concern that you
would like to share with your fellow nurses, why not
write to us. This is your chance to get involved, to
participate in shaping the destiny of your
profession.
'rmvaimmrwiK^^mirm^^m
mmm mmmm
MaryDean Samanski
Little people who could not ask for a
cookie, a drink, or their shoes ... who
could not say "hello," "I'm cold," or
"please help me" ...who could not ask for
a favorite record, toy or song. Worst of all,
perhaps, who could not make the adults
around them realize how much they really
did know ...
These were the non-verbal, hearing,
developmentally handicapped children at
Durham Centre in Whitby, Ontario, just a
little more than a year ago. As staff
members caring for them, we had no
guidelines, no literature, no adviser, only
a book on sign language and the strong
desire to help these little people find a way
to communicate with their counsellors,
teachers, parents and peers.
It was the Speech Pathologist at the
Centre, Karen Portigal, who conceived
the idea of teaching sign language
through the medium of songs and music. I
was a Registered Nurse also employed at
the Centre as Recreation and Crafts
Instructor, and Karens enthusiastic
collaborator. When she left, I continued to
carry out the program with the assistance
of the faithful volunteers who had been
involved in the music program from the
beginning. On most days, the child-staff
ratio was four to one.
Our original aims were to teach
signs, stimulate language and, where
possible, develop speech. We wanted the
children to learn to identify and ask for
necessities, to express some feelings and
to be happy with their accomplishments.
The program had only just begun when
we realized that we were also motivating
the children to want to communicate and
to use signs and/or speech. The first step
was to give a sign and verbal clue that
represented a concrete object, which the
children would imitate. The children
progressed from this to the spontaneous
use of signs. Next came the ability to
vocalize with meaningful sounds and
words.
It did not occur to us when we began
that we would open up a new world to
these children — a world in which they
could learn to think, make decisions, feel
worthwhile and even entertain
themselves. We see children with poor
self-concepts begin to develop an
Total communication
Pornon-vGrbal
hoaring ohildrGn
Improved image through "I" and "me"
songs, dancing, signing in the mirror and
a lot of laughing and hugging. When
babies start to talk they babble, gurgle,
coo and are smilingly encouraged by
Mom and Dad. In our daily classes we
laugh a lot and use every opportunity to
encourage a child to participate at his own
level. For example, a sneeze is a good
opportunity to say "atchoo" and use two
vowel sounds. If a child cannot say
"atchoo," he can at least laugh at
everyone who does.
Each 45-minute session begins with
a lively, sociable "welcome" song that
encourages us to be comfortable with one
another. We greet our friends with signs
and words like, "Hello, how are you?"
"I'm just fine, how are you?" "Sit down,
have a seat, good to see you here with
me." etc. In order to avoid confusion, we
sign only key words. I then ask the
children what record they want to hear
and someone will sign drum. A "noise"
song opens with a booming kettle drum,
inviting us to beat the drum and say
"boom, boom, boom." It tells us to make
the "greatest noises in the whole world
that come from you and me" by
clapping, stomping, snapping,
coughing, kissing, laughing and
whistling. Shouting "wahoo" singing "O"
and a surprise, for example a request to
be quiet, are all included. This record
teaches us to sign, vocalize, sing, find me,
find you and have fun, all at the same
time.
The choice of props and songs is
limited only by the imagination of the
leader. Almost any favorite song, for
example, can be used to teach the signs
:or common objects such as food, clothing
and animals. I am particularly fond of Paul
Nordoff's songs because they are
especially written for developmentally
handicapped children. These songs,
along with the props we use, encourage
spontaneity and creative thinking in the
children. One of the props we use is a
baby puppet. Our baby cries and I cry:
baby sleeps, I sleep, baby says
mama" and each child attempts to say
mama." Some succeed, some do not. A
popular addition to our visual aid
equipment Is a battery-operated dog that
walks and says bow-wow'. The children
indicate to me by the signs for "walk" or
talk" what they want the dog to do. In this
way we elicit spontaneous signs and/or
words. Most of the children respond
appropriately (i.e., in sign language) when
asked their name. It is very important to
use their names in a pleasant manner, for
example in songs. Those who are unable
to do so, will imitate their own name signs
after being shown.
At "sit and talk ' time the children are
asked what they would like to talk about.
They choose by sign or sound from a box
that contains pictures, puppets, etc. One
day there was no response from anyone,
not even Jamie the most responsive,
dependable child "leader"
This is what happened:
Instructor: "Shall we talk about a bus?"
Jamie: folds his hands and shakes his
head.
Instructor: "Shall we talk about a bird?"
Jamie: negative again.
I was shocked! Jamie did not want to
do anything. I looked at Helen — she
shook her head. I looked at Rick — he
shook his head. It took me a few seconds
to grasp the significance of their reaction.
Jamie was thinking! He was making a
decision and standing by it!
On another occasion, I was busy with
Nancy, who was beginning to sign and,
therefore required a considerable amount
of my time. Jamie tapped me on the
shoulder. All Jamie s communication is by
gesture. He can only make a "ba ' or an
"aa" sound. He signed butterfly on the
flower. The message was very clear: he
was not getting enough attention and,
feeling that he should be included, he
decided to make me aware of his
presence. This was evidence that Jamie
was thinking, communicating, and
managing his environment. It is important
to recognize that these were not reflexive,
impulsive acts on his part, but were the
result of logical thought processes. Of
course the reward for this conversation
and all that it implied, were hugs and
laughter from us, and butterfly on the
flower for Jamie.
Group dancing and partner dancing
give the children occasion to socialize and
cooperate as well as move around during
the session. Dancing also aids in the
development of coordination and body
awareness and is a good way to teach
such things as boy, girl, and other signs.
A child may request by signing that we
dance or play a record — an excellent
way to socialize and get approval from the
rest of the group.
Language acquisition and speech
development (where possible) are
long-range goals. We do not offer the
children any material reinforcements.
Certainly, if we did provide
reinforcements, we could elicit
predictable responses at scheduled times
but the children would still only produce
isolated sounds and gestures. It would
take years of training and bushels of
Smarties to produce enough words or
signs to communicate effectively. The
rewards these children receive are the
feelings of confidence and self-esteem
they earn through their accomplishments.
The social approval of the volunteers,
staff and other children is reward enough.
All the eleven children of one group
and seven of another have shown
progress. They have advanced from one
to two or three simultaneous signs and/or
words. Some are speaking or gesturing
spontaneously to communicate; others
have remained at the level of imitation. It
is important to keep trying with all the
children — we do not know for sure why
signing works or when it will work. My
contention is that the accepting, happy
atmosphere and the ability of music to
stimulate emotional response in these
children, in conjuction with an eclectic
approach that encourages input from
many sources, are responsible for the
success of music-signing.
One of my little friends is a boy who
was non-verbal and was only able to
make incoherent sounds a year ago. One
day he was listening to "Look," a song
from a Sesame Street record that we had
played a few times. He jumped from his
chair, ran to the window, opened the
curtain and said clearly and distinctly.
"look car." At the same time he made the
sign for "look" and went around to each
child in the circle saying, "look car, look
me, look tree," etc. An "I" is a difficult
consonant to pronounce and his
articulation was perfect!
No diagnostic labelling, no
assessments or tests, and no data to
analyze. All these have been intentionally
avoided in our program. Instead, we
concentrate on the children and their
individuality. The success of the
music-signing program is in the happy
face of the child who is understood, who
knows that he can understand, and in the
enthusiasm of the little fellow who
combines signs, song and speech to say,
"Look car, look tree, look me." ^
MaryDean Samanski (above) who wrote
"Singing. Signing, Smiling." is a Registered
Nurse with extensive experience in the field of
psychiatry and mental retardation. For the
past six years, she has worked as a
Recreation and Crafts Counsellor, employed
exclusively in music programming. Since
September 1976, she has been on leave of
absence from Durham Centre for the
Developmentally Handicapped at Whitby,
Ontario. She describes her studies in "Early
Childhood Education ' as "an attempt to
supplement my years of practical experience
with theory' and says that she is finding her
sabbatical "very enlightening. "
She is a member of the Canadian
Association for f^usic Therapy, Ontario l\^usic
Therapy Association, Orff Society of Canada,
College of Nurses of Ontario and Canadian
Society for the Prevention of Cruelty to
Children.
IP
The Canadian Nurse February 1977
nssELfitahilit^: a profession;
Muriel A. Poulin Public confidence in the health care system
particularly in the medical services — and in
the mind of the public the two are synonymous
— is at a low ebb. News media reports of
spiralling costs and consumer demands attest
to obvious consumer disenchantment. For
years we have believed the propaganda that
Western, and particularly North American,
health care is the world's best. There is
evidence, however, that for the human and
financial resources we expend, and
considering the fact that we represent some of
the most technically advanced countries in the
world, the system is ailing. '
Nursing as a Primary
Health Profession
As part of that system, what is nursing's
state of health? What is nursings role and its
responsibility in assuring that the health care
delivery system is revitalized and made
whole? If we are to be accountable as
professionals we must give some thought to
what it is that makes nursing unique among the
health professions and to what it has to offer
the consumer. Three key elements of nursing
require clarification and reassessment:
1. The Nurse as the Client's Alter Ego
The various criteria or characteristics of a
profession are familiar to all of us. There is
some agreement that these include a body of
knowledge, a code of practice, professional
organization, and client service. In my opinion,
the critical element is the service focus. It is
within this frame of reference, a client
orientation, that we must clarify our role in the
system. Our first responsibility is to the client
— the patient — or to an aggregate of clients or
patients that is, the society in which we find
ourselves.
In the typical bureaucratic organizations
in which we function, we have all too often
allowed policies, routines and regulations to
dominate and determine the role of patients.
We have ignored individual needs and their
implications for organizational change and
have worked to maintain the organizational
status quo rather than to meet needs of
patients. It is time that each of us recognized
that as a primary health care profession we are
accountable — not to the organization, not to
the medical staff, not to the system — but to
the clients we serve. This is our first
imperative!
imperative
2 Code of Ethics
Nursing has persuaded society that it should
-^ave certain powers and privileges, among
em, control over nursing education ,
admission into the profession, and licensure.
As evidence of its ethical posture, the
profession has a code of ethics which is a
commitment to its clients. The International
Council of Nurses has a code that has been
approved by member organizations of the ICN
including Canada. In the United States, the
American Nurses Association has developed
a code specific to the American scene. These
are all forms of contracts with the patient and
with society and I suggest it is high time for us
to reassess our responsibilities within the
context of these stated beliefs and to
determine clearly our accountability.
3. Standards of Practice
The standards of practice enunciated by a
profession are another form of "contract" with
clients. As they stand now, the Standards of
Nursing Care enunciated by the Canadian
Nurses Association imply competencies
representative of primary care professionals.^
The question facing us is whether we will
ndeed function according to the standards
and hence as primary care providers; whether
we will indeed function to the extent of the
potential inherent in the nursing profession. If
we are going to try to alter the system, we must
first answer this crucial question concerning
our role in it.
There is no doubt that the system will be
altered and that the change will involve a
power struggle of many groups and elements.
Whether or not nursing will have significant
input into that change will depend on its
competence and confidence as primary care
providers.
Throughout its history, nursing has
maintained altruistic goals but altruism without
authority is seldom influential. All too often our
aims have been mighty but our "might" has
been aimless. If we believe in our professional
goals, it follows that we support the position of
our professional organization. We accept its
code of practice and we identify with the
profession. Professional associations of
nurses, cutting across the many spheres of the
occupation, at the local as well as national and
international levels, offer one of the most
promising means of achieving nursings aims.
It is only through collective action that the
authority of the profession will be exercised.
The role of professionals and their
professional organization in determining
standards and controlling practice is
something we need to look at. We are living in
a period in which the quality of the health care
system is being questioned and at the same
time better qualified practitioners are being
introduced into the system. Graduates of
baccalaureate programs can be expected to
exert more and more influence as they
demand a greater voice in determining
practice. Those of us who are already in the
system will be forced to decide whether we
identify with nursing as part of the system or
with particular institutions. One need not
negate the other but priorities must be
decided. Values must be weighed and a
balance established between client needs and
organizational responses to these needs.
Barriers to Professional Development
Today, the quality of care in many
countries is not equal to the human and
technical potential that exists in these
countries, including, probably, Canada.
Organizational, political and legal constraints
have functioned to limit roles and to restrain
group and individual development. If you think
this is too broad a statement, consider:
• the failure of nurse-midwives to gain
acceptance.
• the role of the nurse today compared to 25
or 30 years ago. Formerly the nurse provided
most of the care except for the physician's
diagnosis and medical orders. In terms of the
knowledge of that day, both roles were
"extended." There was a complementary lack
of knowledge, whereas today both have a
firmer knowledge base. Why did the
knowledge: practice ratio in nursing fail to keep
pace? We are not, on the whole, providing the
quality and type of care possible in relation to
the knowledge base available to us.
• the specialist role today compared to the
head nurse role two or three decades ago. The
head nurse was truly a primary care worker
and clinician — in the real sense of the word —
again in relation to the day's knowledge. Why
was the role not maintained through the
years?
• failure to include third-party payments to
nurses as national health insurance plans
developed. Did this contnbute to full utilization
of nurse potential?
Obviously, nursing has not yet found its
appropriate role in the structure of today's
health care system. I believe that there are four
major forces in society that have conspired to
prevent our role enactment as professionals:
medical dominance, female subservience,
political naivet6, and low visibility. These
constraints know no barriers and influence all
of us, regardless of position.
Medical Dominance
There is no doubt that the dominance of
the medical profession in the health care
system has seriously limited the exercise of
nursing's potential and thus the quality of
health care in general. The tendency of
medicine, particularly organized medicine, to
concentrate on the interest of its own
profession has not always been in the best
interest of the larger society. Its efforts to
maintain the status quo rather than encourage
social developments are well documented.^
IVluch closer to our own professional
practice is medicine's newly awakened
interest in the broad health picture. With the
development of family nurse practitioners who
can deal with the broad spectrum of family
health needs, we must expect more
involvement from medicine in health — as
opposed to illness — care.
In my opinion, control has evolved largely
as a result of medical chauvinism. However, I
believe that the practice of increasingly
competent nurses will result in lessening of the
medical mystique and greater awareness on
the part of everyone that M.D.'s are not gods,
but people of a scientific endeavor, with all the
limitations, as well as skills, of mortal beings. I
also believe that medical dominance cannot
be considered outside of the male-female role
question.
Women's Role
I agree wholeheartedly with Rothberg,
who states that "our oppression as women
health workers today is inextricably linked to
our oppression as women..."" We have
traditionally faced overwhelming conditioning
and indescribable brainwashing in learning
women's "proper" role. As we all know,
women's role is not intellectual. It is emotional
and it is family-centered. It is dependent and
nonaggressive. It is not, of course, a
leadership role!
However, things are changing and there
is an opportunity in today's society, particularly
with the women's movement, to assert
ourselves. It is now more acceptable for
women to take definitive, initiating roles.
Women are increasingly career oriented,
regardless of their level of education, and
more and more of them are working outside
the home. It is obvious that the focus of activity
for many of us is not in the home. Our lifestyles
require satisfaction in contributing to and being
"part of the action." In view of the state of the
world, which is an outcome of long male
dominance, I suggest it is long past time for
women to play a greater leadership role in all
aspects of our society.
Certainly, as health care providers, we
must become more assertive. Failure to
question what we consider shortcomings in
care is a disservice to our patients. If the
quality of care is to be improved, nurses must
function to their full potential. This means
TT
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throwing off the subservient role of women and
maintaining active involvement in
decision-making as health care providers.
Political Naivete
We live in the midst of political structure
and yet we are politically naive. In the health
care system and in the individual health care
agencies, there are definite power bases,
power centers and power structures. There is
continual competition for control and obvious
shifting distributions of power. Relationship
patterns display a variety of combinations of
coalitions and alliances and a wide range of
negotiation styles are evident in the many
confrontations.
Unfortunately, nurses have usually been
on the fringe. We've avoided confrontations
rather than acquiring sl<ills in negotiations.
We've developed patterns of avoidance rather
than confidence in risk-taking. We've avoided
true leadership roles rather than face conflict
resolution.
In the arena of power and authority,
nurses — women, mostly — have been
"programmed for failure." Authority to make
decisions may be frightening, or at least
anxiety-provoking, for it means breaking out of
the security of dependency roles and being
held accountable for the results of our
decisions.
It also means the need for discriminatory
judgment in understanding the nature of power
and the values of shared power. We are living
in a time when the dominance of any one
group is to be deplored. Effective use of control
will focus on public rather than on private
interests and, for us, it will focus on providing
nursing care services for all. If we are truly
serious about our goals of meeting nursing
needs of patients, we must be responsive to
the political struggles going on in many of our
agencies, and we must be equally serious
about our involvement in policy
decision-making.
Such involvement will depend on tne
power and prestige afforded us in these
agencies but we must avoid the trap of
acquisition of power solely as a struggle for
prestige and control. We must be cautious that
use of power is for positive purposes. We must
maintain our goals and focus the power we
acquire on goal achievement: i.e. health needs
of the people.
My concern is with the existing imbalance
in the power structure of the health care
system to the patient's disadvantage. And it is
with nursing and its appropriate role in that
structure and system.
Low Visibility
In order to attain power in any system, a
group must have recognized status and
prestige based on a variety of factors such as
wealth, expertise, political popularity, position
in formal organizations and numbers. Nursing
is not likely to achieve its strength from an
economic base in the near future. It has the
potential, however, of achieving strength
based on expertise in a critically-needed social
service, and certainly it has the potential for
power based on numbers.
It is time for us in nursing to change our
public image, to improve our visibility, to inform
the public of the extremely essential and
positive contribution made by nurses and the
nursing profession.
For too long we have shied away from
self-aggrandizement as a profession. I
suggest that we, as individuals, must inform
the publicof nursing's contributions; but I also
suggest that it is time that our collective efforts
be directed toward a massive public relations
campaign, one that will inform the citizens of
our society of the primary and prominent role
played by nursing in the total health care
scheme. The public must be told how nursing
is, and could be, contributing to its health
needs.
Recognizing our accountability
Paraphrasing Freud's question: "What
do nurses want, my God, what do they
want?" Essentially, I believe, we want greater
freedom; freedom to function to our fullest
potential, to contribute as primary health care
professionals and to determine our own
destinies as essential health practitioners. We
want equity in our Focial and economic status.
We want an end to the medical dominance of
the health care system with its major thrust of
medical care rather than consideration of total
health needs of our society.
The next five to ten years will be critical
ones for the nursing profession and for the
health care system. The effects of economic
problems and cutbacks in health expenditures
are already being felt. As nurses who accept
our professional accountability, what can we
do? The first step, it seems to me, is to get
involved, both individually and collectively, in
all aspects of change. I would recommend
that:
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Initially, we must commit ourselves to
5assessing our beliefs relative to nursing
actice. Regardless of the setting or the
osition in which we function, basic beliefs
lust be clarified.
We must reaffirm the primary role of nursing
nd the inherent authority residing in that role.
|Ve must speak up as knowledgeable
'iractitioners in our daily practice, whether as
taff nurses, administrators or educators.
We must assume Individual as well as
ollective responsibility to interpret nursing's
oie to members of the public as well as to
jither health professionals.
We must be confident in our roles as
■rofessional practitioners. We must all throw
;)ff the shackles of the traditional, subservient
ivomen's role and function as full human
Deings. Whether male or female, recognize
''Our worth as professional nurses.
j. We must inform ourselves of the power
{:enters in our agencies. We must all "tune in"
|ind utilize the political structure in achieving
jiursing care goals. We must choose leaders
ivho are educated, intelligent, articulate, and
vho have the inner fortitude to stand up for
,vhat they know is right for the patient and for
itjrsing.
5 We must overcome the anti-intellectualism
;o pervasive in our ranks and recognize that
)nly in functioning on a par with highly
educated, well prepared, scientifically oriented
lealth professionals will we influence
lievelopments in the health care system.
I'. Finally, we must strengthen our professional
ijrganizations, local, national and
international. Collective action can accomplish
what individual effort cannot.
I believe we must define our beliefs and
ijevelop the inner fortitude and commitment
necessary to take an aggressive and initiating
-ole in promoting change in the health care
system. We must become increasingly
self-conscious about our practice, our
educational preparation and our research. We
must recognize our accountability and function
as the patient's advocate.
We have a vital stake in the health care
system, not only as providers but as
consumers as well. The system of the future
will depend in large measure on our ability to
clarify our roles. It will depend on our
jastuteness in planning strategies for
overcoming barriers to our role enactment as
primary health care professionals. In short, it
will depend on our ability to demonstrate our
accountability as professionals and as a
profession. In the days ahead, this is the
imperative that nursing will have to face.*
Muriel A. Poulin.ft./V. Ed. D., FANN, author of
"Accountability: a professional Imperative," is
professor and coordinator of tfie Graduate
Program In Nursing Administration, Boston
University Sctiool of Nursing, Boston, l\/1ass.
Sfie received tier doctorate from Columbia
University in New York. Dr. Poulin believes tfiat
'we fiave traditionally faced overwfielming
conditioning and almost indescribable
braJnwasfiing in learning women's 'proper' role"
and points out tfiat women hiave only recently
begun to overcome some of tfieir inhibitions. "In
view of the state of our health care system, "
according to Dr. Poulin, "it Is time for nursing to
exert sound and definite leadership."
This article Is based on an address she
gave to mark the opening ceremonies of
t^emorial University School of Nursing's 10th
anniversary celebrations in St John's,
Newfoundland, last Fall.
References
1 Example: Lalonde, Marc. A new perspecUva _
on the health of Canadians: a working document,
by... Minister of National Health and Welfare.
Ottawa, Information Canada. 1974.
2 Canadian Nurses Association Guidelines for
developing standards for nursing care. Ottawa,
1972.
3 Harris. Richard. The sacred trust New York.
New American Library. 1966.
4 Rothberg, June S. Nurse and physician's
assistant; issues and relationships. Nurs. Outlook
21:3:154-158, Mar. 1973.
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Jn^canm\aT^urs^^^eowSr^9^^
A MUTED
EXPLOSION...
"The popular press and lay science writers exhibit an
understandable fascination with the more exotic possibilities of
genetic engineering: test tube babies, chimeras, and clones. But
while they write and societies fantasize about spectacular events
which may take place in upcoming decades, they often ignore the
quiet and more muted revolution in human genetics which is
occurring right now — a muted explosion ... of knowledge and
techniques which may be having more impact on parenthood, on
the family, and on the rearing of life itself than cloning ever will...'"'
\
Lucille Pakalnis, Josie Makoroto
Any discussion of man's investigation into the
reproductive process is guaranteed to evoke
strong reactions, ranging from praise and
enthusiasm to condemnation. There is
scarcely an area of human endeavor more
heavily shrouded in myth than that of
reproduction. But right now, investigation into
reproductive technologies is going on;
knowledge in this area of the medical sciences
is proliferating rapidly. The development of
technologies attending such knowledge
ensures that its influence is being felt more and
more.
As nurses, we are closely involved in the
technologies: first as professionals in the
health field, especially in the care of patients in
research units; secondly, as memtjers of a
society whose fabric and structure may be
affected by their use.
The work going on in the reproductive
technologies carries with it a range of
questions, a number of serious ethical and
moral implications. But for the present, let us
look at where the reproductive technologies
are now, andatwheretheymay be going. Our
bibliography suggests a fraction of the works
available on the implications and possibilities
inherent in the development of such
technologies, but we will look at the
technologies themselves.
Hands Off...?
Public response to what is happening in
the area of reproductive technologies seems
to be related to the perceived motivation for
research. Acceptance is greater when the
result of research is more than merely
informative, when it is perceived as being
helpful to people. For this reason, Edwards
and Steptoe in England have had little difficulty
in finding volunteers for their research, (which
includes in vitro fertilization) because their
motives are seen as humanitarian; they wish
to offer help to childless couples through their
studies. 2
But an uninformed public cannot make a
soundjudgment; the 'unknown' threatens. And
in the area of human reproduction, there are so
many unknowns Involved. For example, we
are just beginning to be aware of the
tremendous effect the prenatal environment
— the same environment such research
attempts to recreate and work within — has on
''■9 1 Reproductive Technologies:
Goals, Problems and Questions
Goals
1 ) to understand the actual process that occurs during fertilization.
2) to assist fertilization in childless couples.
3) to enable monitoring of pregnancies, in order to detect genetic
defects, (e.g. Tay Sachs disease and Mongolism) and
cure/eliminate/abort these.
to supplement/replace natural reproduction w'rth lab methods
(IVF-IVC) to allow greater control over the number and quality of
fetuses.
to alter the genetic pattern of the fetus, either to correct an existing
error or to enhance a particular "favorable' trait.
4)
5)
Problems and Questions
1) currently, artificially produced embryos cannot be maintained to
viability, and must be sacrificed.
2) "Atx)ut 10% of couples are infertile due to genetic defect" ^ This
defect could thus be perpetuated through genetic assistance.
3) some will escape detection due to lab error or sheer number of
pregnancies to be screened. How will society treat these
individuals?
4) would remove reproduction from being a family event;
depersonalizing: could normal psychic development of the fetus
occur?
5) DMA structure is extremely complex — there is danger of
accidentally inducing further damage with repair attempts; could
interfere with natural mutations allowing adaptation to our
evolving environment, and jeopardize our race's survival.
the ultimate outcome of the fetus. 3'"
Another area of concern hinges on the
status of the fetus in the eyes of the
researcher. Is the fetus in fact, a human being,
with the r'ights of a human being? Is it on a par
with lab animals, such as rats and mice? Is it a
discrete tissue, useful for organ function
studies? The question needs an answer, as
such an answer will form the basis for the
course of the research itself.
Public reactions to investigation into the
reproductive technologies tend to be strong,
whether in favor or in opposition. This can be
expected because such investigation goes to
the heart of what man is, or seems to be, and
presumes to alter that somehow. But valid
opinions must be based on fact and not on
myth.
At the heart of the research, is a sincere
appeal to go beyond myth, beyond the
sacrosanct "hands-off approach to
examining such a fundamental aspect of
humanity; to attempt to discern what is
essence and what is explanation; to be able to
act out of choice rather than because of
limitation: and thus to arrive at a clearer, more
accurate understanding of mans place in the
universe.
Goals
The goals of research into human
reproduction are attended by problems and
very fundamental questions. Some of these
are outlined in Figure 1.
What is going on...
The various techniques described seek to
The Canadian Nurse February 1977
Fig. 2
NORMAL SEXUAL
UNFERTILIZED
OVUM
Q — '®
+ 23
23
CHROMOSOMES
SPERM
23
CHROMOSOMES
46 CHROMOSOMES
(HALF FROM
EACH PARENT)
, INTRAUTERINE
GESTATION
♦ BABY
IS A UNIQUE
INDIVIDUAL
IN VITRO FERTILIZATION
UNFERTILIZED
OVUM
FERTILIZED
OVUM BLASTOCYST
23
CHROMOSOMES
64 CELL
DIVISION STAGE
46
CHROMOSOMES
(HALF FROM
EACH PARENT)
REIMPLANTATION
FOR INTRAUTERINE
GESTATION
BABY
IN VITRO CULTURE
^-*- BABY
JETTISON OF
EMBRYO
ARTIFICIAL
INSEMINATION
SF€RM INJECTED INTO
UTERUS
*■ BABY
UNFERTILIZED
OVUM COLCHICINE
ENUCLEATED
OVUM
CLONING
SENDAI VIRUS
FUSION
OVUM
BLASTOCYST
46
CHROMOSOMES
(ALL FROM
ONE PARENT)
64 CELL
DIVISION STAGE
REIMPLANTATION
FOR INTRAUTERINE
GESTATION
>• IN VITRO CULTURE
BABY
IDENTICAL
TWIN OF
ONE PARENT
SOURCE OF p. LEADING
DIPLOID CELLS TO MANY
FOR FURTHER CLONING GENETICALLY
(SERIAL CLONING) IDENTICAL
PERSONS
ufKJerstand anij enhance the processes
involved in the fertilization of a human ovum.
They are depicted in Fig. 2
Artificial Insemination
Artificial insemination has long been used as a
practical, efficient means of breeding animals.
This procedure is now popular In assisting
fertilization in childless couples. An estimated
10,000 children are txirn annually in the U.S.
through the use of this method. ^
Sperm from the husband or a suitably
matched donor are injected by syringelnto the
woman's cervix at the time of ovulation. The
sperm may be fresh, or have been previously
collected and frozen for storage. Impregnation
frequently occurs after two or three such
treatments. Several problems are created by
the possibility of artificial insemination:
• donors must be found with similar
physical and intellectual characteristics to the
husband
• donors must be found who have families
free of known genetic defect
• religious, psychological and legal
complications must be dealt with; they tend to
cause further distress if marital discord
develops
• feelings of inadequacy in the husband
must be dealt with; the common
misconception confusing sterility and
impotence must be cleared up
Controlled Ovulation and Harvesting of Ova
Under controlled hormonal stimulation, a
woman's ovaries can be induced to mature
one or more ova on a schedule known to the
researcher. These ova are then removed by
laparoscopy and aspiration. From the
woman's point of view this procedure entails
little risk; but the chance of damaging the ova
removed by a method relatively violent to them
is great.
In Vitro Fertilization
The harvested ova may then be fertilized in
vitro (i.e. in glass, a test tube) with the addition
of human sperm. Visualization of this process
by means of a microscope has revealed what a
complex procedure fertilization actually is.
Rather than occurring at a given moment, it
spans a time period of up to 12 hours, with
several discrete steps between contact of the
sperm and ovum, penetration, and fusion of
the nuclei. Any disrupting influence (i.e.
bacterial/viral contamination, altered
chemical environment, etc.) could lead to
failure or to defective development of the
resulting embryo.
^
'-^
\
f
r
\
In Vitro Culture
In order to determine that IVF has in fact,
occurred, and that cell division is progressing
normally, the embryo is maintained in a
chemical bath and observed closely. As yet,
this may only be continued up to the blastocyst
stage, or 64 cell divisions, the stage at which
the fertilized ovum is normally travelling down
the fallopian tube to the uterus. Beyond this
stage cellular specialization and organ growth
begin, producing the as-yet-unsolved
problems of oxygenation, nutrition, and waste
disposal, normally provided for by the now
Implanted embryo s placenta. Once the IVF
embryo has reached this stage of
development, the researcher is faced with
three options: to attempt reimplantation of the
embryo into the uterus for intrauterine
gestation, to attempt to continue IVC with an
artificial uterus, or to discard the embryo.
A major difficulty lies in the fact that the
only apparent way to discover a supportive
artificial environment is to expose the embryo
to a series of hostile ones, a process of
elimination. An entirely new living organism is
created by IVF, and then because of our
limited knowledge, exposed to what must be
considered to be lethal conditions.
Embryo Re-implantation
It is at this stage that such scientists as
Edwards and Steptoe. are trying to devise
methods for transferring the embryo back into
the uterus for lUG (intrauterine gestation).
One method involves an atxJominal
incision into the uterus, but this has its
drawbacks. It requires major surgery and
traumatizes the uterus, which may lead to
spontaneous abortion.
A more promising method lies in the
\
insertion of a fine tube through the cervix and
injection of the embryo into the uterus. To date,
most sources state that this has not yet been
accomplished (most embryos fail to implant,
and one implanted in the fallopian tube). One
researcher. Dr. Shettles of Columbia
University, claims to have succeeded using
the syringe procedure on a woman scheduled
to have a hysterectomy. At operation, two days
after the reimplantation "...an examination
showed that it had implanted properly..."'
Cloning
For the sake of completeness, cloning should
be mentioned, but the technical problems
involved with such a delicate maneuver are
such that it seems a much more remote
possibility.
In cloning, the haploid nucleus
(containing half the normal complement of
Twn-
human chromosomes, or 23) is removed from
an ovum and replaced with a diploid nucleus
(containing all 46 chromosomes), perhaps
from an intestinal cell. The now "fertilized"
ovum begins to divide and ultimately produces
an individual identical to the donor of the
diploid nucleus. To date, this has only been
done with reptiles such as frogs and
salamanders, although work is progressing on
perfecting the technique in mammals.
Awareness
Scientific investigation into the
reproductive technologies is going on, and its
going on now. The 'muted explosion' of
knowledge and techniques is already making
itself felt in the areas of artificial insemination
and prenatal genetic testing and counselling.
f\^an as we know him, and all that we call life, is
under close scrutiny.
[Microscopic exploration is giving rise to as
many questions as the answers it uncovers.
With advances in this area, new dilemmas and
responsibilities are created. The
establishment of centers for bioethics is an
expression of the need for answers to the
puzzles created by scientific investigation and
proliferating knowledge.
Perhaps our first responsibility is to be
aware as much as possible of what is going on
in the sphere of reproductive technology. From
here, we can begin to deal more knowledgably
with the questions that will confront us. «
About the Authors
This article evolved from a course in
bio-medical ethics attended by the authors at
the University of Sudbury. Lucille Pakalnis
(R.N., Montreal General Hospital School of
Nursing, l\Aontreal, Quebec) and Josie
Makotoko (R.N., South Africa; P.H.
Aberdeen) both have extensive obstetrical
experience, having worked in England, the
West Indies, Africa and Canada. Currently,
both are living in Sudbury, Ontario. They feel
that the subject of reproductive technology is
one "of tremendous importance to all nurses,
both personally and professionally . At present
Canada has no formal policy governing such
research, and the public at large is similarly
unaware and uninvolved in the matter. This is
a very unfortunate state of affairs, as
ignorance of any aspect of nursing having so
potentially profound an effect on our lives is a
serious handicap."
References
1 Twiss, Sumner B. Genetic responsibility. In
Great West Life Assurance Co. Dilemmas of
modern man. Winnipeg, 1975. p. 65.
2 George, G. Life in the lab. Natl. Observer
12:27:1, Jul. 7, 1973.
3 Leboyer, Frederick. Birth without violence.
New York, Knopf, 1975.
4 Lake, A. New babies are smarter than you
think. Woman's Day Jun. 1976. p. 22.
5 Gorney, Roderic. The human agenda. New
York, Simon & Schuster, 1972. p. 232.
6 Leach, Gerald. The biocrats. Baltimore,
Penguin, 1972. p. 86.
7 Rorvik, David M. Taking life in our own hands:
the test tube baby is coming. Look 35:921 :86, May
18, 1971.
Suggested Reading
1 Augenstein, Leroy G. Come, let us play God.
New York, Har-Row. 1969.
2 Berthold, Jeanne Saylor. Advancement of
science and technology while maintaining human
rights and values. Nurs. Res. 18:6:514-522,
Nov./Dec. 1969.
3 Callahan, Daniel. Human rights: biogenetic
frontier and beyond. Hosp. Prog. 54:9:80-84, Sep.
1973.
4 Commoner, Barry. The closing circle. New
York, Bantam, 1972.
5 Fletcher, Joseph. The ethics of genetic
control: ending reproductive roulette. New York,
Doubleday, 1974.
6 Fuller, Watson ed. The biological revolution:
social good or social evil. New York, Doubleday,
1972. - '
7 Hubbard, William N. Human biology medical
ethics. Univers. Mich. Med. Centre 33:49:53,
Mar/Apr. 1967.
8 Hyde, Margaret O. The new genetics:
promises and perils. New York, Watts, 1974.
9 Ramsey, Paul. The ethics of fetal research.
New leaven, Yale Univers. Pr, 1975.
10 —. Fabricated man: the ethics of genetic
control. New Haven, Yale Univers. Pr., 1970.
statistics show that a large percentage of
patients discharged from conventional
psychiatric facilities are readmitted, not
because of recurrence of pathology, but
because of their inability to cope with what
to them is an alien and hostile world. As
one alternative to traditional psychiatric
care, nurses working at the Lakeshore
Psychiatric Hospital established a
self-care unit on an experimental basis. Its
staff members were confident that the ^
supportive environment they were able to
provide and its emphasis on greater
patient responsibility could ease the
transition for patients from hospital to
community and result in fewer
readmissions.
The self" care Units
a bridge
:o the cominuriity
Patricia Barrington
Patient Study No. 1
Twenty-four-year old John Gordon' was
admitted to Lakeshore Psychiatric Hospital for
the second time in Iviarch, 1975. One of five
children of divorced parents, he had a long
history of mental retardation even though he
had completed Grade 8. Psychological testing
done at the hospital showed a dull normal I.Q.
with social and emotional immaturity.
Following the previous admission, John had
spent a year and a half in a sheltered home
before being removed by his father, and sent
bacl< to his mother in Inarch 1975. John's
mother resented this, and the resultant
problems precipitated his current readmission.
When John was first transferred to the
Self-Care Unit in July, he annoyed fellow
patients and staff with his childish tricks and
immature remarks. When he did not receive
the attention he wanted, he would go off by
himself and sulk. In contrast to this behavior,
however, he took responsibility for the tasks
assigned to him on the unit and obtained a job
with Hospital Services. He surprised the staff
there with his efficiency, reliability and
intelligence. With frequent reassurances from
staff and co-patients, John became better able
to interact on an adult level and was soon
talking about discharge plans. His medication
was gradually reduced and then discontinued
entirely.
With help from staff he found a basement
apartment in the community and upon
discharge, moved in with a fellow ex -patient
from the Self-Care Unit. Both young men
managed very well cooking their meals, and
working regularly. Also, Johns relationship
with his mother improved dramatically and she
asked him to accompany her on a vacation.
John has remained stable and self-sufficient in
the community and continues to perform at a
high level at his job in Hospital Services.
■ Names have been changed and detals altered lo prevent
Identification of individuals but the essential facts are taken
directly from the histones of three of the patients who took part
in the program.
iniLanMiinigau ubruaMy;;
In July, 1 975, we established a Self-Care Unit
on an experimental basis at Lakeshore
Psyctiiatric Hospital in Toronto. It was
designed to provide a commune-type
atmosptiere for ten to twelve chronic male
patients between the ages of eighteen and
forty-five. Operated by one R.N. and one
R.N. A., 24 patients have stayed on the unit
over a 7-month period. Four of these patients
were transferred back to their original units
because they refused to accept the
responsibility which went with the additional
freedom offered in the Self-Care Unit. Twenty
patients, John Gordon among them, have
been discharged to the community and have
not required readmission.
A self-care unit setting provides a
psychiatric patient with a transitional
experience to bridge the gap between hospital
and community living. In this warm, caring and
supportive environment, our goal is to help the
patient to relearn and practice living skills and
to develop a feeling of responsibility towards
himself and his fellow patients, thereby
increasing the probability of his successful
return to the community. By nature of its
minimal equipment and staffing, its reduced
number of readmissions and its subsequent
reduction of hospital bed occupancy, it also
offers a maximum of economy in a time of
financial constraints.
A typical program which initiates and
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promotes a sense of responsibility in the
patient towards himself and others may
include:
• a written committment or contract by th'
patient regarding his goals, objectives and
probable 'ength of stay in the Self-Care Unit
• responsibility for household chores on
commune basis
• responsibility for personal medication
• preparation and serving of breakfast an
lunch in the Unit
• participation in group discussion to
encourage communication and the
development of insight
• assistance in voluntary work in various
hospital departments for specific periods
every day
• discussion of job possibilities and
opportunities or various upgrading prograrn
available in the community
• participation in the investigation of
suitable accommodation and social
recreational facilities in the community.
Mature and experienced staff are
necessary to provide the consistent suppon
and guidance that each patient in the self-can
unit needs. As the noted psychiatrist, Dr.
William Glasser states, the staff must achiev
"the proper involvement, a completely honesi
human relationship in which the patient, for
perhaps the first time in his life, realizes thr
someone cares enough about him, not only (
accept him, but to help him fulfill his needs I
the real world." The staff of a self-care unlti
must have the personality and maturity to
direct such a program.
To maintain the continuity of personal
contact that is the very heart of the prograrm
staff members should be on fixed hours rath'
than rotating shifts, so that patients know whe
and where they can find the particular
individual they wish to consult.
Prior to their transfer to the Self-Care Un(
many of these patients had poor prognoses
but the changes that have occurred are
considered remarkable by the staff of the
hospital. The studies that follow serve as
examples of the progress psychiatric patien
can make in a self-care unit environment.
Patient Study No. 2
Larry Black was 24 years of age with a Grade
XI II education. His mother and father were both
jrofessional people and he had two younger
sisters. His first admission was as an
1 nvoluntary patient after being transferred from
a general hospital with a diagnosis of
schizophrenia. In November 1974, Larry had
aeen difficult to handle and had left hospital
several times.
During his first admission to Lakeshore he
//as withdrawn, isolated and seclusive. He was
treated with Chlorpromazine until his discharge
io a private sanatorium. One week after his
discharge from the sanatorium, he was
readmitted to a general hospital. When the staff
found him difficult to manage, he was again
readmitted as an involuntary patient to our
hospital.
Upon admission, Larry showed thought-
blocking, delusions and experienced auditory
hallucinations. He also had a history of
self-destructive acts, and, one hour after
admission made an attempt to jump out of a
third-floor window, but was restrained by staff.
With the administration of electro-convulsive
therapy and phenothiazines, the psychosis
subsided quickly but he still remained
seclusive.
In early April, plans were made to place
Larry on day care. However the weekend
before his discharge, he slashed both his wrists
at home. In May, he began working in Industrial
Therapy, but again, slashed his wrists after an
upset caused by a fellow patient.
Over the summer months, Larry showed
some improvement. His general affect was
good and he was verbalizing more. In
September, he started a general preparatory
course at a Community College but he seemed
anxious about it. His medication at the time
included Chlorpromazine, Moditen, Stelazine
and Kemadrin.
When Larry arrived in the Self-Care Unit,
he was very shy and withdrawn. At first, he was
reluctant to speak out at the morning group
sessions, but as he got to know his fellow
patients and staff he was able to express his
opinions quite well. Larry took responsibility for
the duties assigned to him. He attended his
Community College course daily and spent
weekends with his parents. After awhile, he
told us of his real fears about pursuing higher
education. He felt that his family expected this
of him but he preferred to work at something
less intellectually demanding. In solving this
conflict, Larry made plans to get a job and
completed all the necessary arrangements
himself. At the end of December, he was
discharged to a halfway house, suggested to
him by the staff, and there, experienced greater
independence and became popular with the
other men in the house.
Although he had needed a great deal of
positive reinforcement and support to make
these moves, he made them, and has not been
readmitted. His medication has been reduced
to Moditen injections every two weeks and
Cogentin. His relationship with his family has
improved and he visits them, but not as often as
before. Now, he depends more on friends in the
house and people in the community.
Patient Study No.3
Tom Brown, 28-years-old, had completed
Grade 9 and was employed as a laborer. His
family history was poor. His mother was a
manic-depressive, his one brother had been a
psychiatric patient at Lakeshore and his father
seemed totally indifferent to his family's
problems. Tom also had one sister.
Over a period of four years. Tom had been
admitted four times with increasingly severe
diagnoses of amphetamine psychosis,
schizophrenia, personality disorders and drug
abuse. Most recently, he was admitted after
taking an overdose of Chloral Hydrate tablets,
his second suicide attempt in a short period of
time. Although quiet, withdrawn and lethargic,
he settled in fairly well on the ward and by late
June, he no longer felt suicidal. He was closely
observed by staff for a month, however, and
was granted limited privileges.
On admission to the Self-Care Unit in
November, a psychological assessment
showed that Tom had marked schizoid
features, suffered from depression in schizoid
personality and showed signs of borderline
schizophrenia. He required intensive individual
and group relationships that would provide him
with the support he needed to further his
independentfunctioning and rehabilitation. His
medication included Nozinan and Cogentin.
Like many patients coming to the
Self-Care Unit. Tom lacked self-confidence.
But in a short time, he seemed comfortable and
accepting of the emotional support on the Unit
and he was able to speak up at the daily group
sessions. He took responsibility for his own
chores and lent emotional and psychological
support to his co-patients on the Unit. He
worked daily in Industrial Therapy, participated
in social activities in the hospital and
community and eventually became enrolled in
an upgrading course in a Community College.
His relationship with his parents improved and
he achieved insight into his relationship with his
brother, who had been upsetting him frequently
in the past with his problems.
Tom was discharged in February 1976, to
a room in the community and until this time has
remained independent of the hospital except to
return for a minimum dosage of Moditen.
In his book, "Reality Therapy," Dr. William
Glasser states that everyone has two basic
psychological needs — "the need to love and
to be loved, and the need to feel that we are
worthwhile to ourselves and others."
Psychiatric patients for one reason or another
are unable to fulfill these needs and have
become irresponsible because they have
never learned how to meet them.
In a similar vein, another psychiatrist, Dr.
Victor FrankI in "Mans Search for Meaning"
says, "the therapist should increase the
patient's responsibility. He/she must not
protect the patient from conflict but show him
how he may overcome it himself;
demonstrating that he has untapped reserves
of strength just as an architect may strengthen
a decrepit arch by increasing the load upon it,
forcing the parts more firmly together."
It is the aim of the Self-Care Unit to help
the participants in the program develop this
feeling of responsibility which will enable them
to give and receive love and to build the
self-esteem and independence necessary to
live outside the institutionalized or hospital
setting. *
Patricia Barrington.fRW., St. Mary's School
of Nursing. Montreal) Is presently nursing at
Lakeshore Psychiatric Hospital In Toronto. In
July 1975, she developed and organized the
12-bed Self-Care Unit which was an offshoot
of a rehabilitation program using a token
economy system. In February 1976, the unit
was expanded to a 45-bed facility.
Barnngton is presently a member of the
Health Planning Committee of the Social
Planning Council of Etoblcoke, Ontario and is
taking courses towards her degree.
The Canadian Nurse February 1977
care o
The nurse working in emergency is in an optimal position to
develop a therapeutic relationship with the woman who has
been raped. The hospital experience can be made a helpful
one if staff are open, understanding, and knowledgeable in
their treatment and support of the rape victim.
he rape victim
Sandra LeFort
If you work in the emergency department of a
large center, chances are that sooner or later
you will be called upon to care for a victim of
rape. In 1974, a total of 1,823" rapes were
reported to police officials in Canada. This
figure, however, barely skims the surface of
those who are raped and never press charges.
Many more victims arrive at a hospital for help
than these statistics would have us believe.
Experts estimate that only one rape in ten is
ever reported.
Some hospitals in Canada have refused
outright to treat victims of rape while others
show varying degrees of cooperation
depending on the hospital staff involved. In the
United States, despite nationwide efforts to
improve the mental and physical care of rape
victims, the situation is not much better. RN
magazine (Feb. 1976) reported that many
private hospitals have a "shut -door policy" for
rape victims and those who are treated have to
wait several hours in an emergency room, in a
state of shock and with little privacy.
A recent study by workers associated with
the (viontreal Rape Crisis Centre showed that
78% of hospitals in the Greater Montreal area
refused to answer a questionnaire concerning
the protocol used in the care of rape victims in
their emergency departments. Only 6 out of 1 3
hospitals contacted were willing to have rape
crisis centre workers present inservice
education to hospital personnel about the
realities and myths of rape, the
medical/nursing care required and legal
aspects.
Counsellors at rape crisis centres in
several cities across Canada, when contacted
by CNJ, unanimously agreed on one point: the
emotional crisis that occurs in the life of a
woman who is raped is often secondary or
totally ignored by health professionals in their
initial contact with her. One RCC worker in
Ottawa described some nurses as "cold and
matter-of-fact and seemingly unaware of the
emotional support needed by a woman who
comes into emergency after being sexually
in emergency
assaulted." This worker emphasized that what
is lacking is an informed awareness on the part
of nurses about how an assault of this kind
affects the victims behavior.
A counsellor at Rape Relief in Vancouver
stated: "Overall, the Vancouver medical
people are fairly good but there are the
occasional horror stories. Basically, the
problem is ignorance and insensitivity on the
part of the medical and nursing staff. What
they may view as an innocent question i.e.
'Where were you when it happened?' may sound
judgmental to the women and be interpreted as
They think that it was my fault for being
there.' We cannot sufficiently emphasize a
rape victim's need for understanding and
compassion. "
Societal attitudes are not on the side of
the rape victim. Often, the prevailing attitude is
that a woman who is raped had it coming to her:
she must have done something to provoke the
attack; she is out to get revenge or else cries
rape because she is caught in an
embarrassing situation. For those working in
the health professions, such attitudes can and
do prevent the development of helping
relationships with women who have tjeen
raped.
The woman who has been sexually
assaulted needs assistance and support. The
nurse in emergency is in an optimal position to
use her humanistic skills to decrease the
victim's fearand anxiety: to help herto be more
in control of her situation by explaining what is
happening to her and by listening in an
understanding way: and to share valuable
information about counselling services and
follow-up treatment. In an attempt to increase
knowledge and assist in the development of a
sensitivity toward the rape victim, the Rape
Crisis Centre in Toronto is contacting hospitals
and providing inservice education workshops
to staff. As well as providing concrete
information, sessions also allow for questions
and discussion about the attitudes and
feelings the staff have about rape. To further
aid emergency room personnel, they have
published a booklet entitled "Emergency
Room Care for Rape Victims. " The following
guidelines are excerpts from that booklet
In 1 975, the Provincial Council of Women
of Manitoba prepared a Brief on Rape
which was supported by the Manitoba
Registered Nurses Association and the
Canadian Nurses Association. Among
others, their recommendations included:
changing legislation to recognize rape as
sexual assault: revising courtroom
procedure; expanding counselling and
other supportive services: revising
medical procedures; expanding public
education: providing treatment and
counselling services for sex offenders.
In March 1976, the Criminal Code
was amended and did incorporate some
of these recommendations into the new
legislation. The Justice Department has
conceded the point that moral judgments
are out of place in criminal courtrooms
and, correspondingly, limitations have
been placed on the defense counsel's
right to cross-examine women about their
character and past sexual conduct. Such
questions may be asked only if the
information is essential to a fair trial. Other
amendments give the judge great
discretionary power. Depending on
circumstances, the judge may insist that a
victim's identity be kept secret; that the
public be excluded from the trial; that the
location of the trial be changed — this is
particulaHy beneficial for women in small
communities.
Many people, however, feel that the
recent amendments to the Canadian rape
laws do not go far enough. In response to
this criticism. Justice Minister Ron
Basford has stated that a general revision
of all sexual offenses within the Criminal
Code is in process.
^Statistjcs Canada Catalogue number 85-205. annual publication
Crime ana TraHic Enforcement Statistics. t974.
The Canadian Nurse February 1977
Guidelines for Care of
the Rape Victim
If emergency room personnel are aware of the
psychological Implications of the rape
experience, they have an excellent
opportunity to reassure the victim and to help
her to regain her equilibrium. If the rape victim
does not encounter aware and sympathetic
staff, the hospital procedure will probably only
further frighten and upset her. Caring for the
rape victim's emotional state is more than just
an act of kindness. It is potentially the
prevention of future psychologic disorders.
1 . The patient should not be given low
priority on the grounds that her physical
injuries are slight. She is frightened, upset,
possibly exhausted and should be examined
as soon as possible. This is important for legal
as well as medical reasons. Specimens should
be obtained for forensic testing as soon after
the incident as possible.
2. If a wait is unavoidable, she should be
placed in a private room away from the
embarrassing curiosity of other patients. Any
unused space can serve this purpose, a
conference room for example.
3. She should never be left to wait
alone. The presence of a supportive and
sympathetic person is essential. If a rape crisis
centre is in your community, a caseworker can
be called by the victim or the nurse to provide
support at the hospital and to accompany her
to the police station or her home aftenwards.
4. It is crucial that the nurse display a
sympathetic, non-critical, and non-
judgmental attitude towards the victim.
Societal attitudes are nr^t on the side of the
victim and any attitude \/hich blames her will
only serve to abort any therapeutic
relationship. It is inappropriate for medical
personnel to express any judgments or
opinions as to whether rape actually occurred
or whether the victim was at fault.
5. The offer of small comforts such as
coffee, kleenex, cigarettes, etc. can be very
reassuring and may help her feel more at
ease. She should be kept warm at all times.
6. Telling her story may be a relief or it
may be a painful reliving of the incident. In
either case, she should have to answer
questions only once, preferably to the nurse
who remains with her until the medical
examination. Any attempt to pressure or force
her into giving details of the incident or
submitting to the pelvic exam will be
experienced as a continuation of the violence
and coercion of the rape. There is no need for
the woman to relate the entire story to medical
personnel.
7. The following kinds of information
are relevant:
— Medical history: menstrual,
contraceptive, VD history, pregnancies, etc.
— the time of the alleged assault: whether
she bathed or douched afterwards.
— whether penetration occurred or If
ejaculation occurred elsewtiere on her
body.
— non-genital physical trauma e.g. pain.
— whether she scratched or injured the
assailant.
8. The woman herself has the right to
choose the persons she wishes to notify about,
the incident. She may want to contact the
police, friends, relatives, or the Rape Crisis
Centre. The hospital is under no obligation to
automatically call the police.
9. All medical examination procedures
should be explained to the patient in advance.
Rape victims need emotional support at this
time. The assurance that the examination is
happening with her full understanding and
consent is very important. Remember that she
has just experienced a violation both of her
body and her right to consent.
To protect everyone involved, consent
forms should be obtained from the patient for
the examination, the collection of specimens
and the release of evidence to the authorities.
10. If possible a doctor who is sensitive
to the implications of the rape on her
emotional state and her family life should
examine the victim. She may find the
examination less threatening if it is performed
by a female doctor.
11. /( is never necessary for a police
officer to be present in the examination room
during any part of the physical exam for legal
purposes. The examination will include the
collection of specimens:
— direct smears from vaginal pool and
cervix
— vaginal washings (10 cc normal saline)
for centrif ugation and smears and acid
phosphatase if indicated
— pubic and head hair specimens of the
patient
— other specimens which may be taken
are anal swabs; dried stains on the skin;
fingernail scrapings.
If the woman is not sure whether she
wishes to report the incident, it is possible to
store the specimens under refrigeration for
24-48 hours without contacting the police.
Specimens sent to the forensic lab should not
be sprayed or placed in any kind of
preservative. All samples must be sealed,
dated and signed by appropriate staff.
Before and during the medical examination:
— explain exactly what is is going to
happen. She is probably very frightened I
and it may be her first internal exam.
— make sure a woman is present at all
times.
— do not expose her any more than is
necessary — provide a blanket.
— allow her to undergo the internal exam
in the position which she finds most
comfortable — lying down or semi-sitting.
— warm the speculum with warm water
only.
— try to make her feel as comfortable and
as calm as possible — it may seem like
a second rape.
— if she is reluctant to discuss the
Incident, ask only direct questions
relevant to her immediate care and to the
collection of evidence.
12. In the case of young children, a
complete internal exam is not necessary.
Specimens may be obtained with a sterile
pipette. Many large centres have experienced !
team members who are available to examine
and counsel sexually assaulted children and
their parents.
13. Someone must be available to
accompany the woman from the hospital to
her home. It could be a friend, relative, a police
officer or a rape crisis centre caseworker. If
she lives alone, suggest that she spend the
night with family or friends.
1 4. If the woman appears distraught, it
may be advisable to encourage her to seek
professional counselling. She must
understand, however, that this is simply to help
her deal with a crisis in her life and does not
imply any underlying neurosis.
1 5. Initial responses to sexual attack
tend to fall into one or two categories
— expressed reactions such as crying,
trembling, nervousness or laughter or —
repressed reactions such as outward calm,
■. and controlled behavior. She may insist that
there is nothing wrong with her. In many cases,
the victim with repressed reaction is not
believed by staff. In one case, a rape crisis
centre worker observed that a nurse would not
believe the victim "because she was not
crying."
Studies indicate that approximately an
equal number of women react in each way.
Afterthe initial acute reaction, the victim enters
' a period of withdrawal or repression when she
simply doesn't want to think about the incident
i at all. It is important for nursing staff to be
aware of this stage when recommending
, follow-up tests for VD and pregnancy. Unless
I the importance of these tests is impressed
I strongly on her, she may ignore them as
, reminders of a painful fact she is trying to
forget.
1 6. The woman must understand the
need for follow-up treatment. Some form of
t venereal disease or infection is a possible
result of rape. She should make appointments
I at the hospital or with her own doctor for tests
for gonorrhea after three weeks and syphilis
after twelve weeks.
Many women worry about becoming
pregnant although this actually happens in
very few cases. If she is at a dangerous point in
her cycle, she should be told when and where
to get a pregnancy test.*
Suggested Reading
1 Brownmiller. Susan. Against Our Will. Men,
Women and Rape. New York, Simon and Schuster,
1975.
2 Burgess, Ann. Crisis and Counselling
Requests of Rape Victims, by... and Lynda Holstrom.
Nursing Research. 23:3:196-202, May 1974.
3 Burgess. Ann. The Rape Victim in the
Emergency Ward by ... and Lynda Holstrom. Amer
J. Nurs.. 73:10:1741-5, Oct. 73.
4 Burgess, Ann. Rape: Victims of Crisis, by... and
Lynda Holstrom, Maryland. R.J. Brandy Co., 1974.
5 Williams, Cindy Cook. Rape: A plea for help in the
tiospital emergency room by. . and R. Arthurs.
Nurs. For. 12:4:388-401, 1973.
/ would like to thank the counsellors at the Rape
Crisis Centres in Vancouver, Ottawa, Toronto and
Montreal for their cooperation and willingness to
help in the preparation of this article. A special
"thank you" goes to the Toronto Rape Crisis Centre
for their permission to use part of their booklet
"Emergency Room Care for Rape Victims."
Every nurse has memories buried somewhere of what it was like to be a first
year student, meeting totally new experiences every day and having to deal
with them — somehow. And there are patients that we can remember as if it
were just yesterday. This diary shares the day-to-day 'ups-and-downs ' of a first
year nursing student, and her patient, Mrs. B
Jtrs
and me
Heather Sproul
August 3
Am working afternoons all this week. ..Light
was on above 1017, and I walked into the room
to find a very thin and tiny patient curled up at
the foot of the bed. She wanted to use the
bedpan. Noticed that her right arm was
extended by an armboard held in place by a
Kerlex* bandage, that was wrapped from her
hand to her upper arm. She had an IV — and I
came to the conclusion that the needle must
have been somewhere in the area of her
anticubital fossa.
She was also on a cardiac monitor and
oxygen by nasal prongs — quite a collection of
tubes and wires for a little lady. It seemed to
me that she was a pretty sick cookie. Asked if I
could have her as my patient the next day.
' Kerlex is a registered trademark of Kendall Company (Canada)
Umited.
August 4
Mrs. Burton is officially my patient, and I hope
that I've done the right thing in requesting her.
I'm pretty sure that I can cope, but time will tell
if I've bitten off more than I can chew.
She needs help with meals as she is right
handed, and refuses to use her left hand. Her
IV is in her right brachial vein... a rather stupid
place for it in my opinion, but I guess that
sometimes its a matter of putting it wherever
they can find a vein.
August 5
I seem to be coping fairly well with Mrs. Burton.
Her intravenous is still in her right arm and she
doesn't appear to be any happier about it.
Tonight she said that she hates to see her
supper tray go, because it means that the
doctors are going to come in and fiddle with her
IV, and that hurts. When I took her tray away,
she was almost in tears.
She seems to be a rather unusual person,
"spaced out," very flat in her facial expression.
She always seems preoccupied and doesn't
have much interest in anything that is going on
around her.
She only picks at the food on her tray —
tonight all she had for supper was tomato juice
and milk. She says that just the sight of food
makes her feel ill, and as she eats, a kidney
basin is her constant companion.
I suppose it isn't any wonder that she
seems apathetic, picks at her food, and
appears morbidly preoccupied. In my opiniom
her recent medical history must be very
discouraging for her. At 63 years of age, Mrs
Burton is married, but has no children. Three
months ago, she had a massive myocardiali
infarction, and was admitted to the Coronary
Care Unit at a regional hospital. When her
condition was more stable, she was
transferred from CCU to a cardiac floor. Abou
a week later, she was transferred to Kingstoi:
General Hospital and admitted to CCU therf
with a diagnosis of pulmonary embolism ann
congestive heart failure.
By the time I met Mrs. Burton, she had
been in the hospital for a long time, and hef
problems were considerable. She was
diagnosed as having peripheral neuritis,
congestive heart failure, myocardial infarction;
pulmonary embolism, and leukopenia.
August 6
7945 hours
Mrs. Burton complained of sharp mid-sterns
chest pains. Her blood pressure was 120/651
pulse 70, and regular. Her face was very pale
and drawn. Remembered from my reading
that patients suffering one Ml will probably
have another, more serious, infarction. I
figured that she was doing just that, and askec
the doctor to take a look at her. After his
examination, the doctor asked me what Mrs
Burton had eaten for supper. Then he aske^
me what I thought her problem was. When
told him what I thought, he laughed for wha'
seemed to me to be a long time, told me Mrs.
Burton had indigestion, and asked if he could
give her an antacid. He assured me however,
that I had been right to call him — that it was
always better to be on the cautious side. Did
my charting and sat and read Mrs. Burton's lab
reports until I went off duty. She has had two
bone marrow biopsies done. Will have to do
some reading about leukopenia tonight.
August 7
Mrs. Burton was asleep when I went Into her
room for 1600 hour vital signs. I guessed that
the lung scan she had earlier this afternoon
had taken the puff out of her.
As Mrs. Burton slept, I began to count her
respiratory rate. Her breathing was shallow,
and regular. As I counted, the depth of her
respirations increased gradually, and then
suddenly she stopped breathing for about ten
seconds. This really threw me. I thought that
shed had a respiratory arrest, until her
breathing began again, shallow and regular.
For a few minutes, she followed the same
pattern ...Cheyne-Stoking?This time I decided
to talk to my instructor before I called a doctor.
Quiet after supper. Mrs. Burton was
napping, so I read more of her chart. Still no
word on the cause of her leukopenia.
At report this afternoon, our instructor
suggested that if we had any spare time this
evening, we should look up Valium in the
C. P.S., as it is the most widely prescribed drug
in the world, and just about all the patients on
the floor are taking it. Mrs. Burton has been on
^'^'ium since the beginning of her illness. So,
en Id finished with Mrs. Burtons chart, I
aecided to tackle the C.P.S. and Valium. There
it was on page 222 — the more senous
adverse reactions occasionally reported are
leukopenia"... hmmm.
Went to my instructor with my findings and
she suggested that I talk to one of the doctors
about it. The doctor seemed to think that I had
taken leave of my senses, and informed me
that Valium-induced leukopenia is extremely
rare (why can't Mrs. Burton have a rare case of
Valium-induced leukopenia?). ..Crushed.
7950 hours
Again, Mrs. Burton complained of sharp
mid-sternal chest pains. She looked like death
warmed-over. Decided to play it cautious
again and have a doctor take a look at her. He
gave her one nitroglycerine sublingually and
Mrs. Burton settled down in about five minutes.
Earlier in the evening, I had placed Mrs.
Burton in the textbook position for a person
with dyspnea. But when the doctor came in , his
first comment to me was that she was likely to
smother in all those pillows. So much for my
positioning skills.
My last evening. Next week, lllbeondays
and Mrs. Burton will need a bed bath. With two
IVs, cardiac monitor wires, and oxygen in the
way, one of us is bound to get hanged. Well
see.
August 10
At report this morning, found out that Mrs.
Burton needs a nose and throat swab to be
sent for culture and sensitivity. This should be
no problem for me as I've done swabs before
in microbiology labs. Plan on doing the swabs
before breakfast along with eight o clock vital
signs.
Swabs went without a hitch. So did the
bed bath. Mrs. Burton was taken off the
cardiac monitor sometime over the weekend,
so that meant one less set of cords for me to
worry about. Noticed reddened area just below
her coccyx. Id better get out the brown soap,
and try better positioning too. (I take the
weekend off, and the place falls apart).
Mrs. Burton is still pretty lethargic and has
no interest in what's going on around her
Thought last week that it might be because of
the day's activities, but now I'm more inclined
to think that it's due to the long penod of time
she's been in hospital.
Felt that I was doing a fairly good job with
Mrs. Burton until I read her chart this morning.
The psychiatric resident was down to evaluate
Mrs. Burton yesterday. He found her to be
deteriorating mentally, slow, demented, and
unkempt. I'll admit that Mrs. Burton's hair is
disheveled — it's short, she's between perms,
and she's having oxygen by nasal prongs. The
psychiatrist is scheduled to see her tomorrow.
so I'm going to try to improve her appearance
with a snappy new hairstyle before he sees
her.
August 11
Things were going fine with Mrs. Burton until
breakfast arrived — her IV had gone
interstitial, so one of the doctors decided to
remove it and restart it after Mrs. Burton had
finished breakfast. Mrs. Burton's toast was
ice-cold so I toddled off to make her some
more. Got back to find that her IV had sprung a
leak — blood all over the bed, pouring out from
her IV site. Grabbed a couple of 4 x 4's, applied
pressure and elevated her arm. Realized that
Mrs. Burton is on heparin therapy and that
she'll take her own sweet time to clot. During
all of this, Mrs. Burton was munching away on
her toast, happy as a little clam.
Got the bleeding stopped. Took her tray
away and came back in time to see Mrs.
Burton's breakfast coming back up. All in all,
she vomited 1 00 mis of undigested food.
Guess she was pretty worn out at this point —
she practically begged me to let her rest for
half an hour before I gave her her bath and did
her hair. Fifteen minutes later, guess who
walks into Mrs. Burton's room — the
psychiatrist and his band of interns and
residents (I just can't get ahead!!).
My instructor and I sat in on his
consultation. Learned a lot about interviewing
from watching the psychiatrist — he has the
best technique that I've ever seen — he keeps
the whole interview very open-ended, doesn't
appear to be rushed and asks very few
questions, lets the patient do just about all of
the talking. In the huddle outside Mrs. Burton's
door aftenwards, he stated that she did not
appear to be deteriorating mentally at all, but
was probably just frustrated with her
prolonged stay in hospital. He prescribed
home for her just as soon as her physical
condition would allow it. What a load off my
mind!
August 12
First half of tfiis morning was relatively
uneventful. That brown soap and massaging
really works — the red spot on Mrs. Burton's
coccyx has disappeared. She had no
problems with breakfast today.
At about 1 100 hours, she said that she
wanted to use the commode chair. After about
fifteen minutes on the chair, her light went on.
Mrs. B. announced to me that nothing was
happening and that she wanted an enema or
suppository or else she was going to faint. Told
her I'd check with one of the nurses and let her
know what the verdict was. A nurse suggested
that Mrs. Burton sit on the commode for
another fifteen minutes. Fifteen minutes later,
Mrs. Burton stated that if I didn't give her an
enema or suppository, that she would faint! (a
fact which wouldn't surprise me at all).
The nurse told me that since Mrs. Burton
was so determined, it might be best to ask her
doctor for a glycerine suppository. So, I got to
give my first suppository, and Mrs. Burton got
results.
August 13
Decided today to get one of the other students
to help me and between the two of us we'd
wash and set Mrs. Burton's hair. Found out
while we were washing it (in bed) that it hadn't
^Sometimes, baby getsV|
more air than formula.
>
That's why we make soothing,
peppermint-flavoured Ovol
Drops.
Ovol is simethicone, an
effective but gentle antiflatu-
lent that relieves trapped air
bubbles in baby's stomach and
bowel without irritating gastric
mucosa.
Ovol works fast. And that's a
relief for baby. And for mother.
Also available in adutt^strength
chewable tablets.
OVOL DROPS
FOR INFANT COLIC
AHORRER
been done for seven weeks. Greta set Mrs
Burton's hair while I gave her a bath and thf
two of us got her sitting up in her chair with th
hair dryer. Changed her bed and tidied up th-'
room. Was time for lunch at this point, so w»
combed Mrs. Burton out and put on her ov,
nightgown and bathrobe before bringing hei
tray in. Quite a change — Mrs. Burton glowed li
Just after her tray was brought in, her husban \
and sister dropped by to see her. I just couldn j
believe my eyes — Mrs. B. not only showed a!
interest in things but ate just about all of hel
lunch (it stayed down, too). j
August 17
Back on afternoons this week. Mrs. Burton if
really showing improvement. She asked mil
what I did to keep out of trouble last weekencf
Her chart says that she can be ambulate \
in her room with assistance, so maybe aftej
supper, the two of us will go tearing around ht
room.
Always figured that Mrs. Burton was
about four foot nothing in her stocking feet.'
Was q.gite surprised to find that when she g;
up out of bed that she's really a lot closer to fiv
foot six. She didn't tolerate the rip around h(
room too well — felt dizzy and short of breati'
— probably partly because she's been in bo
for so long. Maybe she'll do better tomorroi
night.
August 18
Mrs. Burton made it around her room twicf
tonight! She still needs a lot of assistance aP'
encouragement but she didn't get really tire-
until halfway through the second lap.
Tomorrow night I'm going to try to get her
walk out in the hall.
August 19
Made it all the way up to the door of the CC
with Mrs. Burton tonight. She's beginning t
tolerate ambulation quite well and in no time >
all, she should be roaring up and down the
halls.
August 20
Came on duty this afternoon to find Mrs.
Burton's room empty — she was discharg*
this morning. She's gone, and I'm really goin
to miss her. She was an interesting lady, anr
really learned a lot from her. Thanks alot. Mil
B.4»
Author's note: Heather A. Sproul is current*
a second year nursing science student at
Queen's University, Kingston, Ontario. She
wrote this article during the clinical
Intersession of her first year She is intereste |
In specializing in orthopedics or burn therafi 1
upon graduation.
References
1 Luckman, Joan. Medical-surgical nursing:,
psychophysiologic approach, by ... and Karen
Creason Sorensen. Toronto, Saunders, 1974. p
669-670.
2 Canadian Pharmaceutical Association.
Compendium of pharmaceuticals and speciaiti'
9ed. Toronto, 1976. p. 222.
Pampers
you both
a break
(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 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
contaimnent, shirts,
sheets, blankets and
bed pads don't have to
be changed as often
as the^• 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.
rROCTER A GAHILE CAR-322
Books
Essentials of Communicable
Disease, 2ed. by Mary Elizabeth
Mclnnes, 401 pages. The C.V.
Mosby Company, St. Louis,
1975. Canadian agent: Mosby,
Toronto.
Approximate price $10.00
Reviewed by Ctiristina Gow,
Assistant Professor, School of
Nursing, University of Britisli
Columbia, Vancouver, British
Columbia.
The author's suggestion that this
book could be used as a quick
reference is, in the reviewer's mind, a
correct one. The text's contents cover
a wide range of material, beginning
with an introductory section which
deals with such topics as historical
events, scope of control, immunology,
social, psychologic and economic
factors, jet-borne communicable
diseases, care of patients with
communicable diseases and rashes.
This section is very general and
somewhat repetitious. Reference
material dating from the early and
mid-sixties is not very current as the
book was published in 1975. The
author has attempted in this
introductory section to present
material in an interesting way. One
problem involved in such a broad
introduction is the sheer bulk of
material available.
The author then divides the text
into sections dealing with the specific
diseases of varied causes:
Section II deals with Bacterial
Diseases: Part A — Infectious
Diseases and Part B — Enteric
Diseases. This classification is
confusing, as both Part A and B
diseases are highly communicable,
eg.. Tuberculosis (Part A), Typhoid
Fever (Part B). In this section,
references cited are again often from
the sixties; in one instance(dealing
with tuberculosis) the author referred
to a 1959 reference on the
effectiveness of chemotherapy.
Section III deals with Viral
Diseases. A table is presented on
page 222 which outlines the
classification of viruses, but no
reference is cited. This introduction
would have been more beneficial had
some of the types of viruses been
further explained. More detailed
information would help the beginning
reader, although the book does not
claim 'exhaustive coverage.' A further
suggestion is that the glossary could
have been more detailed.
Sections IV, V, and VI deal with
Arthropod-borne diseases, diseases
caused by fungi, and Helminth
infections. The information in these
sections is of use for quick reference.
The treatment sections under
each of the diseases are not up to date
in all cases eg.: with Scarlet Fever it is
stated "bed rest is mandatory for one
week."
This text would be useful to
student nurses as a reference guide
and not as a basic textbook. The writer
has attempted to cover many
diseases and has presented a source
which will be of use as a beginning
reference for the nurse.
Diagnostic Procedures. A
Reference for Health
Practitioners and a Guide for
Patient Counseling by Barbara
Skydell, R.N., M.A. and Anne S.
Crowder, R.N., M.A., Little,
Brown and Company, Boston,
1975.
Reviewed by Lou Lewis, R.N.,
M.Sc.N,, Instructor, Nursing
Department, Ryerson
Polytechnical Institute, Toronto,
Ontario.
This book provides a quick and
easy reference for health
professionals who prepare patients
daily for various diagnostic
procedures. It emphasizes the need
forcreative patientteaching regarding
diagnostic tests, and for
communication with the patient so that
he will know what to expect before,
during, and after an unfamiliar
procedure.
The book is divided into twelve
sections. The first section is an
overview which deals with an
approach to communication, and
explains the format of the book. It also
discusses such factors as time,
patient attire, consent and diet that are
common to successful completion of
many diagnostic tests.
The next ten sections of the book
discuss the diagnostic procedures
themselves. The tests outlined include
those used in neurology,
opthalmotogy, urology, the biliary and
gastrointestinal systems,
cardiovascular and respiratory
systems, and female reproductive
system. Also included are
radioisotope scanning, ultrasound
and additional procedures. Each
procedure described follows a similar
format. It includes purpose, time,
location, personnel, equipment,
technique, preparation, patient
sensations, and aftercare. The book
covers the most commonly performed
procedures and those for which health
personnel most often prepare
patients.
A positive feature of this book is a
listing of sensations the patient may
experience as well as points to
remember in the aftercare of the
patient following each specific
procedure.
, This book should be used as a
basic, handy reference for health
professionals. It is not designed as a
definitive reference on either a
procedure or its diagnostic
implications. Rather, it should be most
helpful as an immediate source of
basic information for patient
instruction. It could be a helpful
resource for students and
practitioners.
Maternal Health Nursing
Review, by Josephine Evans
Sagebeer. New York, Arco
Publishing Company, Inc., 1975.
Approximate price $6.00.
Reviewed by Patty Ellis, School
of Nursing, Faculty of Health
Sciences, McMaster University,
Hamilton, Ontario.
The purpose of the ARCO
Nursing Review Series, and more
specifically the Maternal Health
Nursing Review, is to provide nurses
and nursing students with a
comprehensive review of a specific
nursing subject, in this instance
maternity nursing. This is done
through multiple choice questions plus
a few matching questions with
answers and brief explanations given
at the end of each chapter. Each
chapter looks at a different area of
maternity care so that there is
complete coverage of the subject. The
questions and their answers are
documented as to their original
source. The reader is then able to
authenticate all of the material
presented if she/he so desires.
The book is certainly
comprehensive in its factual coverage
of maternity nursing, of both normal
and abnormal cases and can be used
for examination preparation and
continuing education.
It does, however, have several
limitations. First, many questions
dealing with either statistics or history
are irrelevant for Canadians as the
information given is American.
Another limitation is the quality of the
questions themselves. Most of the
questions require only memorization
of facts. Very few of them require
thinking on the part of the reader.
In addition, the technique of
writing good multiple choice questions
has not always been applied as many
errors can be noted in the questions
themselves. For example, the use of
"all of the alxjve" or "none of the
above" as distractors is fairly common
throughout the book. Other questions
deal with useless information such as
asking how many maternal deaths
there were in 1 963 (page 1 1 , question
27). The final limitation is that the
material presented is a review of
textbook information which is often
outdated due to the time process
involved in publication.
Despite the limitations, the book
is thorough in its coverage of maternity
nursing as this subject is presented in
the present texttxjoks. As long as the
reader is aware of the limitations, the
book can accomplish its purpose of
aiding with the education of nurses
and nursing students.
Did you know ...
Why do couples risk conception, even
though they definitely do not want a
baby? This question, recognized as
central to utilization of contraception,
was the principal theme of a
symposium taking place at the Ontario
Science Centre in Toronto late in
1975. The proceedings of the
symposium are recorded in an
informative and stimulating booklet
An Exploration of the Limitations of
Conception. Single copies of the
64-page booklet are available without
charge to those interested from
Department of Public Affairs, Ortho
Pharmaceutical (Canada) Limited, 19
Green Belt Drive, Don Mills, Ontario
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MEDICAL DICTIONARY e/aic-sros
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■ •!« irfaiitnjiuii nurae
rvDruary 19//
Librarfl Update
i
Publications recently received in \he
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 matei lal
that doesnof 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 giving author, title and item
number in this list.
If you vi(ish to purchase a book,
contact your local bookstore or the
publisher.
Books and documents
1, Anderson, Carl Leonard, School
health practice, by,,, and William H,
Creswell, 6ed, St, Louis, Mosby, 1 976,
452p.
2, Argelander, Hermann, The initial
interview in psychotherapy. New
York, Human Sciences Pr,, c1976.
146p,
3, Ashley, JoAnn, Hospitals,
paternalism, and the role of the nurse.
New York, Teachers College Press,
C1976 I58p,
4, Auerbach, Stevanne, Rationale for
child care services — programs vs.
politics, edited by,, with James A.
Rivaldo. New York, Human Sciences
Pr,, C1975, 215p,
5, Billing, Doris H.M. Practical
procedures for nurses. 2ed. London,
Baill6re Tindall. 1976. 157p.
6, Capell, Peter T. Ambulatory care
manual for nurse practitioners, by...
and David 8. Case. Philadelphia,
Lippincott, C1976, 333p,
7, Compliance with therapeutic
regimens, edited by David L, Sackett
and R, Brian Haynes, Baltimore. John
Hopkins University Pr,. c1976. 293p,
8, Conference of Ministers
Responsible for Health, 2nd meeting,
Plymouth, Montserrat, July 12-15,
\Q7&. Final Report. Georgetown.
Guyana, Canbbean Community
Secretariat, 1976, 50p.
9, Conference on Long-Term Health
Care Data held at Tucson, Arizona,
May 12-16, \975. Long-term care
data. Toronto, Lippincott, 1976, 233p,
10, Conference on Teacher
Education, Vancouver, B,C,, May 5-7,
1 975, Continuing education for
teachers — issues and strategies.
Proceedings. Ottawa, Canadian
Teachers Federation. 1976, 179p.
1 1 , Dixon, Eileen P, An introduction to
the operating theatre. Edinburgh,
Churchill Livingstone, 1976, 51 p,
12, Dodson, Burt, Strategies for
clinical engineering through shared
services, by.., and Ben W. Latimer.
Battle Creek, Mi,, W,K, Kellogg
Foundation, 1976, 72p,
1 3, Health education for the public. A
statement of public policy,
September 1976. Prepared by the
State Health Planning Advisory
Council and the Office of Health and
Medical Affairs, Lansing, Mich., 1976,
nop,
1 4, Infant nutrition, edited by Doris H,
Merritt Stroudsburg, Pa,, Dowden,
Hutchison & Ross, C1976, 431 p.
15, International Seminar on Nursing
Legislation, Bogota, Colombia, June
9-19. 1974 Nursing legislation in
Latin America: the last half of the 20th
century. Geneva. International
Council of Nurses, 1975, 109p, (ICN
Publication no, 5)
16, Mahoney, Elizabeth Anne How fo
collect and record a health history,
by,., Laurie Verdisco and Lillie
Shortridge. Philadelphia, Lippincott,
C1976, 133p,
17 Martinon, F, L'infirmi6re en
chi/urgie digestive. Paris, Expansion
scientifique frangaise, 1976. 132p,
1 8. Materiel didactique, edite par
Roilande Gagne, Montreal,
Intermonde, 1975, (loose-leaf) Iv,
1 9. Morton, Barbara M. VD: a guide for
nurses and counselors. Boston, Little,
Brown and Co., c1976. 21 8p.
20. Munneke, Leslie E. Motivation
through management. Swarthmore,
Pa., Personnel Journal, c1968. 114p,
21. National League for Nursing,
Instructor accountability: issues,
facts, impact. New York, c1 976, 208p,
(NLN Publication no, 16-1626)
22. — . Strategies in administration
and teaching in associate degree
nursing education. New York, c1976.
66p, (NLN Publication no, 23-1630)
23, — , Division of Research,
State-approved schools of nursing
L.P.N. iL.V.N. 1976. New York, 1976.
87p.
24, Niswander, Kenneth R.
Obstetrics: essentials of clinical
practice. Boston, Little, Brown and
Co., C1976. 520p,
25, Nutrition in preventive medicine:
the major deficiency syndromes,
epidemiology, and approaches to
control, edited by G,H, Bealon and
J,M, Bangon, Geneva, World Health
Organization, 1976, 590p, (WHO —
monograph series no, 62)
26, L Ordre des Infirmi^res et
Infirmiers du Quebec, Priorites
1976-77 Montreal, 1976. 70p, R
27. Organisation Mondiale de la
Sante, Documents fondamentaux.
Gen6ve, 1976, Iv R
28, — L'element sante dans la
protection des cfoits de t'homme,
face aux progres de la biologie et de
la medecine. Gen6ve, 1976, 50p,
29, Pan American Sanitary Bureau,
Report to the director, 1975.
Washington, 1976, 176p,
30. Piuze, Suzanne. La sante par le
yoga. Montreal, Editions du Jour,
C1967, 134p.
31. Promoting health: consumer
education and national policy, edited*
by Anne R. Somers. Germantown,
Md., Aspen. c1976. 264p.
32, Seguy, Bernard, Garqon ou fille di
votre choix. Paris, Editions
Intermedica, 1975. 171p,
Charting progress in nursing care
SAUVE & PECHERER: Concepts and Skills in
Physical Assessment
This book can save you valuable time in teaching yourself the basics
of physical examinations. It's a modular syllabus for self-study (w/ith
instructor guidance). Each of its 23 units includes a pre-test, glos-
sary, clinical component, a self-test, response sheets, and handy
reference cards for use during actual examinations. An Instructor's
Guide will be available.
By Mary Jane Sauve. RN, BSN. MSN, Calif. State College, Sonoma, Rohnert
Park; and Angela R. Pecherer, RN. BSN, MSN, Intercollegiate Center for
Nursing Education, Spokane, Wash. About 415 pp. Illustd. Soft cover. About
$11.30. Ready Feb. 1977. Order #7939-0.
Dorland's Pocket Medical Dictionary,
New 22nd Edition
Completely up-dated, this 22nd edition has been developed under
the editorial supervision of 84 internationally recognized authorities
in medicine and the health sciences. It presents a wealth of new
definitions, and a thorough revision of existingterms to conform with
today's most accepted medical knowledge and usage. Obsolete
terms have been deleted. The dictionary includes 16 color plates,
and a helpful list of word elements from classical roots.
About 850 pp. Illustd., 16 color plates. Ready March 1977. Order #3162-2.
GUYTON: Basic Human Physiology: Normal
Function and Mechanisms of Disease,
New 2nd Edition
Ideal for the study of nursing physiology, Guyton's Basic Human
Physiology presents the same concepts and principles as in Guyfon's
Textbook oif Medical Physiology, but it omits most of the references
to research work, many of the special qualifying explanations, and
some of the references to clinical problems. Up-dated throughout,
the sections on the kidneys, the nervous system, and the endocrines
in particular, have been thoroughly reworked.
By Arthur C. Guyton, MD, Univ. of Mississippi School of Medicine, Jackson.
About 930 pp., 420 ill. About $17.00. Just Ready. Order #4383-3.
CONN: Current Therapy 1977
Conn — the one therapeutics book that belongs in every reference
library—presents the core of clinical medicine in a nutshell. New '77
articles include: herpes gestationis, pseudofolliculitis Barbae, and
papular dermatitis. It also reports new therapies for diabetes insipi-
dus, herpes simplex, Hodgkin's disease, cardiac arrhythmias,
leukemias, urinary infections, asthma, and hundreds of other
disorders.
Edited by Howard F, Conn, MD; with 14 consulting editors; and 342 con-
tributors. About 995 pp. About $24.75. Ready Feb. 1977. Order #2662-9,
The Nursing Clinics of North America
These quarterly symposia keep you informed on the most important
changes in clinical nursing practice. The March 1977 issue focusffl
on Peripheral Vascular Disease with Dorothy L. Sexton— gueSCT
editor; and on The Minority Patient: Cultural and Racial Diversity.
Other 1977 symposia will discuss: Primary Nursing: Diseases of the
Liver: Patterns of Parenting: Diabetes: and othervital nursing topics.
By respected nursing authorities. Published quarterly: March. June, Sept.,
and Dec. Hardbound. Contains no advertising. Averages 185 pp. Illustd.
$18.90 per year's subscription. (Subscriptions can be obtained at a saving of
$1.60 by sending a check for $17.30 along with your subscription request.)
Order #0003-3.
.\SPERHEIM & EISENHAUER: The Pharmacologic
Basis of Patient Care, Neu 3rd Edition
In this comprehensive revision, you'll find much new data Including
expanded discussions of drug-drug and drug-food interactions,
hyperalimentation, content of the problem-oriented record and drug
therapy, steroid drug therapy, and drug administration to pediatric
patients. It's thoroughly up-dated, and a new Instructor's Guide will
be available too.
By Mary K. Asperhelm, MD, Medical Univ. of South Carolina: and Laurel A.
Eisenhauer, RN, MSN, Boston College School of Nursing. About 575 pp.
Illustd. About $1 1. 10. Ready March 1977. Order #1437-X.
KEANE: Saunders Review for Practical Nurses,
New 3rd Edition
Designed to prepare the student for state board examinations, this
outline review covers the entire course content of practical/
vocational nursing. All units have been carefully brought up to date
in this revision, and a unit on patient assessment has been added.
The section on Nursing the Mother and Her Newborn Infant is com-
pletely rewritten. Blank IBM answer sheets, and a key to the correct
answers are provided.
By Claire Brauckman Keane, RN, BS, MEd, College of Education, Univ. of
Georgia, Athens. About 510 pp., 155 ill. Soft cover. About $7.75. Ready
March 1977. Order #5327-8.
FORDNEY: Insurance Handbook for the
Medical Office
If processing insurance claims is one of your non-clinical respon-
sibilities, this authoritative worktext shows you how to change that
job from a frustrating chore into a simple procedure. All aspects of
handling claims efficiently and without error are covered including:
computerized billing: collecting on unpaid accounts: knowing the
simplest form to use: Canadian health insurance: etc. A Teacher's
Guide is available.
By Marilyn Takahashi Fordney, CMA-AC. Ventura College, California About
350 pp. Illustd. Soft cover. Ready March 1977. Order #3811-2.
W W. B. SAUNDERS COMPANY CANADA LTD.
^ ^ 1 Goldthorne Avenue, Toronto, Ontario M8Z 5T9
Prices subiect to change
To Qrje' .''T/es on 30-03y approval enter order number and autnor
AUTHOR
I Please specify:
r\ .^ Payment enclosed — Saunders pays postages handling
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HOME PHONE NUMBER
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I
The Canadian Nurse February 1977
Librarij Update
33. Shephard, Roy J. Endurance
fitness. Toronto, University of Toronto
Press, C1969. 246p.
34. Smith, lola. Assessment of a
demonstration project on continued
follow-up nursing visits to colostomy
patients. Toronto, Victorian Order of
Nurses for Canada, 1976. 11 7p.
35. Symons, T.H.B. To know
ourselves. The report of the
Commission on Canadian Studies
volumes 1 and 2. Ottawa, Association
of Universities and Colleges of
Canada, 1975. 115p.
36. Thompson, Eleanor Dumont.
Pediatrics for practical nurses. 3 ed.
Philadelphia, Saunders, 1976. 378p.
Pamphlets
37. American Nurses' Association.
Research in nursing: toward a
science of health care. Kansas City,
Mo., 1976. 15p.
38. Atlantic Institute of Education.
Hospitals are for learning. Halifax,
1976. 47p.
39. Bassett, I. Canadian havens from
hay fever, by.C.W. CromptonandC.
Frankton. Ottaw/a, Canada Dept. of
Agriculture, 1976. 23p.
40. Burton, Charles. Gravity lumbar
reduction therapy program, by... and
Gail Nida. Minneapolis. Mn., Sister
Kenny Institute, c1976. 20p.
41. Clarke Institute of Psychiatry.
Report, 1975. Toronto.
42. College of Nurses of Ontario.
Standards of nursing practice: for
registered nurses and registered
nursing assistants. Toronto, 1976.
23p.
43. The employment interview —
techniques of questioning.
Swarthmore, Pa., The Personnel
Journal, 1974. 16p.
44. Foundation Center. The
foundation directory, supplement 3.
New York, Columbia University Press,
1976. 24p. R
45. Lenburg, Carrie, B. Criteria for
developing clinical performance
evaluation. New York, National
League for Nursing, c1 976. 16p.(NLN
Publication no. 23-1634)
46. Milner-Fenwick Inc. 1976 film
catalog: health education, medicine,
dentistry. Baltimore, Md., 1975.
Distributed by Canfilm Media,
Willowdale, Ont. 27p.
47. National League for Nursing.
Patient education. New York, c1976.
38p. (NLN Publication no. 20-1633)
48.^. Your career in nursing. New
York, 1976. 16p. (NLN Publication no.
41-1562)
49. — . Dept. of Baccalaureate and
Higher Degree Programs.
Baccalaureate education in nursing:
key to a professional career in nursing
1976-77. New York, 1976. 25p. (NLN
Publication no. 15-1311) R
50. — . Masfers education in nursing:
route to opportunities in
contemporary nursing 1976-77. New
York, 1976. 25p. (NLN Publication no.
15-1312) R
51. — . Dept. of Diploma Programs.
Education for nursing — the diploma
way 1976-77. New York, 1976. 27p.
(NLN Publication no. 16-1314) R
52. Nursing home administration: a
reader consisting of ten articles
especially selected by The journal of
nursing administration editorial staff.
Wakefield, Ma., Contemporary,
C1976. 43p.
53. Ogg, Elizabeth. Unmarried
teenagers and their children. New
York, Public Affairs Committee,
C1976. 28p. (Public affairs pamphlet
no. 537)
54. Order of Nurses of Quebec.
Nursing in prolonged care. Montreal,
1976 41p.
55. LOrdre des InfirmiSres et
Infirmiers du Qu6bec. Nursing en
soins prolong^s. Montreal, 1976. 44p.
56. Quality assurance: scripts from a
series of tapes developed for nursing
dial access. Madison, Wi., University
of Wisconsin — Extension, Health
Sciences Unit, Dept. of Nursing, 1 975.
32p.
57. Registered Nurses' Association of
Ontario. Guide to qualifications and
responsibilities of registered
personnel in nursing service. Toronto,
1976. 25p.
The 1976 Index for
The Canadian Nurse,
vol. 72, is available on
request. Write to
The Canadian Nurse,
50 The Driveway,
Ottawa, Ontario,
K2P 1 E2.
58. Reynolds, Barbara. The nurse as a
change agent. New York, American
Association of Industrial Nurses,
1976. 5p.
59. Sackett, David L. The
development and application of
indexes of health I: general methods
and a summary of results, by... et al.
Hamilton, Ont., McMaster University,
1976. 23p.
60. Saltman, Jules Manyuana.- current
perspectives. New York, Public
Affairs Committee, c1976. 28p.
(Public affairs pamphlet no. 539)
61. Saskatchewan Registered
Nurses' Association. Guidelines for
implementing a quality assurance
program. Regina, Sask., 1976. 9p.
62. Scholarships and loans for
beginning education in nursing. New
York, National League for Nursing,
1976. (NLN Publication no. 41-410)
63. Smith, E.S.O. Family planning
programs in Britain, West Germany.
Denmark and Sweden, with
implications for Canada. Edmonton,
Alberta Social Services and
Community Health, 1975. 15p.
64. — . Venereal disease programs in
Britain, West Germany, Denmark and
Sweden, with implications for
Canada. Edmonton, Alberta Social
Services and Community Health,
1975. 17p.
65. The techniques of nursing
management, volume two: a reader
consisting of eleven articles
especially selected by The journal of
nursing administration editorial staff.
Wakefield, Ma., Contemporary,
C1976. 46p.
66. Victorian Order of Nurses for
Canada. Charter and by-laws 1976.
Toronto, 1976. 33p. R
67. Zohman, Lenore R. Seyor7dd/ef...
exercise your way to fitness and heart
health. New York, CPC International,
1974. 36p.
Government documents
Canada
68. Biblioth6que scientifique
nationale. Repertoire de la recherche
subventionnee dans les universites
par legouvernementf^d^rall 975-76.
Ottawa, Conseil national de
recherches du Canada, 1976. 2v. R
69. Comit6 consultatif national des
Services de Sant6. Premier rapport
pr^sente au Commissaire du Sen/ice
Canadien des P6nitenciers. Ottawa,
Solliciteur general Canada, 1974.
29p.
70. Conseil national de recherches
Canada. Direction de I'information
publique. Programmes audio-visuels.
Ottawa, 1976. 1v.
71. Health and Welfare Canada. A
parent's guide to drug abuse. 3ed.
Ottawa, Minister of Supply and
Services, 1976. 26p.
72. Health and Welfare Canada.
Advisory Committee on Food Safety
Assessment. Report. Ottawa, 1975.
78p.
73. — . Health Insurance Directorate.
Health Programs Branch. Emergency
sen/ices in Canada, v. 5: architectural
aspects of emergency services.
Ottawa, 1975. 1v.
74. — . Health Protection Branch.
Canadian trends in smoking related
diseases: lung cancer mortality.
Ottawa, 1976. 16p.
75. — . Nutrition Division. Healthful
eating. Ottawa, Supply and Services,
1976. 71 p.
76. Labour Canada. Wage rates,
salaries and hours of labour, 1975.
Ottawa, Supply and Services Canada,
1976. 1v.
77. National Health Services Advisory
Committee. First report to the
Commissioner of the Canadian
Penitentiary Sen/ice. Ottawa, Solicitor
General Canada, 1974. 29p.
78. National Research Council of
Canada. Public Information Branch.
Audio-visual programs. Ottawa,
1976. 1v.
79. National Science Library.
Directory of federally supported !
research in universities 1975-76.
Ottawa, National Science Library,
National Research Council of
Canada, 1976. 2v. R
80. Revenu Canada. Les rouages de
I'impbt. Ottawa, Information Canada,
1975. 69p.
81 . Revenue Canada. Inside taxation.
Ottawa, Information Canada, 1975.
69p. i
82. Sant6 et Bien-§tre social Canada, i
Guide des parents sur I'abus des
drogues, ed. 3. Ottawa, Ministre des
Approvisionnements et Services
Canada, 1 976. 28p.
No. 169
eei/e^ fWuife^ rtccedJ^^ie^
nlec^
M -^
REEVES NAMEPINS . . .smart, distinctive styles from
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with smoothly rounded edges and corners, deeply engraved
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pins . . . It's more convenient, and you have a spare.
1(9, 170 ALL METAL , , rich, tail- 559. 560 PLASTIC LAMINATE , .
slim, broad yet lightweight. En-
graved thru surface into contrast-
ing color core, with matching
beveled border.
510 MOLDED PLASTIC . . . simple.
trim molded plastic with lettering
engravedand lacquer-filled. The or-
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CHECK CHOICES AND LETTERING IN COUPON BELOW.
ored design, gold or silver plated,
with polished, satin or Duotone
combination finish. (No. 170 avail
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100, 111 METAL-FRAMCD . . .
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pered leatherette
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Choose RN, LPN, LVN, or NA,
No. 205 Pins... 2.49
Bzzz MEMO-TIMER
Don't forget! Keyring timer sets to
buzz from 5 to 60 min. Reminds you
to check vital signs, heat lamps
parking meters, etc. Unique gift idea
No. 22 Timer . . . 6.95
PROFESSIONAL BAG
Luxurious Vs" cowhide, beau-
tifully crafted for years of
;?-vice. Water repellent.
-roily, compartmented inter.
.or, snap-in washable liner, 6"
X 7" X 12". in Black or Navy
Blue (specify). Initials Gold-
embossed FREE.
No, 1544 Bag... 42.50
Extra liner No. 4415 8.50
1^
14K G.F. PIERCED EARRINGS
Dainty caouceus snown actual size", with 14K
posts, for on or off duty, Gift-boxeo, Great group
g'ff ^^^^ No. J3 . . . 5.95 pr.
''^^^^
^=— ^ ims: EXAMINING LITE
-; ;. :"--rt ight, on,, 5" long. White, caduceus imprint, alu-
- -.- ij-; and clip, Penlight batteries included,
^No, NLIO Light , , , 3.95 Init. engraved add 60c
Handy MEDICARDS
Six smooth plastic cards 3Vb " x
5V^" crammed with info on Apoth,'
Metric; Household meas.. °Cto °F,
liver, body, blood, urine, bone dis-
ease incub, weights etc in vinyl
holder. You're a walking encyclo-
pedia!
No, 289 Cards 1.75
Add 60c for gold initials on
holder ' , .
TIMEX^ Pulsometer WATCH
Movable outer ring computes pulse rate for
you! Dependable Pulsometer / Calendar
Watch with date,)«hite luminous numerals,
sweep-second hand, deep Blue dial. White
strap. Stainless back, water and dust re-
sistant. Gift-boxed, 1 year guarantee. In
itials engraved FREE.
No. 237 Watch 19.95
Keep-Clean CAP TOTE
Great for caps, wiglets, curlers, etc. Clear
plastic with zipper, white trim. SW x 6",
stores flat
No. 333 Tote . . . 2.95 <S5>
Gold initials add 60c /^
POCKET PAL KIT
White flexible Pocket-Saver with chrome/
silver iW Lister Scissors, 4-Color Ball
Pen, handsome Penlight, Plus change com-
part and key chain.
No. 291... 6.95.
Init. engr. on scissors add 60c
fuhormsjug;
'^
counts on la'l«' "
TO: REEVES CO., Box 719-C. Attleboro. Mass. G2703
COLOR QUANT.
Use extra sheet for additional items or orders
Name for ENGRAVING:
(Max, 15
letters)
INITIALS:
NAME PINS: Print Lettering below, check appropriate boxes
Lettering _
tACHSMHIMI
169kzac
,7QlaSl.er
100 k^
lllf:
Q Quo'.one
□ Polished
□ Satin
QGreerT'
559
560
k □wni:e«— B
■ nweo, GrWii] If
f 0 MM, Blue ►[
r a Cocoa _i
510
Q White,
n Dk. Blue"
□ Dk. Gree^J
lETTEMU PMCESl
QB'ack
n Dk- Blue
O White
n Black
^P Dk Blue
3 White
1 Black
}Dk, Blue
► D White
Sn Black
□ Dk, Blue
♦ QWhite
2 Lines
Lettering
3Lihes
Lelter.n
1 Line
Lenenng
2 Lines
Ler.enng
3 Lines
Lettering
W
0 2.69
0 3.49
n*.29
ni.*9
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59 :■-. ,
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04.49 I
05.79
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02.49
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05.29
I enclose $_
t Please add 50< handling postage
_'( on orders totaling under 5.00
No, COD'S please. Mass, res, ada 5% ST,
,Waster Charge, BankAmericard welcome
on orders of $5.00 or more. Submit complete
Card No , Expiration Date and your signature.
vkl:
-Zip-
^
The Canadian Nurse February 1977
POSEY FOR PATIENT COMFORT
The new Posey products shown
here are but a few included in 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
insure the original quality product,
always specify the Posey brand
name when ordering.
The Posey "Swiss Cheese" Heel
Protector has new hook and eye
fasteners for easy application and
sure fit. Available in convoluted
porous foam or synthetic fur lin-
ing. #6127 (fur lining), M122
(foam).
The Posey Foot Elevator protects
pressure sensitive feet by keeping
them completely off sheets. A
washable flannel liner protects the
ankle. Soft polyurethane foam ring
with slick plastic shell allows pa-
tient to move his foot freely.
#6530 (4 inch width),
The Posey Elbow Protector helps
eliminate pressure sores and fric-
tion burns. Three models are avail-
able. #6220 (synthetic fur w/out
plastic lining).
The Posey Foot-Guard with new
"T" bar stabilizer simultaneously
keeps weight of bedding off foot,
helps prevent foot drop and foot
rotation. #6472,
The Posey Ventilated Heel Pro-
tector helps prevent friction and
skin breakdown while allowing
free movement. The newly devel-
oped closure holds heel protector
on the most restless patient. #6170
(w/plastic shell).
Send for the free new POSEY catalog — supersedes all previous editiora.
Please insist on Posey Quality — specify the Posey Brand name.
Send your order today!
Enns and Gilmore
2276 Dixie Road
Mississaugd, Ontario,
Canada L4Y 1Z5
(41 h) 274-2.i7S
Slow-f^fofic
(ferrous sulfate-folic acid)
hematinic with folic acid
Indications
Prophylaxis of iron and folic acid
deficiencies and treatment of
megaloblastic anemia, during pregnancy,
puerperium and lactation.
Contraindications
Hemochromatosis, hemosiderosis and
hemolytic anemia.
Warnings
Keep out of reach of children.
Adverse Reactions
The following adverse reactions have
been reported:
Nausea, diarrhea, constipation, vomiting,
dizziness, abdominal pain, skin rash and
headache.
Precautions
The use of folic acid in the treatment of
pernicious (Addisonian) anemia, in which
Vitamin Bi2 is deficient, may return the
peripheral blood picture to normal while
neurological manifestations remain
progressive.
Oral iron preparations may aggravate
existing peptic ulcer, regional enteritis
and ulcerative colitis.
Iron, when given with tetracyclines, binds
in equimolecular ration thus lowering the
absorption of tetracyclines.
Dosage
Prophylaxis: One tablet daily throughout
pregnancy, puerperium and
lactation. To be swallowed whole at
any time of the day regardless of
meal times.
Treatment of megaloblastic anemia:
During pregnancy, puerperium and
lactation; and in multiple pregnancy:
two tablets, in a single dose, should
be taken daily.
Supplied
SLOW-Fe folic tablets have an off-white
colour and are supplied in push-through
foil packs of 30; available in units of 30
and 120 tablets.
References
1 . Nutrition Canada National Survey A report
by Nutrition Canada to the Department of
National Health and Welfare, Ottawa,
Information Canada, 1973. Reproduced by
permission of Information Canada
2. R. R. Streitf, MD, Folate Deficiency and Oral
Contraceptives, Jama, Oct, 5, 1970.
Vol, 214, No, 1,
C I B A
□ORVAL. QUEBEC
NHiei
See advertisement ofi cover 4
C-6026
Lihi-ari) Update
13. Science Council of Canada.
'opulation. technology and
esources. Ottawa, Minister of Supply
ind Services Canada, c1976. 91 p.
It's Report no. 25).
14. Statistics Canada. Canadian
•ospitals and related facilities. 1976.
Xtawa, 1976. 75p.
15. — . Causes of deatti; provinces by
ex, and Canada by sex and age
974. Ottawa, 1976. 165p.
16. — . Hospital indicators,
'anuary-f^arcti, 1976. Ottawa, 1976.
29p.
J7.— . Hospital morbidity 1973.
Jttawa, 1976. 159p.
18. — . Hospital morbidity: Canadian
liagnostic list 1973. Ottawa, 1976.
yip.
— . Hospital statistics 1973.
Mawa, 1976. 3v.
K). Statistics Canada. Hospital
ntatistics 1974; preliminary annual
eport. Ottawa. 1975. 44p.
)1. — . Mental healtti statistics, 1973.
Mawa, 1976. v.1 and v.3.
(2. — . Nursing in Canada: Canadian
\ursing statistics, 1975. Ottawa,
rrformation Canada, 1976. 1v.
13. — . Tuberculosis statistics, v. 2.
istitutional facilities, services and
'nances 1973. Ottawa, 1975. 24p.
>4. — . Vital statistics: preliminary
mnual report 1974. Ottawa, 1976.
i9p.
15.—. Vital statistics, v. 1 births, 1974.
Mawa, 1976. 47p.
)6. Statistique Canada. Causes de
lieces: par province selon le sexe et le
'Canada selon le sexe et I'^ge, 1974.
.5ttawa. 1976. 165p.
)7. — . Hopitaux et etablissements
■annexes 1976. Ottawa, 1976. 75p.
)8. — . Indicateurs des hopitaux,
■anvier-mars 1976. Ottawa, 1976.
29p.
)d— .La morbidity hospitali^re 1973.
Dttawa, 1976. 159p.
00. — . La morbidite hospitali^re: liste
•anadienne de diagnostics 1973.
iDttawa, 1976. 81 p.
101. — . Soins infirm iers au Canada:
tatistique des soins infirmiers 1975.
Dttawa, Information Canada, 1976.
1 02. — . La statistique de la
uoerculose. v.2 — installations,
-.ervices et finances des
itablissements 1973. Ottawa, 1975.
:4p.
'03.—. La statistique de l'6tat civil:
apport annuel preliminaire 1974.
Ottawa. 1976. 69p.
104. — La statistique del'etat civil, v.1
- naissances 1974. Ottawa, 1976.
47p.
'105.—. La statistique de I'hygi^ne
-nentale 1973. Ottawa, 1976. v.1 et
y.3.
106. — . La statistique des hopitaux
'apport annuel preliminaire, 1974.
Ottawa, 1975. 44p.
107. — . La statistique hospitali^re,
1973. Ottawa, 1976. 3v.
United States
108. Center for Disease Control.
Venereal Disease Branch. Current
literature on venereal disease, 1976.
no. 1, Atlanta, Ga., 1976. 87p.
109. National Centre for Health
Statistics. Hea/r/7 manpower, a county
and metropolitan area data book,
1972-75. Rockville, Md., 1976. 74p.
(DHEW Publication no. (HRA)
76-1234)
110. National Institutes of Health.
Medicine in Chinese cultures:
comparative studies of health care in
Chinese and other societies: papers
and discussions from a conference
held in Seattle, Washington, U. S.
February 1974. Bethesda, Md.. for
sale by the Supt. of Docs., U.S. Gov't.
Print. Off., Washington, D.C., c1975.
803p. (DHEW Publication no. (NIH)
75-653)
1 1 1 . — . Statistical reference book of
international activities, fiscal year
1975. Prepared by International
Cooperation and Geographic Studies
Branch, Fogarty International Center,
Bethesda, Md., 1976. 40p. (DHEW
Publication no. (NIH) 76-64)
112. National Institute on Alcohol
Abuse and Alcoholism. Alcohol and
alcoholism: problems, programs.
Rockville, Md. For sale by the Supt. of
Docs., U.S. Govt. Print. Off.,
Washington, 1972. 42p. (DHEW
publication no. (HSM) 72-9127)
Studies deposited in CNA
Repository Collection
113. Charpentier-Poupart, Th6r6se.
Effets d'un enseignement structure
dispense a des clients atteints de
maladie vasculaire peripherique.
Montr6al, 1976. 267p. (Th6se (M.N.) -
Montreal) R
1 1 4. Dussaull, Rita. Rapport final du
voyage d' etude, par... et Laurette
Morin. Quebec, 1975. 59p. R
115. Elfert, Helen. Selected aspects
of the childbearing experience as
described by sixty couples, by... and
Linda Leonard. Vancouver, School of
Nursing, University of British
Columbia, 1976. 31p. R
116. Parker, Nora I. Sun/ey of
graduates of the University of Toronto
baccalaureate course in nursing no.
4, 1972, by... and Judith A.
Humphreys. Toronto, University of
Toronto, Faculty of Nursing, 1975. 1v.
(various pagings) R
117. — . Survey of graduates of the
University of Toronto baccalaureate
course in nursing no. 3, 1970 and
1971, by... and Judith A. Humphreys.
Toronto, University of Toronto,
Faculty of Nursing, 1973. 30p. R ^
@
Open to both
men and women
Health and Welfare Canada
Medical Services Branch, Alberta Region
Fort Chlpewyan, Alberta
NURSE IN CHARGE (NU-CHN-4) I
Fort Chipewyan Nursing Station |
Salary: $13,952 - S16,601
Ref. No: 76-E-1792 (PH/
Duties
The candidate organizes, implements and manages a com-
prehensive public health programme for the community:
develops and evaluates nursing personnel; assesses commu-
nity health needs and interprets and co-ordinates Health
Centre programmes. In Fort Chipewyan, the candidate pro-
vides in-patient treatment service to the community.
Qualifications
Eligibility for registration as a nurse in a province of Canada
and a certificate in Public Health Nursing or a Baccalaureate
degree in nursing are essential. Candidates must possess
experience In the administration of a Health Centra. Know-
ledge of English is essential.
]
COMMUNITY HEALTH NURSE
(NU-CHN-3) Fort Chipewyan, Alberta
Salary: $13,298 - $15,783
Ref. No: 76-E-1792 (PH)
Duties
The candidate provides treatment and public health care
service to the community and conducts first aid, health
education and immunization-control clinics.
Qualifications
Eligibility for registration as a registred nurse in Canada and
a certificate in Public Health Nursing or a Bachelor of
Science in Nursing are required. Experience as a Public
Health Nurse is necessary. Knowledge of English is
essential.
How to Apply
Forward completed "Application for Employment" (Form
PSC 367-4110) available at Post Offices, Canada Manpower
Centres or offices of the Public Service Commission of
Canada, to :
Public Service Commission of Canada
300 Confederation BIdg.
10355 Jasper Avenue
Edmonton, Alberta T5J 1Y6
Closing Date: March 4, 1977
Please quote the applicable reference number at all times.
(la.s.sjrkMl
AdviM'liseniont.s
Alberta
Employment Opportunity — Athabasca Health Unit No, 18 requires
a Senior Public Health Nurse for the Athabasca Office. BSc. qualifi-
cation preferred and experience essential. Salary range varies accor-
ding to qualtficalton and experience Apply immediately to: V,
Markowski, Administrative/Secty , Box 1140. Athabasca, Alberta.
TOG 080 Phone 1-403-675-2231.
British Columbia
Administrator/Head Nurse — R N wanted for Treatment/Diagnos-
tic Centre in Pemberton, 100 miles from Vancouver. B.C. Centre is
under construction and successful applicant would be required to
work with the Board in preparation for opening of centre Thereafter to
be responsible to the Board for the efficient management of the
centre. She should have broad experience in Outpatient, emergency
and operating room work Experience m administration at the depar-
tment head level would be an asset. Salary: Commensurate with
RNABC Policies. Apply Secretary, Pemberton & Distnct Hospital
Society. Box 312, Pemberton. British Columbia, VON 2L0,
British Columbia
Head Nurse — Psychiatric Unit — Position requires a R.N. with
psychiatric training and experience in Ward Management. The unit is
1 6 beds With 6 day care units It is a new unit opening in January or
February of 1977 The position becomes available November 1, 1976.
Salary according to RNABC contract. Apply in writing to: The Director
of Nursing. Mills Memorial Hospital. 2711 Tetrault Street, Terrace
British Columbia, V8G 2W7.
Operating Nurse required for an 87-bed acute care hospital in Nor-
thern 8 C. Residence accommodations available. RNABC policies m
effect. Apply to: Director of Nursing, Mills Memorial Hospital, Terrace,
British Columbia. V8G 2W7.
Registered Nurses with psychiatnc training or expenence, for new
psychiatric unit opening January or February 1977. Salary according
to RNABC contract. Please apply in wnting to: The Director of Nursing,
Mills Memonal Hospital, 271 1 Tetrault Street, Terrace, British Colum-
bia, V8G 2W7.
British Columbia
Faculty — New positrons (4) in 2-year post-basic baccalaureate
program in Victoria. B.C., Canada. Generalist in focus, clinical em-
phasis on gerontology in community and supportive extended care
units. Public Health nursing and Independent study provide opportu-
nity to work closely with highly-qualified and motivated R.N. students.
Teaching creativity and research are strongly endorsed. Master's
degree, teaching and recent clinical experience in gerontology/med.-
surg /psychology/rehabilitation preferred Salaries and fringe bene-
fits competitive; an equal opportunity employer for qualified persons.
Positions available NOW, Contact: Dr. Isabel MacRae. Director,
School of Nursing, University of Victoria, Victoria. British Columbia.
V8W 2Y2.
General Duty Nurses tor modern 41 -bed hospital located on the
Alaska Highway. Salary and personnel policies in accordance with
RNABC. Accommodation available in residence. Apply. Director of
Nursing, Fort Nelson General Hospital, P.O. Box 60, Fort Nelson,
British Columbia, VOC IRO.
$>
MONT SUTTON commands the highest peak
within a radius of 100 miles of Montreal. 20
miles of trails and slopes, 6 modern lifts, ski
school, ski shop and full range of facilities,
great snow and superior 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 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.
GeneralDuty Registered Nurses required by a lOO-bed Acute Care
and 40-bed Extended Care accredited hospital Must be eligible for
BC, Registration, Expenence preferred. Salary $1122 to $1326 per
month. (1976 rates). Apply m wnting to the: Director of Nursing, G, R.
Baker Memonal Hospital. 543 Front Street, Quesnet, Bntish Cdunv
bia, V2J 2K7.
Manitoba
Application is invited for a sessional faculty position in a cur-
riculum development and evaluation project for which funding is
being sought. Expertise in clinical teaching and curriculum develop-
ment and evaluation required. Areas of involvement are restorative,
ameliorative, consen^ative, preventive and promotive nursing. Project
involves a two year commitment. Salary negotiable. Apply to: Helen P.
Glass, Ed, D, Professor and Director, School of Nursing, University o*
Manitoba, Winnipeg, Manitoba, R3T 2N2.
University of Manitoba — School of Nursing — Co-ordinator of a ^
Curriculum Evaluation Project — Nurse with graduate preparation !|
and experience in research, curriculum and teaching, particularly j
skilled in evaluation, and with administrative abilities to co-ordinate a '\
major curnculum development and evaluation project in a University :
School of Nursing. Funding is presently being sought tor the project ,!
which is expected to begin in September 1977 and involves a j
commitment of five years. For further information wnte to: Helen P.
Glass, Ed,D,, Professor and Director, School of Nursing, University of ;
Manitoba, Winnipeg, Manitoba, R3T 2N2 I
University of Manitoba — School of Nursing — Applications are
invited for positions on the Faculty of a newly initiated, progressive, '
integrated, health oriented undergraduate nursmg program. Subject
to budgetary constraints, positions are open for community health
nursing and mental health and psychiatric nursing. Expertise in pri-
mary health care skills, including health assessment of children, as
well as rehabilitative nursing skills, beginning in Fall, 1 977, Salary and
rank negotiable. Apply to: Helen P. Glass, Ed.D,, Professor and
Director. School of Nursing, University of Manitoba, Winnipeg. Mani-
toba. R3T 2N2.
Ontario
Director, Putjiic Health Nursing — Applications are invited for the i
position of Director, Public Health Nursing in this Health Unit serving \
110,000 population. Qualifications: a Master's Degree is preferred, :
consideration given to a Bachelor's Degree. Applicants must have .
expenence m administration and supervision, AJaply m wnting to: Dr. 1
Lucy M. C, Duncan. Medical Officer of Health, The Lambton Health i
Unit, 333 George Street, Sarnia, Ontaho, NTT 4P5. , !
Australia
Qualified Nurse Teacher — Prince Henrys Hospital, St, Kilda Rd,,
Melbourne, Victoria, Australia — Requires a qualified Nurse Teacher
to commence as soon as possible in our school, which has approxima-
tely 360 students. Salary and conditions of sen/Ice in accordance with
the Determination of the Registered Nurses' Board. For further details
please contact the: Director of Nursing Sen/ices, Miss D.J. Taylor at
the above address.
Quebec
egistered Nurse required for co-ed children s summer camp in the
■iians (seventy miles north of Montreal) from late June until late
! 1977. Call (514) 487-5177 or write: Camp MaroMac. 5901
noad. Hampslead, Montreal. Quebec. H3X 1G9.
siered Nurses — for children's co-ed summer camp. End of
0 end of August. Prefer season, will consider one month.
0 plus travel. Write- Herb Finkelberg, Director. Jewish
unity Camps, 5151 Cote St. Catherine Road, Montreal, Que-
m3W 1M6
Jnited States
me South! Sunshine, warmth & beaches — mild winters. We
'_-^ent hundreds of clients that are seeking Canadian nurses to )0in
l|ie>i( Staff. Third nation entrants need not apply. These situations are
iried. and income levels are excellent, up to $14,000 (U.S.) for
JU/CCtJ supervisors; $13,500 for shift supervisors and Si 2.000 for
iral duty staff nurses. Some situations may require State licen-
ce exam, however, most are available without examination. One
ar commitment, round-tnp Air Fare, housing assistance and Visa
1 application assistance is provided- Our fee is paid also — you
ive no obligation whatsoever. For complete details, send your re-
with photograph and full particulars, to: Medical Search, 3274
uckeye Road, Atlanta. Georgia 30341,
laglstered Nurses — Hurley Medical Center is a well equipped.
modern, 600-bed teaching hospital offering complete and specialized
lervices for the restoration and preservation of the community s
eai'h. It also offers orientation, in-service and continuing education
■■■"iDloyees, It ts involved tn a building program to provide better
ndings for patients and employees. We have immediate ope-
- 'or registered nurses in such specialty units as Cardio- Vascular.
)perating Rooms. Nursenes, and General Medical-Surgical areas
lurley Medical Center has excellent salary and fringe benefits. Be-
ome a part of our progressive and well qualified work force Today.
\pply: Nursing Department, Mr. Garry Viele, Associate Director of
Jursing, Hurley Medical Center, Flint. Michigan 48502, Telephone
3131 766-0386.
J j'ses — RNs — Immediate Openings in Florida & Arkansas— H
■ ' . rtre Experienced or a recent Graduate Nurse we can offer you
lio--.tions with excellent salaries of up to $1 160 per month plus all
benefits. Not only are there no fees to you whatsoever for placing you,
M;t we also provide complete Visa and Licensure assistance at also
>>t to you. Write immediately for our application even if there are
reasoftheU.S. that you are interested in. We will call you upon
. ' of your application in order to arrange for hospital interviews.
or Employment Agency Inc., P.O. Box 1 133, Great Neck, New
■ 1023, (516-487-2818).
■"■'"r your nursing career by gaming experience at the largest
■^g and acute care referral center in Texas. This medical
ox consists of 7 hospitals and 1200 beds, and offers you a broad
■ of nursing specialty and sub-specialty areas in which to work.
.'6 on semi-tropical Galveston Island (50 miles from Houston),
2 miles of sandy beaches bordering the Gulf of Mexico. Enjoy
■vv^urate temperatures all year long and a low cost of living. Contact:
isary Clark. Asst. Director. Dept. of Nursing, The University of Texas
^/ledical Branch, Galveston. Texas 77550. An equal opportunity F/M
'^ '"lative Action Employer.
Red Deer College
invites applications for faculty
positions in tfie Diploma Nursing
Program.
Preference given to applicants with
advanced preparation and clinical
specialization, who have proven
ability in the teaching of Nursing.
Positions available August 1 , 1 977.
Please forward application,
comprehensive curriculum vitae and
references to:
Dr. Gerald O. Kelly
Academic Dean
Red Deer College
Box 5005
Red Deer, Alberta, Canada
T4N 5H5
Associate
Executive Director
Applications are invited for the position of
Associate Executive Director, Canadian
Nurses Association, Ottawa.
Candidates must be members of the
Canadian Nurses Association, have a
master s degree or equivalent, have at
least five years' administrative
experience, and be bilingual.
Interested applicants are asked to submit
their curriculum vitae, in confidence, to:
Executive Director
Canadian Nurses Association
50 The Driveway
Ottawa, Ontario
K2P 1E2
We'll give you 17 hospitals
to cJH)^ from... and
throw in Miami, Palm Beach
and Ft. Lauderdale.
RNS... Here's an opportunity to
have a choice, A choice of hospitals,
a choice of areas, a choice of special-
ties We offer this choice to exper-
ienced RN S, new graduates all the
way to directors level. ICU, CCU,
Intermediate Care, OB Peds. OR Re-
covery, Med /Surg and Inservice.
We provide a full service: transpor-
tation to and from airport, hotel
reservations, arrange and drive you
to all appointments, housing assis-
tance and a wealth of relocation tips
NO FEES TO APPLICANTS.
For information and application,
write or call Nurse Recruiter:
305-772-3680
Medical Placements
of America, Inc,
800 NW 62nd Street
Ft, Lauderdale, Fla, 33309
An Equal Opportunity Employer M/F
"^
f^ : /I
Come
grow
with us
University of Kentucky
Medical Center —
a progressive tertiary care center
oriented toward service, teaching
and research.
We offer-travel and moving
allowance-salary commensurate
with experience and
education-three weeks paid
orientation-three weeks
vacation-10 holidays-sick leave
benefits-paid tuition
benefits-inservice and continuing
education-professional freedom
and growth.
r-
Write to:
Mrs, Dorothea Krieger
Assistant to the Director for Staffing
Department of Nursing
UNIVERSITY HOSPITAL
University of Kentucky
Lexington, Kentucky 40506
Name
Address
City
State Zip
Degree
Date of Graduation
An Equal Opportunity Employer
i
The Canadian Nurse February 1977
THE UNIVERSITY OF ALBERTA
FACULTY OF NURSING
FACULTY POSITIONS
Faculty members will be required for
positions in expanding four-year basic
and two-year post-R.lvi. baccalaureate
programs. Applicants sfiould hiave
graduate education and experience in a
clinical area and/or in curriculum
development or research!.
Sfiort-term or visiting appointments may
also be available in some areas to replace
staff on leave.
Salary and rank commensurate witti
qualifications and experience, in accord
witfi University policies.
Positions are open to male and female
applicants.
Please make further inquiries, or
submit application and curriculum
vitae to:
Amy E. Zelmer, Ph. D.
Dean
Faculty of Nursing
The University of Alberta
Edmonton, Alberta
T6G 2G3
Okanagan College
NURSING FACULTY
REQUIRED
Okanagan College is establishing
the second year of a new Diploma
Nursing Progrann. Applications are
invited for instructional positions.
Four appointments will be made in
the Spring of 1977; a fifth
appointment will be made at the end
of the year.
Duties:
Classroom and clinical instruction;
curriculum development; other
duties as assigned by the
Coordinator of Nursing Education.
Instructors will be required to travel
to nearby communities.
Qualifications:
Masters Degree preferred;
Bachelor's minimum. Teaching
experience desirable; at least two
years' clinical experience essential.
Salary and working conditions in
accordance with the Academic
Faculty Agreement.
Applications and information:
The Principal
Okanagan College
1000 KLO Road
Kelowna, B.C. V1Y 4X8
Closing date: March 15, 1977.
The Montreal
Children's Hospital
Registered Nurses
Nursing Assistants
Our patient population consists of the
baby of less tfian an tiour old to the
adolescent who has jusi turned
seventeen. We see them in Intensive
Care, in one of the Medical 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, Quebec, H3H 1P3.
Applications are invited from suitably qualified
candidates for the post of Nurse Tutor in the University
of Nigeria Teaching Hospital, Enugu.
Qualifications and Experience
Candidates should be Registered Nurse Tutors.
Previous teaching experience is an advantage. The
appointee will teach general nursing subjects for new
standard of nurse training.
Salary:
(Grade Level 08,
N3,264 — N4, 164)
Conditions of Service
Conditions of service are similar to those in the Federal
Public Service — passages for appointee and family
fringe benefits including pensions scheme, leave car
allowance, part-furnished accommodation or rent
supplement at the approved rate in lieu, and free
Medical services.
Method of Application
Full curriculum vitae and names and addresses of 3
referees to;
Ag. Director of Administration
University of Nigeria Teaching Hospital
P.M.B. 1129
Enugu, Anambra State, Nigeria
Closing Date: March 1977.
Director of Nursing
Dryden District General Hospital
Dryden District General Hospital is a 75 bed accredited
hospital located in the Town of Dryden, population 7,000, area
served 15,000. Dryden is midway between Winnipeg and
Thunder Bay on the Trans-Canada highway in the midst of the
PatriciaTourist Region. Transairprovidestwicedaily jet flights
to Toronto and Winnipeg.
Many cultural and recreational opportunities are available to
residents of and visitors to the community.
Experienced applicants with a university degree will be given
preference but experience in a supervisory capacity in a larger
hospital will receive consideration. Employees benefits are
generous, salary is negotiable. Employment is available
immediately.
Please write or telephone to:
Administrator
Dryden District General Hospital
Dryden, Ontario Phone: 807-223-5261
CH9
THE COLLEGE OF NEW CALEDONIA
Prince George, British Columbia
requires
NURSING FACULTY
A number of positions will be available beginning in 1977 for
qualified faculty to participate in a new Diploma Nursing
Program scheduled to commence September, 1977.
Preferred Qualifications:
— A Baccalaureate degree and registration, or eligibility for
registration, witfi the Registered Nurses Association of B.C.
— A minimum of two years nursing practice or relevant
teaching experience.
Applications presently on file will be considered.
We offer excellent salaries and a complete fringe benefit
package.
To apply: Sumbit a complete resume together with the names of
three references to:
Dr. F.J. Speckeen, Principal
The College of New Caledonia
2001 Central Street
Prince George, B.C. V2N 1P8
Extension Course in Nursing Unit
Administration
Applications are invited for the extension course in Nursing Unit
Administration, a program to help the head nurse, supervisor or
director of nursing up-date his or her management skills. Candidates
will be registered nurses or registered psychiatric nurses employed in
management positions on a full-time basis.
The program provides a seven month period of home study with two
five day intramural sessions, one preceding and one following the
home study. For the 1 977-78 class the initial intramural sessions will
be held regionally as follows:
Vancouver
August
22
-26
St. Johns (NfW.)
August
29
— September 2
Winnipeg
August
29
— September 2
Montreal (French)
August
29
— Septemtier 2
Hamilton
Septeml>er
12
— 16
Ottawa
September
12
— 16
Toronto
September
19
— 23
Early application is advised. Applications will be accepted until May
16, 1977. if places are still available at that time. After acceptance, the
tuition fee of S275.00 is payable on or before July 1, 1977.
The program is co-«!nonsored by the Canadian Nurses Association
and the Canadian Hospital Association and is available in French or in
English.
For additional information and application forms write to:
English Program:
Director
Extension Course in Nursing Unit Administration
25 Imperial Street
Toronto. Ontario
MSP 1C1
The Canadian Nurse Februafy 1977
health ^rK
Experienced nurses are needed to
work in AFRICA, ASIA and LATIN
AMERICA. Background in
community health nursing or
teaching is an asset.
Two year contract; local, not
Canadian salary, transportation
costs paid by CUSO.
For more information, please
contact:
CUSO Health — 12
151 Slater Street
Ottawa, Ontario
K1P5H5
Clinical Specialist
Nursing
We require the services of an articulate,
dynamic nurse with a Master's Degree
and a Major in Medical-Surgical nursing.
We are a 300 bed Hospital Complex on
the verge of a major expansion. We are
close to fine recreational and cultural
areas.
The nurse in this position will work closely
with our Medical Staff, Administrative
Staff and Staff Nurses to further develop
patient centered projects. The salary and
benefits are based on the qualifications
and experience of the applicant.
For further Information about this
opportunity, please forward a
complete resume to:
Director of Personnel
Red Deer General Hospital
Red Deer, Alberta
T4N 4E7
Port Saunders Hospital
requires one Registered
Nurse commencing May
1977 through to October
1977.
Applicants must be registered or
eligible for registration with the
Association of Registered Nurses of
Newfoundland.
Salary is on the scale of $9,963 to
$12,282.
Living-ln accommodations available
for single applicants.
Applications should be addressed to:
Mrs. Madge Pike
Director of Nursing
Port Saunders Hospital
Port Saunders, Newfoundland
AOK 4H0
Dr. Helmcl<en IVIemorial
Hospital
Clearwater, B. C.
Director of Nursing for a 20-bed
general hospital located 70 miles
north of Kamloops, B. C.
To be responsible for all aspects of
nursing care and the day to day
operation of the hospital, reporting to
area administration at Royal Inland
Hospital, Kamloops, B. C. Must be
eligible for B. C. registration with
previous administrative experience
and preferably with advanced
preparation.
Salary negotiable with generous
fringe benefits.
Apply to:
Personnel Director
Royai inland Hospital
Kamloops, B. C. V2C 2X1, Canada
THE IZAAK WALTON
KILLAM HOSPITAL
FOR CHILDREN
HALIFAX, NOVA SCOTIA
Offers a 1 3-week
POST BASIC
PEDIATRIC NURSING PROGRAM
for
REGISTERED NURSES
CLASSES ADMITTED
JANUARY, MAY, SEPTEMBER
For further information and detail
write:
Associate Director of Nursing
Education
THE IZAAK WALTON KILLAM
HOSPITAL FOR CHILDREN
Halifax, Nova Scotia
B3J 3G9
Head Nurse
The Position:
Directing an active 40 bed surgical unit
with opportunity for future advancement.
The Person:
Should have a Baccalaureate degree with
a clinical specialty and/or administrative
experience.
The Hospital:
Central Alberta location in an expanding
regional hospital.
The City:
30,000 population half way between
Edmonton and Calgary and close to the
best in skiing and recreation centres.
Please send complete resume to:
Director of Personnel
Red Deer General Hospital
Red Deer, Alberta
T4N 4E7
University Faculty
Applications are invited for the position of
Assistant or Associate Professor of
Community Health Nursing in a basic
University program enrolling
approximately 200 students.
A Master's degree and expertise in
practice are required. Preference given to
candidates with graduate preparation
and/or experience in Maternal Child
Nursing. Teaching experience in a
university program is desirable.
Candidate must be eligible for registration
in Ontario.
Salary commensurate with qualifications.
Apply in writing giving curriculum
vltae to:
Dr. E. Jean M. Hill
Dean and Professor
School of Nursing
Queen's University
Summerhlll
Kingston, Ontario K7L 3N6
]
Head Nurse
with preparation and/or
demonstrative competence in
Psychiatric Nursing and
Management functions, required for
Head Nurse appointment. To be
responsible for participation in the
organization, initiation, and the
management of a New Psychiatric
In-patient Unit.
Please apply, forwarding
complete resume to:
Director of Personnel
Stratford General Hospital
Stratford, Ontario
N5A 2Y6.
General Hospital
St. John's
Newfoundland
Staff Nurses are required for a 354
bed hospital with adult medicine,
surgery, orthopaedics,
neurosurgery, neurology,
cardiovascular and urology services.
Liberal fringe benefits and salary
according to the Collective
Agreement.
Starting salary $10,800 (new
Contract being negotiated shortly).
Applications should be forwarded to:
Personnel Director
General Hospital
Forest Road
St. John's, Newfoundland
A1A 1E5
CEGEP
JOHN ABBOTT
COLLEGE
Ste. Anne de Bellevue
(Suburban Montreal)
3-YEAR NURSING
PROGRAMME
Requires additional teaching staff
for September, 1977.
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
community of Montreal. It offers a park-like setting close to the city,
on-campus sports, reaeation, and the possibility of residence close to
the campus.
Teaching salaries according to Quebec Teachers' Scales, excellent
fringe benefits, group insurance, pension plan, health benefits, and 2
months paid vacation.
Address application and completed curriculum vltae to the:
Director of Personnel
JOHN ABBOTT COLLEGE
P.O. Box 2000
Ste. Anne de Bellevue, Quebec H9X 3L9
SASKATCHEWAN REGISTERED
NURSES' ASSOCIATION
invites applications for the position of
EXECUTIVE DIRECTOR
This position entails managing the affairs of the
7200-member association. Duties include participating
in the development and implementation of policy,
budgeting and financial management, communication
with groups and individuals. The successful applicant
will have over-all responsibility for a staff of 1 2, and will
answer directly to the association's governing council.
Salary; Negotiable.
Qualifications: Applicants must have a
master's/baccalaureate degree with a major in
administration, several years' experience in an
administrative position or related experience, and be
eligible for registration with the Saskatchewan
Registered Nurses' Association.
Applications, giving fuli details of education,
qualifications and experience, should be sent to:
Mrs. Sheila Belton
Chairman, Selections Committee
59 Empress Drive
REGINA, Saskatchewan
S4T 6M7
Wish
you were
here
...in Canada's
Health Service
Medical Services Branch
of the Department of
National Health and Welfare employs some 900
nurses and the demand grows every day.
Take the North for example. Community Health
Nursing is the major role of the nurse in bringing health
services to Canada's Indian and Eskimo peoples. If you
have the qualifications and can carry more than the
normal load of responsibility. . . why not find out more?
Hospital Nurses are needed too in some areas and
again die North has a continuing demand.
Then there is Occupational Health Nursing which in-
cludes counselling and some treatment to federal public
servants.
You could work in one or all of these areas in the
course of your career, and it is possible to advance to
senior fX)sitions. In addition, there are educational
opportunities such as in-service training and some
financial support for educational leave.
For further information on any. or all, of these career
opportunities, please contact the Medical Services
office nearest you or write to:
Medical Services Branch
Department of National Health and Welfare
Ottawa, Ontario Kt A 0L3
Name
Address
City
\l
l«
Health and Welfare
Canada
Prov.
Sante et Bien-etre social
Canada
The Canadian Nuraa February 1977
Assistant Director
Nursing Services
McMaster University Medical Centre is seeking an
Assistant Director of Nursing Services.
THE POSITION:
An excellent career opportunity exists for a qualified
innovative individual to fill a demanding position
involving responsibility for specific
in-patient/out-patient areas. The incumbent will have
the opportunity to plan, establish, implement, and direct
nursing care.
Interested candidates are required to have the
managerial ability to work with -all levels of nursing,
administration and medical staff.
MINIMUM QUALIFICATIONS:
Must be currently registered in the Province of Ontario.
Preference will be given to candidates with additional
educational preparation and experience in nursing
management.
Resumes should be sent to:
Mr. R. E. Capstick
Manager, Employment & Staff Relations
McMaster University Medical Centre
1200 Main Street West
HAMILTON, Ontario
L8S4J9
Dalhousie University
School of Nursing
FACULTY VACANCIES
Dalhousie University School of Nursing invites
applications for faculty positions in a rapidly expanding
graduate programme which offers clinical specialties in
Medical-Surgical and Community Health Nursing.
Faculty should have post-masters or doctoral
preparation with experience in clinical nursing and
nursing education. Rank and salary for positions
commensurate with qualifications and experience, and
in accord with the salary schedule of Dalhousie
University.
Applications and further information may be
obtained from:
Dr. Margaret Scott Wright
Professor and Director
School of Nursing
Dalhousie University
Halifax, Nova Scotia
B3H 4H7
Index to
Advertisers
February 1977
The Canadian Nurse's Cap Reg'd
33
C 1 B A 56
Cover 4
The Clinic Shoemakers
2
Designer's Choice
5
Equity Medical Supply Company
51
Hollister Limited
22
Frank W. Horner Limited
48
Kendall Canada
51
Miller-Stephenson
1
Mont Sutton
58
The C.V. Mosby Company Limited 7,
9, 11,13
Nordic Pharmaceuticals Limited
40
Posey Company
56
Procter & Gamble
49
Reeves Company
55
W.B. Saunders Company Canada Limited
53
G.D. Searle
14
Stiefel Laboratories (Canada) Limited
21
The Uniform Shop of Peterborough Limited
27
Uniform Specialty
Cover 3
White Sister Uniform Inc
Cover 2
Advertising
Gerry Kavanaugh
The Canadian Nurse
50 The Driveway
Ottawa, Ontario K2P 1 E2
Advertising Representatives
Richard P. Wilson
219 East Lancaster Avenue
Ardmore, Penna. 19003
Telephone: (215) 649-1497
Gordon Tiffin
2 Tremont Crescent
Don Mills, Ontario M3B 2S1
Telephone; (416) 444-4731
Member of Canadian
Circulations Audit Board Inc.
nsEnn
Presenting Fashion for the Woman of Today
from T^MC^oxm Sp^cccoXtcf
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Sizes: 3—15
Pristine Royale
White, Robin
about $26.00
B) Style No. 48567
Sizes: 3—15
Pristine Royale
White, Yellow
about $29.00
7{Hi^(nm Sfleco^(t<f
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A different appearance-
A common need
Doth may benefit from SIOW-R? folk
Prophylactic iron and folic acid supplementation
during pregnancy is now an accepted practice
among Canadian physicians. It has also been
established, through the publication in 1974 of
Nutrition Canada \ that many Canadian women
may not be obtaining the necessary nutritional
requirements from their diets. For instance, 76.1 %
of adult women (20-39) had inadequate or less than
adequate intake of iron and 67.9% were at high or
moderate risk of low serum folate levels. More
recently, a number of physicians have queried the
effect of oral contraceptives on serum folate levels
in women. Dr. Streiff reports: "This complication
(of oral contraceptive therapy), however, may be
recognized more frequently in the future... Folate
deficiency associated with oral administration of
contraceptives does not necessarily require
discontinuance of the drug regimen but folic acid
therapy is definitely indicated. "^
C I B A
Dorval, Quebec
tHo eanadiMMB
MBMmmc
March 1977
ES7607615935
977
56 h/iRMC3 AVc N APT 3
KlY QT6
desigher's choice
A name that speaks for itself
A) Style No. 48508
Sizes: 3-15
Pristine Royale
100% textured polyester warp
White, Robin
about $26.00
B&C) Style No. 48593
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Sizes: 3-15
Pristine Royale
100% textured polyester warp
White, Mint
about $35.00
r^i
desigher'^
choice
A
UMITED
EDITION
Available iit leading department stores and specialty shops across Canada
^
Locked in the
heart of every M
cholesterol- -
conscious
patient is
the wistful
longing for
an egg.
Egg Beaters — yolk replaced eggs — reduce
cholesterol content by 98% .
C.H.D. patients and others at hyperlipid risk may now look
a real egg in the face without concern about cholesterol or
triglyceride build-up.
This is made possible by unique 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 vitamin and mineral fortified corn oil
nutrient plus flavouring agents. Egg Beaters are then
pasteurized, homogenized, and fast frozen.
Egg Beaters taste and smell like fresh farm eggs.
The result of this improvement on nature is an egg
equivalent— with the nutrition, taste, and smell of fresh whole
eggs. Minus the cholesterol disadvantages.
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. Each 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.
IN YOUR GROCER'S FREEZER
Standard Brands Canada Limited
Consumer Service Division
550 Sherbrooke St. West
Montreal, Ouel>ec
€
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k.
I would appreciate
a supply of your "Cooking
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as marked below.
Numt>ers of copies requested: Englisfi French-
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>
For a complimentary pair of : bhowing all the smart Clinic styles, and list of stores selling them, write:
THE CLINIC SHOEMAKERS • Dept. CN-3 7912 Bonhomme Ave. • St. Louis, Mo. 63105
tHe ennadian
nnmme
March, 1977
The official Journal of the Canadian
Nurses Association published
monthly in French and English
editions.
Volume 73, Number 3
^^■^^^■n^^^^^i
Input
6
News
12
Names
52
A Question of Balance
Lynda Ford
19
Calendar
54
Clinical Wordsearch # 4
Mary Blizabeth Bawden
25
Books
55
The Role of the Head Nurse
in Primary Nursing
Vivian Good, Diane Bartels
Susan Lampe
26
Library Update
56
f^irroring : The Leukemic Child
June Kil<uchi
31
Frankly Speaking:
Specialization in Nursing
Eleanor G. Pask
34
A Program That Dares
to be Different
Judith M. SI<elton
36
The Nurse's Role in Health
Assessment and Promotion
RNABC Position Paper
40
Fetal Monitoring
— Why Bother?
Ellen Hodnett
44
The Other Side of the Uniform:
Living with Adult Still's Disease
Yolanda Camiietti
48
The pins on this month's cover are
from CNA's collection of nursing
school pins on permanent display in
the Archives at CNA House. The
collection began ten years ago with
donations from the estates of two
former CNA members and has grown
since then to include the 16 pins
pictured on the cover. The Association
is anxious to expand its collection to
include a more representative
selection from both existing and
formerschools of nursing. If you would
like to see your school represented,
please contact the Librarian, CNA
House. For identification of pins, see
page 4. (Photo by Studio Impact).
The views expressed in the articles
are those of the authors and do not
necessarily represent the policies of
the Canadian Nurses Association.
ISSN 0008-4581
Indexed in International Nursing
Index, Cumulative Index to Nursing
Literature, Abstracts of Hospital
r\/lanagemenl Studies. Hospital
Literature Index. Hospital Abstracts.
Index Medicus The Canadian Nurse
is available In microform from Xerox
University Microfilms. Ann Arbor.
Michigan. 48106.
Tlie Canadian Nurse welcomes
suggestions for articles or unsolicited
manuscripts. Authors may submit
finished articles or a summary of the
proposed content. Manuscripts should
be typed double-space. Send original
and carbon. All articles must be
submitted for the exclusive use of The
Canadian Nurse. A biographical
statement and return address should
accompany all manuscripts.
Canadian Nurses Association,
50 The Driveway, Ottawa, C3nada,
K2P 1E2.
Subscription Rales: Canada: one
year, S8.00: two years. $15.00.
Foreign: one year. S9.00: two years,
517,00. Single copies: Si. 00 each.
Make cheques or money orders
payable to the Canadian Nurses
Association.
Change of Address: Notice should be
given in advance. Include previous
address as well as new. along with
registration number, in a provincial/
territorial nurses' association where
applicable. Not responsible for
journals lost In mail due to errors in
address.
Postage paid in cash at third class rate
Montreal, P.O. Permit No. 10,001.
' Canadian Nurses Association
1977.
mt%in ivrr
IVM'S|>iH'<iYe
Is nursing in Canada going through an
identity crisis? One that affects
130,000 practising nurses and
thousands of young people who hope
to follow in their steps? One that
troubles employers as well as
educators, and recipients, as well as
providers of health care?
Over the past 12 months, I have
listened to many leaders of the nursing
profession as they talked to their
fellow nurses in groups across this
country. I have come away from these
meetings convinced that in order to
consolidate the gains they have made
in the first half of this century in the
advancement of the profession,
nurses are going to have to find some
way of reaching a concensus on some
very basic questions ... questions like
what it is that they do and who it is that
makes the decisions and accepts
responsibility for their actions.
Certainly, nursing does not stand
alone in facing this threat to its identity
... if it is a threat. All of the professions,
but particularly the health professions,
are presently undergoing what has
been called a "crisis of public
confidence" that is forcing them to
take a long, hard look at how close
they actually come to meeting the real
needs of society today.
Inevitably, however, it is criticism
of the nursing profession and
questions about nursing and nursing
care that concern us most closely and
immediately.
What does it mean, for example,
when the majority of
nurse/respondents to a survey on
quality of care in the United States and
Canada describe the care they see
around them as "low grade B"?
What is our own reaction to the
challenge of rising consumer
expectations when we are faced with
budget constraints and administrative
decrees that leave us with neither the
time nor the energy to think of the
patient as a person who depends on
us to help him achieve his goal of
"health"?
Is it true that the nurse is
becoming a "jack-of-all-trades and
master of none" and, if it is, what can
we do about it?
Are we really in danger, as one
nurse/educator claims, of losing our
essential caring quality and, in fact,
our sense of the wholeness of
nursing?
In this issue of CNJ, three nurses
who have wori<ed within a primary
nursing set-up, describe the
difference this makes to their
Editor
M. Anne Hanna
Assistant Editors
Lynda Ford
Sandra LeFort
Production Assistant
Mary Lou Downes
Circulation Manager
Beryl Darling
Advertising
Gerry Kavanaugh
CNA Executive Director
Helen K. Mussallem
perception of their role within the
health care system. For them, the
"one nurse, one patient, planning cara
together approach" and the
responsibility that this entails makes il
a little easier to answer the
fundamental question that all nursoa
are faced with now: "Who am I, what
am I doing here, and where am I
going?
— M.A.Ht
lloriMii
Key to cover photo:
1. Hotel-Dieu du Sacr6-Coeur de
Jesus, Quebec, P.O.
2. Algonquin College, Ottawa, Ont.
3. Victoria Hospital, Winnipeg, Man.
4. Hdpital G4n4ral d'Ottav/a, Ottawa,
Ont.
, 5. Royal Victoria Hospital, Montreal,
P.O.
6. Vernon Jubilee Hospital, Vernon,
B.C.
7. Memorial University, St. John's,
Nfld.
8. Ottavt/a Civic Hospital, Ottawa, Ont.
9. Montreal General Hospital,
Montreal, P.O.
10. The Moncton Hospital, Moncton,
N.B.
1 1 . Toronto General Hospital,
Toronto, Ont.
1 2. Metropolitan General Hospital,
Windsor, Ont.
1 3. Kelsey Institute of Applied Arts
and Sciences. Saskatoon, Sask.
1 4. Metropolitan (Demonstration)
School of Nursing. Windsor, Ont.
15. Winnipeg General Hospital,
Winnipeg, Man.
16. Regina General Hospital, Regina,
Sask.
..."The best is yet to be, the last of life, i
for vi/hich the first was made. "
How do you feel about growing!
older — as an individual or as a nurs(
who cares for our older people? New
month, CNJ explores the subject ol
aging as it involves nursing and yot
We'll look at what goes on in a day
hospital in Edmonton. Alberta, a
nursing home in Hamilton, Ontario,
and a geriatric center in Toronto,
among other places, and talk about
some practical ways that nurses cat
help to make the last of life a little
better for these important people.
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169. 170 ALL METAL rich, tail 559, 560 PLASTIC LAMINATE
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The Canadian Nurse March 1977
The Canadian Nurse invites your
letters. All correspondence is subject
to editing and must be signed,
although the author's name may be
withheld on request.
Input
IF^
The quality of our caring
Thousands of cancer patients
must now present themselves, usual ly
in a teaching hospital, for review and
treatment on a regular basis. As
controls improve, many of us are living
much longer than expected and must
be considered "problems" by
professional staff — secretaries,
technicians, nurses, and doctors. We
flood existing facilities at all levels and
place a great strain on too few
hematologists and oncologists.
I am myself a chronic patient,
beginning my fifth year of therapy in
two centers — one for cobalt, one for
chemo. I am concerned about what is
happening to me and to others like
myself. Somehow, in the treatment of
some incurable diseases, when
patients must be treated or they will
die, 'Equal Rights" has cometo mean
"Everyone is the Same." When this
happens, individual identity is lost: the
patient becomes a nonentity — a
cipher— a case.
Some questions arise:
Why must patients endure
several inept attempts to draw blood,
or insert I.V.'s?
Who decided that patients have
hours to waste in crowded waiting
rooms, waiting for tests or to see their
doctors? Why are they not seen or
treated on an appointment basis?
Why are patients' names called
on a P. A. system, or bellowed by a
staff member without courtesy of a
title?
Why are they herded in groups,
sometimes undressed, from one place
to another?
Does the patient know the name
of the doctor responsible for his care?
How often does he see that doctor?
Is the patient required to submit to
examination by a different doctor each
time? What happens if he refuses
such examination?
Is the patient threatened in any
way?
What does a patient, being
treated as an out-patient, do when he
has a bad reaction, calls his doctor's
office for advice, and is told the doctor
does not speak to patients on the
telephone?
Who decided it is better for
patients, admitted for therapy, to
share rooms, bathrooms, even a
whole floor with other cancer patients?
Perhaps, it is better for the staff? Is a
patient entitled to any privacy? Who
answers his questions if he neversees
his doctor alone? How does the
patient who is lying in bed feel, when a
group standing around, discusses him
as if he were non-existent?
We patients know some of the
answers to these questions and
appreciate at least some of the
problems that are encountered in our
care. But, again, the question arises
— how many of the answers are
merely excuses?
It does seem to me that the
patient is caught in a rapidly
developing atmosphere of
indifference, intimidation, and
coercion. Most certainly we need
medical care for our future
generations, but it distresses me to
think that my children and
grandchildren may endure the added
anxieties and frustration that attend
what, at its best, must be called
difficult therapy.
Perhaps patients might be asked
for suggestions as to their needs or
preferences.
Perhaps the time has come for
patients to teach attending staff, by
expressing their thoughts regarding
attitudes and treatment at all levels.
Pertiaps the time has come, too,
for attending staff to be reminded that
patients are individuals — they do
have feelings and are entitled to
courtesy and respect.
— M.E. Murray, Toronto. Ontario.
Paraplegics revisited
In the December issue of TVie
Canadian Nurse the article "Towards
Independence for Paraplegics" had
two minor errors. On page 25, the
brace (upper photo) is a Jewitt
Hyperextension brace, not
hypertension brace.
The other is on page 27, middle of
page, when mentioning the
radiological examination of adynamic
voiding cysto- urethrogram to
determine the cause of bladder
dysfunction, be it due to spasm of the
external sphincter, urethral strictures,
bladder calculi or reflux. A reflux, if
present, is seen during this
examination, but is a complication of
bladder training, rather than a direct
cause of dysfunction, as are the other
mentioned factors.
— Ane Marie Hansen, R.N., Toronto,
Ontario.
Brash, pretentious, abrasive?
My response to your invitation to
comment on the topic of MA.
Wickham's letter (December, 1976)
follows.
It was with some surprise that I
realized that the June, 1 974 resolution
to omit titles such as Miss or Mrs. in all
CNA communications would result in
only the surname of an individual
being used.
This practice creates a harsh and
abrasive tone.
Would it not be more appropriate
to refer to the individual by his/herfirst
name?
— Mardy Brown, Gulf Station, South
Hazelton, B.C.
The practice of referring to
nursing professionals with "bare "
surnames communicates a kind of
brash pretentiousness. The use of
surnames only calls forth a reaction of
both physical (cringing) and emotional
dimension. Why not use the person's
first name or title appropriate to their
status? This practice was popular in
early nursing-training experience
when one's best friends found the title
"Miss" cumbersome while working in
patient-care areas. Pertiaps the use of
the "bare surname" conjures up
reflections of the driving work ethic
during a period of experience (utility
rooms, waste baskets, maps and
dusting) which many would prefer to
forget.
I find it unattractive in our_.literary
journal.
— Thelma Potter, Reg. N., Toronto,
Ontario.
I, too, abhor the use of bare
surnames in The Canadian Nurse. I
thought initially that I would gradually
adapt to this, however, this has not yet
happened. It seems such a paradox
when we talk about personalizing care
for our patients; yet, our professional
journal addresses individuals in this
coldly impersonal manner.
— Bonnie Hartley, Graduate Student.
Faculty of Nursing, University of
Western Ontario.
Abortion counselling
I was very pleased to read the
article "Abortion Counselling " by
Bonnie Easterbrook and Beth
Rust (January, 1977).
Canadian hospitals have been
avoiding their responsibility of
providing abortion services. Statistics
Canada lists 258 hospitals, out of
1,359 in Canada, with Therapeutic
Abortion Committees. A 1975 survey
conducted by the Doctors for Repea
of the Abortion Law (DRAL) shows
that only one-third of Canadian
hospitals that are technical ly eq uippec
to perform abortions are listed as
having such a committee. The
overdue report of the government
funded Badgley Commission which is
investigating the application of the
present abortion law in Canadian
hospitals should provide more curren
data.
Abortion counselling by
competent personnel is an essential
health service which more hospitals
should provide. Sensitive, concemec
nurses can expand their role into this
important health care area. Please
keep us informed of current
developments.
— Linda Ratcliffe, Reg. A/., C.P.,
London, Ontario,
Long-term care for RN's
The December 1 976 issue of The
Canadian Nurse has an
announcement in the "News" columr
of Canada's "first" extended care
program for registered nurses at
Grant MacEwan College in
Edmonton, Alberta.
Our program here at Centennia*
College in Scartorough, Ontario,
entitled "Certificate of achievement fo
registered nurses in Long-Term Care"i
has been in operation now for almos
two years, and was approved by the
Council of Regents of our provincial
Ministry of Colleges and Universities
Those of us involved with the
formation, development and
implementation of the program feel
that it meets a real need, and we are
delighted to see other colleges
develop programs of similar nature.
— Patricia Prentice, Coordinator of
Applied Arts /Academic/ Health
Programs, Continuing Education
Division, Centennial College of
Applied Arts and Technology,
Scarborough, Ontario.
In this high pressured world of caring and doing and bending and reaching,
walking miles of aisles and wondering whether anybody out there cares... We
do. Barco backs every stitch of every look, every day.
Barco Backs l&ni. Baby.
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Write for your coinplimentary Uniform Brochure to: Barco, 350 West Rosecrans Avenue, CN-77, Gardena, California 90248.
Barco, one of the finest names in Uniforms and Shoes is proud to be in Canada.
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The Canadian Nurse March 1977
Rely on Mosby. No other publisher offers you such
opportunities for choice in every nursing specialty.
New 2nd Edition! .
ADULT AND CHILD CARE:
A Client Approach to Nursing
The new edition of this pacesetting text continues
its unique approach by interweaving both adult and child
care, and organizing material according to five basic human
needs (safety and security, activity and rest, sexual role
satisfaction, need for oxygen, nutrition and elimination). Re-
taining the innovative features which made the first edition so
popular, the authors have made significant revisions that
enhance this texts effectiveness. Here's how they've
amplified this new 2nd edition;
• an increased emphasis on applied pathophysiology evi-
denced throughout:
• major expansion of material on the central and peripheral
nervous systems. Included are new chapters on neurolog-
ical assessment, brain and spinal cord;
• the latest information on assessment and management of
oncologic problems. New tables summarize nursing ac-
tion and pharmacotherapy;
• revised and expanded chapter on the cardiovascular sys-
tem with new material on assessment of dysrhythmias and
new material on myocardial infarction and pump failure;
• more information on nursing management of fluid and
electrolyte problems;
• the section on sexual role satisfaction contains new infor-
mation on assessment techniques in breast cancer and
venereal disease along with client instruction techniques.
A new section on rape considers prevention and treat-
ment;
• additional learning aids; more than 100 new illustrations
plus additional assessment guides and summary tables.
By Janet Miller Barber, R.N., M.S.; Lillian Gatlln
Stokes, R.N.. M.S.; and Diane McGovern Billings. R.N., M.S.
March. 1977. Approx. 1,024 pages. 8" x 10", 738 illustra-
tions. About $18.85.
MEDICAL-SURGICAL
NURSING MANAGEMENT OF RENAL PROB-
LEMS. By Dorothy J. Brundage, M.N. A clear presentation of
the physiologic and psychologic bases for nursing interven-
tion, this unique text approaches nephrology as a vital sub-
system of the whole body system. It offers in-depth informa-
tion on normal and pathologic renal function; causes of renal
disturbances; body responses and acute renal failure; medi-
cal therapy; and nursing intervention. Methods and proces-
ses of renal restoration are carefully detailed, with special
attention to dialysis and transplantation and their psychoso-
cial aspects. 1976, 214 pp., 20 illus. Price, $7.30.
New 3rd Edition! NURSING CARE OF THE
GANGER PATIENT. By Rosemary Bouchard, A.B., A.M.,
Ed.D.. R.N. and Norma F. Owens, A.B., A.M., Ed. D., R.N. This
new edition presents up-to-date discussions on prevention,
detection, and diagnosis of cancer, and explains the effects
of cancer on all major body systems. The authors discuss
traditional cancer therapy — surgery, radiation, and
chemotherapy — and explain nursing approaches to each.
Rehabilitation and care of the terminal patient are explored
in depth. Special consideration is given to the psychological
aspects of primary and advanced disease along with nursing
methods to help provide emotional support. June, 1976. 325
pp., 189 illus. Price, $9.40.
A New Book! ELEMENTS OF REHABILITATION IN
NURSING: An Introduction. By Rose Marie Boroch. R.N.,
M.A.; with 4 contributors. This dynamic new book ap-
proaches the theory and practice of rehabilitation from a
psychosocial perspective. Contributions by specialists in
community health, orthopaedic rehabilitation, and sexual
function stress ways to meet the physical, emotional, and
social needs of the rehabilitating patient. Informative dis-
cussions offer new insights on the health care environment:
physical and psychosocial functions in health related
therapies; and application of the nursing process. Sep-
tember, 1976. 328 pp., 60 illus. Price, $8.95.
A New Book! ENDOCRINE PROBLEMS IN NURS-
ING; A Physiologic Approach. By Judith Amerkan Krueger.
R.N.. MS and Jams Compton Ray. R.N.. M.S. This valuable
new text provides students with a sound physiologic basis
for care of patients with endocrine disorders. The authors
describe both the function and dysfunction of the pituitary,
adrenal, parathyroid, thymus, and pineal glands; the pan-
creas, gonads, and gastrointestinal hormones Further dis-
cussions explain appropriate diagnostic procedures and
pharmacologic treatments. Many helpful charts summarize
patient problems and their implications for nursing care.
August. 1976 175 pp.. 41 illus Price, $6.60.
New 3rd Edition! THE PROCESS OF PATIENT
TEACHING IN NURSING. By Barbara Klug Redman. R.N..
B.S.N.. M.Ed . Ph.D. Greatly revised and expanded, this new
3rd edition presents important principles and methods for
patient teaching. Organized around elements of the
teaching-learning process, this new edition explores; the
Patients Bill of Rights: social learning; behavioral objectives
as educational tools: proposed taxonomy of perceptual do-
main; and a care plan using behavioral modification. June.
1976 282 pp., 14 figs Price. $8.15.
IfVeVe built a reputation for quality and diversity in nursing publishing.
A New Book! NURSING MANAGEMENT OF DIA-
BETES MELLITUS. Edited by Diana W. Guthrie. R.N.,
M.S.P.H.. F. A.A.N, and Richard A. Guthrie. M.D., F.A.A.P.;
with 9 contributors. This important new text presents up-to-
date information to help the nurse better understand dia-
betes mellitus — and to properly educate diabetic patients.
Emphasizing the care of the aged and children with dia-
betes, the authors discuss diagnosis, nursing management,
acute and chronic care, complications, special problems,
and patient education. Psychosocial aspects are examined
in depth. March. 1977. Approx. 240 pp., 64 illus. About
$7.30.
New 2nd Edition! CONTROLLING THE SPREAD
OF INFECTION; A Programmed Presentation. By Betty
Mclnnes, R.N.. B.Sc.N.. M.Sc.(Ed.). Proceeding from simple
to complex, this new edition skillfully combines nursing
management with the study of aseptic principles and control
procedures as they apply to patients and hospital personnel.
This new 2nd edition retains the effective programmed for-
mat of its predecessor, with each section updated, ex-
panded, and clarified. New features include: new headings
for quick reference; a new glossary; and three new appen-
dices for summary reviews. April, 1977. Approx. 128 pp., 12
illus About $6.25.
M05BV
TIMES MIRROR
THE C. V. MOSBY COMPANY, LTD.
86 NORTHLINE ROAD
TORONTO, ONTARIO
M4B 3E5
Th* Canadian Nurae March 1977
We've built a reputation for quality
and diversity in nursing publishing.
FUNDAMENTALS
A New Book! INTRODUCTION TO NURSING ES-
SENTIALS: A Handbook. By Helen Readey, R. N., M.S.; Mary
Teague. R.N.. M.S.N.;and William Readey, III, B.S. An ideal
supplement or study guide, this new text first discusses
study skills, then devotes an entire chapter to the definition
and application of the nursing process, emphasizing mas-
tery of the communication process. The authors also explore
various systems of charting; legal aspects of nursing; and
mathematical problem solving, A glossary and learning aids
are included. April, 1977. Approx. 176 pp., 19 illus. About
$5.80.
New 2nd Edition! THE PROCESS OF PLANNING
NURSING CARE: A Model for Practice. By Fay Louise
Bower, R.N., B.S., M.S.N. This thoroughly updated guide to
planning holistic nursing care reflects the changing health
care setting — increased numbers of ambulatory centers
and home care programs — and emphasizes the nurses
responsibility for making independent judgements. New in-
formation has been added on assessment and the nursing
diagnosis, and on problem-oriented care plans. March,
1977. Approx. 144 pp., 9 illus About $6.05.
New 9th Edition! MOSBYS COMPREHENSIVE
REVIEW OF NURSING. Edited by Dolores F. Saxton, R.N.,
B.S. in Ed.. M.A., Ed.D.; Phyllis K. Pelikan, R.N., A.A.S., B.S.,
M.A.: and Patricia M. Nugent, R.N.. A.A.S., B.S. .M.S.; with 10
contributors. Field tested for accuracy and updated to reflect
current concepts and techniques, this new edition features
expanded discussions on medical-surgical nursing, re-
habilitation and psychiatric nursing, nursing history, and the
physical sciences in nursing. The revised step-by-step for-
mat is especially helpful to students, January. 1977. 624 pp.,
12 illus. and 5 two-color illus. Price, $13.15.
PHARMACOLOGY
13th Edition! PHARMACOLOGY IN NURSING. Sy
Betty S. Bergersen, R.N., M.S., Ed.D.: in consultation with
Andres Goth, M.D. Written by a nurse for nurses, this popular
text continues to be the most widely accepted book in the
field. In this 13th edition, it presents thorough, up-to-the-
minute coverage of pharmacology . . . with emphasis on
understanding drug action in the human body. Two new
chapters, "Antimicrobial Agents" and "The Effect of Drugs on
Human Sexuality, Fetal Development, and Nursing Infant",
reflect this edition s increased emphasis on nursing implica-
tions. Virtually every chapter has been updated and revised
to include the latest pharmacological information. 1976, 766
pp 100 illus Price, $14.20.
10th Edition! WORKBOOK OF SOLUTIONS AND
DOSAGE OF DRUGS: Including Arithmetic. By Ellen M.
Anderson, R.N.,B.S., MA. and Thora M. Vervoren, R.Ph., B.S.
An effective, self-teaching guide, this workbook relates
basic mathematics to common solutions and dosages, and
provides information essential for proper calculation, prep-
aration, and administration of drugs. Updated throughout,
the text places more emphasis on the metric system and
Includes many new problems. 1976, 176 pp., 11 figs. Price,
$7,10.
A New Book! CALCULATING DRUG DOSAGES: A
Workbook. By Ruth K. Radcliff, R.N., M.S. and Sheila J.
Ogden, R.N., B.S. This new workbook is an excellent tool for
students who want to refresh their knowledge of mathemati-
cal skills needed to correctly calculate drug dosage. After a
pretest to determine specific needs, the book discusses
basics in general mathematics (fractions, decimals, percen-
tages, ratios, and proportions). Worksheets and chapter
quizzes assist in the evaluation of learning. January, 1977.
272 pp., 26 flash cards. Price, $8.95.
BASIC SCIENCE
9th Edition! INTRODUCTION TO PHYSIOLOGI-
CAL AND PATHOLOGICAL CHEMISTRY. By L. Earle Ar-
now, Ph.G., B.S., Ph.D., M.B.. M.D. Student-oriented, this
superb 9th edition clearly delineates the principles of chem-
ical reactions and their relationships to clinical medicine.
Chapters have been updated and the appendix contains a
revised table of atomic weights and numbers. 1976, 514 pp.,
225 illus Price, $12.55.
9th Edition! INTRODUCTION TO LABORATORY
CHEMISTRY, By L. Earle Arnow, Ph.G., B,S., Ph.D.. M.B.,
M.D. 1976. 102 pages plus FM l-XVI, 51/2" x Sys", 43 illustra-
tions. Price. $4.50.
12th Edition! ROE'S PRINCIPLES OF CHEMIS-
TRY. By Alice Laughlin. B.S.. M.S., Ed.D. Clear and com-
pact, the 12th edition of this popular text continues to relate
principles to practice in its presentation of the essential
areas of inorganic and organic chemistry, and biochemistry.
The book emphasizes the metric system, molecular and
atomic structure, and recent discoveries in biochemistry.
1976, 414 pp,, 122 illus. Price, $12.55.
7th Edition! ROE'S LABORATORY GUIDE IN
CHEMISTRY. By Alice Laughlin, B.S., M.S., Ed.D. 1976, 238
pages plus FM l-XII, SVz" x 8Vz". 47 illustrations. Price.
$6.85.
New 11th Edition! MICROBIOLOGY AND
PATHOLOGY. Sy Alice Lorraine Smith. A.B., M.D.. F.C.A.P.,
F.A.C.P. This new edition has been extensively revised and
updated to answer your students' questions on the "what s",
"when's", and "hows " of microbiology with the most recent
information available. New topics include: serologic diag-
nosis of protozoal and metazoal diseases, evaluation of
cell-mediated immunity, immunotherapy, and other related
subjects. April. 1976. 698 pp., 564 illus Price, $16,30,
CRITICAL CARE
New 2nd Edition! RESPIRATORY NURSING
CARE: Physiology and Technique. By Jacqueline F. Wade,
R.N., S.C.M., B.T.A. The new 2nd edition ofthis valuable text
continues to provide your students with an exhaustive pre-
sentation of respiratory physiology as it relates to nursing
care. The author places increased emphasis on the applica-
tion of physiology and nursing therapies to prevent respirat-
ory complications, and includes more material on specific
respiratory problems. Two new chapters discuss bedside
monitoring; and hypoxemia, hypoxia, and oxygen therapy.
April, 1977. Approx. 224 pp., 48 illus. About $7.90.
2nd Edition! NURSING CARE OF THE PATIENT
WITH BURNS. By Florence Greenhouse Jacoby, R.N. Writ-
ten by an experienced burn-nurse clinician, this text is a
concise, yet detailed resource for burn care, from first aid
treatment to prolonged care of burn patients. Updated and
expanded, it includes a new chapter on fluid therapy, and
increased emphasis on pathophysiology, causes, and pre-
vention of complications. The book reviews fundamental
facts of anatomy and physiology and provides students with
a working knowledge of the basic pathologic, physiologic,
and psychologic changes that can occur in the burn patient.
Information on the importance of nutrition and special needs
of young and older burn patients is included. 1976, 198 pp.,
18 illus. Price, $7.65.
A New Book! ACUTE MYOCARDIAL INFARCTION:
Reaction and Recovery. By Rue L. Cromwell. Ph.D., et al.
This new text presents a compilation of controlled research
data pertaining to how stress and personality affect a pa-
tients recovery from acute myocardial infarction; and how
these factors affect the health team's approach to care. Prac-
tical discussions explore such topics as: the patient's re-
sponse to nursing care; psychological assessment and nurs-
ing management of coronary patients; and anticipating sub-
sequent infarctions. March. 1977. Approx. 208 pp., 24 illus.
About $11.00.
CURRENT PRACTICE &
PERSPECTIVES IN NURSING SERIES
New Volume I! CURRENT PRACTICE IN FAMILY-
CENTERED COMMUNITY NURSING. Edited by Adma M.
Reinhardt, Ph.D. and Mildred D. Ouinn, R.N., M.S. This ex-
ceptional new text offers a variety of alternatives for coping
with community health situations. Articles range from indi-
vidualized care to broad concepts in community health ad-
ministration, including details for planning and implement-
ing specific programs. The first section of this timely book
explores current opportunities for community nursing in the
health field. Further discussions study cultural influences
and trans-cultural nursing, and then stress the family role,
focusing on family assessment and effective use of indi-
vidual family strengths, January, 1977. 376 pp., 30 illus.
Price: $12.10 (C); $8.95 (P).
Volume I! CURRENT PERSPECTIVES IN NURSING
EDUCATION: The Changing Scene. Edited by Jane A. Wil-
liamson, Ph.D., R.N,; with 18 contributors. 1976, 188 pages
plusFM l-X, 6%" X 93/4", 12 figures. Price: $11.05(0); $7.90
(P).
Volume II CURRENT PRACTICE IN ONCOLOGIC
NURSING. Edited by Barbara Holz Peterson, R.N., M.S.N,
and Carolyn Jo Kellogg. R.N., M.S.; with 27 contributors,
1976, 230 pages plus FM l-XVI, 6%" x 93/4". 3 illustrations.
Price: $1 1.05(C); $7.90 (P).
Volume II CURRENT PRACTICE IN PEDIATRIC
NURSING. Edited by Patricia A. Brandt. R.N., M.S.; Peggy L.
Chinn, R.N., Ph.D.; and Mary Ellen Smith, R.N.. M.S.; with 15
contributors. 1976. 242 pages plus FM l-XIV, 6%" x 9%", 13
illustrations. Price: $11.05 (C); $7.90 (P).
Volume I! CURRENT PERSPECTIVES IN
PSYCHIATRIC NURSING: Issues and Trends. Edited by
Carol Ren KneisI, R.N., Ph.D. and Holly Skodol Wilson, R.N..
Ph.D.; with 24 contributors. 1976, 228 pages plus FM l-XIV,
63/4" X 93/4", 9 figures. Price: $11.05 (C); $7.90 (P).
Volume I! CURRENT PRACTICE IN OBSTETRIC
AND GYNECOLOGIC NURSING. Edited by Leota Kester
McNall. R.N., M.N. and Janet TraskGaleener. R.N., MS ; with
19 contributors. 1976. 254 pages plus FM l-XVI, 6^4" x 93/4",
39 illustrations. Price: $11 05 (C); $7.90 (P).
A New Book! CURRENT PERSPECTIVES IN
NURSING: Social Issues and Trends. Edited by Michael H.
Miller. Ph.D. and Beverly Flynn. R.N., Ph.D.; with 21 con-
tributors. This collection of original articles examines sig-
nificant social issues now confronting the nursing profes-
sion. Written by leading authorities in the field, the book
focuses on five major topical areas of nursing: ethics, re-
search, health care delivery, organization, and education.
Some of the issues discussed include: the establishment of
the nurse practitioner role; the establishment of nursing un-
ions as a political force in obtaining improved personnel
benefits; the creation of professional organizations sensitive
to nursing's needs: attempts to evaluate educational prog-
rams; and changes in the issues the ANA is addressing.
June 1977 Approx 176pp., 4 illus. About$12. 10(C); about
$8.95 (P).
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The Canadian Nurse March 1977
Xcws
MARN representatives
meet with cabinet
The Board of Directors and other
representatives of the Manitoba
Association of Registered Nurses met
with Premier Ed Schreyer and
members of his Cabinet in
mid-January, to present
recommendations on matters of
concern to the Association. The
meeting was the first to take place
between MARN and representatives
of the government of that province.
A brief presented by fi/IARN
stressed the Association's desire for a
continued and regular liaison with
government in matters related to
health care, particularly as such
matters affect the delivery of nursing
care.
The purposes and objectives of
the Association were outlined with a
discussion of the ways in which MARN
is canning out its objectives. For
example: registration of members, a
referral service to assist both nurses
seeking employment and employers,
a program presently in progress to
establish standards of nursing
practice, continuing education,
refresher course programs, promotion
of inservice education, bursaries and
loans to assist nurses in further
education, consultation and funds to
assist in nursing research projects
were mentioned.
Brief reference was made to the
Association's Position Paper on
Nursing Education: "Challenge and
Change. " Concern was again
expressed that only one memberfrom
MARN was permitted to be on the
Ministerial Task Force appointed to
recommend on nursing education.
Resolutions passed at the
Association's annual meeting were
also referred to the Cabinet for
consideration. These dealt with
learning resource centers for health
workers; support of non-smoking
programs and discouraging the sale of
tobacco in health agencies; legislation
forcompulsory use of seat belts, crash
helmets, and reduction in speed limits.
The Association stressed the
urgent need in Manitoba for nurses
prepared at the Master's level and
strongly urged government support for
the immediate establishment of a
M.Sc.N. program at the University of
Manitoba.
CNA research study reveals few key changes
in nursing employment, education patterns since 1966
The research unit of the Canadian
Nurses Association has released the
results of a review of trends in the
grovirth and expansion of the nursing
profession in Canada between 1 966
and 1974.
Highlights of the study, according
to research officer, Marion Kerr,
include the following:
• Between 1966 and 1974, the
number of registered nurses
employed in nursing increased by 56
percent (from 82,517 in 1966 to
128,675 in 1974).
• the field of employment and the
education levels of nurses working
during this period did not vary
significantly from those of the previous
decade.
Increased public and popular
emphasis on preventive and
maintenance health services provided
from community-based agencies and
the need for higher levels of education
to prepare nurses to work in these
settings were not reflected in actual
practice. In 1974 (as in 1966) more
than 80 percent of employed
registered nurses working in
Canada worl(ed In hospital/
institutional settings; more than 80
percent had as their highest
academic preparation the diploma
leading to an R.N.
Other highlights of the study:
• the percentage of registered
nurses employed in community health
settings remained relatively stable;
• the greatest shift in level of
education, a dramatic one from
diploma leading to R.N. to
baccalaureate degree, occurred
among registered nurses employed in
nursing education;
• the number of registered nurses
and the number of those holding the
baccalaureate degree both Increased
by 56 percent;
• the level of education for
registered nurses employed as
directors and assistant directors of
nursing declined;
• levels of education for registered
nurses employed as supervisors and
head nurses and as general duty/staff
nurses rose slightly.
Four questions about the
employment settings and educational
preparation of nurses in the period
between 1966 and 1974 were
investigated :
Q. Was there a shift towards a larger
percerytage of registered nurses
being employed In community
health nursing? -
A. Rather than a shift towards
employment in community health
settings, there was actually a 1.4
percent decline in the percentage of
registered nurses employed in
community health settings. It seems
clear that although the actual number
of registered nurses working in
community health settings did
increase, the expansion of hospitals
and other institutions continued to
absorb the majority of registered
nurses during this period.
0. Was there a shift towards higher
levels of education for employed
nurses?
A. While vety little shift occurred
between 1966 and 1974 in level of
education of employed registered
nurses, what shift did occur was away
from the diploma leading to R.N.
towards the baccalaureate degree. In
both 1 966 and 1 974 over four-fifths of
employed registered nurses had as
their highest academic preparation
the diploma leading to R.N. While
there was an increase of 2.7 percent in
the group holding the baccalaureate
degree, there was little change in the
group holding the master's or higher
degree and little change in the group
holding some credits towards a
baccalaureate degree.
Did you know ...
At a meeting held recently in Montreal
to form the Practitioners of
Infectious Control in Canada, one of
the recommendations was the
formation of local interest groups. One
such group is forming in the Prairies. If
you are interested in this field, please
contact: Laura Black/Jean Harper,
Continuing Medical and Nursing
Education, The Plains Health Centre,
4500 Wascana Pari<way, Regina,
Sask., S4S 5W9.
Q. Were there shifts in level of
education towards greater
preparation for registered nurses
employed in community health
settings?
A. The greatest shift in level of
education did not occur in the group of
registered nurses employed in
community health settings, but rather
in the group employed in nursing
education. Between 1966 and 1974,
the most prevalent level of education
for nurse teachers shifted from
diploma leading to R.N. (29.4 percent
in 1966) to baccalaureate degree
(60.6 percent in 1974). In the same
period the percentage with a master's
or higher degree more than doubled
from 5.9 percent to 13.9 percent. The
second largest shift occurred in the
group of registered nurses employed
in community health settings where
the percentage of those holding the
baccalaureate degree approximately
doubled (as it did in all three fields of
employment).
0. Was there a shift towards higher
levels of education among
registered nurses employed in
administrative and managerial
positions, * in general duty, and in
nursing education?
A. The greatest shift, an upward one,
occurred among the group of nurse
teachers, 60.6 percent of whom held a
baccalaureate degree in 1974,
compared to 25.7 percent in 1966.
Among directors and assistant
directors of nursing there was a
downward shift in level of education.
There was anupward shift in the level
of education of supervisors and head
nurses and the level of education of
the general duty/staff nurse group
also shitted upwards slightly.
* Note, For the purpose of this review
administrative and managerial positions comprise I
the positions of director and assistant director of \
nursing, and supervisor and head nurse. I
i
Table 1 : Registered Nurses Employed in Nursing in Canada
by Field of Employment, 1966 and 1974.
Field of Employment
Hospital/other institution
Community tiealth agencies'
Nursing education programs
aher^
Total
(n^
1 . Community heatth agencies include public health, school health,
occupational health, physician's and/or dentists' office.
2. Other includes private duty and other specified fields.
Table 2: Registered Nurses Employed in Nursing in Canada
by Highest Level of Education, 1966 and 1974.
1966
1974
Highest Level
80.1
83.8
of Education
11.4
10.0
Diploma leading to R.N.
3.6
2.8
Some credits towards a
4.9
3.4
baccalaureate degree
100.0%
100.0%
Baccalaureate degree
= 82,517) (
n = 128,675)
Master's or higher degree
Total
1966
1974
85.2
82.0
9.5
9.9
4.8
7.5
0.5
0.6
100.0%
100.0
(n = 82,517) (n = 128,675)
Table 3: Registered Nurses Employed in Nursing in Canada, by Highest Level of Education and Field of Employment,
1966 and 1974.
Highest Level
of Education
Hospital /other
institutions
Community
health agency
Nursing education
programs
1966
1974
1966
1974
1966
1974
Diploma leading to R.N.
88.8
86.4
72.8
59.4
39.9
11.2
Some credits towards a
baccalaureate degree
7.8
8.1
17.9
23.9
24.8
14.3
Baccalaureate degree
3.2
5.3
8.6
16.0
29.4
60.6
Master's or
higher degree
0.2
0.2
0.7
0.7
5.9
13.9
Total
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
(n =
= 66,172)
(n
= 107,769)
(n = 6,834)
(n = 12,844)
(n = 2,932)
(n = 3,427)
Table 4: Registered Nurses Employed in Nursing in Canada by Highest Level of Education and Position, 1966 and 1974.
Highest Level
of Education
Directors and
Assistant Directors
of Nursing
Supervisors &
Head Nurses
General Duty/
Staff Nurses
Nurse Teachers
1966
1974
1966
1974
1966
1974
1966
1974
Diploma leading
60.1
62.6
84.3
78.8
88.4
86.2
42.7
11.2
to R.N.
Some credits towards
a baccalaureate
degree
15.2
14.7
11.4
13.7
8.2
8.5
27.5
14.3
Baccalaureate
degree
19.3
18.0
4.1
7.1
3.3
5.3
25.7
60.6
Master's or
higher degree
5.4
4.7
0.2
0.4
0.1
0.1
4.1
13.9
Total
100.0%
1 00.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
(n = 2,549
(n = 3,735)
(n = 14,894)
(n =21,207)
(n = 54,906) (
n = 96,793)
(n = 3,053)
(n = 4,720)
Th* Canadian Nuraa March 1977
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CNA Directors hold Work Session
to consider nursing directions
UWO Dean of Nursing addresses
Seneca College Education Day
Directors of the Canadian Nurses
Association have come up with a list of
ive major recommendations for action
Dy the nursing profession. The list
1 ncludes a recommendation
Iconceming the development of a
definition of nursing practice.
I The recommendations were
approved at a special Work Session
;alled by CNA Directors to discuss
I Regulation of the Profession:
JNursing Directions — Power and
Purpose," The session took place in
Dttawa in mid-January and was
attended by memtsersof CNA's Board
of Directors and advisers to the
Directors.
CNA president Joan Gilchrist,
:Aho was chairman of the session,
noted that directors had agreed at
itheir last meeting of the Board that
regulation of the profession must be
considered a priority throughout the
1 976-78 blennium and had expressed
isoncern over the fact that the control
and delivery of nursing services were
ibeing shaped by people outside the
nursing profession. They had
{expressed the desire to meet to gain
first-hand information on what was
'happening in nursing and health
^services across the country so that
they could identify problems, propose
strategies and identify ways that CNA
could assist in solving these problems.
During the work session a
jrepresentative from each of the eleven
Iprovlncial territorial member
associations made a verbal
presentation identifying issues and
concerns within their region.
The five recommendations
approved were:
that a definition of nursing
practice be developed.
• that the Executive Committee (a)
review the CNA Position Statements
land CNA Publications in the light of
'issues discussed, (b) make necessary
irevisions or proposals, and (c) report
Iback to the next Board of Directors
I meeting.
• that a discussion paper be
prepared on principles, alternatives,
implications and strategies related to
registration/licensure by the
provincial nurses' associations.
• that the two consultants in Labor
Relations Services give priority to
preparation of a draft statement forthe
Executive Committee outlining the
role of union vis a vis the role of the
professional association.
• that the Executive Committee
study the feasibility of initiating a draft
paper on the delivery of health care
services with a view to developing a
statement on the delivery of nursing
services independently and in
conjunction with professionals and
others in the health care system; that
the Executive Committee use CNA
memtiers and/or consultants to obtain
needed data and that current CNA
papers In delivery of service and
related documents be utilized; that
projections for future delivery of
nursing services be included.
MARN supports Alert
A recent demonstration of Heart Alert
(Heart and Lung Emergency
Resuscitation Training) was
enthusiastically received by the
Manitoba Association of Registered
Nurses' Board of Directors and
presidents of MARN Chapters. The
Heart Alert demonstration, presented
at a recent Board meeting by Eleanor
Wilson and Dr. W.A. Tweed, teaches
people to deal effectively with cardiac
emergencies by education in coronary
risk factors, recognition of the signals
of heart attack, emergency action for
survival, cardiac first aid, and training
in cardio-pulmonary resuscitation for
hospital and community emergency
rescue personnel.
The program is sponsored by the
Manitoba Heart Foundation and has
received the support of many of the
health care disciplines. Follow-up
cases show that lives have been
saved through emergency cardiac first
aid, administered by persons trained
in the advanced techniques of this
llfesaving program. In order to bring
information about this program to its
members, MARN Is planning
meetings at chapter, district, and
provincial levels.
Nurses In Canada are going to have to
make some tough decisions in the
next few years in order to continue to
grow and develop as a profession and
to meet the expectations of both
employers and consumers of health
care. The decade coming up,
according to Josephine Flaherty,
Dean of the Faculty of Nursing at the
University of Western Ontario is one of
decision and it Is up to nurses to meet
this challenge from within the
profession. "Nurses hold the future of
nursing in their hands, " she says.
Flaherty, who was addressing
more than 200 nurses on the occasion
of Education Day at Seneca College of
Applied Arts and Technology in
Toronto, paid tribute to the
accomplishments of nursing leaders
during the last fifty years. As a result of
their efforts, she said, nurses in
Canada show a new level of maturity
and are better prepared than ever
before to participate in the
decision-making that will be required.
She called on nurses as a group to
prepare themselves for peer review
since "a profession monitors its own
members " and "we as nurses are the
experts in the practice of nursing."
"Many nurses." she pointed out,
"are allowing their practice to be
controlled by the expectations of
others, including members of the
medical profession and administrators
in the hospital and educational setting.
As nurses, we must define nursing
practice and develop and implement
ways of recognizing excellence in that
practice among our own members. "
Often, according to Flaherty
we, accept the principle of maintaining
competency without recognizing it as
"a way of life. " She described
compulsory continuing education as
neither philosophically acceptable nor
practical at this time in Ontario but
pointed out that it Is only by making a
voluntary commitment to continuing
education that an individual can
encourage and assess his own needs,
explore available resources, develop
and grow to meet the challenges of a
dynamic profession.
Flaherty Is a past president of
the Registered Nurses Association of
Ontario and a former member of the
Board of Directors of the Canadian
Nurses Association. Her address set
the tone for the six work sessions that
were also featured on the program for
Education Day at Seneca College
Nursing Divlsbn. The event, which
was first held in 1968, is an annual
affair, open to nurses from all the
hospitals and community agencies
where Seneca College nursing
students obtain their clinical
experience. Donna Wells, Chairman
of the Nursing Division, describes It as
"one way of helping to bridge the gap
between education and service."
Discussion leaders for the 1977
Education Day included: Primary
Nursing — Gail Ouellette, North York
General Hospital; Pat Keams,
Sunnybrook Hospital; Pat Names,
Toronto General Hospital: Nursing
Care Planning — Cathy Cameron,
Seneca College; The Discipline
Hearing — Helen Evans, North York
General Hospital; Dealing with Stress
— Elaine Wood and Pat Hall, Seneca
College; The Professional and
Unionism — Adeline Jack, RNAO;
Kidney Transplant — Kathy Janzen,
Seneca College.
Did you know ...
Living with End- Stage Renal Disease,
a new, 45-page booklet, provides
technical information about dialysis
and kidney transplant surgery in
layman's language. Single copies
available without charge from
Technical Services of the Bureau of
Quality Assurance, 5600 Fishers
Lane. Rockville, Md., 20852. Multiple
copies at SI. 10 purchased from the
Superintendent of Documents, U.S.
Government Printing Office,
Washington, D.C.. 20402.
CUNSA delegates meet in Calgary
to examine nursing and the law
Debi Parish
More than 240 student nurses
representing 20 university schools of
nursing from across Canada attended
the annual CUNSA conference held
this year at the University of Calgary,
in Calgary, Alberta from February 3-6.
The Canadian University Nursing
Students Association (CUNSA) is a
national organization for Canadian
nursing students in baccalaureate
programs. Their annual conference is
aimed at promoting student interest in
nursing activities, and gives members
an opportunity to share their ideas and
enthusiasm, and keep up-to-date with
the latest advancements in nursing.
This year, the official welcome
was extended to all university
representatives by Dr. Cochrane,
President of the University of Calgary.
The theme of the conference, "The
Nurse and the Law," introduced by
Margaret Schumacher, Dean of the
Faculty of Nursing at U. of C, was
discussed by a panel composed of;
J. P. McLaren, Dean of the Faculty of
Law, U.of C; Myrtle E. Crawford,
Assistant Dean of the College of
Nursing, University of Saskatchewan;
Janet Ken-, Professor of Nursing, U.of
C, and co-author of Contemporary
Issues in Canadian Law for Nurses;
and the Honorable Mr. Justice Tevie
H. Miller.
A discussion held on Saturday
focused on the question of euthanasia
and the implications for nursing. An
excellent film entitled "Whose Life is it
Anyway?" prompted lively discussion
and debate among those attending.
Elections for the new members of
the national executive took place on
Saturday afternoon. The newly
elected chairperson is Peggy
Wareham, Memorial University, St.
John's, Newfoundland, who replaces
Ingrid Fed, the outgoing chairperson
from McMaster University, Hamilton,
Ont. The new national research
coordinator is Mary Comer, Mount St.
Vincent University, Halifax, N.S. Both
Peggy and Mary plan to attend the
International Council of Nursing (ICN)
conference in Tokyo in May.
Representatives were also elected
from the three regions — the West,
Ontario/Quebec, and Atlantic regions.
Regional chairpersons are; Ellen
Thorn, University of Calgary, Diane
Thompson, University of Toronto and
Ann Peters, Dalhousie University in
Halifax. Regional research
coordinators are; Debbie Gibson,
University of Calgary, Jeanette Ross,
University of Toronto and Cathy
Toner, Dalhousie University.
Although business meetings and
discussion of nursing issues was a
large part of the three-day conference,
there was time too for socializing and a
trip to Banff. Next year, the national
conference will be held at the
University of Western Ontario, in
London.
Did you know...
The University of Alberta has
individual study program packages
entitled Emergency Care for Nurses
in Smaller Hospitals and Coronary
Care. The programs take 20 hours to
complete and are available for $50/
package (materials for four), $2./
additional participant. For information
contact; Continuing Education,
School of Nursing, Clinical Sciences
Building, University of Alberta,
Edmonton, Alberta, T6G 2G3.
Lifestyle Award
Program Announced
Health and Welfare Minister Marc
Lalonde recently announced details of
a program created to acknowledge the
contribution made by Canadians in the
promotion of positive health lifestyle in
their communities.
In announcing the new program,
Lalonde indicated that while the main
purpose of the Lifestyle Award is to
bring recognition to individuals who
have worked for years, often
unrecognized, to raise the level of
health awareness in their community,
it is hoped that it will also serve to
reinforce voluntary acton among
Canadians.
Deserving persons may be
nominated by Individuals living in their
community, by community
organizations, national and provincial
associations or municipal
governments.
Nominees should have actively
given of their time and energy on a
volunteer basis to the improvement of
health habits in the community or had
significant involvement in the
provision of health-related facilities or
sen/ices. These projects should have
been undertaken for a considerable
period of time and had a significant
impact on members of the community.
Nomination forms are available
by writing to the Secretary, Lifestyle
Award Committee, Ottawa, KIA 0K9.
Did you know ...
Bell Canada's announced intention of
gradually replacing all telephone
receivers with ones that do not create
an electromagnetic field was the
subject of protest by CNA members at
the last annual meeting. Members
pointed out that certain types of
hearing aids equipped with a telecoil
or telephone switch, need an
electromagnetic field to function
properly.
Now, Bell Canada has decided to
maintain the electromagnetic field in
telephones in the homes or wori<
locations of hearing-impaired users
and in public telephones.
Researchers will also look into ways to
make hearing aids compatible with all
types of telephone receivers.
Moving, being married?
Be sure to notify us in advance.
4
>
Attach label from
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copy address and
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Postal Code/Zip
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n I am a personal subscriber
Mail to; The Canadian Nurse, 50 The Driveway. Ottawa K2P 1E2
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for time-consuming culture
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A Question of Balance
The Effects of Chronic Renal Failure
and Long-term Dialysis
PkRTl
To anyone who knows Stephen, his
tears and depression are
understandable. For him, chronic renal
failure has meant some pretty drastic
changes — a change in career goals,
loss of financial Independence, and
emotional instability. A fter a year and a
half on hemodialysis, he feels
threatened by constant illness and
complications, and by his dependence
on a 'machine' to maintain his life.
If you are a nurse working outside
a dialysis or transplantation unit, the
chances are that the image evoked by
the 'chronic renal patient' isn't too
favorable. Unfamiliar with the world in
which he lives, you may be only too
willing to stereotype Stephen as
mistrustful, demanding and
manipulative, or as apathetic and
unresponsive to your efforts. But
supporting Stephen depends on the
time you take to understand ...
^
The Canadian Nurse March 1977
^Q>
Stephen Davidson was first admitted to
hospital in September of 1 972, at the age of
twenty-two, because of problems with
recurrent epistaxis and hypertension. At the
time, he was a student in business
administration at a local university. Stephen
had no past history of renal disease. On
admission, he was diagnosed as having
hydronephrosis secondary to reflux, and
surgery was done to allow direct urine
drainage of the kidney pelvices (bilateral
nephrostomies).
In 1 973, Stephen was admitted to hospital
several times for treatment to control his
hypertension. By February of 1 974, in
end-stage renal failure, he began
hemodialysis and was considered as a
candidate for kidney transplantation.
End-stage renal failure is a condition
affecting approximately 1 000 Canadians each
year. Regardless of its etiology, what the
condition means to the patient is that his
kidneys can no longer excrete body wastes,
that these wastes accumulate in the
bloodstream (uremia), that the balance of
electrolytes in his body is severely disturbed,
and that without treatment, he will die. Medical
and nursing management then is directed
towards providing for removal of body wastes,
artificially maintaining a better balance in body
systems, and supporting the patient through
the changes that alter his whole way of life.
Stephen began hemodialysis in a state of
considerable anxiety. At the age of 23, the
irreversible nature of his condition seemed
more than he could handle. His uremic state
meant that he was fatigued, lethargic, and
weak, augmenting his inability to deal with the
stress of his illness and its treatment. He was
very emotional, crying frequently. He
discussed his fears frankly with the nurses and
doctors in the renal unit and with his family —
there seemed to be so many things to be afraid
of. Stephen's family was close to him, and
openly supportive, but unfortunately lived in a
town 100 miles away from the hospital where
he was being treated. Until August of 1973,
Stephen was dialyzed through an
arteriovenous cannula in his left leg.
Chronic Renal Failure
Chronic renal failure may be the result of
one of several disease processes that cause
loss of kidney function for variable reasons.
Among these causes are:
• Primary Glomerular Disease —
glomerulonephritis
• Infection — pyelonephritis, tuberculosis
• Collagen Disease — disseminated
lupus erythmatosis, scleroderma
• Obstruction — bilateral renal calculi,
prostatic obstruction, neoplasms
• Congenital Disease — polycystic
disease, medullary cystic disease
• Hypertensive (Nephropathy — malignant
and non-malignant hypertension
• Toxic Nephropathy — chronic
phenacetin abuse
• Systemic Disease — diabetes mellitus,
gouty nephropathy, amyloid disease.
In Stephen's case, reflux of urine into the
kidneys caused distention of the kidney
pelvices and calyces, resulting in atrophy of
the kidney parenchyma, a condition called
hydronephrosis. Decreased renal function
resulted because of increased pressure on the
kidney tissue, and hypertension.
Hypertension can lead to kidney disease;
conversely kidney disease can cause
hypertension ... Fluid retention associated with
kidney disease contributes to hypertension.
Damaged kidneys also tend to secrete
increased amounts of renin, resulting in an
augmented aldosterone secretion which
causes retention of fluids and electrolytes, and
consequently hypertension. Hypertensive
nephropathy — further kidney damage
because of inadequate blood supply to the
kidneys — may result.
Loss of kidney function as a result of any
of the causes mentioned may be partial or
complete. Stephen suffered complete and
irreversible loss of kidney function. Ivlore
recent ways of dealing with patients in
end-stage renal failure include dialysis and
transplantation. Stephen was hemodialyzed
until a kidney was available fortransplantation.
In spite of the relative success of dialysis
as a treatment measure for patients in
end-stage renal failure, it must be
remembered that until successful
transplantation, uremia continues to effect not
only an imbalance in fluids and electrolytes
and the excretion of body wastes, but that it
causes changes in the organ systems as well,
altering almost every aspect of normal body
function.
It is easy to see that the negative effects of
uremia on body balance are comprehensive,
that the stresses imposed by the condition are
beyond anyone's capacity to accept without
the greatest difficulty. First of all, he must deal
with the fact that he exists with a condition that
is life-threatening, and that choices for
treatment are not without their own drawbacks
and complications.
Physically, the patient feels fatigue, and
apathy; generally he feels ill. The feeling of
illness often continues throughout dialysis.
Often, he must change his lifestyle, his job, his
goals. There may be financial problems as a
result of his chronic il l-health and the necessity
for dialysis. His whole 'self-image' is
threatened.
The patient's reliance on dialysis to
maintain his life may lead to many conflicts —
he may feel discouraged by his dependence,
confused by the fact that he is encouraged to
maintain independence. His confusion may
express itself in many ways: overdependence
on medical staff and complete assumption of
the sick role, and overt rebellion against the
necessary restrictions inherent in his
treatment regime are two extreme behaviors
that can indicate this confusion.
When Stephen began dialysis, he was still
attempting to keep up his university courses,
although it presented many difficulties for him.
His anxiety was continually expressed through
emotional outbursts. It wasn't long before he
began to develop cann ula infections and other
problems associated with dialysis.
By June of 1974, he had given up his
courses at the university and had begun
training as a hair stylist. This course allowed
him to put in as many hours as he felt up to. He
was on Social Allowance with a supplement
from Manpower to help him out financially.
It was at this time that Stephen began to
express that he desperately wanted
"freedom" from his dependence on the
machine, a kidney transplant, and the chance
for a normal lifestyle that it offered. He also
began training on the home dialysis program in
the hospital in June. After six weeks on the
home dialysis program, he was at least able to
dialyze himself at home.
HE EFFECTS OF UREMIA
IB Imbalance In Body Chemistry
Blood tests of the patient will indicate a
se in the products of protein metabolism:
lood urea nitrogen (BUN), creatinine and
nc acid. The patient's BUN fluctuates,
ifluenced by a number of factors: renal
jnction, dietary intake of protein, rate of
roteincatabolism, rate of urea synthesis, and
,ie patient's state of hydration. Serum
ireatinine, the end product of creatine, an
-imino add present in body tissues
sspecially muscle) is a more reliable indicator
.f renal function, as it is less variable.
Hyperkalemia, an increase in serum
)otassium, is chiefly due to the disability of the
;idneys to excrete potassium. Serum
Dotassium can rise to dangerous levels in the
jremic patient. Serum potassium levels may
ilso be abnormally low in uremic patients as a
esult of gastrointestinal losses (vomiting,
jiarrhea).
I Serum sodium levels may also be
bisrupted in uremic states. The kidneys cannot
jxcrete sodium, and a patient's failure to
adhere to dietary restriction of sodium may
Jesuit in increased serum sodium
'(hypernatremia) and water retention. Low
IjOdium wa\ues (hyponatremia) occur through
'gastrointestinal losses and increased
serspiration.
Serum calcium levels are low in uremia
aecause of a decreased absorption of calcium
from the gut, and in association with an
elevation in serum phosphate levels.
Calcium /phosphate imbalance disturbs
the function of the parathyroid gland. Because
of a decrease in serum calcium, the
parathyroid secretes additional parathyroid
hormone in an attempt to restore serum
calcium levels to normal. Secretion of further
parathyroid hormone as a result of hyperplasia
of the parathyroid gland may eventually cause
ielevated serum calcium levels by stimulating
Ireabsorption of calcium from the bones. Bone
^disease, a common problem in uremic
I patients, is related to the imbalance in serum
calcium, serum phosphate and parathyroid
gland function.
Serum magnesium rises in uremic
patients due to the inability of the kidneys to
excrete magnesium. Low serum magnesium
levels are the result of losses through vomiting
and diarrhea.
Metabolic acidosis occurs in the patient
with uremia because his kidneys cannot
excrete add as ammonium.
Because of the disability of the kidneys to
dilute urine, the patient's water load cannot be
; excreted rapidly or adequately resulting in
[fluid overload.
DB Imbalance in the Respiratory System
Uremic patients have an increased
susceptibity to infection, and a prime site for
infection is in the lungs. Pulmonary edema
\ may result from fluid overbad and congestive
I heart failure. Intrapulmonary bleeding is
I possible as a result of the impaired platelet
j function assodated with uremia. The patient's
\^
^-
respiratory rate may increase to compensate
for his addotic state.
DH Imbalance in the Cardiovascular
System
Hypertension occurs in a large
percentage of patients with irreversible renal
failure. As a consequence of kidney damage,
the kidney secretes increasing amounts of
renin, resulting in rising aldosterone secretion
and thus retention of fluid and electrolytes.
Hypertension is the result of this process, and
in turn it may cause cerebral vascular disease,
coronary heart disease, and congestive heart
failure.
Congestive heart failure is often
associated with hypertension and fluid
retention in the uremic patient, and it may
result in pulmonary and generalized edema.
Pericarditis also occurs with uremia,
although the causes are unclear. Cardiac
tamponade may follow.
Cardiac arrythmias are often related to
elevated serum potassium and serum
magnesium levels. Elevated serum
magnesium and potassium levels may result
in cardiac arrest.
DH Imbalance in the Hematological
System
Most patients with chronic renal failure
areanemic. Normal hemoglobin readings may
ride between 6-8 gm/ 100 ml. The normal
kidney secretes erythropoietin, a substance
that stimulates the bone marrow to produce
red blood cells. Patients in chronic renal failure
secrete inadequate erythropoietin, and the
result is a decrease in red blood cell
production. Red blood cells tend to show a
shortened life span in patients with elevated
BUN levels.
Uremic patients also have a tendency to
bleed, probably related to a deficiency in the
number and quality of platelets.
OU Skin Changes
Changes in the skin are uncomfortable for
the patient in uremia.
Pruritis is severe. The skin is generally dry
and scaly due to calcium/phosphate
imbalance. If the patient scratches iichy skin,
the scratches do not usually heal well, and the
possibility of infection is great.
Skin color changes, becoming sallow
yellow-brown to gray in pigmentation. Anemia
gives rise to pallor.
Clotting abnormalities make bruising and
petichiae common. Perspiration generally
decreases. Nails become brittle and thin, hair
is dry and may fall out.
DH Imbalance in the Gastrointestinal
System
Gastrointestinal bleeding can occur
anywhere along the Gl tract in patients with
uremia, perhaps due to defective clotting
mechanisms (platelet deficiency). Anorexia,
nausea and vomiting are common in uremic
patients, and contribute to weight loss, and
further electrolyte imbalance. Decreased
salivary flow, dehydration, and mouth
breathing (acidosis) may result in parotitis or
stomatitis. The patient may also complain of a
metallic taste in his mouth, loss of smell, and
thirst.
DH Imbalance in the Neurological System
The nervous system of the patient in
uremia is affected in a comprehensive way.
t^ental function can be sluggish, marked
by apathy and an inability to concentrate,
limitations in attention span, and confusion.
Coma and convulsions may occur.
Personality and behavior changes in the
patient with renal failure are remarkable.
These include increased irritability, emotional
lability, depression and withdrawal, agitation,
demanding behavior, and complete lack of
cooperation. Psychosis with hallucinations
may develop.
Peripheral neuropathy may reveal itself in
numbness or burning of extremities and
slowed reflexes. Muscle changes may include
twitching, tremulousness, nocturnal cramps,
and atrophy.
DB Skeletal System and Bone Disease
Because of changes in the calcium,
phosphate and parathyroid balance, bone
disease is a problem for uremic patients.
Bone pain, joint calcifications and
fractures occur. Repair mechanisms in bone
disease cause an increase in serum alkaline
phosphatase levels. If serum calcium and
phosphate levels are high, soft tissue
calcifications may occur.
DB Reproductive Changes
Chronic renal failure means reproductive
changes in both men and women. Ma/e fertility
decreases with a rise in serum creatinine.
Impotence is a major problem . Amenorrhea
occurs in women. Both men and women
indicate a decrease in libido.
Chronic renal failure patients also have an
increased susceptibility \o infection. Now that
dialysis treats kidney failure itself, infection is
the major cause of death in uremic patients. A
change in antibiotic metabolism makes
infection difficult to treat. Uremia is also
asGociated with slow wound healing.
22
The Canadian Nurta March 1S77
^
=^7
^7>
■ Treatment of Chronic Renal Failure
With improvements in the techniques of
dialysis, patients can now be dialyzed more
effectively. In addition to dialysis, the uremic
patient must adhere closely to restrictions in
ifluid intal<e and diet, and to a medication
regime.
mOiet
In the past, dietary restrictions have been
severe. Now, in most cases, restrictions are
moderate, the patient's ability to live with his
diet being considered as a major factor in its
success. But the diet cannot be abused
without consequence, and in this way is similar
to prescription medications for the patient in
chronic renal failure.
Generally, patients on hemodialysis are
allowed a weight gain of 1.5 kg between
dialysis treatments. Daily fluid intake often
consists of 500 cc plus the previous day's urine
output. The use of alcohol is restricted
because of its adverse effects on blood
pressure, and because it usually means an
increase in fluid intake. Obese patients are
calorie restricted.
Sodium, potassium and fluids are
restricted and monitored, the patient's weight,
blood pressure, BUN and creatinine levels
being the indicators for restrictions. Protein is
also restricted because the products of protein
metabolism are not excreted normally. The
importance of intake of high quality protein,
with essential amino acids for body building
(found in eggs, milk and meat) is emphasized
in dietary teaching.
■ Medications
Medications for the patient on dialysis for
chronic renal failure attempt to make up for
body balance interrupted by uremia. They may
include:
• phosphate binding agents — aluminum
hydroxide products, such as amphogel, keep
phosphate from being absorbed into the
bloodstream, and help to deterafurther rise in
serum phosphate levels. None of the
prescribed medications contain magnesium,
and the patient must realize that he cannot
substitute magnesium products as his kidneys
cannot excrete magnesium.
• vitamins — multivites and folic acid are
necessary to supplement the dietary source of
vitamins, because dietary restrictions are
comprehensive, and because water-soluble
vitamins are dialyzed out. Vitamin D is often
prescribed as it helps to absortD calcium from
the digestive tract, and thus to prevent bone
disease.
• anticoagulants — such as Coumadin
may be prescribed to decrease platelet
adherence or clotting, thus maintaining
patency of an arteriovenous shunt.
• iron — ferrous gluconate may be given
intravenously to build serum iron, and
counteract anemia.
• PRN medications — antihypertensives
may be necessary where hypertension is a
problem.
— laxatives may be necessary because of the
constipating effect of aluminum hydroxide.
Only prescribed laxatives are to be used by the
patient, and magnesia is not to be taken.
— vallum may be necessary for anxiety
— antibiotics may be needed periodically for
treatment of infections. The use of many
antibiotics is restricted because of altered
antibiotic metabolism.
When he began dialysis, Stephen was on
a 2 gm Na, 60 mEq K, 60 gm protein diet.
Because his daily urine output was 1 500 cc, he
was allowed 2000 cc fluid in 24 hours. His
medications included folic acid 5 mg q.i.d.,
cloxacillin 500 mg q.6.h. (for a cannula
infectran), and valium prn for anxiety. He was
also on phosphate bw cookies (containing
aluminum hydroxide) t.i.d. with meals.
■ What happens in dialysis
The healthy kidney eliminates waste
products and maintains fluid and electrolyte
balance in the body through filtration in the
glomeruli and reabsorption and secretion in
the tubules. Filtration, osmosis and diffusion
are involved. When these functions are
disturbed, dialysis is the means of elimination
of wastes and maintenance of electrolyte
balance.
In peritoneal dialysis, the peritoneal
membrane is used as a dialyzing membrane to
remove nitrogenous wastes and to
restore to normal body fluids and
electrolytes. Osmosis, diffusion and filtration i
occur across this membrane, between the fluid I
introduced into the peritoneal cavity
(dialysate) and the blood supply of the
abdominal organs. Patients on long-term
peritoneal dialysis (or home peritoneal
dialysis) have indwelling silastic catheters
inserted in the peritoneal cavity and these can
be expected to last for years. Dialysate is
introduced into the peritoneal cavity via the
catheter, stays there for a short period of time,
is then drained out, and a new cycle is begun.
Automatic peritoneal dialysis machines allowi
the patient to sleep while dialysis is taking
place.
One of the drawbacks to peritoneal
dialysis is the time involved in the procedure.
Generally patients using this method must bei
on dialysis for 40 hours per week. Problems i
with infection (peritonitis) used to be a
considerable drawback to peritoneal dialysis,
but now infections are much fewer in number.
Peritoneal dialysis causes protein
depletion, which can be alleviated by
increasing dietary protein. The procedure
cannot be used if the patient has abdominal i
adhesions.
Some advantages to peritoneal dialysis: it
is simpler, and easier for the patient to initiate <
and terminate than hemodialysis. Many
patients are now involved in home peritoneal
dialysis programs, which normally involve a
two to three-week training period before the i
patient is ready to dialyze himself at home.
Hemodialysis involves circulation of ther
patient's blood from an artery through a
dialysis machine, and back into the patient vie
a vein. The artificial kidney eliminates waste
products from the blood by filtration and i
diffusion across a semipermeable membranej
y
1. "Weighing in" on admission
to the dialysis unit.
2. Admission to the dialysis unit includes
taking the patient's blood
pressure and temperature.
3. Teaching the patient to prepare
the dialyser for dialysis.
4. Drawing up heparin to prime needles.
5. Patient learning to do her own
venipunctures for initiation of dialysis.
6. Beginning dialysis.
he patient's blood flows within a
>emipermeable membrane and the dialyzing
luid flows on the outside of the membrane,
jrawing out wastes from the blood.
Hemodialysis is done three times a week for a
Deriod of three to seven hours each time
jepending on the patient's body size and
adherence to diet and fluid restriction. In many
renters, patients are involved in home
lemodialysis programs in order to learn to
lialyze themselves in their own homes.
Repeated hemodialysis necessitates
easy access to the patient's bloodstream
through a shunt. Several types of access are
used, the main types being silastic cannulas
and subcutaneous arteriovenous fistulas.
Both of these methods allow shunting of blood
from an artery to a nearby vein. With a cannula
the patients arterial blood flows through
silastic tubing into a vein, whereas a fistula
involves surgical anastomosis of an artery and
a vein. Grafts are used when the patient's
vessels don't provide adequate access.
When the patient has a cannula, the
connection in the shunt is opened for dialysis
and the arterial tubing is attached to the tubing
leading to the dialyser. The venous tubing is
attached to the tubing leading out of the
dialyser. Shunt failure may arise due to clotting
or infection. If these cannot be remedied, a
new site must be chosen for the shunt.
The cannula offers painless, easy access
to the patient s bloodstream. However, it
requires some care. The cannula is extemal,
and accidental separations can occur.
Dressings must be done to guard against
infection.
The AV fistula allows for greater freedom
of activity for the patient. Infections are
reduced because there is no external
connection, and accidental bleeding is not a
problem. Regular venipunctures for the
initiation of dialysis, however, can be difficult
for the patient.
■ Why transplantation
Improvement in the techniques of dialysis
and the possibility of home dialysis have
allowed patients in end-stage renal failure to
keep up jobs and have reduced the necessity
for in-hospital treatment. Patients can now be
dialyzed successfully for a tonger period of
time ... But the problems associated with
uremia and dialysis itself are such that
transplantation is still the objective of patients
involved in long-term dialysis programs. Some
of the problems associated with dialysis are:
• dialysis disequilibrium syndrome —
This is thought to occur tDecause removal of
urea nitrogen from the blood occurs at a rate
relatively rapid to its removal from the brain.
Reverse osmotic gradient pulls fluid into the
brain resulting in cerebral edema. Symptoms:
headache, nausea and vomiting, confusion,
possible hallucinations and convulsions.
• acute hypertension — This is thought to
be caused by anxiety related to dialysis, and
the disequilitjrium syndrome.
• hypotension — Thought to be caused by
The Canadian Nurse March 1977
VS
i/j
rapid removal of fluid during dialysis
• nausea and vomiting — Causes include
disequilibrium syndrome, hypertension,
hypotension, anxiety, possible peptic ulcer,
inadequate dialysis with retention of uremic
toxins
• headache — Due to anxiety,
hypertension, and the disequilibrium
syndrome
• bleeding — Due to heparinization during
dialysis
• fever — Usually a result of infection
• muscle cramps — Thought to be due to
rapid sodium and water removal
• arrythmias —Due to hypotension,
electrolyte disturbance
• chest pain — Hypotension and
arrythmias may lead to angina
• restlessness — Due to anxiety,
disequilibrium syndrome
• depression and hostility — Related to
the necessity for the regular stress of dialysis
• shunt problems — In hemodialyzed
patients, shunt problems are common, and
may include clotting and infection. Loss of
shunt sites through infection can threaten the
continuity of therapy for hemodialyzed
patients.
■ Awaiting Transplantation
Stephen's eagerness for a transplant was
not a wild hope for a cure that would end all his
problems. The difficulties he had because of
uremia and dialysis, and the restrictions
necessarily imposed on his lifestyle naturally
Inspired his interest in any alternatives. But as
with most patients on a dialysis/transplant
program, he had been fully aware of
transplantation as a realistic altemative since
the beginning of his treatment. The nurses
who saw him weekly, a nurse-teacher on the
dialysis program, a home dialysis instructor,
medical staff, and social workers had begun to
teach him at an early date about the possibility
of a kidney transplant to replace his current
treatment.
By August of 1 974, Stephen was admitted
for the creation of an arteriovenous fistula in
his left arm, because he had had so many
problems with cannula infections in the left leg
site. At this time his blood results indicated:
Hgb 8.1 gm; phosphate 5.2 mg%, calcium 9.1
mg %, creatinine 9.6 mg %, BUN 57 mg %.
By October, another left leg shunt
infection had to be treated with antibiotics, but
the treatment was unsuccessful. As the fistula
in his left arm was small and tortuous, another
shunt was inserted in his right leg. After this
procedure, he returned home and continued
dialysis there. Psychotherapy had since been
initiated for sexual problems. Further shunt
problems led to Stephen's readmission in
June of 1 975, and he was dialyzed in-hospital
using the left arm fistula. By this time , Stephen
was very anxious, discouraged, and
depressed. Venipunctures for dialysis were
difficult because the fistula vessels remained
tortuous. Stephen cried every time the needles
were inserted and was increasingly
apprehensive with each dialysis run. His
anxiety over his illness seemed to find a focus
on the needles he received each time.
Emotionally, he tolerated dialysis very poorly.
In the meantime, Stephen's family had
been tissue-typed for possible kidney
donation. His brothers and sisters were all
willing to donate a kidney, but several were
younger than Stephen, and therefore
unsuitable as donors.
An older sister, married with two children,
was a fair match with Stephen, and shfe was
very willing to donate a kidney. It was decided
after further tests, that Stephen would receive
a kidney transplant in July , with his older sister
as donor.
After almost a year and a half on dialysis,
Stephen was excited about the transplant and
looking forward to the independence that it
offered. He began to say goodbye to the renal
nurses who had cared for him during that time.
■ Implications for Nurses
The nurse's role as teacher and supporter
is an important key in helping the patient in
chronic renal failure adapt to his illness and its
treatment, and to the disappointments that he
may have to face... Nurses who work with
patients in renal failure on a daily basis are well
aware of the stresses on the patient as an
individual; the stress of chronic illness, the
threat and actualization of complications, and
the problems posed by medical treatment.
More important perhaps, they get to know the
patient himself; in helping him learn to cope
with his condition, they become involved in a
relationship with the patient and his family, and
see him as a person of many dimensions in the
context of his life.
Take Stephen as an example. To the
nurse in the renal unit, his tears and
depression can be seen as his response to his
whole life situation, not as a childish reaction to
needles. His illness has brought about a
change in his choice of careers, in his financial
status, in his family relationships. From
independence and health he has become
dependent and feels constantly ill; he is
sexually impotent; and he is frightened. The
renal nurse knows Stephen, knows that his
goals, his lifestyle, his "self", have undergone
a stressful change, and she is able to respond'
to him in a helpful, supportive way. Guided by
Stephen's acceptance of treatment and his
level of knowledge, she is able to teach him
about his illness and understand his
receptiveness or lack of it. She shares his
hope for a successful transplant and helps hinr
to prepare himself for transplantation.
Not so the nurse on another floor of thei
hospital. If Stephen is admitted to her ward
and there is a good chance that he may be, she(
is confronted by a 'renal patient, " lethargic,
sometimes demanding, and "childish. " She
may be unfamiliar with what end-stage renal
failure means, and with his treatment regime. H
she is out of touch with what all this means to i
Stephen, she may interpret his behavior as
plain difficult and respond with feelings of
inadequacy and resentment. It becomes easyi
then to stereotype Stephen as "just another (
renal patient."
Understanding the dynamics of chronic
renal failure, and understanding Stephen, may
take time. But supporting Stephen depends on*
the time you take to understand. ^
Acknowledgment: The author would like to!
thank the staff at the University of Alberta
Hospital in Edmonton for their co-operation
and assistance in the research and writing
involved in preparation of this article. Their
help during my visit, particularly the help of
Anita Yanitski, clinical instructor in the Renal ■
Unit, is greatly appreciated. — L.F.
Bibliography
1 Gutch, C.F. Review of hemodialysis for
nurses and dialysis personnel, by ... and Martha H.
Stoner. 2ed. St. Louis, Mosby, 1975.
2 Hansen, Ginny L. ed. Caring for patients witt) 1 1
chronic renal disease; a reference guide for nurses.
Rochester, N.Y., Rochester Regional Medical
Program and University of Rochester, 1972.
3 Harrington, Joan DeLong. Patient care in
renal failure, by ... and Etta Rae Brener. Toronto,
Saunders, 1973.
4 O'Neill, Mary ed. Symposium on care of thai
patient with renal disease. I^urs. Clin. North Am
10:3:411-412, Sep. 1975.
5 Schlotter, Lowanna ed. Nursing and the
nephrology patient: a symposium on current trends^i
and issues. Flushing, N.Y., Medical Examination j
Publishing Co., 1973.
'
linical Wordsearch no
his is another in a continuing series of clinical
vordsearch puzzles relating to different areas of
•ursing, by Mary Elizabeth Bawden (R.N.,
I.Sc.N.) who presently works as Team Leader
■7 f^e Rheumatic Diseases Unit, University
iospital. London, Ontario.
Solve the clues. The bracketed number
indicates the number of letters in the word or
words in the answer. Then find the words in the
accompanying puzzle. The words are in all
directions — vertically, horizontally, diagonally,
and backwards. Circle the letters of each word
found. The letters are often used more than once
so do not obliterate them. Look for the longest
words first. When you find all the words, the
letters remaining unscramble to form a hidden
answer This month's hidden answer has five
words. (Answers page 30).
G C Y
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1 A variety of nephritis characterized by
inflammation of the capillary loops in the
glomemli of the kidney. (18)
2 Distention of renal pelvis and calices with
urine. (14)
3 Rubber or silastic tubing; may be straight
or indwelling. (8)
4 Amber colored liquid excreted by 12. (5)
5 Function of the kidney. (8)
6 Pertaining to 12. (5)
7 Often pitting around the ankles. (6)
8 The presence of protein in the urine. (1 1)
9 A method sometimes used in patients in
kidney failure to remove from the blood
elements thatare normally excreted in the
urine. (8)
] 0 A method of dialysis which is not
extracorporeal. (10)
1 1 Basic unit of function of the kidney. (7)
12 Sometimes borrowed, hopefully not blue. f6;
13 As it descends and ascends it forms a
loop. (6)
14 Acts as a cistern. (7)
1 5 An advanced form of mathematics, may
be renal. (8)
16 Gland subject to hypertrophy in older
men. (8)
What short-wave radios and bladder
infections have in common. (9)
Not basic to anything. (4)
Inflammation of 14. (8)
Has a burning quality when
accompanying 19. (4)
Not full. (5)
22 To avoid infection, urinary catheter
drainage systems should be maintained
this way. (6)
You've got it with a diastolic > 100 mm
Hg. (12)
Heavy on a dieter's mind. (6)
Presence of pus in the urine. (6)
Presence of nitrogen-containing
compounds in the blood. (8)
Element deleted from or reduced in diets
of many with renal disease. (6)
Useful for those who would rather switch
than fight. (10)
29 The downward displacement of a kidney.
(12)
30 Mineral found in milk and sardines. (7)
17
18
19
20
21
23
24
25
26
27
28
31 The essential or functional elements of
an organ. (10)
32 What some bodies do to unwanted
organs. (6)
33 Type of medication given to prevent a 32.
(17)
34 Situated above the public arch. (10)
35 What Lot's wife became. (4)
36 Null's partner. (4)
37 Basin formed by the hip bones and lower
part of the vertebrae. (6)
38 A growth. (5)
39 What people in glass houses shouldn't
throw. (6)
40 Type of acid which precipitates to form
crystals. (4)
41 Carries urine from kidney to bladder. (6)
42 Blood Urea Nitrogen. (3)
43 The lower it is, the stronger the acid. (2)
44 Intravenous Pyelogram. (3)
45 Important ingredient in Maalox. (2)
46 A drug which may be used in treating T.B.
of the kidney. (3)
47 Liquid. ^5;
The Canadian Nurse March 1977
The Role
of the
Head Nurse
Principles
of Primary,
Nursing
Diane Bartels, Vivian Good, Susan Lampei
Primary nursing as a philosophical and organizational
approach to hospital nursing, is a pattern of care de-
veloped in the mid-Western United States almost ten
years ago. Its chief characteristic is a one-to-one rela-
tionship between the patient and the nurse who provi-
des his care. Innovator Marie Manthey has described
primary nursing as "essentially a return to the concept
of 'my' nurse and my' patient."
Supporters of the system point out that it offers a
means of providing the personalized, comprehensive
or total care that both patients and providers of care
often complain is missing in today's health care sys-
tem. From the point of view of the nurse, the key to
primary nursing is her accountability for the total care
of all patients assigned to her, on a day-to-day basis,
from admission to discharge. Each nurse is a "primary
nurse" when she is responsible for the care of a pa-
tient throughout his stay in hospital; she is an "asso-
ciate nurse" whenever she cares for a patient whose
nurse is off-duty.
Primary nursing was first introduced in 1968 on a
trial basis on a 24-bed medical unit at the 829-bed
University of Minnesota Hospitals in Minneapolis,
Minn. Since then, hospitals in many states of the U.S.,
including California, Michigan, Wisconsin, Illinois,
Pennsylvania, North and South Dakota, Iowa, and
Washington, have introduced primary care programs.
Last year, the American Journal of Nursing (May,
1976), while conceding that primary nursing is "still in
the experimental stage" described the system as
"highly rewarding for both patients and nurses" and
predicted that it was on its way to becoming widely
accepted on a national basis.
In Canada, application of the principles of primary
nursing has been confined largely to the one-to-one
relationship of public /community health nurses with
individual patients in their homes and to psychiatric
and intensive care settings in some hospitals.
Recently, however, nurses working in other areas
of general hospitals have indicated a growing interest
in learning more about the primary nursing concept
and how it can affect their relationship with their pa-
tients, with other health professionals and with their
fellow nurses.
in Primary
Nursing
1. 24-hour decision-making for
several patients by one nurse;
2. nursing assignments based on
matching patient needs and nursing skills;
3. nursing care planner Is the care-giver;
4. direct care-giver to care-giver
communication;
5. head nurse In a crucial role as
leader, clinician, consultant,
evaluator, staff developer and teacher.
Primary nursing brings about changing
roles, responsibilities, and communication
patterns for all members of the health care
team. The head nurse, as she Introduces
new staff to primary nursing and Its
i day-to-day applications. Is In an Ideal
I position to generate enthusiasm for the
goals of the concept. In attempting to
Implement this new care pattern, she must
continually promote the philosophy behind
It by her support and recognition of Its
principles. In the long run. It Is the positive
attitude and high motivation of the head
nurse that will determine the success or
failure of the program wherever It Is
Introduced.
One nurse, one patient — planning care
together ... Primary Nursing, as a
philosophical and organizational approach to
hospital nursing, has been defined by
Manthey' as encompassing five principles:
• 24-hour decision-making for several
patients by one nurse;
• nursing assignments based on matching
patient needs and nursing skills;
• nursing care planner is the care-giver;
• direct care-giver to care-giver
communication;
• head nurse in a crucial role as leader,
clinician.consultant, evaluator, staff developer
and teacher.
Of these, it is the last principle, the role of
a head nurse in primary nursing, that the
authors examine in the light of their own
experience. Their observations reflect
traditional aspects of this position, as v^eW as
some aspects that are unique in a primary
nursing setting.
If the head nurse is to successfully
assume the role of leader, clinician,
consultant, evaluator, staff developer and
teacher, two conditions must be met within the
organizational set-up. First the nursing station
should be of a reasonable size with the
capacity to handle 25-35 patients. Second, a
strong managerial role for the station secretary
(or ward cleric) should be developed.
Why are these factors vital? Size of
station takes on considerable importance
when the reorganization of station functions is
realized. With dissolution of the team leader
position, the head nurse becomes the sole
quality control agent of that station. A small
station, with fewer patients and personnel to
coordinate, affords the head nurse more time
for emphasis in the clinical area.
This clinical emphasis is strengthened
further by the second prerequisite, a strong
managerial role for the station secretary. The
head nurse will never be in a position to focus
on patient care if she is absorbed in activities
centered at the main desk. This implies that
the head nurse must want to relinquish many
of the managerial functions and that she must
have someone who can responsibly assume
these for her. In most cases, the activities of
station secretaries can be extended to include
areasofcommunication, ordering of forms and
supplies, scheduling procedures, traffic
direction, staffing hours, order transcription,
and possibly reception of vertjal and telephone
orders.
When these criteria are met, at least the
supportive envi ronment for a clinically oriented
head nurse role is established.
H The head nurse as leader
In any nursing organization the head
nurse role, broadly defined, is that of
leadership. The main focus of that leadership
in primary nursing is quality patient care. To
accomplish that goal, the head nurse's
emphasis must be more clinically -oriented and
less managerial than traditionally
demonstrated in other systems.
If the goal is quality patient care, then the
head nurse must be out in the area where this
care is given. Both as a role model and by
working closely with the staff and patients, she
can more effectively determine the standards
under which patient care will be delivered. Her
own practice, expectations, and priorities have
an important influence on staff performance.
Patient care must be constantly held as first
priority and staff energies directed towards
use of the nursing process in pertinent
observations, assessment of patient needs,
care planning, intervention, and evaluation. It
is our experience that individuals will most
often excel in those areas consistent with the
indicated expectations and rewards.
In addition to the setting of standards,
another important aspect of the head nurse
leadership role is her style of leadership. In
primary nursing, her leadership style must
facilitate independent and interdependent
decision-making. This is achieved through the
process of decentralization whereby the head
nurse delegates authority, responsibility, and
accountability for the nursing care of a given
number of patients to the primary nurse. The
extent of this delegation increases as the
proven ability of the individual nurse to assume
responsibility broadens. Theoretically, each
Registered Nurse and many Licensed
Practical Nurses (or Registered Nursing
Assistants) can be developed to the point of
effectively managing the high degree of
responsibility required in primary nursing.
To foster decision-making and
accountability, the head nurse must be able to
relinquish tight controls. The pendulum
between autocratic and democratic leadership
must swing more in favor of the latter. Basic to
this democratic style is the ability of the head
nurse to assume risks. Risk-taking is of vital
importance if primary nurses are to know the
freedom of testing the "rightness or
wrongness" of their own decisions. Staff must
know that in some circumstances being wrong
may be acceptable. It may not be ideal but it is
human and sometimes the best a person could
do in a given situation.
As staff competence in decision-making
develops, the head nurse's leadership
emphasis shifts naturally from staff
development to staff consultation. The
strength of herconsultation role is proportional
to her excellence in clinical knowledge and
nursing practice. Thus, her leadership power
base evolves from personal expertise rather
than merely ascribed power associated with
the position.
A vital adjunct to the role of consultant, is
the ability of the head nurse to trust and be
trusted. The staff must not only feel that the
head nurse is competent but approachable,
open and equitable. When the head nurse and
staff can work together in an atmosphere of
open communication and mutual respect, the
potential for excellent patient care and
professional development is unlimited.
Finally, the head nurse must demonstrate
leadership in understanding of and
commitment to the concept of primary nursing.
She is responsible for assisting staff in the
implementation process and she is vital to the
maintenance of the principles. The transition
process from team systems ortask orientation
is long and difficult. An adjustment period of
twelve to eighteen months should be
anticipated.
H The head nurse as evaluator
In her role as evaluator. the head nurse
must deal with assessment of patient needs
and assessment of a particular nurse's ability
to meet those needs. Ideally, she will match
the two appropriately.
In evaluating a patient's needs or
identifying his problems, the head nurse
considers the presenting complaint, as well as
co-existing conditions. Data is also extracted
as available and appropriate from the
following:
• past records
• the nursing admission history
• the physician s history and physical exam
• referral notes
• personal encounter with the patient or
family.
From this infomiation, she attempts to
predict the course of hospitalization, focusing
on long-range plans rather than one day's
Th« Canadian Nurse March 1977
The Role
of the
Head Nurse
expectations. Her initial assessment is not
infallible and may require readjusting at a later
date.
Evaluation of the nursing staff is an
ongoing process. The organizational pattern
of primary nursing provides many tools to
facilitate staff evaluation. A single staff nurse is
responsible and accountable for total ongoing
care of specified patients. Therefore, the
nursing admission history, daily progress
notes, written care plan and observation of that
plan executed provide pertinent information
about the primary nurse. They reflect her
interviev\/ing skills, knowledge and
understanding of her patient's problems, her
ability to monitor those problems, to provide
relevant care, and to evaluate her own
effectiveness.
Since the head nurse is physically present
in the patient care area instead of at the desk,
she is able to observe the quality of nursing
care being given. She may also give bedside
care to a patient whose primary nurse is off
duty. This provides an ideal opportunity to
evaluate the patient's condition and the
completeness or effectiveness of the nursing
care plan recorded in the patient record and/or
Kardex.
Many aspects, then, of the primary
nurse's performance are readily assessed
with concrete examples taken from her clinical
practice. These examples become valuable
tools in preparing meaningful written
evaluations for periodic progress discussion.
The evaluation of patient needs and of
nurse performance are then appropriately
combined in the formulation of the
nurse-patient assignment by the head nurse.
She assigns each patient to a nurse within 24
to 48 hours of the patient's admission. This is a
complex decision. As previously stated, the
head nurse uses all available data to evaluate
the patient's psycho-social and physical
needs. In addition, she must consider the
acuity level of the patient, his education needs
and any personal preferences. This data is
then considered in reviewing the staff nurses
who might be available for assignment. In
selecting the best nurse, the foremost
considerations are the interpersonal and
technical skills of the individual and the scope
of practice permitted by licensure laws as
compared with what is needed by the patient.
Other factors include the current case load of
the nurse and any special interests the nurse
may have. Are there nurses, for example, who
particularly enjoy working with surgical versus
medical patients, with newly diagnosed
diabetic patients, or with geriatric patients?
Another influence is the nurse's work
schedule. Usually a nurse is not assigned new
patients during the week priorto beginning the
night shift. At times a nurse may ask to care for
a particular patient. This can be appropriate
provided the head nurse agrees that the
nurse's selection is compatible with her
abilities and the needs of the patient. Also, a
primary nurse is encouraged to re-establish
her relationship with a patient to whom she
was assigned during a previous
hospitalization.
Educational needs of a nurse might be yet
another consideration influencing assignment.
However, in this case the head nurse is
responsible for helping the nurse to learn and
practice the necessary skills.
Lastly, geographical location of each
patient on the station plays a part but should
not be a major criterion. If geography is
permitted to strongly influence assignment, it
defeats the principle of nursing assignments
based on skills needed by the patients.
H Teacher, staff developer, and
facilitator
Using the evaluation process described,
the head nurse is not only able to assess which
nurse is most appropriate for a particular
patient but she is also able to determine
educational needs of the nursing staff of the
unit.
Areas most frequently identified include
the following:
• interviewing and assessment skills
• technical skills especially with the new
graduate
• disease and its implications for patient
care
• complex psycho-social problems
• teaching techniques
• care planning
• communication skills in reference to
interaction with other health disciplines or
agencies
• change process
• problem-solving and decision-making.
Without doubt the need for skill in
interviewing and data collection influences the
entire nursing process. Poor interviewing
techniques and insufficient data col lection can
only result in deficient planning. Primary
nurses frequently express difficulty in knowing
what kinds of questions to ask of patients or
how to approach "sensitive" topics. The head
nurse is responsible for finding an effective
method to develop these skills.
The head nurse can also be instrumental
in developing technical skills of the new
graduate. One way of doing this is to assign
the nurse to patients who have needs in the
area in which the nurse requires practice. The
head nurse is then obviously required to
provide the necessary teaching, support, and
supervision during this procedure.
The desire for greater understanding of
disease and disease process rates high
priority with primary nurses in terms of ]
educational needs. Perhaps this is a reflection ;
of the "wellness" orientation currently being i
stressed in some nursing schools in the U.S., )
almost to the exclusion of disease process.
Unfortunately, in a hospital setting, nurses are i
caring primarily for persons whose "wellness"
has been interrupted by disease. If they are not
fully equipped to handle this crisis, their care
can only be deficient. Many primary nurses
have recognized this and are now requesting
classes devoted to disease process.
The close relationships that often exist
between primary nurse and patient, make the
handling of death particularly stressful.
Dealing with death and dying or with the
patient who has severe emotional problems
sometimes necessitates other resources.
Patient care conferences attended by
representatives of all health disciplines or by
special resource persons can be beneficial.
Discussion of readings and/or experiences
may also help considerably. Severe problems
may require consultation.
Three important points should not be
overlooked in reference to patient
conferences:
1 . The head nurse should encourage primary ij!
nurses to organize a conference as a means to
inform other staff of patient needs or to elicit
assistance with creative ideas in approaching
the care of a particular individual. Directing a
conference develops the primary nurse's
ability with group process and expands her
own horizons through various viewpoints
presented. Conferences also help the primary
nurse deal with the large responsibility for
patient care and prevent feelings of being "an
island unto one's self."
2. The head nurse should encourage the
inclusion of patient and/or family in
conferences as appropriate. This can assist in
clarifying and solidifying the nurse-patient
contract.
3. The head nurse should not fail to encouarge
utilization of staff talents inherent in the
nursing group on the station. This recognizes,
reinforces, and rewards individual abilities. In
turn this promotes job satisfaction, high
morale, and group sharing.
Since patient and family teaching is one of
the primary roles of the nurse, attention to this
area is essential. Didactic classes on the I
principles of education, experimental '
situations with teaching, and evaluation of the '
effectiveness of teaching skills will help i
improve this area. Nurses can also learn
useful teaching skills through teaching new
technical skills or information to their peers. |
Continuous support by the head nurse will |
encourage growing proficiency in patient
teaching.
Care planning requires some assistance.
Initially, primary nurses may be hesitant to
commit themselves in writing. They need
guidelines and positive reinforcement from the
head nurse. Review of written care plans by
the head nurse is essential to indicate to the
staff this expectation of oerformance.
If inappropriate deviations from the care
plan or lack of adherence to the primary
nurse's care plan by othernurses occur, it may
be necessary for the head nurse to intervene.
Reiteration of the importance of following a
care plan reinforces the fact that nursing
directives are as important as physician orders
to planned care and continuity. Sometimes,
too, the primary nurse needs a reminder to
include the patient in discussion about his plan
of care during his hospitalization.
Communication channels in primary
nursing are radically different from traditional
hospital systems; the head nurse is no longer
the single information source and primary
decision-maker on the station. Instead, she
promotes direct care-giver to care-giver
communication by supporting the primary
nurse as the nursing person responsible for
communication of verbal and/or written data
concerning her patients to physicians and any
other health disciplines involved in the care of
her patients. In addition, change of shift
reports are organized so that the nurse who
has been responsible for patient care reports
directly to the nurse who will assume these
responsibilities on the next shift.
If the transition from a traditional system
of station organization to primary nursing is to
succeed, it is essential that the head nurse
adequately prepare personnel for the change.
Her approach to this task depends upon her
own approach to change. Again, her
openness, willingness to experiment, and
sense of adventure will have a direct influence
on the staff. As in any other aspect of station
activities, change necessitates a positive
support system if it is to succeed. Some
notable factors the head nurse should
consider in promoting changes are: sensitivity
to where the staff is mentally and emotionally
in terms of change; group involvement in
decision-making about the innovation with
recognition of contributions made by staff
members; good sense of timing in terms of
proceeding with the change process; close
communications so that a clear understanding
of the change is commonly held; close
follow-up so that feelings and problems are
dealt with before they become
disproportionate; finally, much positive
reinforcement and feedback.
The primary nurse must be competent in
the areas of problem-solving and
decision-making. The head nurse facilitates
these skills as a consultant and validator by
acting in a way which will maintain open
communication, support and teach the
decision-making process to less proficient
staff, recognize and encourage staff who
make good decisions, and disseminate the
clinical knowledge which the staff nurse
requires to make her decisions.
When the head nurse recognizes that
good judgment is being utilized, immediate
recognition of that fact provides feedback and
reinforcement essential to staff satisfaction
and performance. As more experience is
gained and self confidence grows, the need for
frequent validation will lessen. The staff nurse
will gain more confidence in her own abilities
and the head nurse will learn to trust the
individual's judgments. Responsibility allowed
will then be appropriately proportional to
proven ability. At this point interactions
between staff nurse and head nurse become
informative sessions. The staff nurse will
describe proposed plans or actions already
executed and their outcomes rather than
asking permission to act. In this context the
head nurse maintains final responsibility for
the station activities while fulfilling her role as
quality control agent.
H Rewards
In primary nursing, the rewards for the
head nurse come from her clinical orientation:
• Because she is relieved of many
administrative tasks she has the opportunity to
again become a bedside nurse herself. She is
able to become involved with the patients as
people and not just statistics through bedside
rounds with the primary nurse, through patient
interviews, and through direct teaching and
participation in bedside care.
• The greatest reward of primary nursing is
improved morale and personal growth among
nurses who work in an atmosphere which
promotes expression of the full breadth and
depth of their professional skills. Each staff
nurse can see directly the result of her
individual efforts. This direct feedback fosters
enthusiasm and concern to increase technical
skills and clinical knowledge. Individual nurses
are recognized for an area of expertise and
invited to teach the other staff. More creative
problem-solving is encouraged when one
nurse is responsible for the comprehensive
care of specified patients.
• Continuity of patient assignments
contributes to increased personal
commitment. The patient can identify "my
nurse" and the nurse can identify "my patient."
The primary nurse assignments concern
30
The Canadian Nurse March 1977
people and not tasks. Family members are
especially appreciative to have one particular
nurse to consult.
• Physicians' comments are uniformly
favorable when they discover that the
responsibility for the care of their patient is
assumed by one individual who is thoroughly
familiar with the medical problems involved
and is qualified for and committed to providing
optimum nursing care.
The head nurse who watches her staff
develop professional skill and competence
has the right to be proud. Primary nursing
provides the organizational system which
makes quality, patient-centered care a
possibility. Head nurse leadership makes it a
reality. *
Vivian Good, Diane Bartels and Susan
Lampertai^e each held head nurse positions
on Primary Nursing Units. Diane Barteis was
the first head nurse on the pilot station at
University Hospitals, Minneapolis, Minnesota
where Primary Nursing originated. She was
succeeded by Vivian Good. Both worked with
innovator Marie Manthey in the development
of this new approach to patient care which
has since gained widespread
acknowledgment. Since then, Susan Lampe
implemented Primary Nursing on her medical
unit at United Hospitals in St. Paul.
Each of the authors through their
experience with Primary Nursing identified
the need for a clearer definition of the Head
Nurse role since leadership was observed
over the years to be a key factor in the success
of this innovation. Hence their philosophies,
experiences, and enthusiasm have been
combined to produce this article.
Vivian Good is a native of Winnipeg,
Manitoba and a graduate of St Boniface
Schoolof Nursing in St Boniface. She worked
at the Manitoba Rehabilitation Centre before
moving to Minneapolis to become a staff
nurse in Medical Intensive Care at University
Hospitals, University of Minnesota and a year
later became head nurse on the Primary
Nursing Unit. Since that time she has
conducted numerous workshops on the
topic and has been involved in private
consultation in U. S. hospitals and now in
Canada. Currently, she resides in Detroit
Lakes, Minnesota where she works as an
Adult and Geriatric Nurse Practitioner for
Multi-County Public Health Nursing. She also
holds a part-time position with the University
of Minnesota Community Sen/ices
Department and is in her last year of the
Bachelor of Sciences in Health Services
program at Moorhead State University.
Answers
Clinical Wordsearch
Puzzle no. 4
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Diane Bartels, R.N., B.S., M.A., is a
graduate of St Mary's School of Nursing in
Minneapolis and received her Bachelor's
Degree in Nursing from Marycrest College in
Davenport, Iowa and her Master of Arts in
Psychosocial Nursing from the University of
Washington. She is presently associate
director of nursing at Methodist Hospital in
Minneapolis.
Susan Lampe R.N., is a graduate of
Cornell University- New York Hospital School
of Nursing, and is presently a graduate
student at the University of Minnesota School
of Nursing.
References
1 Manthey, Marie. "Primary Nursing is Alive and
Well in the Hospital, "^mer. J. Nurs. 73:1 , January,
1973.
A reading list is also available from the Canadian
Nurses Association Library.
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The leukemic child looks into the mirror provided by his peers who are sick like himself. The image of his
future self that he sees reflected there provides him with the knowledge and understanding that he needs
to cope with a life-threatening illness.
MM^^^J^^
June Kikuchi
Illness, and especially hospitalization,
subjects a child to a host of uncertainties. Will
his mother return to visit? Will he get another
needle? Will he die? A child with a
life-threatening illness, such as leukemia,
faces these uncertainties repeatedly. In
addition, he is subject to numerous other
uncertainties such as, "Will my hair fall out
when I take this medicine? What will I look like
bald? Will I be able to get a wig to suit me? Will
the treatment work this time? Will anyone
marry me now? How will I know when I'mgoing
to die? Will my parents be able to stay with me,
if I'm going to die? " Too many uncertainties
can be intolerable. How then does the
leukemic child deal with so many questions?
Oneway is by reducing them to a manageable
level through the use of "mirroring" — a
process whereby the child, by identifying with
and watching others, sick like himself, is able
to see his future in them. For the child, it is like
looking into a mirror and seeing a reflection of
his future self.
While working as a clinical nurse
specialist with leukemic children on an in- and
out-patient basis throughout the course of their
illness, I had the opportunity of observing their
behavior. What follows is an account of how
some of these children between the ages of
nine and eighteen years used mirroring as one
way of facing the uncertainties that beset
them . All of them had ample opportunity to see
other children with leukemia in the ward (which
usually contained at least six children with
leukemia at any one time) or in the hematology
out-patient clinic. Some had been told that
they had leukemia and perhaps its prognosis;
others had been told that they had anem ia or a
blood disorder, etc. No matter what they had
been told, they all seemed to get information
from the child who looked like them and
received similar treatment. He was the best
teacher. The children used mirroring primarily
to deal with uncertainties such as body
mutilation and death, described elsewhere.
'
Th« Canadian Nurae March 1977
^ Uncertainties surrounding body
mutilation
The leukemic child reduces his
uncertainty about forms of body mutilation
such as an intravenous infusion to a
manageable level by watching other children.
After he sees that othiers receiving intravenous
Infusion can move about, do things for
themselves and are not badly mutilated, he Is
reassured.
For a child to be told his hair will fall out
because of chemo- or radiotherapy is
frightening. How will his hair fall out? What will
he do without hair? How will he look? Will his
hair really grow in again? To see what will
actually happen to his body and how It can be
fixed is reassuring. Truth is less traumatic than
all kinds of terrible imaginings. For this reason,
he seems to change his uncertainties to
certainties by observing other children who
have lost their hair and now wear attractive
wigs. When he Is Informed that he, too, will
lose his hair, he Is upset and wants to be sure
he can get a wig which will look like his own
hair. He is further reassured by seeing children
whose hair has already started to grow In
again.
Loss of hair is of concern to the
adolescent boy as it signifies loss of
masculinity to him. To the adolescent girl. It
represents loss of feminity. Another concern of
the adolescent girl centers on how her disease
will affect her ability to have a baby. She also
wonders If the baby will be mutilated by her
leukemic drugs.
•
As she approached the third year of her initial
remission, Lynn, an amiable
eighteen-year-old girl, asked the doctor if she
would ever be able to have a baby. She wanted
to know if the baby would be deformed by her
drugs. The ensuing intellectual discussion did
not seem to reassure Lynn. The doctor then
talked with her about Kathy, a twenty-year-old
girl who had had leukemia for five years. Lynn
knew her and had identified with her in the past.
When the doctor told her about Kathy's plan to
have a baby when she came off her drugs in a
half year, Lynn looked relieved. By identifying
with Kathy, Lynn was able to change her
uncertainty about her ability to have a baby to a
certainty. If Kathy could have a baby, then she
could also have one.
In this way, by watching what happens to
others with a similar Illness, the leukemic child
gains information about how his body will be
affected by the disease and treatment.
^ Uncertainties surrounding death
The leukemic children, especially those
who were not told they had a life-threatening
illness, came to suspect It from the necessity
for frequent visits to the doctor, daily
medications, various procedures, blood
transfusions, and repeated hospitalizations.^
They changed this uncertainty about the
nature of their il Iness to a certainty by getting to
know at least one other child who was sick like
themselves. Later, when he died, their
suspicion was confirmed. The children kept
track of one another by writing or visiting their
sick friends when they were hospitalized; they
also asked about one another.
•
Judy, a bright, alert, nine-year-old girl was told
she had anemia. She had two roommates,
Sherry and David, both nearing the terminal
phase of the leukemic process. Soon after
Judy was discharged from the hospital she
began to ask her mother how Sherry and David
were. She knew her mother talked with their
mothers. When told about David's death Judy
was upset and asked, "Whafs going to happen
to Sherry? David and Sherry have the same
thing! " Each time she came to clinic, Judy
would ask me how Sherry was. If Sherry was in
the hospital, Judy visited her. When Sherry
died, Judys mother did not want her daughter
to know, because Davids death had upset her
so. We later decided it would be betterto tell the
truth so as not to lose Judy's trust. Upon being
told, Judy said that she would have kept asking
as she knew something was going to happen to
Sherry. She then cried, " I'm scared I'm going
to die too. Sherry and I have the same thing."
When asked why she thought so, she
explained, "We take the same medicines. We .
both lost our hair. " She had learned by
mirroring, not by being told that she had a fatal
illness.
•
Tim a quiet sixteen-year-old boy, rarely asked
questions about his disease once the doctor
had discussed it frankly with him. But when a
leukemic child Tim knew died, he was anxious
to talk about it: he wanted to know why the child
had died. He also wanted to know if having
leukemia would shorten his life span and he
asked me what he could do to help himself.
Thus, by keeping track of one another,
these children are able to confirm their
suspicion that they have a life-threatening
illness. If Nagy's belief^ is true that at nine
years of age a child achieves a realistic
conception of death as a permanent biological
process, then why would they want to confirm
what seems to be a frightening suspicion?
Probably because it Is easier to face certainty
than uncertainty. A known phenomenon can
be grappled and dealt with while an unknown
phenomenon cannot.
On the other hand, by keeping track of
one another, the child can also confirm the
suspicion that, although he may die, he can
also live for awhile too. For example, the
adolescent girl who has dreamt of marriage
becomes especially worried about whether
she will live long enough to get married.
•
Soon after Sandi, an inquisitive
sixteen-year-old girl was found to have
leukemia, she became friendly with Tom,
another leukemic adolescent, who later died
after being ill for four years. Sandi knew she
had leukemia. After Tom's death, she was
depressed and, no matter what she was told,
talked about having only four years left. At the
clinic, she met an attractive twenty-year-old girl
who had had leukemia for five years and had
just been married. Sandi shed her depression.
She could identify with another girl who actually
had lived for more than four years — someone
who had married. Sandi began to be interested
once again in dating, in getting married and In
having babies.
However, sooner or later as the leukemic
child becomes increasingly ill and the threat of
death becomes more real, he wants to know
when and how he will die and what will happen
to him. Again he learns the answers from other
children with a similar Illness.
•
Upon his second hospital admission.
Danny, a fifteen-year-old adolescent who had
been told he had a blood disorder, asked.
■'What's happened to Ralph, the boy who was
in the room with me before? Did he go home?
Why did his parents sleep here?" When he was
told that Ralph and died, Danny said, "I
wondered if he had made it. He didn't look so
good. Is that why his parents slept here?"
Danny then went on to talk about the possibility
of freezing bodies until cures were found. He
said calmly, "I know I'm incurable." A year later
when his condition worsened and his parents
stayed with him through the night at the
hospital, Danny accepted without question
what this meant.
Sometimes the child observes when and
which child is moved into a private room and
keeps close watch. On passing the room, he
may glance quickly Inside to see how the child
looks and what Is happening. Once the door
remains closed for privacy and he is no longer
able to see Into the room, he watches who
goes in and out and studies their faces.
Occasionally he plants himself In the hall
across from the room and keeps a vigil.
•
Trudy, a curious eleven-year-old girl who had
experienced several relapses, was told she
had a blood disorder. One day while we played
a card game, a child on the ward died. In the
middle of our game. I was called away. When I
returned. Trudy was not in her room. A few
minutes later she returned. She had gone, she
said, to see if I had left the ward. When I
mentioned that I had noticed that the door to
Room 310 was open again. Trudy quickly and
eagerly exclaimed, "Yeah, I saw that too! Did
someone die in there?" When I said yes, Trudy
said, "I thought so. I've seen people come out
of the room crying. " The card game was
forgotten. She talked about how her mother
had almost died giving birth to her but had seen
Jesus and not been afraid. Later, Trudy asked
for the meaning of the words "Blood
Dyscrasia, " an expression she had overheard.
When I answered, "Disease of the blood, "
Trudy emphatically told me, "I'm not afraid to
die you know I've been saved. "
Obviously Trudy had come to recognize
what the opening and closing of a door to a
private room could mean If people had come
out crying. When children, like Trudy, have
I
ade such deductions and have talked about
eir concerns, placing them in a private room
len they are ill does not seem to come as a
shock to them. In fact, they expect it and often
ask for their own room.
•
Carol a twelve-year-old girl who knew she
would soon die from leukemia, asked her
doctor if she could have a private room when
she returned to the hospital. She had known
several ill leukemic children who had been
Tioved into a private room and died. She had
decided she would like to stay at home until that
moment she felt "bad enough to come to the
hospital." Her second request was for her
mother to sleep in the room with her at the
hospital.
Some of the children are more eager than
others to learn about what happens behind the
closed door of a private room. This kind of
information can only be obtained by asking,
and the need to learn what might happen to
them from other children's experiences is so
great, they usually ask.
Where did her mother go? Did her mother stay
with her? We talked about all these things.
Besides wondering when and how he will
die and what will happen to him, the leukemic
child seems to worry most about whether his
parents will be allowed to stay with him. The
most comforting thing he learns from other
children seems to be that, should he become
very ill, his parents will sleep in the same room
with him at the hospital.
Other children, like Danny have asked
why certain parents remain overnight. Later,
when they too become terminally ill, they like
Carol, suddenly ask that their parents be
allowed to sleep with them.
Another worry the child has is how his
death will affect his parents. The adolescent is
especially concerned about how much worry
and trouble he is causing them. As he sees his
parents becoming more exhausted, he worries
about whether they will survive. What will
happen to them? What will life be like for them
without him? Will they miss him?
Janet a frightened ten-year-old knew she had
I leukemia and often talked about the time she
had been so sick she was expected to die. One'
day, after her afternoon nap, Janet saw Katy s
name had been taken off the patient roster.
She asked, "Where's Katy?" When she was
told that Katy had died, Janet asked. "When did
she die? Were her parents there? Do the
nurses know Katy died? They act as if nothing's
wrong! How does Katys nurse feel? How did
her nurse know Katy died? What's going to
happen to the teddy bear she always carried?
Are they going to bury it with her or is her
mother going to keep it? How did the n urses get
Katy out of her room ? Where did they take her?
Pat, a vivacious thirteen-year-old girl who
knew she was in her first leukemic remission,
continued to write and visit the family of a
leukemic fnend who had died. She enjoyed this
contact and commented on how nice it was to
see that Andy's family still remembered him,
had pictures of him. talked about him. and
missed him. She was glad to see how well his
parents were coping and that they had "not fallen
to pieces. "
It must be comforting for a child who may
be concerned about how his family will survive
without him to see that, if he dies he will be
missed but that his family will not disintegrate.
^ Helping the leukemic child to use
mirroring
By identifying with children who are ill like
himself, and by watching what happens to
them, the leukemic child is able to see his
future self in others and thus reduce the
number of uncertainties facing him to a level
he can tolerate. Instead of imagining all kinds
of unreal situations he is able to see for himself
what might happen.
• If he loses his hair, he can get an attractive
wig and his hair will indeed grow in again.
• He can tell how ill he is by whether he is
moved to a private room.
• He knows he will have a nurse and his
parents stay with him when he becomes very
ill.
Having seen all these things taking place,
the leukemic child does not at first feel the
need to ask a lot of questions about himself.
Instead, he is able to take in everything at an
emotionally safe distance, that is, one step
removed.
It is important for staff members caring for
the leukemic child to be aware that mirroring
does take place and that this is the child's
indirect way of clarifying his own situation.
They should realize just how much this
vicarious experience means to him. But
mirroring is a process ttiat the child should be
allowed to carry out on his own. The child
himself must be allowed to control what he
wishes to see and what he wishes to deny.
Staff members can best assist him by being
available to help him deal with questions and
concerns aroused by an experience and to
detect and correct any misconceptions he
might have formed, not by pushing him to see
what he does not want to see. *
Author June Kikuchi's experience includes
five years as clinical nurse specialist at the
Hospital for Sick Children in Toronto where
she worked specifically with leukemic
children and their parents. In this position she
Initiated care of these children after their
diagnosis and then, with staff, continued to
care for them throughout the course of their
Illness.
June Kikuchi, R. N. , B. Sc. N. ,h/I.N.,isnow
in her second year of clinical doctoral studies
in the Nursing Care of Children program at the
University of Pittsburgh in Pennsylvania. Her
studies are funded by the Hospital for Sick
Children Foundation. A graduate of the
University of Toronto, Sdhool of Nursing she
received her t^.N. from the University of
Pittsburgh School of Nursing after being
awarded a scholarship from the Canadian
Nurses' Foundation.
References
1 Natterson, J.M. Observations concerning fear
of death in fatally ill children and their mothers, by ...
and A.G. Knudson, Jr. Psychosom. Med. 22:456,
1960.
2 Green, M. Care of the dying child. Pediatrics
40:Supp.:495, Sep. 1967.
3 Nagy, M. The child s theories conceming
death. J. Gener. Psychol. 73:3. 1948.
I ne Canadian Nurse Marcn isfr
I
^paM^ SpsaSing
TFicIriuznTiori
in nuR/in6
Eleanor G. Pask
In the past few decades, nursing has
functioned in the midst of a world that is
increasingly geared to specialization.
Sophisticated technology and burgeoning
scientific knowledge have succeeded in
widening the scope of our profession. Yet
nursing has tended to favor a pattern of
generalization and has been slow to promote
specialization, especially in the clinical field,
among its members. For the most part, the
development of specialization within the
profession has emerged with little planning.
Now, however, the need for specialization
is at last beginning to be recognized and a
variety of specialties are emerging. Nurses
must take their cue from the other professions;
those of us who want to specialize must
identify ourselves and be recognized as
activists — aware of our goals.'
'"^
The emergence of a specialty follows a
recognizable pattern:
1. development of specialist knowledge
2. application of that knowledge
3. the choice of those with special interest and
aptitude to work in that area.
In nursing, as in medicine, the rapid
expansion of information makes it increasingly
difficult to include specialty instruction in basic
programs. It seems likely that, in the near
future, we will be expected to take specialty
training before we can work in special units.
The problem is that, as yet, the education
system is not geared to meet this expectation.
• The need is known
In 1925, Goldmark= stated that a nurse
should be able to specialize to meet the
demands of advances in medicine and
technology, and in 1932, Weir^ added that
opportunities to do this must be made
available. But nurses have not accepted the
challenge. In 1967, (Murray" decried the
apathy within the nursing profession
concerning the lack of organized specialty
training for graduate nurses.
At its 1970-72 biennial meeting, the
Canadian Nurses Association (CNA) identified
specialization in nursing as one of its priorities
for action. Simultaneously, a nation-wide
survey of Canadian nurses^ confirmed the
need for training in the specialties: the
concensus favored the use of educational
institutions rather than hospitals for such
courses, and stated the need for recognition of
the special competencies achieved through
these courses.
Frankly Speaking is intended as a forum for nurses who want to speak out on
issues that may influence the future of nursing practice, research,
administration or education. Guest columnists from time to time will be
members of the Board of Directors of your national professional association.
If you have an opinion or concern that you would like to share with your fellow
nu rses, why not write to us. This is you r chance to get involved, to participate
in shaping the destiny of your profession.
• Is certification the answer?
fVlany specialty groups in the United
States provide specialty training, and
certification to Canadian nurses because
equivalent courses are not available in
Canada. Thus, Canadian nurses working in
operating rooms, dialysis units, and
emergency departments, for example, may
take American courses. But, the certificate
they earn is not officially recognized in
Canada.
In 1958, the American Nurses'
Association (ANA) set a goal: "To establish
ways ... to provide formal recognition of
personal achievement and superior
performance in nursing. " « During the next 1 5
years, many specialty groups developed,
offering education and certification to their
members. The ANA now has seven such
programs, including geriatrics, psychiatry,
pediatrics, medicine/surgery, community
health, and a combined course in obstetrics/
gynecology and neonatology.
Originally, the term certification' implied
excellence and an advanced level of training.
Now, however, with the proliferation of
specialty groups, it can mean anything from
minimal standards to the highest level of
achievement. There has developed a gradual
recognition of this disparity in the use of the
term certification', and a growing awareness
of the conflict between the goals set by the
ANA and specialty groups. In trying to resolve
their differences, they are working toward the
standardization of certification. For example,
the Nurses' Association of the American
College of Obstetricians and Gynecologists
(NAACOG) recently merged with the nurses'
parent body, to form the
ANA-Maternal -Gynecological-Neonatal
Nursing Specialty, and the O.R. Nurses'
Association proposes to form a similar
association.
• Obstacles to specialization
Nurses as a profession have been
described in uncomplimentary terms — terms
such as apathetic, moribund, and confused.'
We should be indignant at such a description
(moribund we certainly are not, and apathetic-
and confused we hope we aren't) — but when
this comment was made it provoked little
response from nurses. However, this
statement was made from outside the nursing
profession, and it's an old truth that outsiders
can sometimes see the problem more clearly.
So we must ask: how accurate is this
description? In view of the lack of response,
obviously we are apathetic. We have been
confused, too, but hopefully, we are beginning
to sort out the facts.
What are the obstacles, other than
apathy, to specialization in nursing? Certainly,
there are few incentives. Hospitals have
assumed almost complete responsibility for
nurses' clinical graduate training in the
specialties(/.e., working on specialty wards),
but they rarely include instruction in essential
background knowledge and theory. The nurse
\
tl
plans to attend a course must accept that
obably her colleagues will resent her
)sence, because of the additional work for
em. Few hospitals reimburse a nurse for
king a clinical course; they may approve
ave of absence — usually unpaid — but
fovide few bursaries or scholarships. Thus,
jditional training may cost a nurse thousands
I dollars, for tuition, lost wages, and often.
Dkeep in another city. Even then, on her
turn to work, her hard-won training may go
.-recognized both officially and financially.
jome nurses even find that the jobs for which
ey trained have been filled in their absence.
So, the great majority of nurses continue
ii provide the best patient care they can, even
'■ the expense of their own further education.
Solutions
Today, basic nursing performance
,:andards are available. The next move must
}e made by the specialty groups which, with
lie guidance and support of provincial
;rofessional associations, must define
Iniform, high standards for specialty training.
i;epresentatives of the provincial ministries of
lealth and the nurses' associations should
jssess the status of nursing specialization, to
jetermine needs and, along with
Ispresentatives from community colleges and
Iniversities, develop specialty courses and
njform certification standards. The entire
rocess should be co-ordinated, supported
nd interpreted by our national association
3NA) to ensure the same high level of
ompetence throughout Canada. Such
ourses should be presented by educational
istitutions in collaboration with their affiliated
ospitals.
There should be a register of nurses, with
nention of specialty certification, as in a
nedical directory. This could be compiled —
igain, as for doctors — from short
luestionnaires completed for annual
egistration. The programs should be
;onducted jointly by the CNA and the
jrovincial specialty groups.
Ensuring continued competence
jresents another problem, but with a current
;entral registry this could be achieved by
equiring endorsement by colleagues, and
etesting, at regular intervals for example,
jvery five years.
Conclusion
Inevitably, nursing will become more
specialized: the groundwork has been laid, the
heed has been documented repeatedly, and
now we are ready to move into planned
specialization.
Most important is the need to define,
encourage, and recognize specialization; as a
profession we should be working towards it
now. The change will take some time, but we
piust begin to consider attendance at nursing
meetings and education courses a necessary
jpart of our continuing education.
I As a profession , where do we want to go?
How do we want to get there? If specialization
is what we need, and certification is what we
want, we must complain more vociferously
about the obstacles and start removing them. .
Eleanor G. Pask (B.Sc.N., R.N.) is Head
Nurse in the Clinical Investigation Unit at The
Hospital for Sick Children in Toronto.
References
1 Newton, M. The growth of a nursing specialty.
JOGN Nurs. 1:10-11, Sep./Oct. 1972.
2 Committee for the Study of Nursing Education.
Nursing and nursing education in the United States.
Report of the committee for the study of nursing
education and report of a survey by Josephine
Goldmark. New York, MacMillan, 1923.
3 Weir, G.M. Survey of nursing education in
Canada. Toronto, University of Toronto Press,
1932.
4 Murray, V.V. Nursing in Ontario. Toronto,
Queen's Printer, 1970. (Ontario. Committee on the
Healing Arts. Study)
5 Baumgart, Alice Jean. A discussion paper on
specialization in nursing. A summary report
prepared for the Canadian Nurses Association,
1973.
6 Hutchison, Dorothy J. Certification; a new
impetus to continuing education. J. Contin. Educ.
Nurs. 4:5:3-4, Sep./Oct. 1973.
7 Murray, op. cit.
Sometimes, baby gets
more air than formula.
1
i
f
\
That's why we make soothing,
peppermint-flavoured Ovol
Drops.
Ovol is simethicone, an
effective but gentle antifiatu-
lent that relieves trapped air
bubbles in baby's stomach and
bowel without irritating gastric
mucosa.
Ovol works fast. And that's a
relief for baby. And for mother.
Also available in adult-strength
chewabte tablets.
OVOL DROPS
FOR INFANT COLIC
0 HORnp
The Canadian Nura* March 1977
A program
thatdarestobe
Since the publication of Marc Lalonde's/\ New Perspective
on the Health of Canadians in 1974, a public debate has
ensued about the many health hazards that are self-imposed
%^ — obesity, lack of fitness, alcohol and drug abuse, smoking,
' etc. The media have helped to awaken the public to the
importance that individual lifestyles play on health.
^
Participaction posters in buses and subways, television ano
radio advertisements about non-smoking and fitness all
emphasize health promotion. Increased awareness has
prompted many people to seek better and healthier patternsi
of living and it is to the health professions that these people
look for guidance. Obviously, nurses have an important rdd
to play in providing this help — but only if their professional!
associations and schools of nursing can show them the way*
In the article that follows. The Canadian Nurse takes a look ati
what is going on in one province, British Columbia.
I
From the time a few years ago when many traditional hospital schools of nursing transferred to the
community college setting, some employers have voiced the opinion that the two-year-diploma
graduate is not "experienced" enough. Does this mean that the graduate has not had enough
clinical practice to have developed manual dexterity... or that she is unable to cope with a realistic
patient load... or that she is not confident in her nursing care? Whatever the interpretation, the
concern exists and one community college that is trying to do something about it is Okanagan
College in British Columbia. What follows is an explanation of the philosophy and implementation of
the diploma nursing program at that college.
Judith M. Skelton
Preparation of nurses with RN certification has
passed through many stages since Florence
Nightingale introduced gentlewomen into the
profession of nursing during the Crimean War.
Early schools of nursing were established in
hospital settings, with no standardization of
curriculum content, clinical facilities or
entrance requirements. Nearly every hospital,
regardless of size, conducted a training
program since by doing so it was assured of a
continuing supply of low cost staff. In fact,
however, the graduates of such programs
nearly all went into private duty where the
hours and pay were more reasonable.
The introduction of registration for nurses
in the early 1900's in Canada marked the
beginning of a long, slow process of
standardization of the educational
prerequesites for affixing "RN" after one's
name. Until fairly recently, these educational
requirements tended to be expressed in terms
of the number of hours spent in a given setting
rather than in terms of what competencies
were developed — hence the idea that "it
takes three years to become a nurse."
Twenty-five years ago, Mildred Montag
spearheaded the development of "associate
degree" nursing programs that were based in
U.S. community colleges. Community
colleges, as they have developed in Canada
and the U.S., are the logical setting for basic
nursing education. They provide a
post-secondary level education with a
practical orientation, that leads to employment
opportunities and/or university transfer.
Because college nursing students are not
required to provide service to a hospital, their
clinical experiences can be more closely
correlated with classroom learning and the
overall course of study can be accomplished in
a shorter period of time — hence the notion of
"two-year college programs."
In British Columbia, as in most parts of
Canada, nursing education has traditionally
taken place in hospital-based programs. This
trend began to change when the British
Columbia Institute of Technology (BCIT)
instituted a nursing diploma program in 1967.
In the early 1970's, an increasing number of
community colleges throughout Canada
offered nursing programs to students. To date,
all of the hospital-based programs in B.C.
continue to be three years in length while the
college-based programs are two years. In
contrast, in Ontario, until recently, there
existed many two-year hospital-based
programs which have all since moved into
community colleges, while in Quebec, the
CEGEP nursing programs are three years. But
while the question of two-year versus
three-year programs continues to be hotly
debated, perhaps what we really ought to do is
decide what competencies beginning RNs
require and then decide how long and in what
manner these competencies are best
acquired.
The competencies required of beginning
RNs will, of course, change with the changing
health needs of society and education
programs will have to be flexible enough to
adapt. Anticipating these changes, Okanagan
College in Kelowna, B.C. has launched a new
diploma nursing program which has some
unique features. These features include:
• focus on the nurse as a health promoter
• a three dimensional curriculum
framework
• a cooperative education design.
^^Program Objectives
^^It is anticipated that the graduate of the
Diploma Nursing Program at Okanagan
College will be prepared to:
• assume a beginning staff nurse position in
an acute, intermediate or extended care
hospital, clinic, office or home care setting;
• work under the general supervision of an
experienced registered nurse. The more
experienced nurse should be able to answer
questions and give general direction to the
new graduate. In fact, it is hoped that
graduates of the Okanagan College program
will require less supervision, direction and
support than other college graduates, as a
result of having had "real work" experience in
the course of their training.
• work within a framework of written policies
and procedures;
• provide non-specialized, health-oriented
nursing care to a group of patients. It is our
belief that preparation for specialization is
beyond the scope of a diploma program.
• write the provincial nurse registration
examinations.
Within this context, the graduate will
consistently:
1. Communicate effectively with patients
and colleagues.
— demonstrate skill and sensitivity in human
relations and communication
— demonstrate skill in health teaching
— provide leadership in small groups of clients
and auxiliary nursing personnel
— collaborate with other health team
members in the provision and coordination of
quality care.
Th« Canadian Nurse
2. Provide quality nursing care to one or more
patients requiring non-specialized* nursing
intervention.
— use the nursing process to provide
Individualized nursing care to patients: gather
data, identify actual and potential
needs-for-help, set priorities, plan, implement,
and evaluate nursing care
— involve the patient and his significant others
in the plan of care
— demonstrate skill and confidence in the
application of non-specialized nursing
measures.
3. Demonstrate professionalism in the delivery
of nursing care.
— seek to maintain and improve the health of
self and patients
— act as a patient advocate
— exercise professional rights and
responsibilities
— demonstrate an open-minded and
constructive attitude toward changes in health
care and nursing practice
— assume primary responsibility and
accountability for maintaining one's own
competence in nursing practice.
While these objectives may not appear to
be especially unique for a nursing curriculum,
the way in which we fulfill the objectives /s
rather unique.
• The Nurse as a Health Promoter
The promotion of health is a current and
important topic of discussion among all health
professionals. When Canada's present health
care system was established, the causes of
death and disease in the population were
mari<edly different from what they are today.
The current situation shows that "diseases of
excess" due to alcohol and drug abuse,
smoking, overeating, lack of exercise, etc.
probably account for 50% of illness in our
society. Besides this, escalating costs for
health services demands that a less expensive
approach to health — an alternative to the
"disease orientation" — be found. People are
becoming increasingly aware that they are not
at their optimum level of health and are
beginning to seek direction and guidance
in improving this situation. The health
professional of the future must take some
responsibility for giving this direction.
Accordingly, a primary focus of the total
nursing program at Okanagan College is on
the role of the nurse in health promotion.
Fundamental to this approach is the idea that
the nurse must be a good role model of health.
Therefore, it is expected that both students
and faculty be actively engaged in improving
their own health status.
• Curriculum
The framework or foundation for our
nursing curriculum may be visualized as a
cube. In the first dimension are those qualities
*Non-specialized nursing care — the nursing care of infants,
cfiildren and adults exclusive of ttiat requi red tDy critically ill or high risk
patients (Definition adopted from Draft Statement of RNABC Task
Committee to identify cntical components of a Basic Nursing
Program)
which nursing students must develop. These
include effective communication, a logical and
effective approach to nursing care, and
professionalism. In the second dimension are
the various stages of life with which nurses
must be familiar. These stages include
infancy, early childhood, middle childhood,
adolescence, early adulthood, middle age,
and later maturity.
Finally, nurses must have a focus for the
nursing care they provide. At Okanagan
College, we view man as a being who is
constantly responding to stimuli. These stimuli
arise from three sources: from his
development, from his lifestyle, and from
unpredictable events. Some of his responses
to these stimuli will be healthful, and others
unhealthful. It is the nurse's role to try to
Increase the number or quality of healthful
responses.
Growth in all three dimensions of this
framework is planned to occur simultaneously
throughout the program. As the students
tackle new concepts in nursing care, they will
move from:
simple — complex
general — specialized
health — illness
single patient — multi-patient
single problem — multi-problem
team member — team leader.
Clinical practice will be concurrent with
classroom work throughout to allow immediate
application of new knowledge.
• Cooperative Education
Over the past several years, employers
have voiced concern that graduates of
two-year diploma nursing programs "haven't
had enough clinical practice." It is difficult to
know precisely what is meant by this phrase —
.one person may mean not enough practice to
have developed good manual dexterity;
another may mean not enough practice to be
able to cope with a realistic patient load; a third
may mean not enough practice to be
self-confident in giving nursing care; and still
another may mean not enough practice to be
able to function in various specialty areas.
Whateverthe specific meaning, the concern is
very real.
In an attempt to deal head-on with this
problem, we have lengthened the Okanagan
College program to two-and-one-half years
and adopted a Cooperative Education Design.
To my knowledge, this is the only nursing
program in Canada to utilize such a design
although universities such as the University of
Waterloo in Ontario are using a similar scheme
for other programs such as engineering. A
very few American nursing programs have
experimented with this .concept.
Cooperative Education is a college
program within which students are employed
for specific periods of off-campus work as a
required part of their academic program. This
employment is related as closely as possible
to the student's course of study and individual
Interest.
Cooperative Education schemes are
motivated by the belief that education ought to
prepare students, not only for a specific job,
but also for the growing and adapting they will
have to do. Work experience rounds out
education, eases the progression from
knowledge to performance, and satisfies the
need for reality in learning.''
The Board of Directors of The National
League for Nursing (1 972) emphatically stated
that in order to prepare the qualified personnel
needed for the future, nursing education must
become more flexible and provide increasing
amounts of cooperative and collaborative
arrangements for nursing education. A
Cooperative Education design provides these
dimensions.
In addition to receiving the clinical
instruction which is a required part of all
nursing education curricula, cooperative
nursing students have the opportunity to
consolidate their nursing knowledge and skill
while observing and participating in current
methods of health care. This experience leads
to more competent and confident graduates
who are better able to cope with the realities of
their work situations, and avoids the "Reality
Shock in Nursing " which has received so
much attention of late.
Our students will attend Okanagan
College during the regular fall and winter
semesters for 2 1 /2 years. During these "study
semesters ' they will take health science,
nursing and non-nursing support courses,
Cooperative Education Design
for Nursing Program
complemented by an average of two days per
week clinical practice. In the summers the
students will enter 12-week "work semesters"
during which they will work a full shift rotation,
carry a realistic patient load and generally
consolidate the knowledge and skills acquired
in the previous two study semesters. We
believe that the work semesters will assist our
students to:
(a) demonstrate better manual dexterity;
(b) cany a more realistic case load; and
(c) be more self-confident
than graduates of traditional College
programs.
In thefirst work semesterthe students will
be hired as summer relief staff by local
hospitals. They will replace ancillary nursing
personnel who are on vacation. The students
will function as hospital employees according
to a job description which is mutually
satisfactory to the institutions and the Col lege.
They will be paid nurse's aide wages in
accordance with the B.C. Hospital Employees
Union contract. The students will not receive
direct supervision from a College faculty
member. However, someone from the College
will be "on call" to assist the students and/or
employers to work through any problems or
concerns.
In the second work semester — due
primarily to the difficulty in determining within
whose jurisdiction the students would fall —
the students will serve a preceptorship. Each
student will be assigned to a competent RN for
Fall
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the semester. The student will work the same
shift, have the same days off and share the
duties and responsibilities of the graduate.
He/she will remain a student and will receive
indirect supervision from a College instructor.
Students will not be paid by the hospital during
the second work semester but will continue to
receive the provincial government monthly
stipend which at present is S1 50.00.
• Summary
In summary, we have attempted, in
planning the Diploma Nursing Program at
Okanagan Collage, to retain the positive
aspects of existent hospital and college
programs, while at the same time developing
some unique features: a health promotion
focus, a comprehensive curriculum framework
and a cooperative education design. As yet, in
this first year of the program, it is too early to
predict outcomes, but we anticipate that our
students will be better equipped to deal with
the reality of a work situation. ♦
Judith M. Skelton received her B.S.N, from
McMaster University, Hamilton, Ontario in
1969 and her M.S.N, from the University of
British Columbia, Vancouver in 1973. She has
had experience in general duty and public
health nursing as well as teaching experience
in two, three and four year nursing education
programs. At present, she is the Co-ordinator
of Nursing Education , Okanagan College,
B.C.
References
1 Peregrym, John. Cooperative Education.
Unpublished document, Castlegar, B.C., August,
1975.
The Canadian Nurse March 1977
Adopted as an official position paper by the Board of Directors of
The nurse's role in health assessment
and promotion
The promotion of health is a current and important topic for all health
professionals. Causes of death and disease In today's civilized world are
marf<edly different than when our present health care system was
established. Costs of illness care in Canada are rising at truly intolerable
rates. A less expensive approach to health is not only desirable, but
necessary
Lay people are becoming aware of their lack of wellness and are seeking
direction in selecting a path to better health, f^any entrepreneurs have
capitalized on this situation by providing false and often expensive guidance.
To assure relevance to the health needs of today, health professionals must
accept that they have a role to play in giving direction to the "worried well."
D Philosophical Assumptions
The philosophical assumptions guiding this paper on the nurse's role in
health assessment and promotion are as follows:
1. Health, a dynamic process occurring throughout the life cycle, implies
continuous adaptation of lifestyle to anticipated and unanticipated events.
2. Health implies the selection and utilization of individual, family and
community resources. Each person has both the right of access and the
responsibility to use these resources to maintain his health.
3. An individual's values and attitudes about health can be changed by life
experiences and/or interaction with significant others. Nurses, as members
of the health care team can be the significant others, and in that way
contribute to a person's health assessment and promotion.
4. The nursing process is an interpersonal problem-solving approach which
is used for the assessment and promotion of a person's health.
D Definition of Terms
Health: a state of complete physical, mental and social well-being and
not merely the absence of disease or infi rmity ;' "not only adding years to our
life, but life to our years "^
Health Assessment: a systematic process of collecting and interpreting
information relative to an individual's state of physical, mental and social
well-being.
Health Promotion: a process which encourages individuals to adopt a
lifestyle compatible with optimal health.
Lifestyle: an individual's habitual and characteristic pattern of living.
Optimal Health: the highest degree of physical, mental and social
well-being achievable by an individual at any given time.
Stress: a physical and emotional state always present in the person,
intensified when environmental change or threat occurs internally or
externally to which he must respond.^
Nursing: The RNABC in its Position Paper on Nursing Practice,
accepted the following definition of nursing:
The unique role of the nurse is to assist the individual, sick or well, in the
performance of those activities contributing to health or its recovery (or to
peaceful death) that he would perform unaided if he had the necessary
strength, will or knowledge."
This association feels that this definition, by its inclusion of the words "well"
and 'health, " clearly identifies the fact that a significant part of nursing care is
health promotion.
Giving further weight to this concept is tvlarc Lalonde's exposure of the
facts that:
self-imposed risks and the environment are the principal or important
underlying factors in each of the five major causes of death between age
one and age seventy ..^ and
diseases of the cardiovascular system, injuries due to accidents, respiratory
diseases and mental illness, in that order, are the four principal causes of
hospitalization, accounting for some 45% of all hospital days. ^
Lalonde further states:
one can only conclude that, unless the ermronment is changed and the
self-imposed risks are reduced, the death rates will not be significantly
improved. '
It seems safe to assume that morbidity statistics will not alter unless
these factors are dealt with as well. As one strategy for improving the overall
health of Canadians, Lalonde suggests:
7776 continued extension of the role of nurses and nurse practitioners in ...
counselling on preventive health measures, both mental and physical, and
in the abatement of environmental hazards and self-imposed risks. ^
D Principles
Two principles form the basis for this paper:
1. Nurses must accept responsibility for optimizing their own health.
2. Nurses must accept their role and responsibility to sensitize others to the
need to optimize their own health.
Health assessment is the first step in any program or plan for health
promotion. Health assessment is defined as collecting and interpreting
information relative to an individual's state of physical, mental and social
well-being. Effective health assessment requires knowledge and skills on the
part of the nurse, appropriate technology, and inter- and infra-professional
cooperation. The range of skills is wide, including manual, managerial,
attitudinal and communicative aspects.
Health promotion is defined as a process which encourages individuals
to adopt lifestyles compatible with optimal health. To be effective as a health
promoter, the nurse first must be a role-model of health. IVIoreover, she must
have special knowledge and skills, access to appropriate technology and
resources, and an ability to collaborate with other health workers.
D Functions
All practicing registered nurses should perform at least the following
functions in relation to health assessment and promotion.
Health Assessment:^
1 . Assessment of physical status
2. Assessment of psycho-social status
3. Assessment of lifestyle status.
Health Promotion:
1. Be a role-model of health
2. Act as a change agent with/for patients
3. Encourage lifestyle activities compatible with optimal health
4. Collaborate with other health workers in providing health-oriented care
5. Support those policies, procedures and activities which promote health.
According to their level of interest and preparation, individual nurses
may take more active roles in health assessment and promotion. Table A
contains one suggested format for obtaining appropriate data relative to self
and patients, regardless of the setting in which they are found. A variety of
other appropriate assessment tools are also available. Table B contains a
suggested list of activities which nurses may perform in promoting health.
In conclusion, that nurses have a role in health assessment and
promotion seems hardly a matter for debate. The problem is preparing and
encouraging nurses to fulfill this role. To this end, the following
recommendations have been approved by the RNABC Board of
Directors:
— That the RNABC officially adopt the Position Paper on the Nurse's Role in
Health Assessment and Promotion.
— That the position paper be published in RNABC News ; moreover, that it be
widely circulated to other nurses and related health workers.
—That funds be allocated in the RNABC budget to assure that the role of the
nurse in health assessment and promotion be properly initiated (e.g.
continuation if appropriate of the 1 976 project designed to sensitize members
to their role in health promotion). *
References
1 World Health Organization, Constitution, Geneva, Palais des Nations,
1960, p. 1.
2 Marc Lalonde, A New Perspective on the Health of Canadians,
Ottawa, Govemment of Canada, 1974. p. 6.
3 Ruth Murray and Judith Zentner, Nursing Concepts for Health
Promotion, New Jersey, Prentice-Hall, Inc. 1975, p. 160.
4 Registered Nurses' Association of British Columbia, Pos/f/Of7 Paper on
Nursing Practice, RNABC, 1973, p. 2.
5 Lalonde, A New Perspective on the Health of Canadians, p. 1 5.
6 Ibid, p. 23
7 Ibid, p. 15
8 Ibid, p. 71
9 Murray and Zentner, Nursing Concepts for Health Promotion, pp.
81-85.
:he Registered Nurses' Association of British Columbia.
Table A Health Assessment
1. Assessment of physical status,
including:
1.1 state of growth and development
a.physiological developmental tasks to
be accomplished at this stage
1.2 circulatory status
a. character of pulses
b. character of blood pressure
c. movement of fluids (e.g. edema)
1 .3 respiratory status
a. character
b. interference with respirations
1 .4 fitness status
a. fitness test
b. health hazard appraisal
1.5 motor ability status
a. current mobility status
b. posture
c. range of joint motion
d. muscle and nerve status
e. coordination
1 .6 status of physical rest and comfort
a. sleep and/or rest pattern
b. presence of pain, discomfort,
restlessness, etc.
c.use of supportive aids
1.7 nutritional status
a. condition of buccal cavity
b. ability to masticate
c. ability to swallow
d. appetite
e. ingestion of nutrients
f. digestion of nutrients
g. weight
1.8
1.9
elimination status
a. bowel
b. bladder
reproductive status
a. external genitalia
b.age at menarche
c. pattern of menses
d. pregnancies
e. breasts
1.10 body temperature status
a. range
1.1 1 status of skin and appendages
a. skin
b.hair
c. nails
1.12 status of special senses
a. hearing/speech
b. vision
c. taste
d. smell
e. touch
2. Assessment of psycho-social status,
including:
2.1 stage of growth and development
a. age
b. psycho-social developmental tasks to
be accomplished at this stage
2.2 demographic status
a. sex
b. marital status
c. relatives
d. occupation
e. financial status
f. housing
2.3 ethno-cultural status
a. race
b. ethnic origin
c. religion
2.4 mental status
a. state of consciousness
b. orientation
c. intellectual capacity
d. insight into health status and/or
problems
2.5 personal status
a. motivation/readiness
b. strengths, weaknesses, limitations
c. stress factors
d.risk factors
e.sexuality
2.6 interpersonal relationship status
a. family
b. significant others
3. Assessment of lifestyle status
3.1 effects of daily habits
3.2 effects of work
3.3 effects of culture
3.4 effects of home and work environment
3.5 commercial products and/or
environmental circumstances detrimental
to health
Table B Health Promotion
1. Be a role model for health
1.1 maintain physical health
a. undertake an appropriate physical
activity program
b.cope with stress
c. avoid harmful products and
circumstances
d. ensure proper nutrition
e.keep immunization current
f. have regular check-ups
g.plan for relaxation and sleep
1.2 maintain psycho-social health
a.strive for positive interpersonal ■.'"
relationship
b. increase self-esteem
c. avoid harmful circumstances
d. select health/role-models
e.have regular check-ups
f. anticipate developmental tasks rather
than just living in the here and now
1.3 adopt a healthy lifestyle
a.cope with stress
b. avoid harmful products and
circumstances
c. adjust own concepts of health and
fitness
d. set realistic goals, priorities, guidelines
e. assume accountability for own health
2. Act as a change agent with/for
patients
2. 1 use appropriate motivational approaches
a. establish a trusting relationship
b. increase clients' self-esteem
c. identify and enlist support of significant
others
d. contact
e. participate
f. induce anxiety and/or guilt
2.2 get patient commitment to change
2.3 assist in the formulation of realistic goals
and priorities
2.4 reinforce health responses
2.5 provide anticipatory guidance for each life
stage
3. Encourage lifestyle activities
compatible with optimal health
a. appropriate physical activity program
b. adequate rest and relaxation
c. avoidance of harmful products and
circumstances
d. identify and cope with stress
e. regular check-ups
f. fluoridation
g.good hygiene
h. proper nutrition
i. current immunization J
j. appropriate management of chronic i
disorders |
k. appropriate use of community j
resources ]
I. accountability for health maintenance ,
4. Collaborate with other health workers
in providing health-oriented care j
a. know own role and limitation j
b. refer appropriately j
c. cooperate
5. Support those policies, procedures i
and activities which promote health j
a. health-oriented institutional
philosophies ;
b. health standards and guidelines <
c. health-oriented institutional policies, ,
procedures and routines \
d. health-oriented evaluation procedures
and criteria .
e. health-oriented community and political '
involvement I
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The Canadian Nivae March 1977
mam w!)\m^®mm
An increasing number of hospitals in North America are
buying fetal monitors for the purpose of assessing fetal
health just prior to delivery. There are many who see the
use of the electronic device as a means of reducing North
America's high perinatal mortality rates. However,
continuous electronic fetal monitoring has its critics:
those who term it an 'expensive gadget', those who say it
increases the primary cesarian section rate, that its
recordings are difficult to interpret, that it constitutes a
risk to mother and fetus, or that it depersonalizes the
relationship between an obstetrical nurse and her
patient. Are fetal monitors worth the money, time,
training, and risks involved?
Ellen Hodnett
Critics of electronic fetal monitoring are
adamant in ttieir stand against its use. No one,
they say, has proven that monitoring lowers
perinatal mortality rates, adding perhaps that
disadvantages to its use far outweigh assets,
or that it only b eneflts high-risk patients. Many
hospitals buy the expensive equipment to let it
sit alone and rarely used In an unobtrusive
corner of the labor and delivery suite.
What about the proponents of fetal
monitoring, those actively Involved In its use?
As a labor and delivery nurse and instructor to
undergraduate students in maternal and
infant health, I felt that it was important to
Investigate what they had to say.
I set out to answer the questions raised
by fetal monitoring by reading about the
experiences of those who use it in a variety of
hospital settings In North America. This article
is based on the writings of those involved In
fetal monitoring and associated research.
□Ways and Means
Continuous electronic fetal monitoring
involves the use of direct or indirect techniques
to measure and continuously record both the
fetal heart rate and the activity of the uterus
during labor.
The indirect method of fetal monitoring
involves the use of two devices to be placed on
the mother's abdomen during labor: a
tochodynamometer to indicate the frequency
and duration of uterine contractions and a
transducer to measure fetal heart rate.
The technique is non-invasive,
with no inherent risks to mother or fetus. It can
be used before the rupture of the membranes,
and throughout all stages of labor.
There are some problems evident with the
use of indirect fetal monitoring. If the patient is
obese or restless, it is often difficult to obtain a
clear monitor tracing. Some patients find it
uncomfortable, and too restrictive to their
freedom of movement. The information
derived from indirect fetal monitoring is
somewhat lacking in two specific areas: it
gives no data on beat-to-beat variability, an
important indicator of fetal welfare; it provides
no information on the strength of uterine
contractions or on the resting tone of the
uterus.
The direct method of continuous fetal
monitoring is an invasive method. A uterine
catheter is inserted around the presenting part
of the fetus and lies floating in the uterine
cavity to measure the tonicity of the uterus. A
spiral electrode is attached to the presenting
part of the fetus to record the fetal
electrocardiogram.
Direct fetal monitoring provides more
specific data than the indirect technique and
allows the patient more comfort and freedom
of movement. However, the method is not
without limitations. First, the membranes must
be ruptured, the cervix one to two centimeters
dilated, and the presenting part of the fetus no
higher than -2 station. Secondly, there are
risks to both fetus (such as neonatal scalp
abscess) and to mother (such as uterine
perforation), fortunately rare in occurrence.
The procedure requires practice and technical
skill on the part of the obstetrician inserting the
catheterand electrode. Regardless of the type
of monitoring used, fetal heart rate
deceleration patterns do provide information
about the welfare of the fetus. There are three
significant deceleration patterns to watch for.
m 1 Early deceleration is thought to be
^ due to fetal head compression during
contractions. The degree of heart rate
slowing generally reflects the intensity
of the uterine contraction. Early
deceleration is usually a benign
pattern, transitory in nature and
apparently well-tolerated by the fetus.
^ 2 Late deceleration is thought to
be due to utero-placental insufficiency
and is ominous. It is frequently
associated with high-risk pregnancies,
uterine hyperactivity, and/or maternal
hypoxia.
m 3 Variable deceleration is thought
to be due to umbilical cord
compression. It is also a pathologic
pattern, but it can often be alleviated by
changing the mother's position.
\/\/hY bother :
9
1973 Perinatal Mortality Statistics *
(per
1000 live births)
Sweden
14.1
Canada
17.7
Dennnart<
14.6
Japan
18.0
Switzerland
15.5
England and
Wales
21.3
Iceland
16.3
Australia
22.4
Netherlands
16.4
Scotland
22.7
Norway
16.8
Federal Republic
of Germany
23.2
Hong Kong
17.6
• World Health Statistics Annual Vol. 1,
Vital Statistics. Geneva. Switzerland
World Health
Organization 1973-76,
Tables, pp. 15-18.
Beat-to-beat variability can only be
assessed through direct nnonitoring
techniques. This term refers to the degree
of short-term fetal heart rate fluctuations;
average variability is defined as fetal
heart rate fluctuations of 6-10 beats per
minute. Because variability is due to the
continuous interaction of the sympathetic
and parasympathetic divisions of the
autonomic nervous system, a decrease In
variability indicates fetal distress.
□Fetai Monitor vs. Fetoscope
It appears that fetal monitoring
can tell us a great deal about the
welfare of the fetus. But what about the
obstetrician who counters with the
statement, "No machine can equal the
skill of a competent labor and delivery
nurse, amned with a fetoscope? ' In a
study of 24,863 labors, the fetal heart
rate was taken every fifteen minutes
during periods in the first stage of
labor, and every five minutes during
the second stage orduring any serious
complications. However, only the most
extreme cases of fetal distress were
detected. Auscultation of the fetal
heart rate proved to be a very
unreliable indicator of fetal distress.^
Furthermore, another source has
stated that nurses relieved of
"fetoscope duty" have more time to
give emotional and physical comfort to
their patients, that fetal monitoring
need not be done at the expense of the
comfort and well-being of the mother.^
□Effect on Primary
Cesarian Section Rate
There is some controversy as to
whether fetal monitoring increases the
primary cesarian section rate. One study
indicates that monitoring resulted in a
decrease in the number of cesarian
sections necessary. Many deliveries
which would have been performed by
cesarian section because of auscultated
fetal distress are managed conservatively
because of the use of the more accurate
electronic fetal monitor. The result was
the delivery of healthy, non-depressed
babies.^
A second source showed a decrease
of about 75 percent in the primary section
rate, with a resultant decrease in the
number of depressed newborns.''
A four-year study in yet another
setting indicated a definite rise in the
number of primary cesarian sections, but
there was a corresponding reduction in
the perinatal mortality rate.^
According to Dr. Edward Hon.
variable deceleration is the offending
pattern in about 90 percent of fetuses who
have been diagnosed as "in distress." In
many hospitals, this "fetal distress"
commonly contributes to the performance
of a cesarian section. If patients were
monitored, variable decelerations could
probably be alleviated by maternal
position change, which could prevent
unnecessary cesarian sections.^
Although these sources show some
disagreement as to the effect of fetal
monitonng on the primary section rate,
they do agree that overall, perinatal
outcome is improved because of its use.
48
Th« Canadian Nurse March 1977
□ Interpretation of Recordings
Are the recordings difficult to
interpret? Again, thiere is a difference of
opinion. According to one author,
although interpretation of abnormal fetal
heart recordings may be difficult, a normal
recording is decisive evidence in ruling
out the possibility of fetal hypoxia.'
Other authors feel that fetal
monitoring techniques are simple and
convenient enough to be used routinely
on an obstetric service, and that with little
instruction there is minimal difficulty in
recognizing a variety of fetal heart
patterns and in being able to classify them
as innocuous or ominous.^
□ Who Should Be Monitored?
Many authorities recognize that fetal
monitoring is a necessity when the patient
is classified as being of "high risk." One
author found that late decelerations may
persist for only thirty minutes before the
fetus is severely compromised. ^
What about the "lov-rlsk" patient, the
well-nourished, healthy, married
twenty-two-year-old middle-class
housewife who has had excellent prenatal
care and is in labor at forty weeks'
gestation? She is not a likely candidate for
utero-placental insufficiency. However,
cord compromise is estimated to occur in
about one-third of all labors, according to
blood gas and acid-base studies.^"
In an obstetric service practicing fetal
monitoring on all patients in labor,
researchers found that fetal distress was
detected earlier, and that because of the
resulting remedial action, there was a
marked decrease in the number of
newborns with low Apgar scores." In
addition, a normal fetal heart rate pattern
has been found to be almost completely
accurate in predicting high Apgar
scores.' 2 (it should be noted here that the
five minute Apgar score is a useful
predictor of long-term neurologic
impairment). '3 In 1972, Schifrin and
Dame stated that not a single case of
sudden unexpected fetal death has been
documented on a monitored fetus.'"
In another setting, deceleration
patterns were seen in 52.8 percent of all
monitored deliveries. One hundred and
seventy eight of 749 patients showed cord
complications during labor.' ^
One report compares the perinatal
mortality rate in a large group of
monitored patients with that of a larger,
unmonitored group. Of 28,621 births,
6,923 were monitored, approximately 25
percent. For the most part, only high-risk
patients were monitored. Ordinarily, this
group would be expected to have a higher
perinatal mortality rate. But in fact, the
mortality rate in ttie monitored group was
lower than in the low-risk, unmonitored
group.'^
In another hospital, only high-risk
patients were monitored. The results
were so favorable as far as reduction in
perinatal deaths were concerned, that the
service decided to use continuous fetal
heart monitoring with all patients in
labor.''
□ Cost vs. Value
Strong evidence from several
sources suggests that total fetal
monitoring (i.e. monitoring every fetus
during labor) will halve the incidence of
mental retardation and the yearly total of
intrapartum deaths. '^ The cost of each
monitor is about $6,000. It also costs to
educate obstetric personnel in the
interpretation of monitor recordings. The
yearly increase needed to an already
tightened hospital budget would, at first
glance, make the concept of routine fetal
monitoring, seem very impractical.
In an article published in 1975,
Quilligan and Paul included a cost
analysis that included the cost of
equipment, supplies, and the training of
personnel. The added cost per patient
was estimated at approximately $35.50;
on a nationwide scale in the United
States, total fetal monitoring would cost
$100 million per year. But if is estimated
that by halving the incidence of mental
retardation, savings to the taxpayer would
be in the range of two billion dollars. It is
also estimated that 6,000 intrapartum
deaths would be prevented. Certainly
these factors should be considered when
cost of the monitors is being evaluated.
□ Weighing the Evidence
My review of the literature on
continuous fetal monitoring has
convinced me of many things:
• monitoring is not merely a fad;
• it does not necessarily depersonalize
the nurse-patient relationship and may
even enhance it;
An illustration of the indirect or
external method of fetal
monitoring. A tochodynamometer
(at the top of the patient's
abdomen) indicates the duration
and frequency of uterine
contractions. The transducer
(lower on the patient's abdomen)
indicates fetal heart rate.
References
1 Benson, Ralph C. Fetal heart rate as a
predictor of fetal distress, by ... et al. Obstet.
Gynecol. 32:2:266, Aug. 1968.
2 Beazley, John M. The active management of
labour. /Vner. J. Obstet Gynecol. 122:2:165, f^ay
15. 1975.
3 Effer, S.B. Management of high risk
pregnancy: report of a combined obstetrical and
neonatal intensive care unit. Canad. Med. Ass. J.
101:63, Oct. 4, 1969.
4 Paul, Richard H. A clinical fetal monitor, by ...
and Edward H. Hon. Obstet. Gynecol.
35:2:161-169, Feb. 1970.
5 Tutera, Gino. Fetal monitoring: its effect on ttie
perinatal mortality and caesarean section rates and
its complications, by ... and Robert Newman. A/ner.
J. Obstet Gynecol. 122:6:750-754, Jul. 15, 1975.
6 Hon, Edward H. Introduction to Fetal Heart
Rate Monitoring. Unpublished. 1975. p. 35
7 Simmons, S.C. Monitoring the fetus during
labour. Nurs. Times 68:43:1350. Oct. 26, 1972.
8 Paul and Hon, op cit. p. 168.
9 Russin, Ann Woolbert. Electronic monitoring
ofthefetus,by...etal.Amer. J. Nurs. 74:7:1299, Jul.
1974.
1 0 James, L.S. The aad-base status of human
Infants in relation to birth asphyxia and the onset of
respiration, by ... et al. J. Pediatr. 52:379, 1958.
1 1 Gabert, Harvey. Electronic fetal monitoring
as a routine practice In an obstetric service: a
progress report, by ... and Morton A. Stenchever.
Amer. J. Obstet Gynecol. 118:4:534-537. Feb. 15,
1974.
12 Schifrin, Baoy S. Fetal heart rate patterns.
Prediction of Apgar score, by. ..and Laureen Dame.
JAMA 219:10:1322-1325, Mar. 6, 1972.
13 Drage, J.S. The Apgar score as an index of
infant mortidity. A report from the collaborative
study of cerebral palsy, by ... et al. Develop. Med.
Child Neurol. 8:2:141-148, Apr. 1966.
14 Schifrin and Dame, op. cit. p. 1324-1325.
15 Gabert Harvey. Continuous electronic
monitoring of fetal heart rate during labour, by ... and
Morton A. Stenchever. Amer. J. Obstet. Gynecol.
115:920, Apr. 1, 1973.
16 Paul, Richard H. Clinical fetal monitoring vs.
effect on perinatal outcome, by ... and Edward H.
Hon. Amer. J. Obstet. Gynecol. 118:4:529-533,
Feb. 15, 1974.
17 Tutera, op. cit. p. 754.
18 Quilligan, Edward. Fetal monitoring; is it
worth it? by... and Richard Paul. Obstet. Gynecol.
45:1:96-100, Jan. 1975.
• It is inexpensive in comparison to the
long-term costs of caring for the mentally
retarded and the savings in terms of
human resources are incalculable;
• it may or may not increase the
primary cesarian section rate but it does
increase the chances for a favorable fetal
outcome;
• interpretation of the recordings is a
skill that can and should be learned by all
obstetric personnel;
• monitoring is as important to the
low-risk fetus as it is to the high-risk fetus
— while the former may not be subject to
chronic utero-placental insufficiency, he
is still at risk from cord compression ; there
is currently no way to detect cord
compression unless the fetus Is
monitored during labor.
One of my questions remains
unanswered by the literature: why do we
delay? Our perinatal mortality rate is a
cause for concern in comparison with that
of many other countries, our statistics for
cerebral palsy and other intrapartum
tragedies are appalling.
My reading convinces me that the
evidence in favor of routine fetal
monitoring is strong frnm mRdiral , ethical,
humane, and econ'. s. The
benefits to be reap rable.
Why are we in North /Amenca so slow to
insure the welfare of our greatest
resource, our unborn children? s>
TRANSCERVICAL CATHETER
Direct Fetal Monitoring
Ellen Hodnett (B.S.N., Georgetown
University, Washington, D.C.)is
presently working as Lecturer with the
University of Toronto Faculty of Nursing,
teaching second and third year students
in the undergraduate Baccalaureate
program. Prior to 1975, Hodnett was Unit
Administrator of the labor and delivery
unit of North York General Hospital in
Willowdale, Ontario.
The Canadian Nurse March 1977
of tn# unlf orm^
Living m\Jn
yidulT Still's Disease
Being on the "receiving end" of medical and nursing care instead of the "providing end" can be a
disconcerting experience for those of us who rarely assume the role of the patient. The author of "The
Other Side of the Uniform," sheds some light on the frustrations and anxieties that accompany the
unknowns of an illness such as Adult Still's Disease.
•::iii:::::::::::::::v:::::::::$;[;^^
^^^^:::^:::::::^:::::::y::v:<riHlI:^i
iii
iil
i
Yolanda Camiletti
Everything seemed to be happening to me all
at once... I had just graduated from university
with a B.Sc.N. and a B. A. in psychology, a new
job in an Emergency ward was waiting for me
and in one month I was going to be married. It
was great the way things were working out.
Although the past three months had been
stressful, I was just now beginning to get
accustomed to my new life style.
September rolled around and the hustle
and bustle of the changing season was partly
responsible for the streptococcal throat
infection that I developed. Having had throat
infections before, I thought nothing of it, and
asked the doctor I was working with for an
antibiotic. Ampicillin was prescribed. The next
day, an itchy, pink rash developed on my arms
and I felt flushed. Although I had taken
Ampicillin as a child, it now seemed that I was
allergic to it. Consequently, the Ampicillin was
discontinued and replaced with Erythromycin.
Thinking that the adverse side effects of
the Ampicillin would disappear, I was
surprised that at the end of a week, my
temperature was still elevated (38.5-39.5°C)
and the pink, itchy, rash persisted becoming
more evident at night. Another problem
occurred as well — the fingertips of my right
hand became very sore. I thought I might have
injured them somewhere but I couldn't
remember having done so.
The next day, the soreness started again
but this time in my right wrist, and became
increasingly severe so that by evening, I was in
excruciating pain. My temperature continued
to rise and the rash which now covered my
whole body was in full "bloom." My husband
took me to the emergency ward of the local
hospital. An X ray of my wrist showed no
abnormalities and it was diagnosed as "some
type of tendonitis!" The physician told me that
if it persisted, I should see my family doctor.
After a restless night's sleep, I woke up
the next morning to find that my temperature
was normal and that my rash had
Still's Disease, also known as
juvenile rheumatoid arthritis, is a chronic
systemic disease involving a wide
spectaim of manifestations. All three
forms of the disease — polyarticular,
monoarticular, and acute febrile — have
arthritis as a symptom but the pattern of
joint involvement varies widely. In some
cases, the systemic manifestations may
he more obvious than the arthritis.
I The etiology of the disease is
! unknown, but recent research suggests
that some factor, for example, a viral or
bacterial infection, triggers the normal
Inflammatory response. It may be related
to collagen and autoimmune diseases. It
occurs 2-3 times more frequently in
females than males, usually before the
onset of puberty.
The onset of the disease often
becomes manifest after physical trauma
to a joint or following an acute systemic
infection. In its early stages, one or more
joints may show signs of inflammation
with stiffness, swelling, impaired range of
motion and pain. The articular cartilage of
the joints undergoes physiological
change. Tendons, tendon sheaths,
synovial tissue and muscle tissue may
also be involved in inflammatory changes.
Systemically, Stills Disease is
characterized by severe fever (as high as
41" C), non-specific skin rashes, and
enlargements of the liver, spleen, and
lymph nodes. Anemia and cardiac
involvement may also occur. The
development of nodules is rare.
In children, the disease may cause
irreversible eye damage due to scarring
and adhesions. Certain skeletal
abnormalities may occur due to
interference with the normal rate of
growth especially in the cervical spine.
Similar signs and symptoms occur in
Lupus Erythmatosus and in allergic
reactions to medication. It is important to
rule out these diseases before making a
diagnosis of Still's Disease.
disappeared. My good fortune did not last long
however. By late afternoon, the fingers and
wrist of my left hand were becoming sore. It
seemed that the joints affected followed some
kind of symmetrical pattern.
At this point I went to see my family
physician. He felt that my symptoms were still
due to my allergic reaction to the antibiotic and
that after a couple of weeks, they would
disappear. So I waited for two weeks.
Instead of getting better, however. I got
worse. Every evening, my rash would emerge
in pink-red blotches and streaks. Some areas
of the rash were elevated, others weren't.
There seemed to be no particular pattern to it
and any area of my body that was scratched
left a rash. The unique appearance of the rash,
unfortunately, did not help the doctors in their
diagnosis.
I found that my fever was always elevated
in the evenings. More and more joints became
involved, among them, my knees, shoulders,
jaw and ankles. They began to swell and
became reddened and hot to touch. The pain
was very severe and at times would leave me
immobile.
One month after the onset of this illness,
there was still no concrete evidence to support
a specific diagnosis. So my family doctor
referred me to a rheumatologist. Every
possible blood test was done but they revealed
little. The results showed that I had an elevated
erythrocyte sedimentation rate, elevated white
blood cell count and a decreased hemoglobin.
Tests for Lupus Erythmatosus and the
Rheumatoid Factor were both negative.
During the physical examination the
rheumatologist found that my spleen was
enlarged. He also noted that I had a second
grade systolic heart murmur. Xrays all came
baek negative.
One morning, a little more than five weeks
afterthe beginning of this "conundrum" (as my
physician referred to it), I was unable to move.
My body was stiff and it caused me
considerable pain to make the slightest
movement. My doctors felt that I should be
admitted to hospital.
There were many feelings racing through
my mind at this time. I had not reached the
"why me" stage of my illness but, instead, was
in the "self-centered" here and now. I had pain
and I wanted relief from this physical condition
which was causing me discomfort and many
psychological conflicts.
For a long time, I had no certain or fixed
diagnosis. This produced feelings of anxiety
and fear. How would the doctors be able to
treat me if they didn't know what to treat? Why
didn't they know what to treat? Out of the
millions of people in the world, could I be the
only one with these symptoms?
In hospital, it was strange to be on the
other side of the uniform. I felt helpless, as
though I had lost all strength and vigor. In
familiar surroundings, where once I had been
bouncing with energy, helping the sick by
being 'useful, " I was now in the role of the
"sick patient. " The tables were turned and it
was all the more difficult for me to accept my
illness. Even the hospital bed with its side rails
which should make a patient feel secure did
just the opposite for me. It made me feel caged
in, and very separate from my husband at a
time when I really wanted to be close to
someone.
There were many physiological,
psychological and emotional problems that I
had to deal with during my illness. Some of my
feelings changed with time and reflection;
others because I was able to talk them over
with medical staff or with my family.
That fi rst evening in hospital , I was given a
number of different kinds of medication.
Unfortunately, I was allergic to one of the drugs
and developed a reaction to it. My eyes played
tricks on me, nothing seemed to be in the right
perspective, everything was hazy. I felt
nauseated and my body was covered with a
red rash. My confidence in the doctors was
dwindling rapidly. Fortunately, my husband
was able to stay with me until two o'clock that
morning. However, by morning, instead of
being better, I was worse, both physically and
mentally. I felt like signing myself out of the
hospital and going home. It seemed as though
nobody was able to help me and that I was
considered by the medical staff to be just a
■'specimen " with a rare illness.
To add to my frustration, at about nine-
thirty that morning, two teams of medical
students were given the opportunity to 'view'
my unusual rash. Although I realize that
experience is the best teacher. I resented
having ten student doctors examine my skin by
checking for blanching and elevated areas.
Besides feeling like the star of a 'freak show,' I
was extremely uncomfortable since I was in
pain. All this led me to an increasingly negative
attitude towards my illness.
Late that same afternoon, I was
transferred to a medical floor where I spent the
rest of my hospitalization. My memories of the
first five days in this room are still obscure. I
can remember the pain, nurses helping me to
the bathroom, eating and sleeping. With my
physical needs met, I had no interest in
anything else. Although I was indifferent to his
presence, my husband sat with me every day
while I would either cry or sleep.
By the sixth day, I had become more
aware of my surroundings. Out of curiosity,
fear and the hope of finding a cure for my
illness. I questioned doctors and nurses on
almost everything they did. I would get very
angry when I received the wrong X ray, a
double dosage of Prednisone or when the
nurse caring for me had no idea of what my
illness entailed.
After several weeks of physical
examinations, laboratory testing and careful
observation of my signs and symptoms, a
diagnosis of Adult Still's Disease was finally
made. According to my rheumatologist, my
treatment woukj consist of rest, medication
The Canadian Nurse March 1977
Living wWh
/Iduir Still's Disease
and time. There was no instantaneous cure
and since the cause is unknown, my doctor
was only able to treat the symptoms. The drug
of choice at this time was Prednisone 60 mg
per day.
It was not long after this that I was
discharged from hospital and returned home.
It was necessary to carry on with the medical
regime and to begin to undertake normal daily
chores. It was also important for me to realize
my own physical limitations since almost every
joint in my body was affected by the
inflammatory process. Because of this, I had to
be careful not to place too great a strain on my
joints or to exercise them too strenuously. If a
joint became reddened and sore one-half hour
after exercising, then I had gone beyond my
limitation.
By the first week of December, three
weeks after the onset of symptoms, I was sure
that I was getting better. I could walk well, my
joints caused me only minor discomfort and
my Prednisone level which the doctor had
decreased by 5mg per week, was down to 5
mg every second day.
However, two weeks later, my
temperature became elevated each night, my
rash returned, my fingers were reddened and
swollen and my other joints were sore. Again it
was necessary for me to go into hospital during
this exacerbation period. Prednisone 70 mg
per day was prescribed. I remained in hospital
until all the symptoms had stabilized.
It is now many months since my last
discharge from hospital. I am still taking
Prednisone and continue to experience mild
joint pain. I must still watch out for activities that
might put too great a strain on my joints but I
am able to do most things for myself. The side
effects of the Prednisone such as moon face,
fat deposits, weight gain and an elephant
hump at the back of my neck are still apparent
although subsiding.
To conclude, I would like to stress some
major points about Still's Disease:
• The disease itself has many unknowns.
What we do know is that this illness is not the
debilitating type of arthritis.
• , Steroids do not cure the illness but serve
only to alleviate the symptoms. It is important
for the nurse and patient to realize the many
side effects caused by this medication and to
understand the physiological and
psychological effects the drug may produce.
• Due to the drug therapy which causes the
suppression of symptoms, there is no method
of detecting the different stages of the disease.
• Steroid levels must be decreased very
slowly. A rapid decrease may cause an
exacerbation of symptoms.
Tips for patients with Still's Disease
• Relaxation — rest for 8 to 1 2 hours
per day.
• Avoid stressfulsituations, if possible.
• Know your own limitations. Only you
know how much you can do. Physical
exercise is important to maintain joint
mobility, but set your own pace.
• Take medication as prescribed.
• When joints become stiff and swol len ,
the best therapy is rest. An ice pack or hot
compress, whichever feels most
comfortable, may help.
• Although the joints may not be visibly
swollen, they may be sore.
• Use self-help devices e.g. sit on a
stool to do dishes, allow dishes to dry
themselves, use electrical appliances
such as a can opener.
• Remember, healing takes time.
Never give up. Start out slowly then
progress.*
Yolanda Camiletti, ffl.A/., S.A;, aufrtoro^The
Other Side of the Uniform, worked for three
months in an Emergency Department before
the onset of her illness. After six months of ill
health, she began the search for a new
position. She states, " Looking for work was a
very frustrating experience. The general
questions asked by employers were:
1. When do you think you will have another
flare-up?
2. Oh, you are still on medication?
3. Do you think you can stand for 12 hours of
the day?
After another six months of searching for
a position, I found an understanding
exmployer at the fvliddlesex-London District
Health Unit
At the time I started working with the
health unit, I did have another exacerbation of
symptoms. With the early recognition of
symptoms, and prompt medical care, my
recovery rate is progressing at a much faster
pace than during the previous relapses. I was
kept mobile and out of the hospital. I was also
able to hold my position at the health unit
At this point, only time will reveal the
course of my Illness. It is my greatest hope that
some day, someone, interested in
researching this disease will discover the
exact cause of the illness and perhaps even
the cure."
Bibliography
1 Beeson, Paul B. Textbook of Medicine 13ed.
by ... and Walsh McDermott. Philadelphia,
Saunders, 1971, p. 1,898.
2 MacRae, Isabel. Arthritis: It's nature and
management. Nurs. Clin. North Am. 8:643-52, Dec.
73.
3 Magalini, Sergio I. Dictionary of Medical
Syndromes, Philadelphia, Lippincott, 1971, p. 495.
Saunders fills your prescription
for excellence.
REED & SHEPPARD: Regulation of Fluid and
Electrolyte Balance: A Programed Instruction in
Clinical Physiology. New 2nd Edition
Individual self-study units progress from the least complex aspects
of fluid and electrolyte balance to the more difficult, giving you a
tsetter understanding of these problems and the appropriate pa-
tient care measures.
By Gretchen Mayo Reed, BS, MA (Ed), MA (Bio), Univ. of Tennessee Center
for the Health Sciences; and the late Vincent F. Sheppard, MEd, PhD. About
350 pp. Illustd. Soft cover. About $8.25. Ready March 1977.
Order #7513-1.
GUYTON: Basic Human Physiology: Normal
Function and Mechanisms of Disease, New 2nd
Edition
Geared to the needs of student nurses, this text presents the same
concepts and principles as in Guyton's Textbook of Medical
Physiology, but it omits most of the references to research work,
many of the qualifying explanations, and some of the references to
clinical problems. Up-dated throughout, the sections on the kid-
neys, the nervous system, and endocrines in particular have been
thoroughly reworked.
By Arthur C, Guyton, MD, Univ. of Mississippi School of Medicine, Jackson.
About 930 pp., 420 ill. About $17.00. Just Ready. Order #4383-3.
MOORE: The Developing Human: Clinically
Oriented Embryology. Sew 2nd Edition
Here's an excellent text with easily understood material, exciting
illustrations, and more thought-provoking references to clinical
conditions. This revised edition has even more pages of color
diagrams (including the popular Timetables of Human Prenatal
Development, up-dated to show the latest Carnegie Staging of
Embryos).
By Keith F. Moore, MSc, PhD, FIAC. Prof, and Chairman. Dept. of Anatomy,
Univ. of Toronto, Faculty of Medicine. About 430 pp.. 360 ill. Ready March
1977. Order #6471-7,
LEIFER: Principles and Techniques in Pediatric
Nursing, New 3rd Edition
This comprehensive clinical nursing text/reference bridges the gap
between theoretical knowledge of and practical skills in pediatric
nursing. Completely up-dated and substantially expanded, you'll
find added coverage of new equipment, inhalation therapy, dietary
considerations, poisoning, drug interactions, and a whole new
chapter on The Pediatric Outpatient and The Clinic Nurse.
By Gloria Leifer, RN, MA, formerly of Hunter College of CUNY. About 350
pp., 195 ill. About $10.05. Ready March 1977. Order #5713-3.
GILLIES & ALYN: Patient Assessment and
Management by the Nurse Practitioner
This outstanding text provides specific guidelines for developing
your skill in interviewing, physical examination, laboratory test
interpretation, and psychosocial assessment. There are also prac-
tical insights into the management of patients with chronic illnes-
ses such as hypertension, diabetes, osteoarthritis, arteriosclerotic
heart disease, obesity, alcoholism, and chronic obstructive lung
disease.
By Dee Ann Gillies, RN, EdD, the Dept. of Education, Heart and Hospitals
Governing Commission of Cook County, Chicago: and Irene B.Alyn, RN, PhD,
Univ. of Illinois College of Nursing, Chicago. 236 pp. Illustd. $9.80. April
1976. Order #4133-4.
LUCKMANN & SORENSEN: Medical-Surgical
Nursing: A Psychophysiologic Approach
In the two years since its publication, more than 125, (X)0 of your
colleagues have added a copy of Luckmann & Sorensen to their
professional libraries. Why? Because this clearly written text con-
solidates nearly all of the current thinking on medical-surgical
nursing into a single easily-read sourcebook. Coverage includes
detailed discussion of nursing measures indisordersof eachof the
major systems and precise instruction in the nursing and medical
care of patients. The pathophysiology of disease states is em-
phasized throughout.
ByJoanLuckmann. RN.BS. MA: and Karen Creason Sorensen, RN BS. MN.
1634 pp. 422 ill. $21.35. Sept. 1974, Order #5805-9.
rajw.B.
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The Canadian Nurse March 1977
]Vaine.s and Faces
Shirley Alcoe (B.A.; B.Ed.: M.A.:
M.Ed.: Ed. D.) Associate Professor,
Faculty of Nursing, University of New
Brunswick, is the new Chairman of the
Canadian Tuberculosis and
Respiratory Disease Association
Nurses' Section. She has previously
worked as a staff nurse in Port
Colborne, Ontario, Edmonton and
Ottawa and in public health in New
Brunswick. In 1965, she joined the
World Health Organization and went
to India to assist national nursing
groups to provide short courses for
nurses. Later she advised Bombay
University on Nursing Curriculum.
Alcoe has worked on planning
comm ittees for the New Brunswick TE
and RD Association and has
published several papers on health
and physical education for students.
Val Cloarec, executive director of the
Saskatchewan Registered Nurses'
Association since 1974, has resigned
effective IVIarch 4, 1977, and has
accepted the position of Director of
Vital Statistics, Department of Health,
Regina, Saskatchewan.
Cloarec is a native of
Saskatchewan and since her
graduation from Holy Cross Hospital
School of Nursing in Calgary, has
spent most of her time in the nursing
field. She has worked as a staff nurse
in hospitals in Saskatchewan and in
the Northwest Territories, as well as
having worked for the Department of
Public Health as a staff nurse, regional
nursing supervisor and nursing
consultant.
Nicole Fontaine has been appointed
Director of Public Relations Services
for the Canadian Nurses Association.
A journalist, broadcaster and
consultant, she has served, since
1970, in various capacities with the
Secretary of State, Health and
Welfare's Fitness and Amateur Sports
Directorate, Federal-Provincial
Welfare conferences, and more
recently the Official Languages
Branch and Communications Division
of the Treasury Board.
A graduate of the University of
Ottawa, her experience includes
working for the French Government in
Rabat (Morocco), newspapers in
Paris, Ottawa and Montreal, Expo '67,
advertising and town planning firms in
Quebec, Radio-Canada in Vancouver
and the 1970 British Commonwealth
Games, at Edinburgh.
Marilyn D. Wlllman has been
appointed director of the School of
Nursing, University of British
Columbia effective July I, 1977.
Willman, president of the state-wide
University of Texas System School of
Nursing, earned her B.Sc.N from the
University of Michigan In 1952. After
working as a staff nurse and clinical
instructor for six years, she enrolled at
the University of Texas where she
received her master's degree
specializing in administration in
nursing education and herdoctorate in
educational psychology. She joined
the faculty of the University of Texas in
1961.
Willman succeeds Muriel
Uprlchard, head of nursing at U.B.C.
since 1971, who has been an
outspoken critic of what she termed
the 'hand-maiden servant" role
assigned to nurses in many hospitals.
She retires June 30, 1977.
The Canadian Council of
Cardiovascular Nurses has
announced its board of management
for 1977. Members of the Executive
Committee are:
Chairman: Carolyn Stockwell,
Windsor, Ont.;
Past Chairman: Joan Breakey,
Toronto, Ont.;
Vice-Chairman: Cecile Boisvert,
Montreal, Que.:
Recording Secretary: Therese
Poupart, Boucherville, Que.;
Treasurer: Jane Wilson, Toronto,
Ont.;
Membership Secretary: Madeleine
McNeil, Dartmouth, N.S.;
Provincial representatives are:
Alberta: Kathryn Bradley, Edmonton;
British Columbia: Judith Shields,
New Westminster;
Manitoba: Gina Taam, Winnipeg;
New Brunswick: Helene Roy,
Bathurst;
Nova Scotia: Anna Freeman, Halifax;
Newfoundland: Glenys A. Whelan,
St. John's:
Ontario: Isabelle Kemp, Sudbury;
Prince Edward Island: Barbara
Baglole, Charlottetown;
Quebec: Franclne Beauchamp,
Montreal;
Saskatchewan: Toni Beerling,
Saskatoon.
Registered nurses interested in
cardiovascular health care are invited
to join the C.C.C.N. Write:
Canadian Heart Foundation, Suite
1200, One Nicholas St, Ottawa,
K1N TB7.
Rachel Palmer of Bunjul, Gambia has
been elected President of the
Commonwealth Nurses Federation.
Forty national nurses' associations of
Commonwealth countries are now
members of the Federation.
Leona Margaret Bowes has been
honored by the University of
Saskatchewan as the most
distinguished graduate in nursing at
the fall convocation.
New Appointments
Sandra A. E. Rencz. (R.N. Kingston
General Hospital, Kingston, Ontario;
B.N., McGill University) has been
appointed lecturer in nursing at The
University of New Brunswick,
Fredericton. Her primary
responsibilities at U.N.B. will be
clinical teaching in the nursery area,
pediatrics and obstetrics.
Faye Birt has recently joined the staff
of the Prince Edward Island Nurses'
Provincial Collective Bargaining
Committee as an Employment
Relations Officer. Faye, a graduate of
the Prince Edward Island School of
Nursing, was employed by the Prince
Edward Island Hospital,
Charlottetown, P.E.I., and served as
President of their Staff Association.
Patricia A. Phillips (R.N., Vancouver
General Hospital; B.Sc.N., University
of Alberta) has been appointed
MEDICO project director of a
14-member CARE/MEDICO team
that conducts training programs for
physicians, nurses and laboratory
technologists. Based in Sarakarta
(Solo), Indonesia, she will also
coordinate a newly planned
community health program which will
extend into rural areas.
Phillips has had extensive
overseas nursing experience having
worked in South Africa and with CUSO
in India and Bangladesh in
mother-child health centers and family
planning projects.
CURITY
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The Canadian Nurse March 1977
Calendar
March
Issues in Community Health to be
held March 28-April 1, 1977 at the
Academy of Medicine, Toronto. Public
Health Nurses and those interested in
community health issues invited.
Contact: Grace Batch elor,
Coordinator of Continuing Education,
Division of Community Health, Room
124, Fitzgeraid Building, University of
Toronto, Toronto, Ont., M5S lAI.
Nursing and the Law — a one-day
seminar for nurses and allied health
professionals to be held on March 19,
1977 at the University of New
Brunswick, Fredericton, New
Brunswicl<. Guest lecturer — Mr.
Lome Rozovsky. Contact: Carole
Estabrooks, President, Nursing
Society, Faculty of Nursing,
University of New Brunswick,
Fredericton, New Brunswick,
E3B 5A3.
Foundations of Hospital
Management — A three-day program
for managers from all hospital
departments. To be held in Montreal
on March 16-18, 1977 and in Toronto
on March 23-25, 1977. Tuition: $120.
Contact: R.M. Brown Consultants
1115-1701 Kllbom Ave., Cntawa, Ont.
KIN 6M8.
The Executive Nurse — A three-day
program for nurses in management
positions. To be held in Vancouver on
March 9-11,1977, and In Toronto on
April 20-22, 1977.Tuition $120.
Contact: A.M. Brown Consultants,
1115-1701 Kilborn Ave., Ottawa,
Ont., K1H 6M8.
Workshop In Psychodrama at the
Clarke Institute of Psychiatry, Toronto
on March 17-18, 1977. Contact:
Dorothy Brooks, Chairman,
Continuing Education Program, 50 St.
George St., Toronto, Ont. IVI5S lAl.
The Management of Motivation — A
two-day program for all health
services managers. To be presented
in Montreal on March 14-15, 1977.
Tuition: $100. Contact: RM. Brown
Consultants, 1115-1701 Kilborn Ave. ,
Ottawa, Ont. K1H 61^8.
Annual Meeting of the Canadian
Nurses Association, 31 March 1977,
Ottawa. Contact: The Canadian
Nurses Association, 50 The Driveway,
Ottawa, Ont., K2P 1E2.
April
The Grieving Process and the
Dying Process at the University of
Toronto on Wednesday evenings April
6 - May 25, 1977. Contact: Dorothy
Brooks, Chairman, Continuing
Education Program, 50 St. George
St., Toronto, Ont. M5S /A/.
GALVESTON ISLAND
a natural choice for Canadian nurses
r
There are reasons w/hy. THE UNIVERSITY OF TEXAS
MEDICAL BRANCH HOSPITALS spai 80 acres of the Island,
and serve Texas as its largest general acute care referral center.
You'll discover that all major nursing specialty and sub-specialty
areas are available here. Let us supply you with more reasons
nurses are choosing Galveston. Our representatives will be in
Canada in early April. To vurite for locations, contact: Gary
Clark, Dept. of Nursing, UTMB Hospitals, Galveston, Texab
77550.
An equal opportunity m/f affirmative action employer.
First international Congress on
Toxicology to be held March 30 -
April 2, 1977 in Toronto, Ontario.
Contact: Dr. Robert G. Burford,
Secretary, ICT, do G.D. Searle & Co.
of Canada Ltd., 400 Iroquois Shore
Road, Oakville, Ontario. L6H 1M5.
May
intensive Care Symposium.
Lectures in Cardiology, Neurology,
Respiratory Problems, and
Hyperalimentation. To be held at
Selkirk College, Castlegar, B.C., on
May 28-29, 1977. Contact: Ms Sandra
Rubin, Kootenay Lake District Hospital,
3 View St, Nelson, B.C.
Oncology Nursing Society Second
Annual Convention to be held in
Denver, Colorado on May 15-16,
1977. Contact: Ms. Daryl f^aass.
Secretary, Oncology Nursing
Society, N.Y.U. Ivledical Center, 560
First Ave., New York, N.Y. 10016.
Getting Through to People — A
two-day workshop to improve
communication skills. To be held In
Toronto on May 9-10, 1977. Tuition:
$120. Contact: R.M. Brown
Consultants,1 115-1701 Kilborn Ave.,
Ottawa, Ont. K1H 6M8.
The Educator-Manager — A
three-day program for directors,
coordinators and instructors in staff
development and inservice education
departments, to be held in Toronto on
May 11-13, 1977. Tuition:$120.
Contact: R.M. Brown Consultants,
1115-1701 Kilborn Ave., Ottawa.
Intensive and Rehabilitative
Respiratory Care presented by the
Pulmonary Division of the University
of Colorado Medical Center, Denver,
Colorado, May 23-27, 1977. Fee:
$150. Contact: American College of
Chest Physicians, 911 Busse
Highway, Park Ridge IL, 60068.
Association for the Care of
Children In Hospitals Annual
Conference, "Speaking Out for
Children,' in Dearborn, Mich., May
25-28. 1977. Contact: Mary F.
Podolak. R.N., Children's Hospital of
Michigan, 3901 Beaubien Blvd.,
Detroit, Michigan 48201.
Nursing Care of the Patient
with Burns by Florence Jacoby.
(2ed.) St. Louis, C.V. Mosby.
1976.
Approximate price $7.30.
Reviewed by Mary Shields, R.N.,
B.Sc.N., Clinical Instructor,
School of Nursing, University of
Alberta Hospital.
A bool< devoted to nursing care of
a patient with burns is very rare
and consequently the new edition of
Florence Jacoby's text was most
welcome.
As in the first edition, Jacoby
covers general topics such as the
incidence of burns, and the history of
burn treatment. She also discusses
specifics in anatomy,
pathophysiology, nutrition,
complications, and related nursing
care.
The bool< is written in an
easy-flowing style, but is very detailed
in topic coverage in its 1 75 pages.
I was pleased to see two new
chapters included in the second
edition. One of these deals with the
volume and composition of fluid
therapy. This chapter opens up the
controversy concerning what kind of
fluid and how much of it is to be given
to burned individuals during the acute
phase of their illness.
The second new chapter is called
a Teaching Appendix. It is divided
into theoretical and clinical objectives.
with review topics and content clearly
and concisely listed. As is stated:
"They can be adapted to fit
undergraduate, graduate, in-service,
and continuing education programs.'
In the remainder of the book, I
discovered a very thorough updating
of all topics. Where relatively new
advances have been made, (for
example in topical antibio' :s -snd
debriding enzymes) Jacorv has
thoroughly cove-'ed the
pathophysiolr~v and nu- rig
implications of thesr advances.
Statistical references and
bibliographies have oeen extended
and updated.
I would have no hesitation in
recommending this text to any nurse
who is interested in helping to further
the care of a burned patient.
Discussing Death: A Guide to
Death Education by Gretchen C.
Mills, Raymond Reisler, Jr., Alice
E. Robinson and Gretchen
Vermilye, 140 pages, Illinois,
ETC Publications, 1976.
Approximate price: $5. 50
Reviev/ed by Larry Schruder,
Instructor, Social Sciences,
Algonquin College Nursing
Program, terrain Centre,
Pembroke, Ontario.
Social scientists, nursing
educators, teachers and the public are
becoming progressively more aware
of the alarming paucity of information
that humems possess regarding the
topic of death, and the lack of
awareness of their own feelings and
attitudes about it. Discussing Death
starts from this realization and does an
admirable job at suggesting ways and
means of correcting this situation. It
joins a very small, select group of
publications that centers on
techniques for educating on the topic
of death.
The authors have presented their
information in a style that is written
primarily for teachers. It is a resource
txjok dealing with mawiy aspects of the
topic of death, but it is not structured
as a death education course. The
guide IS separated into four age levels:
5-6 years, 7-9 years, 10-12 years, and
13-18 years, and presents material
and experiences that would be most
relevant at each level. The comments
at (he beginning of each age unit
briefly summarize the typical
conception of death held by the child
at this devekjpmental level. Each
learning experience is organized into
Opportunity, Objectives, Activities and
Notes to Teacher, Complete
bibliographical information follows
3ach of the four age levels Within
each age unit, the learning
experiences are presented in a
somewhat sequenti-il fashion from the
basic to the more difficult concepts.
The material dealing with the
elementary school-age child occupies
approximately one-half of the book
and provides refreshing avenues for
introducing the topic of death to this
group. It has an excellent focus on
feelings and would be a tremendous
resource for an innovative elementary
school teacher or a concerned parent.
The remainder of the book
examines techniques and themes for
use with young adolescents. Although
the feeling, experiential, and
awareness measures are still
incorporated, there is a greater
inclusion of factual or informational
material on the topic of death. Literary
themes are used to direct the
discussion of death issues. I had some
difficulty with such a strong literary
emphasis, although an appendix
section gives the wary {such as
myself), some pointers on its efficient
use.
As an instructor in Death
Education courses, I found this
publication refreshing, with some
innovative techniques and resources.
I particularly enjoyed the
feeling-centered approach of many of
the ideas because I see this as being a
crucial element of any death
education endeavor. Although it is
primarily geared for the e'ementary
and secondary level, Discussing
Death (with some selection and
modification) would enrich any
instructional work on the topic of death
in the health and nursing area. It could
serve as a valuable resource to those
who see a need to educate in this
area, but who question their courage,
insight or ideas to implement a
constructive program on their own.
Did you know ...
The Alcoholic is a 38-page booklet
examining some aspects of the
alcoholic and his problems. Write to:
The Ontario Blue Cross, 150 Ferrand
Drive, Don M/7/s, Ontario, M3C 1H6.
SPECIAL
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Send cheque or money order to:
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The Canadian Nurse March 1977
Canesten
Antifungal and clotrimazole
trichomonacidal agent
PRESCRIBING INFORMATION
INDICATIONS Canesten Cream and Solution Topical
treatment of the following dermal infections tmea pedis,
tinea cruris and tinea corporis due to T rubrum, T menla-
grophytes and Epidermophyton floccosum. candidiasis due
to C albicans, tmea versicolor due to Malassezia furfur
Canesten Vaginal Tablets Treatment of vaginal candidiasis
and tnctiomoniasis Canesten Vaginal Tablets may be used
in both pregnant and non-pregnant women as well as m
women taking oral contraceoti».es (See Precautions)
DOSAGE AND ADMINISTRATION Cream and Solution
Thinly apply and gently massage sufficient cream or solu-
tion into tfie affected and surrounding skin areas twice
daily, in the morning and evening
For vulvitis. Canesten Crearr shou'd be applied to the vulva
and as far as the ana '■egior Fc ba:anttis and prevention of
vaginal infection or remfectior bv 'he partner. Canesten.
Cream should be applied to tne y'ans penis
Vaginal Tablets One tablet a day for six consecutive days
Using the applicator, insert one tablet deep mtravaginally.
preferably at bedtime In order to avoid treatment during
menstruation it rs suggested that treatment be started at
least 6 days prior to the anticipated menstrual period
DURATION OF TREATMENT Cream and Solution The
duration of therapy vanes and depends on the extent and
localization of the disease Generally clinical improvement
with relief of pruritus usualtv occurs within the first week of
treatment Tmea infections requ. re app' ox-ma tely 3 4 weeks
of therapy while in candidiasis. 1 -2 weeks treatme'ii is often
adequate If no clinical im prove rr-.e"^! is observed after 4
weeks, the diagnosis should be reviewed
If a cure is not mycotogically co-ifirmed or in order that
relapses may be prevented iparticularly m mycoses of the
foot), treatment should, as a rule, be continued for 2 weeks
after all clinical symptoms have disappeared
Vaginal Tablets The six-day therapy may be repeated if
necessary
SPECIAL REMARKS Cream and Solution Added hygien-
ic measures are of special importance m the management
of the often refractory fungal diseases of the fool To avoid
trapped moisture, the feet — particularly between the toes
— should be dried thoroughly after washing
Onychomycoses owing to their location and physiological
factors, generally respond poorly to topical antimycotic
therapy alone due to poor penetration into horny substance
Treatment with Canesten may be considered m cases of
paronychia and as adjunctive therapy in onychomycoses
following extraction or ablation of the nad
Vaginal Tablets Added hygienic measures such as twice
daily tub baths and avoidance of tight underclothing is
highly recommended
In the case of clinically significant tnchomonal infection,
additional therapy with a systemic trichomonacidal agent
should be considered Such therapy is essential for the
treatment of vaginal infections which may also involve
Bartholin s glands and the urethra
CONTRAINDICATIONS Except for possible hyper-
sensitivity, Canesten Solution Cream and Vaginal Tablets
have no known contraindications
PRECAUTIONS As with all topical agents, skin sensitiza-
tion may result Use of Canesten topical preparations should
be discontinued should such reactions occur, and approp-
riate therapy instituted
Canesten Solution and Cream are not for ophthalmic use
Canesten Vaginal Tablets are not for oral use
Use m Pregnancy Although intravaginal application of
clotrimazole has shown negligible absorption from both
normal and inflamed human vaginal mucosa, Canesten
Vaginal Tablets should not be used m the first trimester of
pregnancy unless the physician considers it essential to the
welfare of the patient
The use of the supplied applicator may be undesirable m
some pregnant patients, and digital insertion of the tablets
IS an alternative which should be considered
SIDE EFFECTS Large scale clinical trials haveshown that
Canesten is very well tolerated after topical and vaginal
application
Cream and Solution Erythema, stinging, blistering, peeling,
edema, pruritus, urticaria, and general irritation of the skin
have been reported infrequently
Vaginal Tablets Skin rash, lower abdominal cramps, slight
urinary frequency, and burning or irritation in the sexual
partner, have occurred rarely In no case was it necessary
to discontinue treatment with Canesten Vaginal Tablets
AVAILABILITY Canesten Solution }% is supplied in 20 ml
plastic bottles, m carton Each ml contains 10 mg of
clotrimazole in a non-aqueous vehicle
Canesten Cream 1% is supplied in 20 g tubes, in carton
Each g contains 1 0 mg of clotrimazole m vanishing cream
base ^
Canesten Vaginal Tablets 100 mg are supplied in boxes
containing one strip of six tablets with plastic applicator and
patient leaflet of instructions.
REFERENCES 1 Lohmeyer. H , Postgrad Med J , 50
SuppI 78. 1 974 2, Schnell. J D Ibid . p 79 3 Legal
HP , Ibid . p 81 4 Widholm. 0 , Ibid . p 85 5 Couch-
man. J M fbid., p 93 6 Higton, B K Ibid p 95 7
Dates. J K . Ibid , p 99 8 Masterion, M B , et al Curr
Med Res Opm . 3, 83, 1975 9 Sawyer. PR et al
Drugs. 9 424. 1975 10 Postgrad Med J , 50 SuppI
54-76. 1 975
For further prescribing information please consult the
Canesten Product Monograph or your Boehnnger Ingelheim
representative
FBA Pharmaceuticals Ltd.
Distributed by:
Boehringer Ingelheim (Canada) Ltd.
2121 Trans Canada Highway
Dorval. P.O. H9P 1J3
See advertisement on page 17.
Librarij Update
Publications recently received in the Canadian
Nurses' Association Library are available on /oan —
with the exception of items mar1<ed 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 by letter giving author, title and item number in this
list.
If you wish to purchase a book, contact your
local bookstore or the publisher.
Books and documents
1 . Archer, Sarah, Ellen. Community health nursing;
patterns and practice, by., and Ruth Fleshman.
North Scituate, Ma., Duxbury Pr., c1975. 441 p.
2. Association of Registered Nurses of
Newfoundland. Annual meeting programme and
folio of reports 1976. St. John's, 1976. 112p.
3. Auertiach, Stevanne. Child care: a
comprehensive guide, edited by. ..with James A.
Rivaldo. New York, Human Sciences Press, c1976.
2v.
4. Canadian Council on Hospital Accreditation.
Guide to hospital accreditation. Toronto, 1977.
128p.
5. Canadian Council on Social Development.
Community multi-service centres; summary of
recent developments in the delivery of personal
health and social services and report of meeting on
community multi-service centres, Vancouver 1976.
Ottawa, C1976. 127p.
6. Canadian Heart Foundation. Heart: facts &
figures. Ottawa, 1976. 12p.
7. Care for the injured child, by the Surgical Staff,
the Hospital for Sick Children, Toronto. Baltimore,
Md., Williams and Wilkins, c1975. 444p.
8. Carter, Novia. Evaluating social development
programs, by. ..with Brian Wharf. Ottawa, Canadian
Council on Social Development, 1973. 161p.
9. Citizen evaluation of mental health services: a
guidebook for accountability, by Val. D.
MacMurray... et al. New York, Human Sciences
Press, C1976. 124p.
10. Le Conseil canadien de D6veloppement social.
Les centres communautaires de services
polyvalents; resume des d6veloppements r6cents
de la prestation de services sociaux, sanitaires,
personnels et rapport sur la reunion relative aux
centres communautaires de services polyvalents,
Vancouver 1976. Ottawa, c1976. 146p.
1 1 . Ethics and health policy, edited by Robert M.
Veatch and Roy Branson Cambridge, IVIa.,
Ballinger, c1976. 332p.
12. Gartner, Alan. The preparation of human
service professionals. New York, Human Sciences
Press, C1976. 272p.
1 3. Morris, Terry. The story off^EDICO; a service of
CARE. Baltimore, Md., Waverley Press, 1976. 62p.
14. National League for Nursing. Council of
Baccalaureate and Higher Degree Programs.
Accountability and the open curriculum in
baccalaureate nursing education. Papers
presented at a Workshop.. .in February 1976 at
Denver, Colorado, New York, 1976. 48p. (NLN
Publication no. 15-1628)
15.—. Dept. of Baccalaureate and Higher Degree
Programs. Curriculum in graduate education in
nursing: Pt 2. Components in the curriculum
development process. New York, 1976. 64p. (NLN
Publication No. 15-1632)
16. O'Bryan, K.G. Les langues non officielles;
6tudes sur le multiculturaiisme au Canada,
par...J.G. Reitz and O.M. Kuplowska. Ottawa,
Ministre des Approvisionnements et Services
Canada. c1976. 294p.
1 7. — . Non-official languages; a study; a study in
Canadian multi-culturism, by... J.G. Reitz and O.M.
Kuplowska. Ottawa, Ministerof Supply and Services
Canada, c1976. 275p.
18. Organization for Economic Co-operation and
Development. Reviews of national policies for
education; Canada. Paris, 1976. 264p.
1 9. Organisation mondiale de la Sant6. I^at^riel de
r6f4rence destine aux auxiliaires sanitaires et a
leurs enseignants. Geneve, 1976. 97p. (OMS
Publication Offset no. 28)
20. Padilla, Geraldine V. Interacting with dying
patients; an inter-hospital nursing research and
nursing education project, by... Veronica E. Baker
and Vikki A. Dolan. Duarle, Ca., City of Hope
National Medical Center, 1975. 21 9p.
21. Roche, Douglas. Justice not charity; a new
global ethic for Canada. Toronto, McClelland and
Stewart, c1976. 127p.
22. Les toxicomanies autres que I'alcoolisme.
Guide de diagnostic et de traitement, 6d. 4, revue et
mise ci jour. Montreal, Corporation professionnelle
des m6decins du Qu6bec, 1976. 54p.
23. Victorian Order of Nurses for Canada. Report
1975. Ottawa, 1976. 80p.
24. World Health Organization. Reference material
for health auxiliaries and their teachers. Geneva,
1976. 97p. (WHO Offset Publication no. 28)
Pamphlets
25. Association canadienne contre la tuberculose et
les maladies respiratoires. Rapport 1975/76.
Ottawa, 1976. 14p.
26. Botterell, E.H. A model for the future care of
acute spinal cord injuries, by... etal. Ottawa, Royal
College of Physicians and Surgeons of Canada,
1975. pp. 193-218.
27. Canadian Tuberculosis and Respiratory
Disease Association. Report 1975/76. Ottawa,
1976. 14p.
28. Day care: problems, process, prospects, edited
by Donald L. Peters. New York, Human Sciences
Press, C1975. pp. 135-222.
29. Thomson, S.A. Common pediatric surgical
lesions, by. ..and J.C. Fallis. Toronto, Hospital for
Sick Children, Emergency Dept., 1976. 36p.
30. National League for Nursing. Dept. of
Baccalaureate and Higher Degree Programs.
Baccalaureate programs accredited for public
health nursing preparation 1976-77. New Yori<,
1976. 21p. (NLN Publication no. 15-1313)
31. — . Dept. of Practical Nursing Programs.
Practical nursing career; information about
state-approved schools of practical nursing
1976-77, New York, 1 976. 37p. (NLN Publication no.
38-1328)
Government documents
Canada
32. Advisory Council on the Status of Women. Birth
planning. Ottawa, 1976. 16p. (The Person Papers
series no. 4)
At Last... \
a Canadian supplier t
for nurses needs
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chase (except walch) (State initials
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STETHOSCOPES
Dual-Head Type - mo prerty
colours Exceptional sound
:r3nsrnisS'on adjustable hgtil-
Meighf b'naurais Mas bolh
diaphragm and Ford type bell
Mith NON-CHILL r<ng Com-
plete wtth spare diaphragm and
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Diaphragm Type As above
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SPHYGMOMANOMETERS
Mercury type. The uiitmaie
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OTOSCOPE SET
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SCISSORS* FORCEPS
LISTER BANDAGE SCISSORS.
4 mus' >or e^cv f^urse
Manufactured of finest steel and
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»699 4 :' S2.93
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=7104 IRIS scissors $3.65 each
FORCEPS
Finest Stainless Steel 5 long
Kelly Forceps »724 Straight, box-locK S4.69 each
Keiiy Forceps ■725 Curved, box-lock $4 69 each
Thumb Dressing b741 Straight serrated $3.75 each
NURSES WATCH
A dependable attractive watch Full
"umbers on white face Sweep
second hand Chrome case stainless
steel back Jewelled movement
Di'ack leather strap f yr guarantee
=900 $18.50
MEDICAL DICTIONARY e/aksfon 5
Gould Medical D'Clionary The standard reference
'or the medical professions
A hugebook — '826 pages $24.20each.
^CCxETED-r 0^^-964pages $11.95each.
NURSES PENLIGHT Powerful beam for
examination of throat etc Chrome case with pocket
clip %2A9 with batteries.
THERMOMETERS Ceis^uS type n .na-
. dual piasrc zasG%^.ZO each. $11.00 doz-
INSTITUTIONAL NURSES:wr,,eor,
.Our Co^ipany letlefHeaa *0f ow catalogue
Ge^'e'CL-s :::scou'^!5 ava at- ^
SEND TO EQUITY MEDICAL SUPPLY CO
PC BOX 726.S, BROCKVILLE. ONT K6V 5V8
Colour [ Price j Amount
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ONTARIO RESIDENTS ADD 7- TAX
ADDSOC HANDLING CHARGE I* LESS THAN S10
IF COD ORDER — ADD $2 00
TOTAL ENCLOSED MO CHEQUE CASH
USE A SEPARATE SHEET OF PAPER IF NECESSARY
33.— Fringe benefits. Ottawa. 1976. 16p. (The
Person Papers senes no. 3)
34. — . Regarding rape. Ottawa. 1976. 16p. (The
Person Papers series no. 2)
35. Biblioth6que nationale du Canada. Rapport
annuel du directeur g^n^ral, 1975/76. Ottawa,
Ministre des Approvislonnements et Services
Canada. 1976. 61 p.
36. Le Conseil consultatif de la Situation de la
Femme. Le cas du viol. Ottawa, 1976. 16p.
(Dossiers Femmes no. 2)
37. — . Planification des naissances. Ottawa, 1976.
16p. (Dossiers Femmes no. 4.)
38. National Library of Canada. Report of the
national librarian 1975/76. Ottawa, Minister of
Supply and Sen/ices Canada, 1976. 61 p.
39. Sant6 et Bien-etre social Canada. Protection de
la Sant6. Les malades liees a I'usage du tabac au
Canada: les tendances de la mortalite cancer du
poumon. Ottawa, 1976. 16p. (Son Rapport
technique no. 3)
40. Statistics Canada. Hosp/fa/ sfahsf/cs. Vol. 1.
Beds, services, personnel, 1973. Ottawa, 1976.
293p. R
41. — . Hospital Statistics. Vol. 2. Expenditures,
revenues, balance sheets, 1973. Ottawa, 1976.
142p. R
42.—. Hospital statistics. Vol. 3. Indicators. 1973.
Ottawa, 1975. 102p. R
43. Statistique Canada. La statistique hospitali^re.
Vol. 1. Uts, services, personnel, 1973. Ottawa,
1976. 142p. R
44. — . La statistique hospitali^re. Vol. 2. D6penses,
revenus, bilans hospitallers, 1973. Ottawa, 1976.
293p. R
45. — . La statistique hospitali6re. Vol. 3.
Indicateurs, 1973. Ottawa, 1975. 102p. R
Nova Scotia
46. Council of Health. Committee on Professional
Licensure, fleporr. Halifax, 1976. 69p.
Ontario
47. Ministry of Health. The clinical specialists in
psychiatric and community mental health nursing in
Ontario. Toronto, 1976. 12p.
48. Ministry of Labour. Research Branch. O.H.I. P.,
major medical, prescription and dental plans in
Ontario collective agreements. Toronto, 1976. 15p.
(Bargaining information series, no. 16)
49. — . Paid vacations and paid holidays in Ontario
collective agreements. Toronto, 1976. 23p.
(Bargaining Information series, no. 15)
50. — . Reporting, call-back and stand-by pay; shift,
Saturday and Sunday premiums, and work
clothing, safety equipment and tool allowances in
Ontario collective bargaining agreements. Toronto,
1976. 12p. (Bargaining information series, no. 11)
Quebec
51. Minist6re des Affaires sodales. Cours sur la
grossesse et I' accouchement: memoire d'intention
sur I'implantation progressive du programme.
Ou6bec, 1975. 127p.
52. — . Orientations generates en sant6
communautaire. Qu6bec, 1973. 106p.
53. — . Comit6 d 6tude sur la r6adaptation des
enfants et adolescents plac6s en centres d'accueil.
Rapport. Quebec, 1975. 173p.
54. R6gie de I'assurance-maladie. Statistiques
annuelles, 1975. Qu6bec, 1976. 182p.
Studies deposited In CN A Repository Collection
55. Cunningham, Rosella. An analysis of the
application of the concept family-centered care in
public health nursing visits. Toronto, Faculty of
Nursing, University of Toronto, 1976. 68p. R
56. Perron. Marie-Reine, Sister. Report on survey.
A project undertaken at a large hospital located in a
metropolitan city in Ontario, by Sister
Sainte-Honorine. London, Ont. 1970. 76p. (Thesis
(M.Sc.N.) — Westem Ontano) R
THE JOB-FINDER
Use it to find a better
career in nursing.
Job-hunting? Here's where to starti
The new 1977 edition of Nursing Op-
portunities* is a unique 8 X 11" guide to
professional employment. It tells you
about hundreds of hospitals and insti-
tutions in the U.S. . . . with positions
open for registered nurses.
Here is the up-to-date job information
you want and need. About hospital
sizes, facilities, and locations. Affilia-
tions. Salary policies. Benefits like in-
surance, pension plans, education, va-
cations. Plus all this:
• Expert advice on how to select the
right job, secure out-of-state licens-
ure or endorsement, write letters of
application.
• Free "Action" Cards — simply fill in
and mail to receive specific data on
the hospitals of your choice . . .
quickly and confidentially.
• Geographical index of hospitals.
• Questions to ask on your interviews;
what to take with you.
Cost for the complete Nursing Oppor-
tunities service, just 54. 50. Order today.
NURSING OPPORTUNITIES*
An RN Publication
\ursing Opporlunities® . Box 541 s;q
Westuood. \ I. 07675 US
Please send copies oi 1977 Nursing
Opportunities @ $4.50 each.
Enclosed find S check or money
order.
-Xddre^i
The Canadian Nurse March 1977
ClassifM^cl
Aclvortiseiiients
British Columbia
United States
Faculty — New positions (4) in 2-year post-basic baccalaureate
program in Viclona, BC . Canada. Generalist in focus, clinical em-
phasis on geronlology in community and supportive extended care
units. Public Health nursing and Independent study provide opportu-
nity to work closely with highly-qualified and motivated RN. students.
Teaching creativity and research are strongly endorsed. Masters
degree, leaching and recent clinical experience in gerontology/med -
Surg, /psychology/rehabilitation preferred. Salaries and fnnge bene-
fits competitive; an equal opportunity employer for qualified persons
Positions available NOW. Contact; Dr. Isabel MacRae, Director,
School of Nursing, University of Victona. Victona, Bntish Columbia.
V8W 2Y2.
Operating Nurse required for an 87-bed acute care hospital m Nor-
thern B C. Residence accommodations available. RNABC policies m
effect. Apply to: Director of Nursing, Mills Memorial Hospital, Terrace.
British Columbia. V8G 2W7.
General Duty Nurses for modem 35-bed hospital located in south-
ern B.C. s Boundary Area with excellent recreation fadlilies, Salarv
and personnel polfaes in accoroance with RNABC. L-omfortable
Nurse s home. Apply Director of Nursing, Boundaiy Hospital. Grand
Forks, British Columbia. VOH IHO.
Experienced General Duty N urse for modem 1 0-bed hospital situa-
ted on the beautrful West Coast of Vancouver Island. Accommodation
$100.00 per month. Apply: Administrator, Tahsis Hospital. Box 398.
Tahsis, British Columbia, VOP 1X0.
Manitoba
Director of Nursing. Applications invited for the position of Director of
Nursing for 23-bed, gen, hospital (accredited). Preference given to
applicants with formal administrative educaton and experience. Sa-
lary in line with qualifications and MHSC approval. For details apply to:
Administrator. Shoal Lake District Hospital, Shoal Lake. Manitoba,
ROJ IZO. Phone: 759-2336.
New Brunswick
Instructors reqiired for two year IrxJependent Diploma Program in
Nursing. Enrollment 230 students. Faculty required June-July 1977.
Contact: Miss Anne D. Thome, Director, Saint John School of Nur-
sing. P.O. Box 187. Saint John, New Brunswick. E2L 3X8.
Quebec
Registered Nurse required for co-ed chiWren's summer camp in the
Laurentians (seventy miles north of Montreal) from late June until late
August 1977. Call (514) 487-5177 or write: Camp MaroMac. 5901
Fleet Road, Hampstead, Montreal, Quebec. H3X 1G9.
Nurses for Children's Summer Camps in Quebec. Our member
camps are located in the Laurentian Mountains and Eastern Town-
ships, within 100 mile radius of Montreal. All camps are accredited
members of the Quebec Camping Association. Apply to: Quebec
Camping Association. 2233 Belgrave Avenue, Montreal. Quebec.
H4A 2L9. or phone 489-1541.
Saskatchewan
Director of Nursing requi red for a 1 0-bed general hospital 35 miles
N.W of Saskatoon, Salary and personnel policies according to S.U.N,
contract. Accommodation available tn residence. Apply: Director of
Nursing, Borden Union Hospital, Borden, Saskatchewan, SOK ONO.
University of Saskatchewan. Term and regular appointments m
Maternal-Child. Pnmary Care. Community and Mental Health Nur-
sing. To teach in four-year basic and three-year pest diploma pro-
grams and implement revised curhculum. Master s or higher degree
and experience m clinical field for appointment at protessonal ranks;
Baccalaureate degree and experience for appointment as lecturer.
Starting date: Summer 1977. Contact: Dean. College of Nursing,
University of Saskatchewan. Saskatoon, Saskatchewan. S7N0W0.
Registered Nurses — Dunhill. with 200 offices in the USA., has
exciting career opportunities tor both new grads and experienced
R.N.s. Send your resumd to: Dunhill Personnel Consultants. No. 805
Empire Builaing, Edmonton, Alberta. T5J 1V9. Fees are paid by
employer.
Registered Nurses — Huriey Medical Center Is a well equipped,
modern , 600-bed teaching hospital offering complete and specialized
services for the restoration and preservation of the community's
health. It also offers orientation, in-service and continuing education
for employees. It is involved in a building program to provide better
surroundings for patients and employees. We have immediate ope-
nings for registered nurses in such specialty units as Cardio- Vascular.
Operating Rooms, Nurseries, and General Medical-Surgical areas.
Hurley Medical Center has excellent salary and fringe benefits. Be-
come a part of our progressive and well qualified work force Today.
Apply: Nursing Department. Mr. Garry Viele, Associate Director of
Nursing, Hurley Medical Center, Flint, Michigan 48502. Telephone
(313) 766-0386.
Nurses — RNs — Immediate Openings in Florida — Arlcansas —
California — If you are expenenced or a recent Graduate Nurse we
can offer you positions with excellent salaries of up to $1160 per
month plus all benefits. Not only are there no fees to you whatsoever for
placing you, but we also provide complete Visa and Licensure assis-
tance at also no cost to you. Write immediately for our application even
if there are other areas of the U.S. that you are interested in. We will
call you upon receipt of your application in order to arrange for fxispital
interviews. Windsor Employment Agency Inc.. P.O. Box 1 1 33. Great
Neck. New York 11023. (516-487-2818).
Hospital Affiliates
International Inc.
NURSING
CAREERS
United
states
Hospital Affiliates International, tfie leader
in tfie field of fiospital management, has
over 70 hospitals In operation or under
construction in 23 States.
On-going opportunities exist for Canadian
citizens who have graduated from an
accredited Canadian School of Nursing.
Openings exist in all clinical areas.
If you are considering working in the
United States, and have an interest in
associating yourself with one of our
hospitals, please contact our Canadian
representative who will be pleased to
discuss your specific needs. All enquiries
will be treated in confidence and should
be directed to:
DOW-CHEVALIER
SEARCH CONSULTANTS
365 Evans Ave., Toronto M8Z 1K2
416-259-6052
Nursing Supervisor
Nursing Supervisor
required for an active
treatment accredited
hospital.
For information apply to:
Director of Nursing
Lioydminster Hospital
4611 - 48 Avenue
Lioydminster, Saskatchewan
S9V 0Z5
or Phone: 825-2211
Advertising
rates
For Ali
Classified Advertising
$15.00 for 6 lines or less
$2.50 for each additional line
Rates for display
advertisements on request
Closing date for copy and
cancellation is 6 weeks prior to 1st
day of publication month.
The Canadian Nurses Association
does not review the personnel
policies of the hospitals and agencies
advertising In the Journal. For
authentic information, prospective
applicants should apply to the
Registered Nurses' Association of
the Province in which they are
Interested in working.
Address correspondence to:
The Canadian Nurse
1
50 The Driveway
Ottawa, Ontario
K2P 1E2
^
The Canadian NurM Marcn 1977
FOOTHILLS
HOSPITAL
HEAD NURSE
This individual will be di rectly involved with the management of
nursing care of the high risk neonate in a family centered
maternity care unit of a University Teaching Hospital.
The successful candidate will have a BScN with a minimum of
two years working experience in neonatal care. A completed
University Program in Nursing Service Administration would
also be prefen-ed.
Qualified applicants are Invited to reply sending a
complete resume and salary expectations to:
Personnel Department
Foothills Hospital
1403- 29 Street N.W.
Calgary, Alberta
T2N 2T9
O.R. Nurse?
Switzerland needs you!
You've been promising yourself atrip to Europe for quite
some time now, haven't you? So why not come with us
to work and play in Switzerland, the very heart of
Europe, you can travel all you want or ski all year round.
And you'll earn the highest salaries in Europe to go with
it - up to SF2,700 (approx. SC1, 102.95) plus 4 weeks
holiday and 8 public holidays.
We can offer you many Interesting jobs in various towns
throughout French-speaking Switzerland. Contracts are
for one year - renewable if you wish. We ask for a fair
knowledge of French - an intensive 1 month course can
be arranged in London if you need to brush up a little. So
If you have at least one years experience as an O.R.
nurse, write to us. We'll arrange your work permit and
trip for you. You won't regret it!
For further information write tor-
Miss Susan Bentley, SRN
Administrator
BNA International
Trafalgar House
11 Waterloo Place
London SW1Y4AU
England
TWO CAREER OPPORTUNITIES AVAILABLE AT
ONE OF CANADA'S LEADING TEACHING HOSPITALS
1 .Clinical Nursing Head for Intensive
Care Services
Clinical Areas Include:
a) Intensive Care Medicine
b) Coronary Care
c) Cardio Vascular Thorocic Surgical Area
(Cardiac Surgery)
d) Intensive Care Surgery
The successful applicant will have the opportunity to provide
nursing leadership and functioning clinically in:
• Cardiac Surgery Team
• Renal Team
• Cardiology Team
• Neuro-Surgery Team
• Respiratory Team
Qualifications:
a) Advanced academic preparation
b) 5 years clinical experience preferred
c) management experience
Position Open: May, 1977
2.lnservice Instructor — Maternal
and Child Health
The successful applicant will work in conjunction with the
Nursing Coordinator and Clinical Nursing Head in the planning
and implementation of Orientation of New Staff, Continuing
Education, Specific In-Service and Skill Training Sessions for
all units in the perinatology department which consists of:
• Intensive and Intermediate Care Nurseries
• Labour and Delivery (including fetal Intensive Care)
• Ante Partum — Post Partum
Qualifications:
a) a minimum of 2 years perinatology experience
b) a Baccalaureate degree
c) teaching experience
Eligibility for registration with the Manitoba Association of
Registered Nurses is necessary for the above two positions.
Please apply to:
Mrs. Phyllis McGrath
Director of Nursing
St. Boniface General Hospital
409 Tache Avenue
Winnipeg, Manitoba R2H 2A6
The Canadian Nursa March 1977
Extension Course in Nursing Unit
Administration
Applications are invited for the extension course in Nursing Unit
Administration, a program to help the head nurse, supervisor or
director of nursing up-date his or her management skills. Candidates
will be registered nurses or registered psychiatric nurses employed in
management positions on a full-time basis.
The program provides a seven month period of home study with two
five day intramural sessions, one preceding and one following the
home study. For the 1 977-78 class the initial intramural sessions will
be held regionally as follows.
Vancouver
August
22
— 26
St Johns (Nfld.)
August
29
— September 2
Winnipeg
August
29
— September 2
Montreal (French)
August
29
— September 2
Hamilton
Septetntrer
12
— 16
Ottawa
September
12
— 16
Toronto
September
19
— 23
Early application is advised. Applications will be accepted until May
16, 1977, if places are still available at that time. After acceptance, the
tuition fee of $275.00 is payable on or before July 1, 1977.
The program is co-sponsored by the Canadian Nurses Association
and the Canadian Hospital Association and is available in French or in
English.
For additional information and application forms write to:
English Program:
Director
Extension Course in Nursing Unit Administration
25 Imperial Street
Toronto, Ontario
MSP 101
Dalhousie University
School of Nursing
FACULTY VACANCIES
Dalhousie University School of Nursing invites
applications for faculty positions in a rapidly expanding
graduate programme which offers clinical specialties in
Medical-Surgical and Community Health Nursing.
Faculty should have post-masters or doctoral
preparation with experience in clinical nursing and
nursing education. Rank and salary for positions
commensurate with qualifications and experience, and
in accord with the salary schedule of Dalhousie
University.
Applications and further information may be
obtained from:
Dr. Margaret Scott Wright
Professor and Director
School of Nursing
Dalhousie University
Halifax, Nova Scotia
B3H 4H7
NURSES
Join us at one of the three Hospitals of the South Saskatchewan
Hospital Centre, Regina, Saskatchewan
• Provincial Capital
• University Centre
Nursing Areas:
• Chronic Care
• Coronary Care
• Emergency
• Intensive Care
• Maternity
• Medicine
• Nuclear Medicine
• Nursery
• Operating/Recovery Room
• Orthopaedics
• Paediatrics
• Plastics
• Rehabilitation
• Research
• Surgery
• Teaching
• Urology
*-i^"iWWwii-^^y»Tia
CX^i-ii- — ^'t^s:::,y\
Interested applicants should be eligible for registration in
Saskatchewan.
Apply to:
Personnel Department
Pasqua Hospital
4101 Dewdney Avenue
Regina, Saskatchewan
S4T 1A5
Western Memorial Hospital
Corner Brook, Newfoundland
VACANCIES
STAFF NURSES
For a 350 bed, fully accredited, acute treatment. Regional General
Hospital serving a population of approximately 100,000, scenic city
with modem shopping, housing and education facilities.
Salary Scale: $10,800.00 — $13,165.00 per annum.
Service Credits Recognized.
Shift Differential — $1 .50 per shift.
Charge Nurse — $3.00 per shift.
Uniform Allowance — $90.00 per year.
Educational Differential
Annual Vacation
Statutory Holidays
Extra three steps on salary scale for
B.N. Degree, four steps for
Masters Degree.
Twenty days.
Nine plus Birthday.
Residence accommodation for $35.00 per month.
Transportation available.
Applicants please apply to:
(Mrs.) Shirley M. Dunphy
Director of Personnel
Western Memorial Regional Hospital
Corner Brook, Newfoundland
A2H6J7
Nurses
The Department of Health, Psychiatric
Services Branch. Saskatchewan
Hospital, North Battleford, has openings
for full-time and part-time nurses. Duties
involve planning the patient care program
in a stimulating atmosphere of a large
progressive hospital. Programs range
from acute psychiatric nursing, long term
and rehabilitation to psycho-geriatric
nursing.
The successful applicants will have
graduated from an approved school of
psychiatric or general nursing.
Salary:
$10,092 -$11,712 —
Graduate Nurse
(non-registered)
$11,256 -$13,068 —
Nurse 1
(Saskatchewan registration)
Competition NumlMr:
604111-6-282
Closing Date:
As soon as possible
For further i nf ormation, please contact the
Supen/isor of Personnel, Saskatchewan
Hospital, Box 34, North Battleford,
Saskatchewan. S9A 2X8.
The salaries listed are under review with
an effective date of October 1 , 1 976 for
any adjustment.
Forward your application forms and/or
resumes to the Public Service
Commission. 1820 Albert Street, Regina,
Saskatchewan, S4P 2S8, quoting
position, department and competition
numtjer.
THE UNIVERSITY OF ALBERTA
FACULTY OF NURSING
FACULTY POSITIONS
Faculty members will be required for
positions in expanding four-year basic
and two-year post-R.N. baccalaureate
programs. Applicants should have
graduate education and expenence in a
clinical area and/or in curriculum
development or research.
Short-term or visiting appointments may
also be available in some areas to replace
staff on leave.
Salary and reink commensurate with
qualifications and experience, in accord
with University policies.
Positions are open to male and female
applicants.
Please make further Inquiries, or
submit application and curriculum
vitae to:
Amy E. Zelmer, Ph. D.
Dean
Faculty of Nursing
The University of Altierta
Edmonton, Alberta
T6G 2G3
AUSTRALIA
MERSEY
GENERAL HOSPITAL
LATROBE, TASMANIA
(a) Nurse Educator
(b) Theatre Supervisor
Why not travel? This 220-bed training
school for General and Auxiliary Nurses is
set in most pleasant surroundings.
Accommodation available if required.
Uniforms provided.
Salary Flange:
Nurse Educator
— $A9,533 — $A10,782 per annum.
Theatre Supervisor
— SA10.574 — $A10,782 per annum.
Diploma and Certificate Allowances
payable.
For further information, contact:
Miss G. Bingham
l^dy Superintendent of Nursing
Mersey General Hospital
Latrobe, Tasmania, Australia
Prince Henry's Hospital,
St. Kilda Road, Melbourne, Victoria, Australia
TRAINED NURSES
Due to our expanding educational programme for student nurses, we
have a numt>er of vacancies for
STATE REGISTERED NURSES
In critical care areas and general medical and surgical wards. Qualified
Nurse Teachers are also required for our School of Nursing.
SALARY: From $A159.50 to $A187 10 per 40 hour week for general
nurses and $A224.90 to $A236.90 for qualified teachers. Penalty rates
attached to night and weekend duty.
VACATION LEAVE is 6 weeks per annum.
BOARD AND RESIDENCE is available, if required, in our modern
nurses' home, at a cost of $A18.00 per week.
Economy class air fare to Melbourne will be refunded upon
commencement of duty and in return for an agreement to work at the
hospital for 12 months from date of commencement.
QUALIFICATIONS: Applicants must be registrable with the Victorian
Nursing Council and details in this connection are available from the
Australian Embassy or Consulate in Ottawa. Montreal. Toronto or
Vancouver.
Prince Henry's, a 409 bed acute general teaching hospital, is
conveniently situated on one of Melbourne's attractive thoroughfares
adjacent to extensive parklands. It is within 10 minutes walking distance
from the heart of the city and is well served by public transport.
Interested nurses, who must have had at least 12 months post graduate
experience should write to the Director of Nursing Services (Miss D. J.
Taylor). Prince Henry's Hospital, St. Kilda Road. Melbourne, 3(X)4,
Australia, giving details of age, qualifications and nursing experience,
in time to reach Miss Taylor before 14th April. 1977 on which date she
will depart for overseas to conduct personal interviews in Toronto (19th
— 22nd April) and Ottawa (25th — 29th April). ,
UNIVERSITY OF WINDSOR
SCHOOL OF NURSING
The University of Windsor. School of
Nursing invites applications for faculty
appointments for the academic year
1977-78.
The School is seeking individuals with
expertise in nursing research, community
health nursing, psychiatric nursing and
maternal-child nursing who are interested
in the challenge of implementing new
integrated curricula in the generic and
post-basic baccalaureate programmes.
Appointments effective July 1, 1977.
Qualifications:
Master's Degree in Nursing
Clinical Work Experience
Teaching Experience (desirable)
Salary and Flank commensurate with
qualifications.
For further information contact:
Mrs. A. Temple
Director, School of Nursing
University of Windsor
Windsor, Ontario, N9B 3P4.
UNITED STATES
OPPORTUNITIES
FOR REGISTERED NURSES
AVAILABLE NOW
IN CALIFORNIA
FLORIDA
MISSISSIPPI
NEW ORLEANS
TEXAS
WE PLACE AND HELP YOU WITH:
STATE BOARD REGISTRATION
YOUR WORK VISA
TEMPORARY HOUSING - ETC.
A CANADIAN COUNSELLING SERVICE
Phone; (416)-449-5883 OR WRITE TO:
RECRUITING REGISTERED NURSES INC.
1200 LAWRENCE AVENUE EAST, SUITE 301,
DON MILLS, ONTARIO M3A 1C1
J^RIV
NO FEE IS CHARGED
TO APPLICANTS.
OPEN 7 DAYS A WEEK.
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, September
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
MANIT
DEPARTMENT OF
HEALTH AND SOCIAL DEVELOPMENT
The School of Nursing
Selkirk Mental Health Centre
is offering a
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
September through May and Includes
theory and clinical experience in hospitals
and community agencies, as w/ell as four
w/eeks 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 15/77 to: Director of
Nursing Education, School of Nursing,
Box 9600, Selkirk, Manitoba R1A 2B5
Head Nurse
The Position:
Directing an active 40 bed surgical unit
with opportunity for future advancement.
The Person:
Should have a Baccalaureate degree with
a clinical specialty and/or administrative
experience.
The Hospital:
Central Alberta location in an expanding
regional hospital.
The City:
30,000 population half way between
Edmonton and Calgary and close to the
best in skiing and recreation centres.
Please send complete resume to:
Director of Personnel
Red Deer General Hospital
Red Deer, Alberta
T4N 4E7
Red Deer College
invites applications for faculty
positions in the Diploma Nursing
Program.
Preference given to applicants w/ith
advanced preparation and clinical
specialization, who have proven
ability in the teaching of Nursing.
Positions available August 1 , 1 977.
Please forward application,
comprehensive curriculum vitae and
references to:
Dr. Gerald O. Kelly
Academic Dean
Red Deer College
Box 5005
Red Deer, Alberta, Canada
T4N 5H5
Clinical Specialist
Nursing
We require the services of an articulate,
dynamic nurse with a Master's Degree
and a Major in Medical-Surgical nursing.
We are a 300 bed Hospital Complex on
the verge of a major expansion. We are
close to fine recreational and cultural
areas.
The nurse in this position will work closely
with our Medical Staff, Administrative
Staff and Staff Nurses to further develop
patient centered projects. The salary and
benefits are based on the qualifications
and experience of the applicant.
For further information about this
opportunity, please forward a
complete resume to:
Director of Personnel
Red Deer General Hospital
Red Deer, Alberta
T4N 4E7
Head Nurse
w/ith preparation and/or
demonstrative competence in
Psychiatric Nursing and
Management functions, required for
Head Nurse appointment. To be
responsible for participation in the
organization, initiation, and the
management of a New Psychiatric
In-patient Unit.
Please apply, forwarding
complete resume to:
Director of Personnel
Stratford General Hospital
Stratford, Ontario
N5A 2Y6.
School of Nursing
Assistant Director
required in a 2 year English
language diploma Nursing
program
Qualifications:
Master's degree in Nursing Education,
preferred, with experience in Nursing
Education Administration and teaching
and at least one 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.
E1C 8H7
Port Saunders Hospital
requires one Registered
Nurse commencing May
1977 through to October
1977.
Applicants must be registered or
eligible for registration with the
Association of Registered Nurses of
Newfoundland.
Salary is on the scale of $9,963 to
$12,282.
Living-in accommodations available
for single applicants.
Applications should be addressed to:
Mrs. Madge Pike
Director of Nursing
Port Saunders Hospital
Port Saunders, Newfoundland
AOK 4H0
can go a long way
...to the Canadian North in fact!
Canada's Indian and Eskimo peoples in the North
need your help. Particularly if you are a Community
Health Nurse (with public health preparation) who
can carry more than the usual burden of responsi-
bility. Hospital Nurses are needed too... there are
never enough to go around
And challenge isn't all you II get either — because
there are educational opportunities such as in-
service training and some financial support for
educational studies
For further information on Nursing opportunities in
Canada's Norttiern Health Service, please write to:
I
I
Medical Services Branch
Department of National Health and Welfare
Ottawa. Ontario K1A0L3
Name
%
AO'jress
City
■ ^ Health and Welfaf I
Canada
Prov.
Sante et Bien-etre social
Canada
Clinical Co-ordinator
Surgical Specialities
Responsible to the Assistant Director of
Nursing for planning, co-ordinating and
supervising patient care.
Applicants should be university graduates
with Ontario registration and with a minimum
2 years experience at the Head Nurse level.
Toronto
General Hospital
University
Teaching Hospital
• locatetj in heart of downtown Toronto
• within walking distance of accommodation
• subway stop adjacent to Hospital
• excellent benefits and recreational facilities
apply to Pttonml Otfic*
TORONTO GENERAL HOSPITAL
67 COLLEGE STREET, TORONTO, ONTARIO, M5G 1 L7
work
oyerseas
...join CUffd
If you are a medical professional, we need you.
CUSO IS looking for people who are willing to work
overseas sharing their skills with those who need
them most CUSO workers usually combine practical
application of their skills with training duties But in
the end, they learn as much as they teach.
We need:
COMMUNITY HEALTH NURSES
NURSE INSTRUCTORS
HEALTH EDUCATION COORDINATORS
Two year contracts are standard. Salary generally
equals a local worker's in a similar job. Couples and
families are eligible, but families with pre-school
children are easier to place. CUSO pays for life
insurance, health and travel expenses and an
allowance for re-settlement in Canada.
WANT TO GET INVOLVED?
CONTACT: CUSO Recruitment: 13
151 Slater Street
Ottawa, Ontario KIP 5H5
Director, Public Health Nursincp
Applications are invited for the position of Director,
Public Health Nursing in this Health Unit serving
110,000 population.
Qualifications:
A Master's Degree is preferred, consideration given to a
Bachelor's Degree.
Applicants must have experience in administration and
supervision.
Appiy in writing to:
Dr. Lucy M. C. Duncan
Medicai Officer of Health
The l-ambton Health Unit
333 George Street
Sarnia, Ontario
N7T4P5
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-graduate nursing training (with special
emphasis on midwifery and nurse practitioner training) for a period of
up to one year commencing July 1st, 1977.
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 work 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 forwarded on
request.)
And should submit:
• A resume of their academic and nursing career to date;
• Copies of the educational qualifications submitted on entry to
nursing school;
• Verification of their R.N. Diploma, or equivalent;
• Their proposed course of study;
• Acceptances and/or preferences for place of study;
• Two character reference letters.
To: Chairman, The Board of Trustees,
Judy Hill Memorial Fund,
829 Centennial Building,
Edmonton. Alberta,
Canada.
By: May 1st, 1977.
' The Scholarship is conimgeni on the successful applicants being registrable by a
nursing association m 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
ine uanaoian nurse marcn 19//
Index to
Advertisers
March 1977
Abbott Laboratories
Cover 4
Barco of California
7
Jean-Luc Belanger Inc.
55
Boehringer Ingelheim (Canada) Ltd.
17, 56
The Canadian Nurse's Cap Reg'd
53
The Clinic Shoemakers
2
Connaught Laboratories Limited*
42,43
Designer's Choice
Cover 2
Equity Medical Supply Company
57
Health Care Services Upjohn Limited
14
Hollister Limited
18
Frank W. Horner Limited
35
Kendall Canada
14, 53
The C.V. Mosby Company Limited 8,
9, 10, 11
Nursing Opportunities
57
Reeves Company
5
W.B. Saunders Company Canada Limited
51
Standard Brands Canada Limited
1
Stiefel Laboratories (Canada) Limited
Cover 3
♦ CORRECTION NOTICE: The pages of this ad were reversed in the January
issue.
Advertising
Gerry Kavanaugh
The Canadian Nurse
50 Ttie Driveway
Ottawa, Ontario K2P 1 E2
Advertising Representatives
Richard P. Wilson
219 East Lancaster Avenue
Ardmore. Penna. 19003
Telephone: (215) 649-1497
Gordon Tiffin
2 Tremont Crescent
Don Mills, Ontario M3B 2S1
Telephone: (416) 444-4731
Member of Canadian
Circulations Audit Board Inc.
n^B
Benoxyl Lotion 20%
proven effective
in treatment of cutaneous ulcers
BEFORE AFTER
Left: ulcer of right greater trochanter, 14 cm In diameter, with
undercutting of superior border to 3 cm. Right: full healing after
8 months therapy with benzoyl peroxide.
Benzoyl peroxide, a powerful organic
oxidizing agent, was applied topically
according to a carefully developed
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Exceptionally large pressure ulcers
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There were only 13
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Assoc J 115:11 01, 1976
nummo
April 1977
ES76C7615935
-HA5 — Eo wccue
977
58 h^RMER AVE N APT 3
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trends called
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April, 1977
The official journal of the Canadian
Nurses Association published
monthly in French and English
editions.
Volume 73, Numtjer 4
^^^^^^^^^^^^^^B
mpur
6
A Cailng Expsftanco
MwySamton
24
News
12
Practical Concerns for Nursing
the Elderly in an Institutional Setting
Myrtle 1. Macdor)ald
25
Canadian Nurses Association
Financial Statements
and Auditors' Report
Year ended December 31 , 1 976
58
It's Time to Go Home Now:
Another Look at Nursing Homes
Lynda Ford
31
Names
61
Ivlaking the Most of the
Golden Years
Mike Grenby
39
Library Update
62
Frankly Speaking —
Aging: The Myth and the Reality
Johr) Duffle
40
Living to Eat:
Nutrition for Senior Citizens
Mike Grenby
42
Needed: A New Way of Helping
Richard McAlary
45
Community Resources for the Ekleriy:
Day Hospital
Day Therapy Centre
Hazel Schattsciineider
M. Ann Morlok
47
50
Baycrest Geriatric Centre:
A Continuum of Care
Suzanne Emond
52
Psychodrama and the
Depressed Elderly
Dorottiy Burwell
54
One Gentle Man
Bemadette Walsh
56
The cover photo for this month's
theme issue, 'The Seventh Age —
Caring Makes the Difference, " was
made available through the Canadian
Council on Social Development.
Photos for the theme montage on
page 23 are courtesy of Information
Canada Phototheque, Health and
Welfare Canada and Canadian
Council on Social Development.
The views expressed in the articles
are those of the authors and do not
necessarily represent the policies of
the Canadian Nurses Association.
ISSN 0008-4581
Indexed in International Nursing
Index, Cumulative Index !o Nursing
Literature, Abstracts of Hospital
Management Studies, Hospital
Literature Index. Hospital Abstracts.
Index Medicus. The Canadian Nurse
IS available in microform from Xerox
University Microfilms, Ann Arbor,
Michigan. 48106.
The Canadian Nurse welcomes
suggestions for articles or unsolicited
manuscripts Authors may submit
finished articles or a summary of the
proposed content. Manuscripts should
be typed double-space. Send original
and carbon. Ail articles must be
submitted for the exclusive use of The
Canadian Nurse A biographical
statement and return address should
accompany all manuscripts.
Subscription Rates: Canada: one
year. S8.00; two years. $15.00.
Foreign: one year, S9.00: two years,
$17.00. Single copies: $1.00 each.
Make cheques or money orders
payable to the Canadian Nurses
Association.
Change of Address: Notice should be
given in advance Include previous
address as well as new. along with
registration number, in a provincial/
terntorial nurses association where
applicable. Not responsible for
journals lost in mail due to errors in
address.
Postage paid in cash at third class rate
Montreal, P,Q. Permit No. 10,001.
^ Canadian Nurses Association
1977.
$
Canadian Nurses Association,
50 The Dnveway, Ottawa. Canada,
K2P 1E2.
The CanwHan Nutm Apr1 1*77
Per.s|>oe<iYO
Janet C. Kerr, associate professor in
the Faculty of Nursing, the University
of Calgary, is probably best known to
Canadian nurses as the co-author
with Shirley R. Good, of
"Contemporary Issues in Canadian
Law for Nurses."
She holds a Specialist in Aging
Certificate in Public Health from the
Institute of Gerontology, the University
of Michigan/Wayne State University,
and has presented several papers on
gerontological/geriatric nursing to
groups that include the Canadian
Association of University Schools of
Nursing, Public Health fvlursing
Supervisors in the Province of Alberta
and nursing staff of institutions in that
province.
She has sen/ed on a variety of
committees of professional
associations, including the Alberta
Association of Registered Nurses,
Alberta Public Health Association,
Canadian Nurses Association Testing
Service and Canadian Association of
University Schools of Nursing.
Guest editorial
The issues in geriatric/
gerontological nursing are not
difficult to find; the scope and variety of
articles in this month's journal attest to
this fact. Nevertheless, how many
practicing nurses make a point of
becoming informed in this very
significant area of nursing practice? How
many are even interested? How
many students enrolled in schools of
nursing across the nation have the
opportunity to experience a curriculum
sequence designed to assist them to
learn to nurse elderly people?
Negative stereotyping of the elderly
permeates our society, and nurses are
by no means immune to social values
and conventions resulting from this
phenomenon. Unfortunately caring for
the elderly is commonly viewed in
nursing as less interesting, less
challenging and less satisfying than
caring for persons in other age groups.
Nothing could be furtherfrom the tmthl
Analysis of health service
requirements for various age groups
indicates that the elderly require a
substantial proportion of available
nursing services in both community
health nursing and hospital nursing
practice. It is likely that in the future
nurses will be spending even more of
their time engaged in geriatric nursing.
The population of the
institutionalized aged is often
overestimated — possibly because of
the high visibility of institutions and
possibly because we tend to think of
aging in terms of illness, disease or
death rather than a natural biological,
psychological and sociological
process that shows great variation
from one individual to another.
Currently the former represents only a
little more than seven percent of those
over 65 years of age.
Caring for the sick is an important
social responsibility and we have
provided facilities for this in Canada to
the extent that we now have one of the
highest institutional bed ratios for
persons over 65 years of age of any
country in the world, according to the
World Health Organization Expert
Committee on Planning and
Organizatkjn of Geriatric Services.
Even so, we staff the institutions that
provide geriatric care for the most part
with non-professionals. Here we have
the sick elderly receiving nursing care
which is rendered in large part by
untrained individuals. It is obviously
not a case of insufficient professional
nurses, but, rather, of not valuing the
standard of care which can only be
provided by professionally prepared
nurses.
It has been suggested that for every
aged person in an institution, there are
two comparable aged persons who
are housebound and who refuse to go
the route of the institution. Certainly
the elderly individual entering an
institution is likely to lose his networi<
of social relationships based in the
community and thereby lessen his
capabilities for independent living. For
this reason, there is a great need for
more emphasis upon prevention of
illness through the development of
viable alternatives to institutionaliz-
ation in the form of strong community
supportive services for the elderly.
The philosophy of health care that
prevails in society finds its
implementation in the financial
arrangements which make it possible
for people to receive that care. If
these arrangements do not make
provision for community health and
social sen/ices to enable people to
stay well and remain in their own
homes and familiar environments,
then it would seem that our society
does not value these ends to the
extent that we may feel is desirable.
We need to develop more than token
home care programs, homemaker
and handyman services, day hospital
and day care centers, and so on to
enable senior citizens to remain with
their families and in their own homes if
they so desire for as long as they wish.
Finally, what is the responsibility of
community health nursing agencies
for meeting the health needs of elderly
citizens? While the voluntary agencies
have been highly involved in the
provision of health care to senior
citizens for a numtier of years, the
official health agencies have
historically been preoccupied with the
needs of mothers and children.
Although there is now a beginning
awareness of the need for change and
some visible evidence of it, there
Editor
M. Anne Hanna
Assistant Editors
Lynda Ford
Sandra LeFort
Production Assistant
Mary Lou Downes
Circulation Manager
Beryl Darting
Advertising
Gerry Kavanaugh
CNA Executive Director
Helen K. Mussallem
needs to be considerably more
concrete action in this sphere.
Community health nursing has an
important and vital contribution to
make to senior citizens living
independently and most certainly
there is an urgent and important need
for this service.
Indeed, practitioners in every area
of nursing can exert a potentially
positive influence on the improvement
of geriatric health care services by
keeping abreast of the new knowledge
in this field, by becoming more
sensitive to the individual and
collective needs of the elderly and by
standing up and being counted on the
issues!
— Janet C. Kerr
To our readers:
It has t)een brought to our attention
that the February issue of Ttie
Canadian Nurse contained a
classified advertisement that
contravened our policy of accepting
for publication only those ads which
cannot be considered discriminatory
under the Human Rights Code.
We do our utmost to prevent this
type of unfortunate occurrence. In this
case, our utmost was not good
enough.
We apologize to all of our readers
who found the ad as offensive as we
did when it was drawn to our attention.
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The Canadian Nurse ApfH 1977
Input
Declining standards of care
During the past year nursing staff in
tfiis province as indeed in most other
provinces has been greatly reduced.
This situation has caused much
concern as on several occasions it has
literally forced us to run — not for the
sake of fire or hemorrhage — but in
order to keep up with workload.
I could give many examples of
situations which were potentially
hazardous although, so far, not fatal.
However, the last straw, a
comparatively trivial incident, came
when a patient complained that
although told to drink he had not been
supplied with any fresh water for
sixteen hours!
The fact that I had been busy giving
an hourly heparin I.V. and
concentrated care to two of my six
patients (on one occasion I had had
ten patients) pushing one patient to
emergency etc. did not impress him.
As a uroiogical patient he felt and
indeed I agreed with him that service
should have been better. Also, since
he was the fittest of my patients it was
after my tour of duty ended that I was
able to make his bed.
Arriving home that evening I was
exhausted, frustrated and angry.
Although I had worked hard and finally
got everything done, the reason I
hadn't done my nursing duties at the
right time was because I was portering
patients and running to the diet kitchen
for their lunch etc. This made me
decide to write to my members of
parliament in an effort to improve the
situation.
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MEDICAL SERVICES
I enclose a copy of the letter
addressed to the Hon. R H.
McClelland (B.C. Minister of Health)
for your perusal.
Dear Sir:
Recently a patient under my care
complained that never in his life had
he received such poor service!
Unfortunately his complaint was
justified! NOT because the Nurse was
neglecting her duties. NOT because
the Nurse was at coffee break but
simply because the Nurse (as indeed
the rest of the staff) had too heavy a
workload and too few hands.
A Registered Nurse with many
years of experience in all areas of
nursing, I am used to pressure and
accustomed to hard work.
Nevertheless, I am tired that in order to
maintain high standards of care I must
give up my coffee breaks and go off
duty thirty to forty -five minutes late on
an almost regular daily basis. The sad
part is that a high percentage of a
nurse's time is spent in non-nursing
duties! A mechanic does not change
tires, a chef does not wash pots. Why
should a Nurse spend her time
running messages and specimens to
the lab, or portering patients to other
departments?
If, sir, the government is determined
to run a hospital on a strict budget with
a skeleton staff, then, sir, the public is
entitled to be made fully aware of the
reasons for this intolerable situation
which does indeed sometimes cause
poor service. Pamphlets should be
published and placed in each patient's
drawer (if not pamphlets at least
display large notices) advising them
and their relatives of the fact that there
has been a great reduction in staff
numbers resulting in extra nursing and
non-nursing duties, which makes it
almost impossible to give care to
every patient at the right time.
Naturally it is the patient who is the
least ill who receives less attention.
Though sometimes their
psychological needs are greater!
Perhaps instead of determining size
of staff by statistics and work
efficiency experts the government
should employ a Registered Nurse
Consultant who actually spends three
to six months at a time in busy areas
not discussing, not looking, not
evaluating or supervising (for as Sir
Winston Churchill once said anyone
can criticize not everyone can do!) but
actually working all three shifts on a
full-time basis. And who knows, when
one of the efficiency experts
experiences the frustration,
exhaustion and heartache associated
with modern day nursing maybe the
human element might once again
become the greatest part of nursing.
If all the hours of unpaid overtime
each nurse had done within the past
year were added together, we must
have saved the government
thousands of dollars.
I beg of you to take some
constructive measures to aid your
fellow man, for who knows perhaps
you or your loved ones might find
yourselves without help because one
nurse is too busy pushing a patient to
another department and the other
nurse is too busy answering the
telephone which sometimes rings
incessantly, or answering half a dozen
call bells which somehow all go on at
once...
I would be pleased to discuss this
increasingly intolerable situation, both
for the patients' safety and the staffs
sake with you and your ministers.
— Thelma Elizabeth Miller, R.N.,
Surrey, B.C.
Reducing patient anxiety
I am writing to express my
appreciation for publishing "Nursing
the Acutely Psychotic Patient, "
(February). I work in a Psychiatric
Hospital myself and found this article
very helpful as I often feel we don't use
the necessary measures to reduce ■
patients, anxiety in their psychotic |
state. '
Hope to see more articles in the
future regarding the psychiatric
patient.
— Marjorie Newton, Reg. N.,
Scarborough, Ont.
Salutations!
Dear Hanna: To avoid any possible
confusion, lest someone share this
nominal identity with me, I hereby
declare myself Dann No. 1. If,
however you feel this too "& la 1984"
you could refer to me as Mrs. Sheila E.
Dann.
— Nurse, Ontario, 52-11040.
Parnpecs
you both
abieak
Ceeps
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 stays drier, and
baby's bottom stays
drier than it would in
cloth diapers.
Saves
vou 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.
fftOCTER k GAMBLE
The Canadian Nurse April 1977
I]i|nit
Nursing diagnosis needed
in response to Jessie l\^antle's
letter of February 1 977, we commend
tier for fier timely questioning of tlie
"appropriate clinical content" for The
Canadian Nurse. This question fias
been on our mind for a long time.
We agree that nurses need
"enough information about the
pertinent etiology, incidence, signs
and symptoms of a disease state,"
but, as Mantle contended, such
information is obtainable from the
medical journals and/or medical,
nursing texts. What we need, in an
attempt to help nurses improve their
nursing care, is more than knowledge
on disease states, we need the ability
to problem solve.
A registered nurse is expected
and has been taught to mal(e
professional judgments and
decisions regarding the client
situation. In order to do this, the nurse
should be able to use the knovsrtedge
she possesses. Nursing diagnosis, as
mentioned by Mantle, is the
mechanism through which the nurse
demonstrates her ability to apply
scientific knowledge in the provision of
patient care. Furthermore, the
knowledge on disease states which
we gain today may be outdated by
tomorrow, because of the
advancement of scientific and medical
technology in our complex society.
Thus the issue to which we
should address ourselves is not the
knowledge on disease states, but
rather, the thinking process. The
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clinical articles published in The
Canadian Nurse should deal mainly
with the areas on nursing diagnosis
and nursing process.
— Shirley Wong, R.N., Julia Wong,
R.N., Halifax, N.S.
Nursing intervention
I would share Jessie Mantle's
concern regarding the interpretation of
the term "clinical" and therefore the
types of articles which would be
acceptable for publication in the
journal. I agree with your view that
"...information about pertinent etblogy...
of a disease state ..." if one exists Is
important. But much of nursing care is
or should be addressed to
health-related problems in which no
disease state is evident; sharing of
information and experience regarding
this care is important.
We have been concerned for some
time about the whole question of
describing patient problems
amenable to nursing in terms which
are conceptually consistent with
nursing intervention, i.e., making a
nursing diagnosis. During the past two
to three years, we have been
attempting to develop a listing or
taxonomy of such nursing diagnoses:
and at the present time, with
assistance from National Health
Research and Development funds, we
are formulating a proposal to test the
wider application of this approach.
This experience has brought me to
the view that widely understood and
accepted terminology describing
nursing diagnoses (examples of
which are cited by Jessie Mantle)
would result in improved patient care
plans and should provide the basis for
a more precise description of nursing
care and for evaluation of Its
effectiveness.
For example, it seems to me that if
we are to benefit by Jessie Mantle's
valued nursing contribution, we need
to be attuned to the terminology of the
problems with which she is assisting
the patient/family to cope, e.g. fears of
death, changes in body image, pain
and changes in activities of daily living;
furthermore, if we are to care
adequately for patients, we urgently
need to share our growing knowledge
regarding nursing problems and our
nursing intervention.
— Phyllis E. Jones, Professor, Faculty
of Nursing, University of Toronto.
Abortion Pro and Con
As a registered nurse no longer
employed in nursing, I find the present
"Canadian Nurse" most valuable. I
treasure my knowledge and past
experience, but am most keen on
learning new things and staying aware
of what's happening now in nursing. I
appreciate the case study type of
article the most.
I commend you for the article
"Abortion Counselling" by
Easterbrook and Rust (January,
1 977). Would that all centers had such
a nursing team as does Toronto
General Hospital. There is so much
misunderstanding surrounding this
issue, that many abortion patients are
not getting the type of care that would
be called optimum. I hope that other
centers get inspired by the article so
that abortion patients throughout
Canada may benefit from the work at
T.G.H.
Please keep up the good work. I find
the magazine more interesting with
each issue. Thank you!
— Barbara Cope, Reg. N., Otten/ille,
Ont.
So, the Toronto General Hospital
has set up a 'New Role for Nurses' —
counselling women who have decided
to dispose of their children before they
are born. I wonder if this hospital
provides such wonderful service to
mothers with sick children — mothers
who want their children to live?
This is one of your readers who
would prefer you filled the pages of
The Canadian Nurse with stories
about nurses who are working in the
field of preserving lives. Hopefully we
are still in the majority. — f^ame
withheld, Powell River, B.C.
As a nurse I am very disappointed
in the article and disagree in the
encouragement of nurses being
involved in such counselling. In my
opinion, this is a direct promotion of
abortion when, today, there are so
many alternatives, for example
organizations such as Birthright and
Right to Life which promote the life of
the child.
— A Concerned Nurse, (name
withheld) Charlottetown, P.E.I.
m%Mwv mf/i I
• • I
move for cholesteiol
concerned patients.^
is to Fleischmann's Margarine and Egg Beaters.
Egg Beaters, the anti-cholesterol
eggs.
The average large egg contains 275 mg
of cholesterol. It's the single highest source
of cholesterol in man's diet. By replacing
egg yolks with corn oil and a vitamin/
mineral fortified nutrient, we've reduced
the cholesterol content of eggs by 98%. Yet
Egg Beaters look, cook and taste like fresh
farm eggs. They're versatile and delicious.
Egg Beaters. Even cholesterol patients
can eat them every day
In your grocer's freezer
Tell your patients about
polyunsaturates.
Because Fleischmann's Margarine is made
from 100% corn oil, it has a very high poly-
unsaturate level— 40%, and only 18% saturates.
A very sensible choice for patients with
cholesterol problems. Incidentally, when you
recommend Fleischmann's for its health
— benefits, they'll thank you for the
taste! Fleischmann's. We make all
our margarine with 100% corn oil.
Special give-aways to help
your patients.
Please send me at no extra charge:
J
"Cooking with Egg Beaters"
. Ejig. copies
Fr.
^
"Cholesterol, Calorie,
Sodium Calculator"
copies
City:.
Province:
CN-77-1
Mail to: Fleischmann's, Consumer Service Division. 550 Sherbrooke Street West,
Montreal, Quebec. H3A 1B9
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Where service complements research
The Canadian Nurse April 1977
News
Members of CNA's Special
Committee on Nursing Researcti took
a break during tlieir recent two-day
meeting in Ottawa to have their
picture taken. Standing, left to right
are: Rose Imai, Ottawa; Odile Larose,
Montreal; Jacqueline Chapman,
Toronto; Helen K. Mussallem, CNA
executive director; Joan Gilchrist,
CNA president, Montreal; Peggy
Overton, committee vice-chairman,
Edmonton; Helen Glass, committee
chairman, Winnipeg; Margaret
Rosso, Regina; Ada Simms,
Carbonear, Nfld.; Lesley Degner,
Winnipeg; Marion Kerr, CNA research
officer. Committee members absent
for the meeting were Margaret
Scott-Wright, Halifax, and Pamela
Poole, Ottawa.
During the meeting, held at CNA
House on February 21 and 22, the
committee prepared a review of the
Report of the Task Force on Cervical
Cancer Screening Programmes (the
Walton Report) released last June.
(See The Canadian Nurse, June,
1976).
Highlights of the review, prepared in
response to a request from the Board
of Directors of the Canadian Nurses
Association, follow:
Comprehensive data base
The Report analyzed data from a
number of sources. These data were
not necessarily complete nor
comparable and referred only to short
time periods. With this kind of
information, it is difficult to make valid
comparisons between provinces or
programs. In addition, international
references to studies of cervical
cancer were limited to research
conducted in the Westem
industrialized natrans. The committee
agreed with the finding of the Report
that in order to make meaningful
comparisons:
• a centralized registry for cervical
cancer is essential
• further investigation into
developing uniform terminology is
required
• standardized methods of
reporting incidence and mortality rates
are also needed.
This type of information must be
collected over a long period of time so
that longitudinal data are available in
addition to cross-sectional data.
Expert advice on the development of
such a data base is essential to collect
the right kind of data and to ensure that
appropriate statistics are used when
reporting comparisons.
Lifestyle factors
In addition to improving the reporting
system, it would appear that more
clear-cut evidence should be obtained
from multivariate, multicultural
research if lifestyle factors are to be
used to identify risk groups.
Mechanisms of implementation
If the development of the data base on
cervical cancer continues to justify the
need for screening programs,
possible strategies for implementation
should be explored. The following
general principles would appear to be
important during planning stages:
• Implementation of programs
should be decentralized and should
allow enough flexibility to
accommodate differences in medical
practices and to permit the
development of innovative methods in
each province.
• Some coordination of proposed
plans for implementation is necessary
to obtain comparable data across
Canada.
• Detailed planning of potential
costs should be made. Provision must
be made for the integration of new
programs into the existing health and
social services system so that current
services are utilized advantageously
and there is minimal duplication.
Although the Report suggests that
such a program will not require
additional costs, during
implementation phases it may be
necessary to duplicate services as
opposed to direct substitutions.
• A comprehensive educational
program must be planned not only for
health professionals providing
services but also for the general
public. Careful interpretation will be
required when screening patterns
change. When some routine services
that have been accepted in the past,
for example, are to be withdrawn or
changed for women in certain age
groups the women will need to be
informed of the risks. Further, care
must be taken that classification of
women as "high risk" does not result
in social stigma.
Evaluation
Plans for evaluation should be made
when new programs are being
developed. A requirement shoukj tie
made, then, that each proposal for a
screening program include an
evaluation component. Careful
monitoring and documentation of
each program is essential and this
information should be made available
on a national basis. Expert
consultation in program evaluation will
be necessary to ensure that:
• programs are monitored
• valid services are being provided
• adequate follow-up is provided to
persons for whom the present pattern
of services is altered.
Orthopedic Nurses
hold education day
Two and one-half years ago, a group
of southern Ontario nurses interested
in providing better care for the
orthopedic patient got together and
decided to "do something." Organizer
Melanie Hitch contacted the American
Orthopedic Nurses Association and
with their help started what today is
known as the Toronto Area Interest
Group of the Orthopedic Nurses
Association.
With an active membership of
approximately 80 nurses, the group
meets once a month to keep abreast
of new trends and developments in
orthopedics and ultimately to learn
better ways of caring for their
orthopedic patients. So far, the only
other such interest group in Canada is
located in Hamilton, Ontario with Irene
Cummings as president.
One of the main objectives of the
Interest Group was met in
mid-February when they held their first
education day . The conference was
enthusiastically received by the 265
nurses who attended — nurses who
came from all across Ontario, from
London, Hamilton, Ottawa,
Peterborough and as far as North Bay
— to hear speakers discuss various
aspects of care as it relates to the
orthopedic patient.
Heather Reuber, President of the
Toronto Area Interest Group and an
O.R. nurse at St. Michael's Hospital in
Toronto, introduced Dr. Robert
McMurtry, orthopedic surgeon at the
Sunnybrook Medical Centre in
Toronto who discussed priorities and
approaches in treatment for the
patient suffering from accidental
trauma in the light of his experience as
a member of the Regional Trauma
Unit at that hospital.
In reminding the audience of the
importance of prompt diagnosis and
treatment of traumatic injuries. Dr.
McMurtry encouraged nurses always
to have a sense of curiosity about
"what else" is happening to the patient
both on the wards and in emergency.
Alert and questioning nurses can be
instrumental in recognizing the less
obvious injuries that might
compromise a patient's life.
Dr. John Barrie, consultant
(continued on page 1 6)
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THE PHARMACOLOGIC BASIS OF PATIENT CARE New 3rd Edition
In this comprehensive revision, you'll find much
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structor's Guide will tie available too.
By Mary K. Aspertieim. MD. Medical Univ. of South
Carolina: and Laurel A. Eisenhauer. RN, MSN, Boston
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... of psychiatric nursing.
PSYCHIATRIC NURSING AS A HUMAN EXPERIENCE New 2nd Edition
A popular text, well known and respected for its
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By Lisa Robinson. RN, PhD, Prof, of Psychiatric Nurs-
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CONCEPTS AND SKILLS IN PHYSICAL ASSESSMENT
This book can save you valuable time in teaching
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THE CARDIAC RHYTHMS
Here's a self-teaching guide to recognizing and
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made throughout for self-testing.
By Raymond E. Phillips, MD and Mary Kay Feeney, RN.
354 pp. 928 ill. $13.15. Oct. 1973. Order #7220-5.
use during actual examinations. An Instructor's
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By Mary Jane Sauve, RN. BSN, MSN, Calif. State Col-
lege, Sonoma. Rohnert Park; and Angela R. Pecherer,
RN, BSN, MSN. Intercollegiate Center for Nursing
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INSTRUCTOR'S KIT FOR
A CARDIAC CARE COURSE
Valuable for use in cardiac care workshop ses-
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The slides graphically portray all common ar-
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By Raymond E. Phillips, MD. FACP. 100 black-and-
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$103.00. Apnl 1976. Order #9917-0.
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The Canadian Nurse April 1977
\l»\Y.S
Ontario nurses document
declining standards of care
When provincial governments across Canada initiated cutbacks and
curtailments in hiealtti care spending, there was a cry of protest from the
public and from providers of health care services, that cutbacks would result
in a deterioration in the quality of care provided. Over the past year, the
effects of budget restraints in health care delivery have varied from province
to province. In an attempt to reduce the high cost of health care, some
provincial governments have taken steps such as closing hospitals, cutting
hospital budgets (a move which has forced hospital administrations to close
beds and to cut staff), and allowing little or no increase in the amount of
money available for nursing homes, home care, and community programs.
One group which has indicated
concern about the effect of these
measures on the quality of health
service in their province is the Ontario
Nurses Association. Recently ONA
released a Health Care Review as an
expression of concern with what it
sees as "a decline in the Health Care
Services in Ontario."
The report, researched over the
past year by Bartiara Linds, is the
result of discussions held with
representatives of local chapters of
ONA, an association including 23,000
nurses across Ontario, nurses
involved in many aspects of health
care, from both urban and rural
settings.
The report concentrates on eight
major areas of concern: nursing
homes and homes for the aged;
psychiatric facilities: misuse of
hospital facilities, beds, and services;
wastage and unnecessary expense;
high quality care at less cost;
community nursing services; public
health; and nursing workload and
patient care.
In all, 41 recommendations for
change are made, recommendations
which the report states: "have been
made time and time again in
numerous studies, many
commissioned by the Ministry of
Health. To date, we have seen few of
them implemented."
Although the recommendations
themselves are not unique, the report
is characterized by an unusually
strong nursing perspective. Included
in the preface to each group of
recommendations are statements
made by nurses about how they view
the present health care situation.
These are just a few of their
comments:
On nursing homes
"We have forty patients on the chronic
floor and twenty on the medical floor
waiting to get into the home for the
aged. IVIost of them die before they
get in. They just built a new home in
the area, and it's already full. We have
132 beds in our hospital. "
On psychiatric facilities
"We know we are sending people
back to home situations that are the
same as the ones that sent them to the
hospital in the first place, but there is
not much in the way of follow-up in the
community for them. "
"We have a good psychiatric
follow-up program in public health
and we have a community mental
health program. As well, public health
nurses are involved, working with a
psychiatrist in the community..."
On misuse of hospital facilities
"In our whole area, everything which
could be done by public health, home
care and doctors in their offices — it all
gets focused on the emergency
department "
"Since the 'cuts' we have had people
in emergency for 24 to 72 hours
waiting for a bed. Before, that was
rare. "
On wastage and unnecessary
expense
"They built a fantastic new Intensive
Care Unit nursery nine months before
a specialized hospital was built in our
area. Any newborns requiring
specialized services are immediately
transferred. We feel this is poor
planning. "
"When we send patients to other
hospitals with test reports, they do the
tests all over again. "
On home care services
"Home care isn't as effectively used
as it could be. It doesn't relieve
hospital beds because patients aren't
discharged quickly enough to use
what home care was meant for in the
first place. This is because doctors
don't refer people."
"I have worked in the health unit for
five years and don't remember once
getting a referral from a head nurse."
On public health
"Our school health program has been
cut back to less than one third of our
time. If they don't see you in the
school, they don't use you as much. "
"In one hospital, we visit each new
mother in the hospital. In another, we
aren't allowed on the floor, because
they don't like us bothering the
mothers. "
"Every year our number of visits
increase by 2,000. No new staff. They
increase our programs and don't
evaluate the old ones. They just add
on. Many staff respond to family
requests on their own time."
On workload
"It's like a car wash — we attempt to
give adequate physical care and
that's it Patients tend to get more
information from the housekeeping
staff because they are in the rooms
more often. "
"We cannot see the concern on the
part of Administration for the patient
There is no longer patient-centered
care. When we are understaffed the
attitude seems to be 'it's too bad you'll
just have to manage. "
The report focuses on the areas of
greatest concern within the present
health care system, and proposes to
bring these concerns to public
attention, "to begin a process of
questioning and discussion in our
communities."
In conclusion, the report makes five
broad recommendations:
• Restructure the present
fragmented, overlapping, costly and
inefficient health care services by
developing a planned, coordinated,
health care system with a shift in
emphasis from the acute institutional
care concept to preventive, supportive
and rehabilitative community health
care.
• Involve citizens and health care
workers in all aspects and levels of
planning and evaluating health care.
• Identify and validate community
needs, from which appropriate
programs would be developed and
funded accordingly.
• Continuously monitor programs
to provide flexibility in meeting the
changing health needs of the public -
and to provide appropriate value for I
monetary support. '
• Delegate responsibilities and
functions to health wori<ers based on a
comprehensive assessment of their
abilities to contribute.
Health happenings
A group of Japanese nurses visiting the
offices of the American Journal of
Nursing, had some tips to offer
prospective participants in the 16th
Quadrennial Congress of the
International Congress of Nurses.
Among the questions they answered,
according to a report in the February
issue of the AJN:
How expensive is Tokyo?
• A nurse who passes up the more
elatHDrate dining rooms in favor of small
neighborhood restaurants, can manage
on between $10 and $20 a day,
including transportation, but excluding
hotel costs.
What about shopping?
• Finding English-speaking sales people
is easy in large shopping centers but not
to be depended on elsewhere. A
number of Japanese nurses have,
however, volunteered to act as guides.
•A souvenir shop will also be available
at the site of the ICN meeting.
Food and drink?
• If you insist on coffee you would be well
advised to carry your own instant variety,
available in Japanese markets.
• Although rice is the staple item in
Japanese diets, seafood and
mushrooms are also important and
Japanese meats, particularly Ijeet, are
excellent.
eei^ed fWuid&f rtceedj^^tw
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COLOR QUANT, PRICE
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TTie Canadian Nurse April 1977
Xews
(continued from page 12)
pathologist at the Toronto East
General Hospital and at the
Orthopedic and Arthritic Hospital,
Toronto, believes that pathology can
be fun. Humorously and with great
ingenuity, he reviewed the pathology
of rheumatoid arthritis and described
the marvels of cartilage. His advice to
old people was: "Lengthen your
stride." Joints which don't stretch or
extend to the fullest, he said, quickly
become useless. He encouraged
nurses to be sure that the older patient
walks with a long stride — "It will add
ten years to your patient's life. '
One problem the orthopedic
nurse faces lies in making the correct
assessment and giving the
appropriate treatment to the patient
who complains of "pain." Vahe
Kehyayan, faced this problem as a
nursing student when working nights
at the Orthopedic and Arthritic
Hospital in Toronto.
The patient may say "I have pain," but
he may mean something quite
different. Kehyayan now, psychiatric
nurse consultant, stressed that
patients should have a choice in the
treatment of their pain.
A highlight of the day was the
panel presentation of a nine-member
patient care team from the Orthopedic
and Arthritic Hospital consisting of an
orthopedic and arthritic specialist,
orthopedic surgeon, primary nurse,
pharmacist, dietician, physiotherapist,
occupational therapist, social service
student and the hospital coordinatorof
home care. Dr. Swanson, Director of
the Arthritic Service, explained that
the entire team meets on a bi-weekly
basis to discuss each patient and plan
his assessment, treatment and
evaluation. Using the problem-solving
approach, they focus on the person
who has the disease rather than on the
disease itself. Everyone on the team,
contributing his/her unique
knowledge of the patient, assesses
the problems and suggests possible
solutions — solutions not only to
medical problems but also financial,
emotional or family difficulties the
patient might have. In this way, they
believe that the "whole" patient is
cared for and that the end goal of
effective daily living is met.
The concluding speaker was Dr.
Robert Salter, Professor of
Orthopedics at the University of
Toronto and Chief Surgeon at the
Hospital for Sick Children, widely
recognized for the inominate
osteotomy (known in other countries
as the Salter operation) used in the
treatment of Legg-Perthes disease. In
his talk, he touched on the physiology
of Legg-Perthes disease and current
treatment. Adding weight to the
previous discussion of total patient
care. Dr. Salter emphasized the
importance of the "child's head" as
well as the "femoral head " in deciding
on treatment — whether it be surgery,
a brace, casts or bedrest.
At the end of the day, president
Heather Reuber announced that the
Interest Group was hoping to make
the orthopedic day an annual event.
Outstanding Texts in Nursing
PRINCIPLES AND PRACTICE OF NURSING
Sixth Edition, Virginia Henderson, R.N., A.M., and Gladys Nite, R.N. A.M., with 17 contributors
This classic text and reference volume provides an indis-
pensable source of information for student and practicing
nurse alike, and for all those interested in basic health care.
It has been extensively revised and expanded, and greatly
enriched by the contributions of a second author and 17
other clinically-active nurses.
As in past editions, health maintenance is the primary
focus of this definitive volume. Preventive, supportive,
and rehabilitative health care are emphasized and scientific
principles underlying nursing and related fields are ex-
amined in detail. Throughout this volume, the authors
avoid jargon and maintain an integrated view of the pa-
tient's emotional, physiological, and spiritual needs.
Many tables, charts, photographs, and drawings con-
tribute to the clarity of the text.
1978 1600 pages (approx.) Ilius. S21.95
NORMAL AND THERAPEUTIC NUTRITION
Fifteenth Edition. Corinne H. Robinson, M.S., D.Sc. (Hon
and Marilyn R. Lawler, M.S., R.D., formerly, Yale— New H
This world-famous textbook provides a complete founda-
tion in the science of nutrition — both normal and therapeu-
tic— for students of nursing and dietetics. It continues to
offer substantial coverage of the application of nutrition to
meal selection for the entire life cycle, with respect to
economic psychologic, and cultural factors.
Among the important additions to the fifteen edition are:
• mechanisms for action of vitamin D
• the role of zinc in nutrition
• "health food" and "natural food" movements
• emphasis upon world crisis in food supply
• dangers of overfeeding in infancy
• food-drug interactions
) R.D., Professor of Nutrition Emeritus, Drexel University;
aven Medical Center and Southern Connecticut State College
• behavior modification in obesity
• high-fiber diets and reviser" diets for diabetes mellitus,
etc.
1977 768 pages (approx.) Illus. S14.25
A New Feature:
Now for the first time, an outstanding new workbook is
available to accompany Normal and Therapeutic Nutri-
tion, Fifteenth Edition, or any other textbook of nutrition.
CASE STUDIES IN CLINICAL NUTRITION: A
Workbook and Study Guide for Students of Nursing and
Dietetics
208 pages (approx.) Illus. 56.50
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Years ago, most ostomates went home with a so-called "permanent" appliance. The
disposables available then were mainly for post-op use. Now, though, there's a
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tough multi-layered film that holds back odor more than 200 times as effectively as
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Hollister disposables in the hospital have gone right on using them as their full-time
appliances. Your patients can, too.
COLOSTOMY:
Send her home confident.
An odor-barrier Karaya Seal stoma
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ILEOSTOMY:
Send him home secure.
Specify a Karaya Seal Drainable-
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It fits snugly
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UROSTOMY:
Spare her the faceplate-cement-
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18 The Canadian Nurse April 1977
Looking
for contemporary^ new texts
for next semester?
Look to Moshy.
A New Book!
MATERNITY CARE:
The Nurse and the Family
Emphasizing the human dimensions of childbirth, this dynamic
new text helps you prepare students to function as competent,
sensitive maternity nurses in today's changing society. Discussions
integrate psychosocial factors with current clinical information and
show how to apply this to actual patient care. Throughout, the authors
provide detailed plans for nursing intervention based on diagnostic,
therapeutic, and educational objectives. They stress the importance of
setting care goalsibefore planning care or attempting to assess results.
All information is logically arranged, following the chronologic order
of conception, pregnancy, labor and complications, birth, post
delivery, and parenthood. Superbly illustrated with more than 650
original drawings and photographs, chapters examine such diverse
topics as contraception, genetics, infertility, and legal aspects of
maternity nursing. Comprehensive clinical information ... a conve-
nient format . . . emphasis on the human dimension . . . quality
drawings and photographs — these are the elements that make the
text uniquely significant in the literature of maternity nursing.
By Margaret Jensen, R.N., M.S.. Ralph C. Benson, M.D., and Irene M.
Bobak, R.N., M.S. April, 1977. Approx. 832 pages, 8V2" x 11", 659 illus.
About $18.40.
Maternal/ Child
A New Book! ASSESSMENT AND MANAGEMENT OF
DEVELOPMENTAL CHANGES IN CHILDREN. By Marcene L
Erickson. R.N.. B.S.N . M.N. This new text provides a systematic
approach to developmental screening and assessment of infants
and preschool children. It carefully shows how to use specific
assessment tools to the best advantage, and how to plan the
management of behavioral problems caused by developmental
changes. The author suggests supportive approaches for use
with parents before, during, and after the assessment of their
child. July. 1976. 280 pp.. 161 illus. Price, $8.95.
A New Book! BEHAVIORAL APPROACHES TO CHIL-
DREN WITH DEVELOPMENTAL DELAYS.Sy Sa//y M ONeil. R.N.,
Ph.D.: Barbara Newcomer McLaughlin. R.N., M.N.; and Mary Beth
Knapp. R.N.. M.S.N.; with 29 contributors In this new book, leading
authorities in the fields of behavior modification, mental
retardation, and child development demonstrate the use of
behavior modification techniques in the management of children
with developmental delays. Organized into sections on early,
middle, and late childhood, case studies show how to apply
principles and provide models for program planning and
evaluation Cases deal with both the normal" and exceptional"
child. March, 1977. Approx. 200 pp.. 58 illus. About $6.85.
2nd Edition! TEACHING CHILDREN WITH DEVELOP-
MENTAL PROBLEMS: A Family Care Approach. By Kathryn E.
Barnard. R.N., B.S.N. . M.S.N.. Ph.D. and Marcene L Erickson. R.N..
B.S.N. . M.N. This helpful text presents both the rationale and
specific approaches for teaching young children and infants with
developmental disabilities. It can help students develop the
creative problem-solving skills and sound strategies demanded
in daily care and management. This revision incorporates the
latest information on child development and handicapping
conditions, family reactions and strategy planning, and methods
for observation and assessment. Emphasis is on parental roles
and nursing responsibility — a new chapter fully explores how
nurses can work with parents in the group setting. 1976. 194 pp.,
illustrated. Price, $6.60.
Behavioral Science
New 2nd Edition! BEHAVIOR MODIFICATION AND THE
NURSING PROCESS. By flosemananeem/, R.N., M.N. and Wilberl
E. Fordyce, PhD The new 2nd edition of this widely known text
presents practical, up-to-date guidelines to help students apply
behavioral modification techniques to a variety of deviant or
disordered patient behaviors. Focusing on operant conditioning
or contingency management, the text explores applications in
diverse health care settings. Extensively revised and updated
chapters examine such topics as: increasing or decreasing
behaviors, pinpointing targets, measuring behaviors, reinforcers.
and systems implementation and evaluation, f^^any additional
demonstration problems and study examples help students apply
the concepts presented. May, 1977. Approx. 160 pp., 10 Illus.
About $5.80.
Medical/ Surreal
A New Book! PEDIATRIC NEUROLOGIC NURSING. By
Barbara Lang Conway. R.N.. M.N. The author focuses on deficient
neurologic development as the basis for many pediatric
disorders, as she presents clinical information that helps
students recognize the signs of neurologic abnormalities. The
text begins with a clear, detailed account of neurologic
physiology, pathophysiology, function, and normal development
of perception, integration, and response. Following chapters
provide techniques for general neurologicassessmentandforsix
categories of specific disorders. Discussions of each disorder
describe specific manifestations and appropriate nursing care. A
final chapter explores such adaptive problems as learning
disabilities, mental retardation, etc. February, 1977. 382 pp., 102
illus. Price, $15.25.
New 2nd Edition! CARE OF THE OSTOMY PATIENT. By
VirginiaC. Vukovich.R.N.. E.T. and Reba Douglass Grubb, B.S. This
book continues to show students how to meet the special
physical and emotional needs of ostomy patients. Its how-to
approach focuses on the patient before and after surgery and
throughout social and vocational rehabilitation. This new edition
has been extensively revised and updated to include current
techniques for pre- and post-operative care and patient teaching;
and offers new material on physiology and medications. Students
will especially appreciate such new features as the nutritional
table of foods containing sodium and potassium; and the
18-point guide for complete nursing assessment. April, 1977.
Approx. 160 pp., 23 illus. About $6.85.
Terminology
/A A/ewSoo/c/ NURSING AND MEDICAL TERMINOLOGY:
A Workbook. By Ruth K. Radcliff. R.N., M.S. and Sheila J. Ogden,
R.N.. B.S. This workbook — the first of its kind — combines
medical and nursing terminology in a comprehensive, single
source. Extensively classroom-tested, it can help students
develop and expand their nursing and medical vocabulary as they
prepare to learn various subjects to implement nursing care.
Beginning chapters introduce terminology components —
prefixes, medical combining forms, and suffixes. Subsequent
chapters then organize material according to body systems. A
final chapter presents abbreviations and symbols used in
medicine and nursing for oral and written communication. Three
self-evaluation quizzes, answer sheets, and flash cards accompany
each chapter - making this workbook a valuable self-help guide
for either classroom or individual learning. January, 1977. 212
pp.. 27 illus. and 784 flash cards. Price, $11.05.
MOSBY
TIMES MIRROR
THE C. V. MOSBY COMPANY, LTD
86 NORTHLINE ROAD
TORONTO, ONTARIO
M4B 3E5
We've built a reputation for quality and diversity in nursing publishing. A-70419
20
The Canadian Nurse AprU 1977
Pharmacology
13th Edition! PHARMACOLOGY IN NURSING. 8/ 8effyS
Bergersen. R.N., M.S., Ed.D. and Andres Goth. M.D. Written by a
nurse for nurses, this well written text continues to be the most
widely accepted in its field. This new 13th edition thoroughly
examines pharmacology as it relates to clinical patient care.
Fact-filled discussions explain the basic mechanisms of drug
action, indications, contraindications, toxicity, side effects, and
safe therapeutic dosage range. Emphasis is on understanding
drug action in the human body in order to ensure rational and
optimal drug therapy. Presenting the most current drug data
available, this new edition features: a major revision of
information on drug legislation, respiratory system drugs, and
skeletal muscle relaxants; inclusion of DESI ratings; and in-
creased emphasis on pharmacodynamics. Two new chapters,
"Antimicrobial Agents" and "The Effects of Drugs on Human
Sexuality, Fetal Development, and Nursing Infants," reflect this
edition's increased emphasis on nursing implications. 1976. 766
pp., 100 illus. Price, $14.20.
New 6th Edition! BASIC PHARMACOLOGY FOR
NURSES. SyJess/eE. Squire, R.N.. B.A., M.Ed. andJeanM. Welch,
R.N., A.B., M.A., B.S.N. Ed. Clearly designed to meet students'
needs, this widely established text presents basic information
about drugs and drug administration. The convenient outline
format and self-help approach make it a particularly effective
learning tool. Revised to incorporate instructors' suggestions,
this new edition features many new drawings and new informa-
tion on intravenous therapy, pediatric dosages, geriatric medicat-
ing techniques, and nursing responsibilities. It includes current
concepts of drug action to expand students' understanding of
purpose and contraindications of drugs. New end-of-chapter
assignments and additional sample problems provide more
practice in problem-solving. For convenient reference, updated
tables of measurement now appear on the book's inside covers.
April, 1977. Approx. 360 pp., 58 illus. About $7.30.
New 2nd Edition! INTRAVENOUS MEDICATIONS: A
Handbook for Nurses and Other Allied Health Personnel. By
Betty L Gahart, R.N. The new edition of this popular handbook
offers fingertip access to current 'nformation on I.V. medications.
It includes concise, up-to-date discussions on dosages,
therapeutic actions, indications, contraindications, precautions,
incompatibilities and antidotes. More than 60 new drugs have
been added to this edition; obsolete drugs have been deleted. For
rapid reference, all drugs are listed alphabetically, and cross-
referenced by generic and trade names. As an added conveni-
ence, the drug index is now printed in colored stock. May, 1977.
Approx. 224 pp. About $7.30.
A New Bool(! HANDBOOK OF PRACTICAL PHAR-
MACOLOGY. By S^e//a A Ryan, R.N., M.S.N, and Bruce D. Clayton,
B.S., Pharm.D. An effective supplement to basic pharmacology
texts, this practical new handbook summarizes essential infor-
mation on more than 80 commonly used single-entity drugs.
Drugs are conveniently categorized into chapters according to
their pharmacologic activity; arranged alphabetically by generic
name within each chapter; and indexed at the end of the book.
For each drug discussed, students will find concise data on:
generic name and representative sample of trade names; primary
action and most common usage; characteristics such as half-life,
extent of protein-binding, rates of absorption, and duration of
action; dosage administration; drug interactions, possible side
effects, and special precautions. January, 1977. 252 pp., 1 illus.
Price, $7.30.
New 4th Edition! PROGRAMMED INSTRUCTION IN
ARITHMETIC, DOSAGES, AND SOLUTIONS. By Dolores F.
Saxton, R.N.. B.S., M.A., Ed.D.: Norma H. Ercolano. R.N.. B.S., M.S.;
and John F. Walter. Sc.B., M.A., Ph.D. This valuable programmed
text can help students overcome the confusion that surrounds
the arithmetic necessary to safely prepare and administer
medications. In a logical step-by-step format, it discusses the
metric and apothecaries' systems; problems involved in moving
from one system to the other; and basic arithmetic concepts in
terms of both "old" and "new" math. This updated, revised 4th
edition reflects the types of (jroblems nursing students encounter
during actual patient care. Students will find updated problems in
computing intravenous dosages; dosages for children and
infants; etc. The chapter on drugs ordered in units features
expanded material on such drugs as heparin and potassium
chloride; there is more information on parenteral computations.
May, 1977. Approx. 88 pp., 1 illus. About $5.80.
Issues, Trends, Exiucation
and Administration
New 8th Edition! HISTORY AND TRENDS OF PROFES-
SIONAL NURSING. By Grace L Deloughery. R./V.. M.P.H., Ph.D.
The new edition of an established text surveys the history of
nursing from its ancient beginnings to the present time. A
unifying theme stresses the parallel evolution of professional
nursing and the role of women In western society. This edition
has been revised and reorganized for greater cohesion and
organization; many new drawings and photographs add to a
contemporary appearance. The author provides new Information
on recent nursing history (since 1945) and on trends that are still
developing. Other new material examines minority nursing and
minority nurse education, continuing education for relicensure.
and new nurse practice acts. An entirely new section, by Eileen
O'Neil. J.D., Investigates the legal aspects of nursing. Through-
out, the author stresses the political, social, economic, and
educational factors that have Influenced the development of
professional nursing. June, 1977. Approx. 288 pp., 37 illus. About
$8.95.
A New Booif! POWER AND INFLUENCE IN HEALTH
CARE: A New Approach to Leadership. By Karen E. Claus. Ph.D.
and June T. Bailey, R.N.. Ed.D.: with 2 contributors. This original
new book analyzes power as a positive force and the core of
effective leadership. The authors present an operational defini-
tion of leadership and clearly demonstrate how nurses can use
power to Influence change in the health care field. Two major
themes unify the discussions; first, that the effective leader can
use power to attain goals; second, that the leader is a planner,
energizer, initiator and humanlzer who acts and is responsible for
results. Part I applies the power-authority-influence model to
show how to; set goals; define tasks and environmental variables;
utilize personal, social, and organizational power bases; use both
formal and functional authority bases; and take actions based on
a functional and humanistic approach to management. Part II
analyzes how nurses can develop and use power to influence
others. April, 1977. Approx. 176 pp., 20 Illus. About $6.85.
A New Book! MANAGEMENT OF PATIENT CARE
SERVICES. 8/ Russe// C. Swansburg. R.N., M.A. This new book is
the//rsf programmed manual on the management of patient care
services. It can help you prepare your students to meet the need
for efficient management and successfully assume tomorrow s
leadership positions. Current, practical guidelines show how to;
improve primary nursing functions; plan and manage budgets:
develop and implement personnel policies; originate in-service
training and educational programs; and Improve communication
between nurses and patients. There is specific advice on how to
define job roles and performance standards, implement evalua-
tion and control systems, and organize assignment planning. The
author effectively combines nursing management theories with
practical applications and procedures — the result Is a
comprehensive guide to all aspects of decision-making and
supervision. June, 1976. 424 pp.. Illustrated. Price, $11.50.
Nursing Fundamentals
A New Book! COMMUNICATION IN HEALTH CARE:
Understanding and Implementing Effective Human Relation-
ships. 8y Maff/e Co/Z/ns, R.N.,B.S.. M.S. This Important new guide
shows students how to apply theoretical concepts of human
behavior to the real life situations of clinical practice. It clearly
explains the ■what", "why", and "how" of therapeutic relation-
ships — In a direct and easy-to-read style. Thoroughly
documented discussions offer guidelines for dealing with the
grieving patient; persons who are anxious, depressed and
contemplating suicide; those with a terminal Illness; and those
who are experiencing pain, sensory deprivation, or changes In
body image. Students will find practical methods for com-
municating with blind and deaf patients and suggestions for
counseling patients and families about euthanasia or abortion. A
series of practical exercises provides situations for analysis and
application of theory. Both correct and Incorrect responses are
analyzed. June, 1977. About 240 pp., 9 illus. About $6.25.
NURSE-CLIENT INTERACTION: Implementing the
Nursing Process. By Sandra J. Sundeen. R.N., M.S.; Gail Wiscarz
Stuart. R.N . M.S.: Elizabeth DeSalvo Rankin. R.N.. M.S.: and Sylvia
Parrino Cohen. R.N.. M.S. This stimulating book compiles
concepts from the behavioral sciences and humanities and
applies them to the nursing process. Chapters discuss the
emergence of self, the dynamics of self-growth and all aspects of
interpersonal communication. Chapter 6, "The Course of the
Helping Relationship", examines both basic concepts and
phases of the nurse-client relationship. Chapter 8, "Nursing
Intervention", summarizes and applies the theory presented
throughout the book to help students understand the reciprocal
nature of the various concepts. 1976. 214 pp., 38 illus. Price,
$7.90.
Look to Mosby
MOSBV
TIMES MIRDOR
THE C. V. MOSBY COMPANY, LTD
86 NORTHLINE ROAD
TORONTO, ONTARIO
M4B 3E5
We've built a reputation for quality and diversity in nursing publishing.
The Canadtan Nurse April 1977
Metamucil
for bowel management
and anorectal
surgery patients
"Gentle persuasion sums it up!" Metamucil
is a natural source preparation that pro-
duces a gentle action.
Metamucil, refined and purified from natu-
ral psyllium seed, works gently but firmly.
It does not depend on chemical irritants,
methylcellulose or other synthetic laxative
agents for its effect.
Mixed with a cool liquid, Metamucil passes
through the digestive system to promote
soft, fully-formed stools and gentle, yet
definite urging of peristalsis followed by
easy passage and elimination. Regular
bowel function usually takes place without
stress, strain, irritation, or cramping.
Importantly, Metamucil is non-habit-form-
ing and may be prescribed for short or
long term therapy. The dosage can be
individually regulated.
SEARLE
Available as Metamucil Powder and
flavoured, effervescent Instant Mix.
caring makes the difference
"Aging is a normal process that goes hand in hand with living. It is not a disease; neither is it an
inborn handicap. What we see as problems of aging are the difficulties more likely to be
encountered by people who have passed their 65th birthday."
Senator David Croll, Final Report of the Special Committee of the Senate on Aging,
Ottawa, Queen's Printer, 1966.
The Canadian Nurse April 1977
The dependable volunteer in the community is always in great demand. Nurses who share their caring
qualities with fellow community members, and not confine themselves to institutions and "patients" can
add an extra dimension to their own lives and the lives of those they help.
ff Caring Experience
l^ary Bawden
Four years ago, in London, Ontario, a group of
concerned professionals tfiat included several
nurses, a social worker, an occupational
therapist, and the executive director of a
community agency, got together to create a
citizen advocacy program that came to be
known as "Friendship in Action. "
This program has two target groups:
senior citizens living alone in the community,
lacking family support, and the adult retarded.
Based on a concept developed by Dr. Wolf
Wolfensberger of the National Institute on
Mental Retardation, the program provides a
service to individuals who are lonely and/or
isolated but who, with the friendship and
support of another person, could become
more active, independent, and fulfilled.
In addition the advocates (volunteers) are
expected to speak for and represent their
friends (proteges) in problems of their rights in
obtaining full benefits as community members.
The volunteer helps his friend meet
whatever needs become apparent for social
contact, new experiences, emotional support,
professional services, etc. He or she offers a
very personal relationship that differs in
quality and scope from the service offered by
professionals, but complements and facilitates
their work.
Volunteers need much the same personal
qualities as nurses working in the field of
geriatrics — a warm and friendly personality,
dependability, good judgment, and a deep
regard for human beings and their rights.
How "Friendship in Action" Works
Mrs. F, was a seventy-eight-year-old
widow who lived alone in a Senior Citizens'
Apartment. Her husband, four sons, and a
daughter had all died years ago. She was
a very lonely lady who found it difficult
to understand why she had been spared and
why she must continue to go on living.
Mrs. F. suffered from a mild case of
diabetes — controlled by diet and tolbutamide
— and from fairly severe osteoarthritis. Her
osteoarthritis was mainly in her knees and
hips, greatly limiting her mobility. She was
therefore unable to get out on her own to
shop, and relied on neighbors to pick up the
odd thing.
When I first visited Mrs. F. as a citizen
advocate, I found an elderly white-haired lady,
very tall and thin, with a distinct twinkle in her
eyes. Her crowded little living room was filled
with old photographs of her family and friends
from years gone by. Mrs. F. had a fantastic
memory and having always lived in the City,
would tell me all kinds of historical facts, and
could chronicle many of the architectural
changes over the last sixty years. She also told
many stories of her family and their growing-up
years. Having sung in her church choir for
years, often as a soloist, Mrs. F. enjoyed a
singsong, but didn't take kindly to those who
sang louderthan she, and off-key to boot. She
knew everything that was going on in her
building and would tell about it in her own
inimitable sarcastic style.
Much of my time with Mrs. F. was spent
visiting , listening to her stories and telling her a
little of my life and family. Within a short time,
we were friends in the true sense of the word.
Mrs. F. enjoyed any contact with the world
outside her apartment so when weather
permitted we both went grocery shopping,
made the odd trip to the farmers' mari<et or a
local shopping malL Sometimes we simply
went for a drive through the pari< that she
remembered from Sunday School picnics sixty
years earlier or to the cemetery where her
husband was buried.
.^>^r^
Being a very realistic, down-to-earth
person, Mrs. F. prepared to give up her
apartment when she could no longer
reasonably manage, and moved with her T.V.
to St. Mary's, a hospital for the chronically ill.
She did not regard this move as in any way a
defeat but remained active, wheeling around
in her chair, keeping track of the nurses and
attending O.T. during the week.
In good weather, I pushed her in her
wheelchair around the block, gathering Fall
leaves.
Mrs. F. died very s uddenly of a myocardial
infarction in the middle of the night, just before
her eightieth birthday. It was the way she
hoped to die, not lingering, not being a burden.
All her funeral arrangements had been made
in advance and her favorite daughter-in-law
from Western Canada fiew down to officiate.^
Mary Bawden, fleg. N., B.Sc.N., who wrote
"A Caring Experience," Is already familiar to
readers of The Canadian Nurse through her
Clinical Word Search Puzzles which have
appeared at Intervals over the past year She
was recently named president of the Board of
Directors of Friendship In Action, the citizen
advocacy program she describes In her
article.
An active member of the Registered
Nurses Association of Ontario, she Is
president of the fvliddlesex North Chapter of
the RNAO and has served on numerous
committees and working parties of her
professional association. A graduate of South
Waterloo t\Aemorlal Hospital School of
Nursing In Gait, and of the University of
Windsor, she is currently Team Leader In the
Rheumatic Diseases Unit of the University
Hospital in London, Ontario.
Myrtle I. Macdonald
ractical Concerns
for Nursing the Elderly
in an Institutional Setting
Physical and psychosocial needs of the elderly are closely interwoven.
Within the constraints of time and budget, there are many steps that nurses
can take, on general or geriatric wards, or in the community, to meet these
needs and to improve the general sense of well-being of those who are old.
Careful attention to details of nursing care — changes that don't require major
expenditures of time or money — can make all the difference in the world to
these "senior citizens" ... can make it possible for them to become more
mobile, to present an attractive appearance, hear and see better, eat and sleep
better, avoid problems of incontinence and constipation, and prevent
respiratory problems.
When this happens, they feel a sense of mastery over their environment,
become more alert and aware of their surroundings, and benefit from more
productive relationships with their family, friends and community.
The Canadian Nurse April 1977
O Physical Care Goals
/ Maintaining and improving muscle
coordination and ambulation
Musculo-skeletal changes
— decreased muscle power and strength
— decreased mobility of and stiffness of joints
— increased susceptibility to fractures
— prolonged healing of fractures
Nursing measures
1. Wheelchairs and feeding chairs
• An adequate supply of both wheelchairs and feeding
chairs makes it possible for patients to get about, to leave their
rooms, to dine and enjoy social activities. This is a mixed
blessing, however, for ambulatory patients rapidly lose their
ability to walk if you do not take time to walk with them.
2. Walking
• It takes time to assist an elderly patient to a stable
standing position but this is time well spent since just one or
two weeks of sitting is enough for the hips, knees and ankles to
become flexed in a rigid shortened position and calcification to
set in.
• Often it takes longer to help a person get up and walk to
the dining room, for example, than to lift him into a wheelchair
and push him there. Plan your daily schedule to allow for this;
start helping patients walk to the dining room long enough
ahead of the arrival of trays to avoid rushing.
• When walking with an individual patient use encouraging,
ego building words to say, 1 ) walk tall (which is more effective
than saying "straighten up," 2) lift your knees, 3) have a wide
base with feet far apart, and 4) point your toes fonward.
• Exercising of legs and knees, ankles and toes, just before
standing up to walk, helps patients get the idea of using their
joints more flexibly. The quadriceps plant is an exercise that
nurses can readily teach. It consists of having the patient
press down the back of his knee and lift his heel, by tightening
his thigh muscles. This can be done either lying in bed or
sitting in a chair. It helps the patient to learn the exercise if the
nurse places one hand under the patient's knee and the other
hand under the heel, to raise it passively, slightly. After the
patient understands how to do the exercise actively, only
verbal encouragement is needed to keep him/her performing
the exercises q.i.d.
3. Enriched program of physical activity
• The provision of an enriched program of physical activity
to keep all joints mobile is an integral part of nursing. Include it
in your schedule on each shift, and, as well, try to arrange
referrals to both volunteers and other disciplines. N/lany nurses
do not realize that Occupational Therapists are adept at
teaching activities of daily living, devising appliances where
needed. It is also part of their function to retrain fingers using
dynamic splints and other equipment.'
• The elderly can become almost as agile as youths even if
they do not start to train for flexibility until late in life. They can
learn to dance or do gymnastics. Yoga has been found to be
surprisingly suitable for the elderly as it does not demand
quick movements.-- '
a) Group Games
• Some patients walk about a great deal, and it is common
to assume that they are getting enough exercise. However,
closer observation reveals that many of these patients have
lost their ability to tie bows, do up buttons, bend over and put
on shoes, and raise their arms above their heads to dress
themselves and care for their hair. Why does this happen
when for decades nurses have been encouraging patients to
maintain self-help? One reason may be that using the requi red
muscles only once or twice a day is not enough to keep them
functional. Other ways need to be found to keep the joints and
muscles limber through frequent use.
• Group games in which rings are moved on a string, soft
balls are tossed, or beanbags or suction darts are thrown are
ideal for exercise. Lawn bowling and horseshoes entertain
many elderly people. Once a week is not enough, f^orning,
afternoon and evening varied activities that encourage use of
shoulder and hand muscles, should be planned.
• In one hospital, a group of volunteers goes to a geriatric
ward to lead a group meeting called Remotivation-Therapy.^
They include action songs such as "Under the spreading
chestnut tree." They have given a good deal of thought to
selection of songs that appeal to the elderly, and they make up
actions to go with the songs.' They have found that the music
must be very slow and repetitive, and that sometimes even
one stanza of a song is enough to keep the people actively
participating for some time.
b) Group exercises
• In another large institution a representative of the
recreation department comes to the geriatric ward two orthree
times a week to lead group exercises. He sits on a stool in the
middle of a circle of people seated in armchairs, uses
traditional physical education movements of arms and legs
and head, and each day adds something new or different for
variety. To promote better range of motion of head and neck,
he has them turn to left and right, as well as lean forward and
hyperextend their necks backward. He also gives attention to
the abduction of the legs and the lifting and extending of the
knees. These movements are vital if nurses want to keep
patients from scissoring their legs and permanently flexing
their knees in the fetal position.
• If left to chance and spurts of enthusiasm, exercising is
soon neglected. Nurses can reach out into the community to
find volunteers, but then you need to guide and encourage
these volunteers, wori<ing along with them to supplement what
they are doing. The time this takes is actually not great and
results, eventually, in a lightening of the nursing workload.
4. Consultation and referrals
• Physiotherapy is a must for every geriatric patient and
nurses need to be familiar with the exercises and goals of each
of their patients. This is especially true when the treatment is
given off the ward. Often a patient carries out quite advanced
maneuvers with the physiotherapist, but gets away with
sedentary behavior on the ward. If you know what is going on,
your expectations will be consistent with those of the
physiotherapist, and you can reinforce the teaching provided.
• Recently, there have been great advances in nursing in
the specialties of orthopedics, rehabilitation, and
rheumatology. The nurse who devotes years to geriatrics may
easily become outdated in these fields, and without knowing it
deprive her patients of the benefits of these advances.
Sabbaticals to practice for some months in these other fields
would help to solve this problem.
• t\/lany nurses are timid about providing exercise after a
fractured arm or hip and, as a result, their patients do not
regain function. Exercises are started too late and not carried
out t.i.d. Pain is usually a result of disuse and favoring of
muscles, rather than injury.
in« uanaaian n\M9
II Looking and feeling better
Integumentary changes
— hair loss
— skin dry with decreased turgor
— skin mottled with pressure sores
— slow wound healing
Nursing measures:
1. Personal needs and clothing
• An adequate supply of shoes and clothing is a must.
Usually this is provided by relatives and special funds. If not,
nurses can take steps to see that pension cheques are
withdrawn from hospital trustfunds, signed, and money made
available to relatives to purchase what is needed. (The same
sort of initiative is required to obtain trips to a podiatrist when
nails are too horny for nurses to tnm).
• Relatives may need advice about suitable purchases:
slippers need to provide firm support for walking and be
washable for those who are incontinent; they may need to be
larger than formerly due to edema as heart failure develops
and circulation slows down. Clothing needs to be attractive,
easy to launder, wrinkle-resistant, and long enough to avoid
embarrassment when sitting in a low chair.
• The appearance of elderly patients can be enhanced by
the provision of full length mirrors, a laundry and ironing room,
and a seamstress to help with mending at least once a week.
Integration of wards for both sexes promotes greater attention
to grooming. Excursions for shopping and social events, and
weekend and day passes further promote maintenance of an
attractive wardrobe and appearance.
2. Teeth
• Care of the teeth of the elderly needs very careful
planning, for confused patients lose their tooth brushes and
even their dentures, and stiff fingers make self-care difficult.
• Nurses frequently find the cleaning of dentures unpleas-
ant and so there is a tendency to slip upon it,sometimes for
days at a time. Therefore the head nurse needs to find a
method of holding nurses accountable for their care. A graphic
sheet similar to a medication sheet, initialed t.i ,d. could be one
answer. Perhaps there should be cards for mouth care and
other treatments similar to medication cards.
• Tooth brush racks and shelves should be attached near
the sink, and some consistent method of sorting tooth brushes
worked out so that changing nursing staff can count on finding
the tooth brush where it is supposed to be, and thus save steps
and time. The patient's name should be attached to brushes
and other toilet articles. Could dentists be asked to engrave
the name of the owner on dentures?
• When teeth do not fit, visits to the dentist for adjustments
may be arranged. One reason why people put up with
ill-fitting dentures is that they do not realize anything can be
done about it. Why should pension cheques accumulate and
go unused? Sometimes relatives would be glad to take the
patient to the dentist since this offers them some concrete and
constructive way to help.
3. Cleanliness
• Bathing elderly patients can be a heavy task but tub baths
or showers at least twice a week are necessary to keep skin
intact and prevent rashes. Only those with a new surgical
incision or a plaster cast should be given a bed bath instead. A
shower can be given with the patient sitting on a stool. Well
positioned hand rails need to be provided.
• Bathtubs should be at least four feet away from the wall
on each side, so that patients can be transported into the tub
by a portable lift. Four or five sets of canvases are needed for
each patient so that they can be lowered into the tub. This is
not a great expense: many a lift goes unused because of
shortage of canvases and unfamilianty with the equipment.
Those who are accustomed to their use find that patients feel
secure in them, and that bathing is greatly facilitated, and
takes less time and energy.
• Shampoos should be given at least once a week, and a
record kept of them, for it is easy to slip up on hair care. Ward
supplies of shampoo and deodorant are needed.
4. Skin Care
• If the goal of improved ambulation is met, there is little
opportunity for skin breakdown from poor circulation and
pressure. To prevent skin breakdown from pressure areas,
patients should sit in a variety of chairs and not favor just one
chair.
• Turnings are necessary at night. The prone or semiprone
position should be required for at least a short time every night,
long before there is a pressure area on the coccyx and each
hip.
• Because muscles adduct and shorten from much lying in
the fetal position, plus sitting in chairs, it is really important for
the patient to counteract the tendency to curl up in tjed. Even
after the fetal position becomes habitual, it is possible to
extend the legs gradually; they yield to firm slow pressure
more readily than to quick movements.
• Nurses tend to assume that sheepskins are expensive
and hard to obtain. Actually, with adequate planning, a large
supply of inexpensive synthetic sheepskins can tje
maintained. They may be washed in the hospital laundry by
ordinary methods.
/// Remaining alert and aware
Sensory changes
— decreased vision and hearing
— decreased taste and smell
— decreased tactile sensation
Nursing Measures
1. Hearing
• Many older people have trouble becoming accustomed to
hearing aids. They should be encouraged to lip read; some
can do so already but are unaware of it. If they begin to
recognize their ability they can improve it by watching the
speaker more carefully.
• Speaking slowly and clearly to a partially deaf person is
not easy. Sentences should be short. The voice should not
drop. Above all, before saying very much to the person, you
should make sure that he is listening. What passes for
deafness is often just not knowing that he is being spoken to,
and not taeing given time to tune in.
2. Vision
• Loss of visual acuity creeps up on many people so
gradually that they are unaware of a visual problem.'^
Sometimes the reduced ability to see is attributed to emotional
problems. Loss of interest in sewing, reading, carpentry, or
The Canadian Nurse April 1977
repairs is often not recognized as being due to need for
glasses. Many retired persons have never had glasses; most
have not had their eyes tested for a long time.
• Nurses should make sure that eyes are examined. Just to
advise patients to have such an examination when they return
home is not enough. Most will not carry through the advice.
They need support each step of the way until thdy have the
glasses and have learned to use them with ease.
IV Eating better
• Those who have lived alone often come to hospital in a
malnourished state, having relied too much on tea and toast.
Initial finicky eating soon gives way to a better appetite. An
appealing diet even of minced foods can be provided.
• Whole grain breads and biscuits (rather than white bread,
cakes and cookies) should be made available. Real rather
than artificial fruit juices should be used because of their lower
sugar content and higher nutritional value.
• Reducing diets are important, not only to make the patient
more mobile, but also to increase his sense of self-esteem and
well-being.
• Those who live at home or will be returning to their homes,
need help in the selection of nutritious, inexpensive foods.
Going over the weekly grocery advertisements with them is
one means of discussing the relative merits of foods. A useful
guide is the Nutrition Canada survey.
V Avoiding incontinence
Urinary tract changes
— urinary retention
— urinary incontinence
— oliguria, nocturia
Nursing measures
1. Increasing fluid intake
• Elderly people often try to correct incontinence by
decreasing their fluid intake. However, an inadequate fluid
intake tends, among other things, to lead to urinary tract
infection. Infection in turn increases incontinence. It is
important to treat the infection with appropriate medications
and to increase the fluid intake.
• Bladder training like that carried out in rehabilitation
centers may be useful. One such regime is a large fluid intake
combined with training in regularity of urinating, and provision
of an environment that stimulates reality orientation and
relieves monotony."
2. Improving communications
• It is a good idea to make individualized plans to assist
patients who have to urinate at night so that they can use the
toilet, commode, bedpan or urinal. If they realize that you will
come to their rescue, they will try to control their voiding.
• New types of call lights that can be activated by those with
limited finger function are especially useful."
• Intercom systems also make life easier for both you and
the patient.
VI Preventing constipation
Gastrointestinal changes
— constipation leading to fecal impaction
— fecal incontinence
— malnutrition
Nursing measures
Fiber intake
• The increase of fiber in the diet, especially in the form of
whole wheat bread and natural bran, is advocated by many
authorities, including Denis Burkitt, leading speaker at the
Miles Symposium of the Nutrition Society of Canada, June
1976.'°"
• The normal stool should be large in quantity and soft,
rather than formed. Hemorrhoids, diverticulitis, constipation,
and varicose veins have been attributed to unnatural, highly
refined diets peculiar to western society with its emphasis
upon white breads, cakes and sugar. Diverticulitis should not
be treated with a bland diet, but rather with an increase in
intake of natural bran.
2. Fluid intake
• Increase in fluid intake is important for the correction of
constipatiori. Of particular value is the intake of several cups of
hot fluids early in the morning. The natural time for defecation
is after breakfast, so the schedule should be planned to
promote unhurried toileting at this time.
VII Obtaining adequate rest
Changes in sleep pattern
— wakefulness
— worry
Nursing measures
1. Aids to sleep
• Western society loses a lot of sleep worrying about loss of
sleep. It really does not matter how much we sleep: the need
for eight hours of sleep on the average is a myth that has
terrorized many people. A happy night in which one reads,
writes, meditates, has some hot milk or tea and a snack may
well be as restful as a night in which one sleeps all night.
• Sometimes people cannot sleep because they are
hungry, and do not recognize the problem.
• You can help by taking the time to listen to a distressed
person, giving support to think through his problem, which
might be too overwhelming to face alone.
Vill Preventing respiratory distress
Respiratory changes
— dyspnea
— orthopnea
Nursing measures
1. Deep breathing
• Frequent changes in position and deep breathing
exercises are essential to prevent pooling of secretions and
subsequent development of pneumonia. As on surgical and
medical wards, no less on geriatric wards, nurses need to
teach deep breathing and coughing. It takes weel<s of specific
practice for anyone to develop a strong diaphragm and good
chest expansion at the base of the lungs. The
inspiration should be made quickly and the expiration very
gradually, evenly, and completely, as in singing or swimming.
Sudden expirations tend to trap air in the alveoli and lead to
emphysema.
• It should be accepted practice for physiotherapists to
make rounds to all geriatric patients giving chest
physiotherapy if indicated, and ensuring that deep-breathing
exercises are tieing carried out well.
2. Humidification
• Humidification of air in the winter months should be
standard practice. Steam heating does not humidify the air, for
the steam stays within the ducts. Humidifiers of various sizes
can be purchased. There are inexpensive table models in
which a motor rotates and a fine cool mist is produced.
• Warm steam humidifiers are not recommended, as the
output of steam is small and the droplets are too large to reach
the alveoli of the lungs.
• An inexpensive rotary drum humidifier can be installed in
hot air furnaces. This rotates wheneverthe heat turns on, and
the fan sends the hot dry air over the drum before it moves up
through the air ducts into the rooms.
1^ Psychosocial Care Goals
/ Mastering the environment
Behavioral changes
— confusion
— disorientation
— forgetfulness, poor short-term memory,
shorter attention span
— depression, anger
Nursing measures
When most of the goals of physical care are being met in an
optimum manner, there is likely to be a real sense of mastery,
particularly if the person is permitted choices, and
consideration is given to individuality. Of particular value is
ability to move about the community to make arrangements to
attend concerts, social events, and church and go for walks in
parks and shopping malls.
1. Orientation to reality
• Ideally windows in the building will be set low enough for
patients to see the grounds from a seated position. Also, when
walking with patients, nurses can take time to pause by a
window to let them look out.
• Furniture may include a clothes cupboard, dresser,
desk and book shelf. As far as possible, patients in long-tenn
facilities should be permitted to use their own prized furniture.
It is unfortunate that many elderly people have been so
depersonalized that they are no longer allowed to use an
antique desk or have a treasured oil painting on the wall
opposite their bed. Shelves for a few books, ornaments, plants
and a couple of teacups are also appreciated.
2. Overcoming depression, anger
• People who are self-centered or confused may be that
way because of depression. The loss of spouse, family home,
or a special friend often results in mourning. Malnutrition and
physical illnesses or disabilities further increase their sense of
loss. You can help these persons resolve their mourning by
understanding its stages, '- accepting them as a natural part of
grief, and not looking upon them as "difficult patients." Be
willing to listen to their story repeatedly — each time helping
them move on a little toward resolving another facet of grief.
As their grief becomes less overwhelming, they are gradually
able to appreciate people and the little pleasures of daily living.
// Better family and community
relationships
Changes in social habits
— narrowing of interests and activities
— social disengagement
— loneliness and insularity
Nursing measures
1. Adjusting to a new lifestyle
• Some residents have chosen to live in a long-term
residential setting. They are happy to have at last found a
place to live where they can give up some of their
responsibilities, and, at the same time, appreciate the
comforts of a gracious setting where they are no longer lonely.
They move in and out of the residence to maintain ties with the
community. In fact, it may be easier now to get out to concerts
and social events. They may even have a new urge to take on
some volunteer political or cultural responsibility in the
community.
• Other residents have been placed in similar settings
against their will by relatives, and as a result, barriers of
resentment and a sense of rejection and loss of self-esteem
have developed. Nurses can help them improve relationships
with their family and the community.
2. Interpersonal communications
• Every elderly person has a wealth of experiences and
wisdom. Over the course of a lifetime, each of us develops a
belief in the dignity of our own lifestyle. In order to maintainor
restore this "ego integrity," elderty patients need to know that
those who are caring for them appreciate and understand
them as individuals.
Nurses can do a great deal to help patients express
themselves more effectively. You could, for example, help
patients to make up scrapbooks to display their photos and
mementos. Sometimes relatives can assist in this project by
bringing in clippings, sorting pictures and writing captions.
• When relatives are unable to help, volunteers can be
found to give a hand. Sometimes a family would be pleased to
"adopt" a grandparent when their own grandparents live far
away.
3. Remotivation therapy
• A very effective means of encouraging people to talk
about their interests and views is Remotivation Therapy. This
is a group method which promotes growth in the "unwounded"
side of the personality. It was originally used for people with
chronic mental illnesses, with remari<able results. Seriously
The Canadian Nurse April 1977
withdrawn people began to talk again and dormant talents
came to light. In recent years its use has spread to a variety of
age groups and settings, including nursing homes and
geriatric wards. *
The author of "Practical Concerns for Nursing the
Elderly," Myrtle Macdonald, received her basic nursing
education from the University of Alberta. She also received a
Certificate in Public Health Nursing and M.Sc. (Applied) in
Nursing from McGill University.
She has practised in public health, educational and
psychiatric nursing roles in India and Canada and is currently
sessional lecturer at the University of Victoria in Victoria, B.C.,
teaching in the newly launched post-R.N. baccalaureate
program in which there is an emphasis on chronicity and
gerontology.
References
1 Macdonald, Myrtle \. Remotivation-therapy: a group mettiod
that promotes rehabilitation, by... et al. Montreal, Associatbn of
Remotivation-Therapists of Canada, 1975.
2 Spillane. D. A unique remotivation approach towards the
long-term regressed patient. Paper presented at Fifth Annual
Meeting and Worksfiop of the Remotivation-Therapists of
Canada, Montreal, 1976.
3 Wilson, Robin L. An introduction to yoga. Amer J. Nurs.
76:2:261-263. Feb. 1976.
4 Marshall, Lyn W/ake up to yoga. Chicago, Regnery, 1976.
5 Luckmann, Joan. I^edical-surgical nursing: a
psychophysiologic approach, by... and Karen C. Sorensen.
Philadelphia, Saunders, 1974, p. 1224-1226.
6 Macdonald, Myrtle I. A three year study of role definition
and function: home visiting of mental patients by a public health
nurse, 1970-1974. Montreal, 1976.
7 Canada. Health and Welfare Canada. Nutrition: a national
priority. A report by Nutrition Canada to the Department of National
Health and Welfare, C»ttawa, Information Canada, 1973.
8 Brunner, Lillian Sholtis. The Lippincott manual of nursing
practice. Toronto, Lippincott, 1974, p. 35-38, 764-766.
9 What's new; call switch for disabled patients. Canad. Nurs.
72:11:52, Nov. 1976.
10 Burkitt, Denis P. Economic development-not all bonus.
Nutrition Today 11:1:6-13, Jan. /Feb. 1976.
1 1 Burkitt, Denis P. Nutrition Society of Canada. Paper presented
at Miles Symposium, Dalhousie University, Halifax, N.S., June 1976.
1 2 Crate. Marjorie A. Nursing functions in adaptation to chronic
illness. Amer J. Nurs. 65:10:72-76, Oct. 1965.
o go home now../'
ANOTHER LOOK
AT NURSINO
HOMES
Lynda Ford
For many nurses, the idea of working in a nursing tiome is less ttian inspiring. Nursing homes
have the doubtful distinction of being a last resort in career choices; they are seen as
depressing institutions where work is routine and centers around custodial care. In many
cases our negative attitudes go untested; many of us have never been inside the doors of a
nursing home. So let's take another look ...
The Florence L. MacKenzie Downtown
Convalescent Centre is an unobtrusive four
storey building just opposite the bus terminal
in downtown Hamilton, Ontario. From the
outside it looks like a rather ordinary
apartment building.
Inside, it is a friendly community, the
family numbering 105 members, people who
have much more than age In common. The
staff and patients communicate freely and
work together closely. The second and third
floors of the building room the more active
members of the nursing home. The fourth floor
residents need more nursing care; they tend
to be confused, they are 'wanderers'.
I visited the f^acKenzie Nursing Home to
talk to the nurses there, nurses pleased to
share their involvement and ideas about the
community where they work. I came away
after talking to nurses and visiting patients in
the home with impressions that were strongly
positive. Nursing homes seem to exist in a
world of their own. At the t^acKenzie Nursing
Home, both the nurses and patients seem to
have a lot to share.
Q. Let's start at the beginning, with why
you decided to work in a nursing home.
How did you end up working here, Joan?
Joan: It was a new concept of nursing for me...
tfiat's why I was ititerested. I really had no idea
how you worked in a nursing home. I'd really
never been in a nursing home before except to
visit my grandmother, and you look after
yourself there. So Mrs. Godzisz was talking
about working here, and I thought I would
come here and see what it was all about.
Q. Were you coming out of a hospital
setting?
Joan: I hadn't really worked for quite a while,
and my last job had been working with
retarded children. Before I started here, I
wasn't doing much of anything, and thought Id
like to start back.
Q. Did you find it took some getting used
to?
Joan: Oh very much. It was the complete
opposite of what I had been used to working in
a general hospital. Policies and those types of
things were quite similar to those I had known
working with retarded children. But it's a real
change from an active hospital.
Q. How about you Sophie? Howdidyouget
started?
Sophie: Well, for myself I wanted to get out of
the hospital setting. I felt that I had spent my
years there and left it for the younger girls —
they're a lot busier now, especially now with
cutbacks. I've always liked older people. I
wanted to get into a new area, and I hadn't
worked for four years or whatever it was at the
time. So I thought that there were various
areas that I hadn't been in — doctors' offices,
clinics — actually nursing homes hadn't really
entered my mind. I had been watching the
newspaper and Id see these ads come up for
various nursing homes .... I thought — now
that might be something different — and
geriatrics was something I didn't know that
much about. One day I saw an ad in the paper
for a nursing home that sounded interesting,
and I thought — why not, I'll just put in my
application and go from there — well, I walked
in the door and had a great reception because
Ivlrs. Smith was here, and of course we knew
one another from the hospital . So I was
introduced, went on a tour of the home, and I
was impressed. It looked like a nice setting,
something I'd probably like to work in. And
since I appreciate older people anyway — I
think they've got a lot to tell you and there is so
much to learn from them — I accepted, and
I've enjoyed it since then — very much.
The Canadian Nurse April 1977
Q. How about you Mary Ann?
Mary Ann: I left the hospital setting and came
directly to the nursing home. I was really
searching for something else — working in
intensive care was starting to become the
norm instead of the abnorm', and frustrations
had really piled up. The way my work in the
hospital was going at the time — well, going
Into the hospital was becoming very tedious.
I'd go in and never know what I was going to
find when I got there. I began to think "there's
got to be something better ... something
different." I had probably exhausted myself of
hospital settings. I saw an ad in the paper and
thought I'd be interested in some part-time
work. I came and applied, accepted a position
as a part-time R.N., and worked my way up to
where I am now.
Q. Many nurses express thecomplaint that
they feel very powerless in a general
hospital setting, more particularly an ICU
setting. They get a feeling that they're just
carrying out orders, that they haven't much
to say about long-term goals for the
patient, that they're caught in a big
machine. Do you find your position
radically different here? Do you generally
feel you can use your initiative more?
Sophie: I think that if you talk to the girls
working in hospitals, you'll find that they leave
at the end of a shift with a great feeling of
dissatisfaction and frustration. It's a real
pressure situation from what I can understand,
and it doesn't seem to be easing. Here, with
our patients, we've got a good rapport, and we
feel totally responsible ... I almost get
possessive ... I care so much for them and
want the best for them. In a hospital, you've got
short stay cases, you don't necessarily get to
really know your patients in a hospital
setting ...
Q. And so you can't make a realistic
assessment of what might be best for
them?
Sophie: Hospital settings don't give you the
right to do it ... because you're strictly on
doctor's orders, whereas here there's more
flexibility ...
Mary Ann: ... And we have better
communication with doctors here in our
nursing home. We can discuss with them and
make suggestions. They'll say "Well you know
that patient 24 hours a day, and know what he
is like " and accept suggestions. You don't get
an "I am the doctor ... You do this." pose. We
talk cases over with the doctor and suggest
changes and this brings a lot of satisfaction.
We also really get to know the relatives and
working with the relatives really makes our job
a little nicer.
Joan: One thing that helps is that this is
altogether a different atmosphere — these
people really aren't sick and we're here to help
them enjoy the last few years of their life in
most cases. I think that this is why we have
such good relationships with everybody —
doctors and visitors and patients — because
they aren't really sick, they're here because
there's really no other place to go, and we're
here to help them along.
Mary Ann: The family can't be with them day
and night and have reached the point of no
return — where they have to let someone else
take over so that they can continue to enjoy
them. Othenwise there are family breakups —
we have a positive role in helping to stop that.
Joan: We're in a different category — we can t
even class ourselves with hospital work — it's
a world of its own ...
Mary Anne: Well, I think, Joan that nursing
homes are like what we used to know in
medical floors with their long-term medical
patients ... you really got to know those
patients, and got satisfaction from doing more
than just active treatments ... you were there to
help them along. In really active settings you
just don't have the time to spend with the
patient.
Q. Do you feel now that you have enough
time to spend ... if a patient needs more
time, can you give it?
Joan: Most times, yes — there are a few days
when just nothing goes right and you don't
have time for anything, but most days there is
more time just to get to know people.
Q. What about the comment that many
people, including nurses make — that
nursing homes are depressing places to
be. You people incidentally don't seem to
be depressed.
(Laughter)
Sophie: Well, people get the picture of a
dungeon of old sad people lying around like
little skeletons. They think it's a terrible
atmosphere...
Joan: It's just lack of education of the public —
that's what it is. The people here just aren't sad
— and that goes for staff and patients.
Q. How about the patients? Coming into a
nursing home I guess they might feel pretty
sad at the beginning?
Joan: That I think, depends on your patient...
Mary Ann: ... Not on the fourth floor, but on the
second and third floor we often see an initial
depression. Our fourth floor is what we
consider to be our senile floor — still
ambulatory, they're wanderers and very
forgetful. Patients on the second and third
floors are our more alert patients — they know
what is going on, are able to talk for
themselves and make their own decisions.
Sometimes they have problems at first.
Q. Can patients bring anything with them to
make them feel more at home?
Mary Ann: Definitely yes. If they are in a
private room they can bring in anything they
want — fridge, television set, a bed, anything
they can bring in. Ward and semiprivate
patients can bring in a T.V. set if there isn't
already one in the room ...their own radios, a
special chairthatthey like, pictures, a lamp for
their bedside table, chest of drawers. They are
allowed their own telephone with a private
number that doesn't go through our
switchboard, and that really gives them a
feeling of independence.
Q. Do you encourage the residents to look
after themselves and their room as much
as possible?
Mary Ann: If they are able to. ..An alert patient
is still able to look after himself. We don't strip
him of the privilege of looking after himself
because you can only deter him by doing that.
It's important to keep patients as active and
interested as possible, and this is one way of
doing it. We also encourage them to go into
different programs that we have at the nursing
home ... to visit back and forth with each other
... and this keeps them pretty active.
Q. What programs can residents get
involved with while they are here?
Mary Ann: Our residents get physio every
day. They make crafts — we have a showcase
on the main floor where we display their crafts
and they go on sale. The patients get a
percentage back of whatever is sold. There is
bingo once a week ... and our patients think
that it's terrific that there is no charge for bingo
here. They win prizes. There's a monthly
birthday party for residents that have their
birthday that month, and everyone attends.
Different volunteer groups come in to
entertain. We hold two non-denominational
church services a week and a full Roman
Catholic service once a month. They see
movies once a month, and more often if we can
get them. We have library services for them
and get books with large print. For patients
who can't read, we get talking books that they
can sit and listen to. There's always something
going on. I have to smile at some of the
patients come Friday at 3:30. They say 'Well
now we've got the weekend to rest.' Some
patients ask Margaret, our therapist, for some
work to do over the weekend. I think they're
busy.
... We have a lovely roof garden in the summer
and we hold barbecues or picnic lunches on
the roof. The chef will prepare something
special for these occasions. I've brought in live
entertainment for our roof picnics and
everyone seems to thoroughly enjoy it. Some
patients really prefer not to go out the front
door, but after a barbecue on the roof will say
what a terrific outing they've had and talk about
it for weeks.
The first real barbecue I had on the roof
was comical. All the staff brought in their
barbecues. Now Hamilton has a CHML
helicopter flying around at 4 p.m. We lit the
barbecues and smoke was pouring from the
roof ... I'm sure they were ready to call the fire
department from the helicopter. We turned on
the radio and sure enough we heard there's a
barbecue being held on one of the rooftops.'
Q. What types of community input do you
get?
Mary Ann: We have church groups coming in
... the Senior Citizen Band in Hamilton comes
in to entertain the patients ... School groups
come in with their performances. Two
volunteers entertain at our monthly birthday
parties. A couple come in to help with the crafts
program... We also call on the V.O.N,
occupational therapy department to help us
with OT or speech therapy, or Chedoke
Hospital to help with rehabilitation. School
groups come in and sing a few songs or talk to
the patients and visit. The patients really enjoy
having young people around ...
Sophie: ... Some of them go out with their
families — out for supper during the week or
home for the weekend.
Mary Ann: Occasionally patients are alert
enough to take responsibility to go out alone —
usually these are the patients getting ready to
go back into community life.
Q. What about exercise for the patients?
Mary Ann: Every morning there's a whole
routine that they go through — hands, arms,
legs, breathing ... even patients in wheelchairs
are still encouraged to move their legs around
and keep their circulation going.
Q. Do all these activities bring everyone
together?
Joan: ...I feel that more should be involved.
The ones that are more interested or capable
go in for the more active participation.
Q. Is there a lot of interaction between
patients? Do they really get involved with
one another?
Sophie: Oh yes. They'll care for one another.
One that is in a wheelchair will call on one that
■floats around.' who acts as a kind of
babysitter. And sometimes you'll find that the
one in the wheelchaircan get quite demanding
... they get so used to someone catering to
them. The patients seem to really care for one
another once they get to know each other a
little better. They feel responsible.
Q. I was wondering if it wouldn't help new
residents to get used to the nursing home
... just the fact that there are other people
around and everyone is doing things
together. Probably part of getting used to
the home would be through interaction
with the nurses ... knowing that they are
cared for. Another part would probably be
the other residents. It must be difficult to
get into a community after you have lived
Independently for such a long time. Do the
other residents help?
Sophie: Well this sure is a real community in
itself. We have several residents who are
usually the floaters' on the floor ... they know
what is going on, and keep an eye out for who's
doing what, they know who's going out, when
they get back, they notice if they don't see
someone in the lounge or the dining room.
If a new patient comes in there is a little
time necessary for the older patients to accept
the new ones. They wonder where, for
example, the new patient will sit in the dining
room. I have one patient who will say 'You
can't sit there, that chair isn t yours, it belongs
to Mrs. So and So. After a while though, they
get friendly, and acceptance comes.
Mary Ann: ... We have two patients who take
an afternoon rest together. If I am showing
visitors through the home at about 2:30, they
sometimes ask if we have two patients to a bed
here. The two of them take turns resting in
each others' room. They lie side by side and
just talk to one another. I ve asked them if they
would like to share a room but they say 'No that
would break up our friendship' but they
continue to rest together and are really close.
Q. Whataboutbedtime? Because this is an
institution, is there a certain time
everybody has to go to bed?
Mary Ann: Oh no, they are free to go to bed
when they choose.
Q. That's good for night owls ... What are
some of the reactions you get from people
when they first arrive here?
Joan: Oh that really varies. Some people are
really belligerent — they're not going to have
any part of it; some are quiet. Then others just
seem to fit in nght away as if it was just the
natural thing for them.
Mary Ann: Often a patient who accepts the
home from the beginning is one ... who has
visited the home with the family before. He
comes to live here having had some say in
where he is going. The patient who wants to
get out and feels rejected by his family is one
whose family says we re going to leave you
here for a couple of days' with no explanation.
If they say to us 'Don t tell mother that this is a
nursing home, we ve told her its a hospital , ' we
can expect problems. This takes away the
patient's hghts and responsibilities. Patients
with any sense of reality at all need to have a
choice in what they are doing with their lives.
Q. It must be tricky for you if the family tells
you not to tell mother.
Sophie: You have to let your staff know that
the family is keeping the truth from the patient.
It's really difficult if you know that the patient is
someone who will not return to the community.
It's unfair because it takes longer for these
people to adjust ... so much longer. The family
is also making it so difficult for themselves —
they feel guilty to begin with and it's worse
because they have to live with this lie.
Q.I suppose that the problem might be that
the family feels that their mother can't
accept the fact that she is in a nursing
home.
Joan: I think the problem is guilt ... and the
family just cant face it ...
Mary Ann: The family feels that they are
rejecting a family member and they feel so
guilty. It takes approximately 6-8 weeks to
settle the patient and family. You may have a
patient very nicely settled, but the moment the
family shows up, the patient gets upset — and
it takes a while to settle them again. It happens
all the time ... its a natural reaction and the
patient soon grows out of it.
Q. Do relatives generally keep visiting,
even if the patient gets upset?
Mary Ann: I tell the relatives very clearly that
this is not a drop-off center. Once a patient is
admitted, we want to see his relatives visit
frequently and if we don t get frequent visits, I
tell them that they can expect a phone call.
Sophie: Sometimes we get a situation where
we are told that the patient is not to know he is
in a nursing home, and many times this patient
will get really agitated when his visitors show
up. Sometimes then you have to ask the family
to stay away for a few days because it's
upsetting the patient too much. It always
makes me wonder — if they had told the
patient the truth from the beginning — would
the adjustment be that much easier. I think that
probably it would, for both the family and the
patient.
ineuanaaian Nurse April \^u
Q. Could you tell me about the way a patient
adjusts to the home — perhaps a particular
patient?
Mary Ann: Something we really like to see ...
well, I'll use Mrs. M. as an example. When Mrs.
M. came to us, she was a chronic complainer
... very down, not too much going well for her,
she wanted to see her doctor constantly.
When she was at home, her doctor heard from
her daily with complaints. Meeting Mrs. M. now
is like meeting a different person — she
doesn't use her walker any longer, she is one
of the most active people in our programs, both
crafts and physio, she always goes to the
dining room. Occasionally shell complain of
her leg bothering her, and then say well, it's
probably the weather'. It's really gratifying to
see her accept us and her present life
situation.
Sophie: She gets so involved with other
patients — she has to know what is going on
on the floor. As soon as she finds out, — she's
the news messenger — she goes and tells
everybody else.
Mary Ann: When she first came, she would
hardly ever leave her room, and she constantly
complained of her own ill-feelings. Now you
cant find a happier, more involved patient.
Q. She sounds like she feels very useful ...
Joan: She really likes to be ...
Mary Ann: At home she was by herself, with
her family. All she had to think about was
herself, her leg, her arthritis. She couldn't do
this and she couldn't do that. The family
comments now that they find her so enjoyable
to visit.
Q. It sounds as if she feels that this is really
her home.
Mary Ann: Oh yes, that goes for other patients
too. If they go to the hospital from here, they
always say they want to come home, and they
mean here: or they will say I'm so glad to be
home' when they come back. Even visiting
relatives on the weekend, they will tell them
It's time to go home now,' and they mean here.
Q. That's good to hear. So many people
tend to think that a nursing home is an
awful place, depressing, with so many old
people around — mayt>e that's why
families feel so guilty.
Joan: Old people? You know, it's really
amusing to see that some 99 year olds around
here don't think of themselves as old ...
Sophie: ... and you don't dare call anyone
Grandma. They II say Who do you think you re
calling Grandma?' They, like anyone else I
suppose, don t feel the age they actually are.
Mary Ann: Only one person here likes to be
called Gran ....Sometimes patients request
you to call them by their first names, but for the
most part they like to be called Mr. or Mrs.
Sophie: One patient, Mrs. S. used to be a
school marm in England and you just would
never call her by her first name. It's respect ...
Joan: When these people were young, first
names weren't used as freely as they are now,
and it's only respect to call them by their Mr. or
Mrs
Q. Mary Ann, what do you go through with
families before their relative is admitted to
a nursing home?
Mary Ann: I have quite a lengthy discussion
with them, explain to them what is available for
them in our nursing home, what activities there
are. I also try to help them let go — to allow
professionals to take over... I try to see how
they feel, talk to them and let them know that I
am aware of the feelings that they are going
through. I try to put them at ease and tell them
that if they have any questions at all after they
leave that they needn't hesitate to call. Once
the relative is admitted to the nursing home, I
encourage the family to come and talk to me to
ease them through this change. We have
some really good relationships with families,
when they get to know that they can talk to us.
We get to know each other well.
Q. What would you say makes your job
interesting and satisfying?
Joan: It's a friendly atmosphere. In contrast to
a hospital — to me a hospital is like a factory —
the more you can produce the better they like
you. Here. I enjoy my work. I laugh a lot. I like
the things the patients do and say ... I get so
much enjoyment out of just trying to help...
doing little things. Some days, I don't seem to
do so much ... I do my routine work, but haven't
done anything extra, and that frustrates me.
But there is always the next day to try again. I
just enjoy it — I can't give you any specific
reason.
Sophie: I think the personalities of the patients
themselves are really interesting. The
satisfying part of it is in having patients come in
and working with them for a long penod of time.
Over a long term, if you set a goal for them, you
see them progress to a point where they will
take the initiative and say I am ready to do
such and such a thing.' It's great even if they
start participating in physiotherapy and loosen
up their limbs, or start walking. This is where I
find satisfaction ... in seeing a person
developing, in taking a part in it.
Mary Ann: We get patients from rehab
centers and we will be told ' We have taken this
patient as far as he can go ... he will no longer
be able to walk ... he is a wheelchair patient ...
he will never be able to use his hands, etc. ..
When we get them into our nursing home we
start activating them again. We work with them
and work with them and we never set a
short-term goal for the patient, say that he has
to attain this goal in six weeks or six months.
We take as much time as the patient needs.
We have patients now — we were told they
would never walk — and they are walking ...
because we never set a time limit. We have as
much time as they do. For myself, that's where
I get great satisfaction ....
Sophie: And yet, we don't have the elaborate
physiotherapy equipment that they do in some
places ...
Joan: But don't you think it's because its the
same familiar person looking afterthem all the
time ... the same face, the same voice, ... and
that helps them ...
Mary Ann: Tr.at familiarity helps with reality
orientation too. If the patient is confused, we
tell him who he is, where he is ... Earlier, we
were talking about families who didn't want to
tell a relative that he was in a nursing home. It
only makes it difficult to orient a patient if you
can't tell them that they are in a nursing home.
And it makes it difficult for us to build a
relationship with the patient too.
Q. I think after visiting the different floors
here that I can see a friendly relationship
between yourselves and the patients and
among the patients themselves. That must
be satisfying.
Joan: You do some silly little thing during the
day — to other people it's silly — but the
patient really thinks a lot of it ...
Sophie: I think the patient gets used to the
staff ... to certain people for certain things ...
they know the channels of communication ...
Here the patients really tune in to you, pick up
your moods ... It's really like a family in that
respect.
Q. It seems to me that you really enjoy
working with the patients here. How do
other nurses that you know react when you
talk about working in a nursing home?
Joan: They think I'm crazy. They just say ...
oh, that place ...'
Soph ie: ... or. How can you stand to work with
all those old people?'
Joan: I've had a doctor say that to me. Once
people know where you work they never seem
to ask any more questions ... it seems to end
everything as soon as you say where you
work.
Mary Ann: Hospital nurses go on and talk
about what is going on where they work ...
Maybe they think that we have nothing to say.
Q. Mayt}e it's because our attitudes about
getting old are really negative. Nursing in a
nursing home seems to be considered a
dead end. In hospitals we take so many
extreme measures to continue life. No one
wants to admit that aging is taking place...
Mary Ann: We've had relatives and doctors
ask us, when patients are getting towards the
end of their lives... they want them to stay with
us, to let them die with friends around, to die
with dignity ... It's missing in a hospital ...
there's just so much confusion. Here the
patients are also quite open. They say they are
ready to die — and there are no heroics... It's
personal here, no room numbers, no bed
numbers, no disease labels. It's more
understanding...
Acknowledgement
/ would like to thank the nurses at the
MacKenzie Nursing Home who took part in
what turned out to be a very enjoyable
interview: Mary Ann Smith, the Director of
Nursing: Sophie Godzisz. who works on the
second floor of the home: and Joan Harding,
who works part time on all three floors of the
nursing home. All are graduates of St.
Joseph's Hospital School of Nursing in
Hamilton. ^
>lu(horitaNve texts for todaK>s students,
INTRODUCTORY
FUNDAMENTALS OF NURSING:
The Humanities and the Sciences of Nursing, 5th Edition
By E. V. Fuerst, R.N., M.A. et al
The content has been thoroughly revised and reorganized, and
much new material reflecting current nursing concepts and
practice has been added. There is greater emphasis on a holistic
approach to nursing practice, and on preventive care. A major
innovation is the inclusion of the first application of systems
theory to nursing care to be found in a textbook on funda-
mentals of nursing.
Lippincott 512 Pages Illustrated 1974 S11.50
FUNDAMENTAL SKILLS IN PATIENT CARE
By L.W. Lewis. R.N., M.A.
This excellent introduction to tho fundamentals of patient care
Is an entry-level book for any type of nursing program. It
presents the basic nursing concepts and skills which every
nurse needs to know, regardless of the educational program in
which she is enrolled. Holistic in approach, the text touches
upon material that students have learned m related courses.
I.e. anatomy and physiology, and applies that knowledge to the
performance of nursing skills.
Lippincott 495 Pages Illustrated 1976 $10.40
By means of its highly engaging style and format, COMMUN-
ICATION IN NURSING PRACTICE involves the student as well
as the practicing nurse in the process of communication and
creates in them an awareness of their own personalities and how
they affect their relationships with patients.
Little, Brown 242 Pages 1973 S7.30
BASIC SCIENCES
BASIC PHYSIOLOGY AND ANATOMY, 3rd Edition
By f. £. Chaffee, R.N., M.N.. M.Litt. et al.
This edition offers a generously expanded coverage of human
physiology, and is enhanced by some two-hundred-twenty new
drawings by the eminent medical illustrator, Neil Hardy. Much
new material has been added, including an entirely new chapter
on body fluids and electrolytes and the book has been com-
pletely redesigned with an attractive new format.
Testing Program with answers available to instructors upon
request.
Lippincott 559 Pages Illustrated 1974 S14.70
LABORATORY MANUAL IN PHYSIOLOGYAND ANATOMY,
3rd Edition Revised
By E. E. Chaffee, R.N., H/I.N., M.Litt.
Practical applications and provocative study questions support
the teaching-learning process [Ariswer section available to
instructors.)
Lippincott 236 Pages Illustrated 1974 S6.60
BASIC MICROBIOLOGY, 3rd Edition
By W. A. Volk. Ph.D.: and M. F. Wheeler, M.A.
Extensively revised, reorganized for greater sequential logic,
and updated to include recent research findings, this Third
Edition meets all of the criteria for a one-semester course.
Lippincott 592 Pages Illustrated 1973 S15.25
LABORATORY EXERCISES IN MICROBIOLOGY
By R. B. Otero, Ph.D.
For introductory courses it provides students with adequate
knowledge of clinical microbiology.
Lippincott 165 Pages 1973 S5.20
THE HUMAN BODY IN HEALTH AND DISEASE, 4th Edition
By R. L. Memmler, M.D.:and D. L^f^/ood. R.N.. B.S.. P.H.N.
A wealth of study aids, andt^^ full-color illustrations by
Anthony Ravielli, notad"mec}ical arftst, spotlight this completely
revised and updated text To hep students understand normal
body processes and abnarrnal states and conditions, it skillfully
integrates the sciences of anatomy, physiology and pathology
. . . and includes elements of microbiology, chemistry and
physics.
Lippincott About 350 Pages Over 100 Illustrations 1977
COMMUNICATION IN NURSING PRACTICE
By E. C. Hein, R.N., M.S.
Covers a wide range of skills that nurses must use to commun-
icate effectively with an infinite variety of patients, and she
analyzes a communication model that takes the reader along a
sequential route comprising the component parts of the comm-
unication process. The text goes beyond the theoretical level,
however, and presents in a lively fashion the human element in
the nurse-patient relationship. Numerous examples from actual
nurse-patient interactions are included.
New 2nd Edition — Workbook for
THE HUMAN BODY IN HEALTH AND DISEASE
Lippincott About 200 PagK /-^ Illustrated
Qut 2UU Pagai ^
1977
STRUCTURE AND FUNCTION <3t THE HUMAN BODY,
2nd Edition
By R. L. Memmler, /MOD., and D. L. Wood, R.N., B.S.. P.H.N.
For those requiring a beginning level text on normal anatomy
and physiology, this concise, up-to-date book integrates lively.
■*S 7ad.:h.-t-
>lu(horitaMve texts for
lucid text with beautifully rendered color illustrations to famil-
iarize students with the parts of the human body and how they
work together.
Lippincott About 250 Pages Over 90 Illustrations 1977
New — Workbook for
STRUCTURE AND FUNCTION OF THE THE HUMAN BODY
Lippincott About 200 Pages Illustrated 1977
MEDICAL-SURGICAL
TEXTBOOK OF MEDICAL-SURGICAL NURSING, 3rd Edition
By L. S. Brunner, R.N.: and D. S. Suddarth, R.N.. B.S.N.E.
Outstanding in its depth of scientific content and in the practi-
cality of its applications, this leading text has been heavily
revised and updated, with much new material.
Lippincott 1156 Pages Illustrated 1975 S20.50
CARE OF THE ADULT PATIENT:
Medical-Surgical Nursing, 4th Edition
By D. W. Smith, R.N., Ed. D.; and C. P. H. Germain. R.N.. I\/!.S.
A superbly useful tool for nursing education and practice, this
well established text has been massively revised, updated and
expanded, and provides an authoritative basis for understanding
tha patient's therapeutic regimen.
Lippincott 1228 Pages Illustrated 1975
Paper, S17.80 Cloth, $22.85
Uie Clinical Pradice of
Adedical-Siifgical Nursing
MiiivricBeiie>s,R\ M>\ Skshh Dmks, K \. ,\ I SN
sibilities. The authors integrate the physical, psychological,
social, and technological components of nursing into the clinical
nursing procedures. Each chapter includes the full spectrum of
nursing care, assessment, primary care, acute care, chronic care,
and rehabilitation. Extensively illustrated with line drawings,
photographs, diagrams, and color illustrations, this book
provides students with a comprehensive picture of this most
essential nursing field.
Little, Brown Abt 1^00 Pages Illustrated 1977
Paper, Abt.S18.00 Cloth, S26.00
A GUIDE TO PHYSICAL EXAMINATION
By B. Bates, M.D.
An expertly-illustrated "how-to" text that bridges the gap
between anatomy and physiology and their application to the
physical examination
Lippincott 375 Pages Profusely Illustrated 1974 $19.70
Also available . . .
PHYSICAL EXAMINATION FILMS
A series of twelve sound motion pictures, correlated with the
content of A Guide to Physical Examination.
(Write to ttie Marketing Coordinator, A/V Media for infor-
mation.)
NURSES' HANDBOOK OF FLUID BALANCE, 2nd Edition
By N. M. Metheny, R.N., M.S.; and W. D. Snively. Jr., M.D.,
F.A.C.P.
The nurse's expanded role in diagnosis, treatment and evaluation
of lab findings is reflected in this edition.
Lippincott 313Pages 89 Illustrations 1970 $9.20
ADVANCED CONCEPTS IN CLINICAL NURSING,
2nd Edition
By K. C. Kintzel, R.N., M.S.N.
Written by professionals active in their respective fields, this
revised second edition continues to assist students and prac-
titioners in developing expertise in the more complex and
challenging aspects of clinical nursing
Lippincott About 550 Pages 153 Illustrations 1977
THE CLINICAL PRACTICE OF »
MEDICAL-SURGICAL NURSIIM<S-*
By M. Beyers. R.N., and S. Dudas, R.N., M.S.N.
A major new classroom text that focuses on patient care exper-
iences, this highly readable book incorporates all the scientific
background necessary for a full understanding of nursing respon-
Coming Soon:
INTRODUCTORY MEDICAL-SURGICAL NURSING
By J. C. Scherer, R.N., M.S.
Lippincott ^^^^ Spring 1977
Also:
Workbook for
INTRODUCTORY MEDICAL -SURGICAL NURSING
By J. C. Scherer, R.N., M^.
Lippincott Spring 1977
MATERNAL CHILD HEALTH
MATERNITY NURSING, 13th Edition
By S. R. Reeder, R.N., Ph.D. et al.
This outstanding text integrates nursing assessment of both
physical and emotional factors, applies evaluation and diagnostic
skills, and provides thorough coverage of current concepts in
maternity nursing. New and revised material covers society's
changing attitudes toward child bearing in light of socio-econ-
omic factors, physical problems and psychological stresses:
recent advances in maternal physiology, development and
physiology of the embryo and fetus: and clinical aspects of
human reproduction.
Lippincott 706 Pages Illustrated 1976 S15.50
omorrow's nurses.
1
NQRStNG C^^r
9TH EDITION
Waechter and Blake
NURSING CARE OF CHILDREN, 9th Edition
By E. H. Waechter. R.N., Ph.D. et al.
Completely revised and expanded, this edition is without peer
as an in-depth study of pediatric nursing. The text is organized
by age groups, from infancy to adolescence, with emphasis on
physical and psychosocial growth, development, and health care
planning for each age. Major revisions reflect increased nursing
responsibilities in assessment and management of the well child,
children at risk, and the ill child.
Lippincott 894 Pages Illustrated 1976 S18.85
NURSING CARE OF THE GROWING FAMILY:
A Maternal-Newborn Text
By A. Pillitteri, R.N.. B.S.N.. M.S.N. . P.N. A.
The first of two comprehensive and extremely well written
texts designed to meet the needs of today's nursing student in
maternal-newborn and child health nursing, respectively. The
author covers such topics as the prepartal period, parturition,
the postpartum family, the newborn, high-risk pregnancies,
and the high-risk infant.
Little, Brown 445 Pages Illustrated 1976 S15.75
NURSING CARE OF THE GROWING FAMILY:
A Child Health Text
By A. Pillitteri, R.N.. B.S.N. . M.S.N. , P.N.A.
A major new student text in pediatric nursing that comprehen-
sively covers family-centered child health care with extensive
attention to normal growth and development and emotional and
social dimensions of the family. This second of two volumes
discusses thoroughly the latest nursing techniques and pro-
cedures and emphasizes the broader role for nurses in today's
health care system. Topics covered include the growth and
development of the ctiild at all ages, newborn through adol-
escent, health assessment of children, and nursing intervention
with the ill child.
Little, Brown Abt. 800 Pages Illustrated 1977 $19.25
THE CHILDBEARING FAMILY; A Nursing Perspective
By M. A. Miller, M.S.N. . and D. Brooten, M.S.N.
The well-organized and easy-to-follow chapters of this important
new text focus on the biological changes in the expectant
mother as well as on the emotional needs of the mother and
father. A unique feature Of this major book is its cogent dis-
cussion of such current issues in maternity nursing as psycho-
logical adjustment to pregnancy, the unwed mother, the unwed
father, single parents, and the father's role in pregnancy and
childbirth.
Little, Brown Abt. 500 Pages Illustrated 1977 $15.95
EMOTIONAL CARE OF HOSPITALIZED CHILDREN:
An Environmental Approach
By M. Petrillo, R.N.. M.Ed.; and S. Sanger, M.D.
This book deals knowledgeably with the reduction of psychic
trauma in hospitalized children and their parents. Techniques
of communication are presented realistically and specifically.
Preventive approaches to minimizing unhappy experiences are
supported by analyses of actual clinical situations.
Lippincott 259 Pages Illustrated 1972
Paper, S6.60 Cloth, S8.95
FOUNDATIONS OF PEDIATRIC NURSING, 2nd Edition
By V. Broadribb. P.N., M.S.
A concise, practical presentation emphasizing the cardinal
principles involved in the nursing of children; and organized by
age groups, birth to adolescence.
Lippincott 500 Pages Illustrated 1973
Paper, S9.40 Cloth, $10.50
PHYSICAL GROWTH AND DEVELOPMENT:
From Conception to Maturity. A Programmed Text
By I. Valadin, M.D., M.P.H., and D. Porter, Ed.D.
This book covers basic principles of growth and development,
methods of assessment, and the functioning and development
of the major body systems.
Little, Brown 539 Pages Illustrated 1977 $15.75
MENTAL HEALTH
BASIC PSYCHIATRIC CONCEPTS IN NURSING, 3rd Edition
By J. J. Kyes, R.N., M.S.N. : and C. 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.
Lippincott 600 Pages 1974 $10.25
THE PRACTICE OF MENTAL HEALTH NURSING:
A Community Approach
By A. J. Morgan, M.D.: and J. W. Moreno, R.N.. M.S.N.
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 concepts basic to the
delivery of patient care.
Lippincott 211 Pages 1973 $6.25
MENTAL HEALTH AND MENTAL ILLNESS, 2nd Edition
By A. J. Morgan, M.D., and M. K. Johnston, R.N., M.S.Ed.
Designed to serve those studying the concepts of mental health
and illness for the first time, this excellent text has been thor-
oughly revised and expanded.
Lippincott 301 Pages 1976 $7.30
'^J^
NURSING OF FAMILIES IN CRISIS
By J. E. Hall, R.N.. M.S.; and B. R. Weaver, R.N., M.S.
With 20 Contributors.
This unique book is designed to increase the student or practi-
tioner's understanding of crisis theory as it applies to nursing
situations, and to provide exannples of strategies and tactics
useful to the nurse, in any area of practice, in helping families
to resolve crises.
Lippincott 264 Pages 1974 $7.30
THE NURSE AND HER PROBLEM PATIENTS
By G. B. 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.
Springer 192 Pages 1972 S5.80
PHARMACOLOGY
CLINICAL PHARMACOLOGY IN NURSING
By M. J. Rodman, B.S., Ph.D.: and D. W. Smith, R.N., M.D.,
Ed.D.
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, concisely presented.
Lippincott 701 Pages 1974 $13.90
Included:
NURSES' GUIDE TO CANADIAN DRUG LEGISLATION
By D. R. Kennedy, Ph.D.
Lippincott 1973
PHARMACOLOGY AND DRUG THERAPY IN NURSING
By M. J. Rodman, B.S., Ph.D.: and D. W Smith, R.N., M.A.,
Ed.D.
Lippincott 738 Pages Illustrated 1968 312.10
^ iTevtevond
apj^icotion of
Clinical Pbai'mcKdo^jv;
s.isv\tj;\i5iON
(lynocMiiiu.
INTRODUCTORY CLINICAL PHARMACOLOGY
By J. C. Scherer, R.N., M.S.
This practical book is valuable as either a brief introduction to
pharmacology or a handy review. It offers a concise overview of
modern pharmacology focusing on clinical aspects, plus a sum-
mary of drugs commonlv used in patient care.
Lippincott 367 Pages 1975 $10.00
REVIEW AND APPLICATION
OF CLINICAL PHARMACOLOGY
By S. E. Ralston, R.N., B.S.N. , M.Ed.: and M. Hale, R.N., M.S.
Suitable for any nursing program that integrates pharmacologs"
throughout its nursing courses, this text allows students to study
drugs in an applied and associated manner.
Lippincott 260 Pages 1976 $8.35
PROGRAMMED MATHEMATICS OF DRUGS
AND SOLUTIONS
By M. E. Weaver, R.N., M.S., and V. J. Koehler, R.N., M.N.
Lippincott 109 Pages 1966 Printing with Revisions $2.90
DIET THERAPY
NUTRITION IN HEALTH AND DISEASE, 16th Edition
By H. S. Mitchell, A.B., Ph.D., Sc.D. et al.
Presents a comprehensive survey of the science of nutrition,
with special emphasis on the application of theory to practice.
Lippincott 652 Pages Illustrated 1976 S15.20
NUTRITION IN NURSING
By L. Anderson, M.P.H. et al.
A compact text that provides the essentials of normal nutrition
and patient-centered clinical nutrition, without extensive cover-
age of biochemistry research data, or food preparation.
Lippincott 406 Pages Tables and Charts 1972 $10.25
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Mike Grenby
There's free money for the asking when
you're a senior citizen— but you've got to
ask...
Nurses involved with senior citizens
can play a vital and rewarding role in
helping these patients to get all the
benefits to which they are entitled. After
all, financial health (real or imagined) and
physical health are often closely
interwoven.
While government pension benefits
may be regarded as inadequate, whafs
even worse is not getting those benefits
for which somebody does qualify.
Don't take for granted that people
know about and are collecting such
benefits: all too often they don't know
and/or aren t collecting.
To find what's available, contact the
local Canada Pension Plan and Old Age
Security offices plus any provincial and
municipal government departments
which offer retirement or low-income
benefits.
Some groups and companies have
gathered this information. For example,
City Savings and Trust Company has
published Dollars and Sense of
Retirement, originally compiled by the
Vancouver Resources Board.
It deals with topics like the following
— and these apply right across Canada
— telling what is available and how to get
it:
Veterans' benefits: There a^e
disability pensions and allowances for
certain civilians as well as for veterans,
widows and dependents. Benevolent
funds for veterans also exist.
Canada Pension Plan: In addition to
the retirement pension, there are also
widow s and widowers pensions and
death benefits.
Old Age Security: If one has little or
no income, in addition to the old age
pension, there is a Guaranteed Income
Supplement. And there is a spouses
allowance.
Documents: This is a list of the vital
documents needed when one applies for
the various benefits — also, what
alternate documents will be accepted for
proof of age, for example.
Income tax: It s important to know
what income is taxable and what is not.
This booklet also provides
information on provincial, municipal and
community services for seniors.
While this part will be of specific
interest only in B.C., it could also be useful
in other provinces: to give an idea of the
types of resources which are available.
(Copies — single or in reasonable
quantities — of Dollars and Sense of
Retirement are available free from City
Trust, 777 Hornby Street, Vancouver,
B.C. V6Z IS4.)
You could also check your local
community groups and appropriate
government departments to see if
anybody has put together a similar
booklet for your province or community.
Even if you don't uncover a handy
list, the search in itself should help you to
compile your own list of services.
This is an invaluable asset: If you
cannot help someone yourself, the next
best thing is to know where to turn for help
or to whom to refer a patient.
Here s a quick rundown of the types
of things you might look at, in addition to
the points mentioned earlier:
Banking privileges, customer
services, housing, health care, help at
home, legal services and information,
congratulatory messages, action on
issues, transportation and travel, senior
citizen organizations, learning
opportunities, libraries, clubs and centers,
immigrant and interpretative services,
and volunteer opportunities.
Many services are free or offered at
reduced cost to senior citizens — bank
services, bus transportation, drugs,
movie admission — but again, you have
to know about them and know how to get
them.
It's extremely important for everyone,
but particularly older persons, to have a
record of personal and other important
financial documents.
There could be pension money
building up rather than being paid out, or
bond coupons going undipped, for
example.
Many banks, trust companies, credit
unions and other financial organizations
produce free booklets to help the
individual compile such a personal
record.
One of the best I've run across is
Knowing, available free from The Institute
of Chartered Life Undenwriters, 41 Lesmill
Road. Don Mills, Ontario. M3B 2T3.
The first half of its 24 pages deals
with personal papers, a household
inventory, will executors, being an organ
donor, funeral arrangements and
knowing whom to contact.
The other half of the booklet contains
forms to fill out, detailing the particulars of
topics like personal papers, insurance,
investments and personal advisers.
To keep control of money, you must
know how much is coming in and going
out. Only then can you make decisions as
to arranging and planning your affairs.
Again, financial institutions produce
free budget books. I'd recommend Your
Scotiabank Budget Book, from the Bank
of Nova Scotia.
Find out who handles the patient's
financial affairs.
If nobody, look around for a
sympathetic, intelligent adviser —
somebody you could probably use for
your own affairs, too.
Finally, make sure there's a recent
will.
Don't take the patient's word for it.
Find out who drew up the will and check
with that person to see if the will is
adequate, given the patient's current
situation and outlook.
Especially where there are
dependents, it s vital to have a properly
drawn will so that the financial as well as
the emotional grief following death will be
minimized.*
If you have any questions on your
personal finances — involving
investment, insurance, banking, creditor
any other such matters — write to me
do The Canadian Nurse.
While I cannot reply individually. I will
answer as many questions as space
allows.
Letters must be signed, but only your
initials will be used if you so request.
Copyright
M & M Creations Ltd.,
585 Hadden Drive,
West Vancouver, B.C.
V7S IG8.
The Canadian Nursp Aoril 1977
Frankly
Speaking
OAipth and the
John Duffie
For many older Canadians, life has become a
nightmare. There are now three million people
in this country 60 years of age or older, and far
too many of them are living at or below the
poverty level — lonely, demoralized, and
frightened by a runaway inflation that is
robbing them of the fruits of their life s work.
The economic consequences of aging are
only one aspect of the problem. We are now
beginning to realize that the emotional and
psychological impact of retirement is, if
anything, more important. Many of us derive
our place in society, our very identity, from our
jobs. With retirement, there is a terrible feeling
of loneliness, a feeling that we have been cut
off from the mainstream and have become a
little less than human. One of the most
destructive features of our society is the way
we equate chronological age with biological
and physical age, thus depriving the old of their
independent status and their nght to use their
talents and abilities.
Young people tend to regard the old as
obsolete or useless. Dr. R.N. Butler, winner of
the 1976 Pulitzer Prize for his book "Why
Survive?", coined the word ag/sm to describe
this negative attitude toward the elderly. He
considers agism to be on a par with racism and
sexism, and states that in its simplest form it is
just "not wanting to have all those ugly old
people around."
/g>"AII those ugly old people..."
V_y A negative attitude towards old people
may be based in part on an underlying fear of
growing old ourselves. Our tendency to ■avoid
the word old and substitute euphemisms such
as "harvest years" or "golden years" may be a
kind of denial of this tear.
Agism is also reinforced by our economic
system. Inorderto keep this system operating,
there must be constant growth,
ever-increasing production, a high level of
consumption, and corresponding waste.
Products are designed to wearout quickly or to
be superseded by new models. Everything
must become obsolete and be discarded
quickly, and it follows that the same attitude
carries over into the value we place on human
beings: the old, labelled useless and
non-productive, have no other destiny than the
scrap heap.
How do we rationalize our collective and
unconscious cruelty? Looking at the image we
have of the 'old' we find a stereotype that runs
somewhat along these lines:
Most old people are sick and confined to
institutions. They are unproductive, and
unemployable because they miss too
much time due to illness, besides being
accident prone. Intelligence declines
with age, sexual desire and ability
disappear, and most elderly people
become cranky and disagreeable.
It's not a pretty picture. How much of it, if
any, is true?
©Investigating the myth
The fact that about five percent of the
elderly population is confined to institutions
usually comes as a surprise to most of us.
Furthermore, many of our institutionalized
elderly are suffering from conditions
contracted earlier in life, conditions that are not
the result of old age per se.
Are the old unproductive? They may not
be prominent in areas requiring physical
strength or innovative thought, but in fields
calling for knowledge, experience and
judgment, there are thousands of people who
have made tremendous contributions to
others in their later years. We have only to
think of people like Picasso, Bertrand Russell,
and Golda Meir — people whose quality of
aciiievement has certainly not been limited by
age. Artur Rubenstein. one of the greatest
pianists of all time, undertook a lengthy tour of
one-night stands at 82 years of age that
younger musicians have described as
"killing."
Studies of industrial workers have shown
that production per man-hour is greater among
employees over 60 than among those under
20. Also, older workers have better
attendance records and suffer fewer disabling
injuries; nor do they switch jobs as frequently
as their younger counterparts.
The only real cause of unproductivity
among the old is the absurd barrier against
employment erected by governments, in the
selection of the arbitrary age of 65 as the start
of what has been called "statutory senility."
The myth of declining intelligence
became part of our folklore about a generation
ago when investigators drew some doubtful
conclusions on the basis of tests they were
carrying out. These tests were cross-sectional
in nature: identical questions were asked of i
subjects of different ages at the same time.
Invariably, the younger candidates outscored
the older. More recent longitudinal studies,
testing the same individuals at intervals along
their life spans, have shown that the original
studies overlooked many important factors:
• older people had received less schooling
than the young, what they had received had
relied more on memorization than on problem
solving.
• the old were more subject to fatigue
• they were generally more cautious,
reluctant to blurt out what might turn out to be a
wrong answer.
• generation differences were important: a
test involving the vocabulary of the space age
or of computers naturally favored the young.
To quote Dr. Jack Botwinick of Duke
University, "The elements of wisdom and
sagacity are not represented in the scientific
data and were not given the emphasis they
deserve." In other words, there is no space on
a punchcard for qualities such as judgment
and insight, qualities that develop with
experience.
The young and middle-aged share in a
belief that the old have no interest in sex. It is a
strange paradox that a younger generation
that has brought about such a revolutionary
change incur sexual attitudes is so puritanical
in the way it regards sex on the part of its
elders.
Often people refuse to recognize the fact '
that sexual desire can continue long into later
life. It is true that sexual activity declines
among many of the old, but in most cases this
is due to the acceptance of the old age
stereotype on the part of the elderly
Adapted from an article by John Duffie in
Victoria's Monday Magazine July 28-August, 3,
1975.
themselves. Impotency becomes a
self-fulfilling prophecy, and desire disappears.
Proof of the enduring power of sexual
feeling can be seen in the fact that, despite a
negative attitude on the part of society and the
lack of appropriate atmosphere for courtship,
marriages among the elderly continue to take
place. Dr. Isidore Rubin, in "Sexual Life After
Sixty, " tells of one home for the aged in which
there were 29 marriages in a 21 -year period,
these marriages proving more durable and
congenial than most unions contracted at
younger periods.
As to the charge that old people become
cranky and disagreeable, — it can be argued
that ttiere are just as many disagreeable
young people. Cicero, in his essay on Old Age,
said: Old men are said to be peevish and
fretful and irascible ... but these are faults of
character, not of age. " After 2,000 years, his
words still ring true. The kind of old person you
become depends entirely on the kind of young
person you have been, on the kind of person
you are.
/~\From the Age of Aquarius...
VyWhile the 20th century stereotype
persists, there are signs of change
everywhere. The old are becoming news and
after years of total preoccupation with the
young, television, magazines, newspapers
and radio, are adjusting their sights and
beginning to pay attention to the old. There is
evidence on all sides that the Age of Aquarius
is over and that we may be entering the Age of
the Elderly.
The reason for this surge of interest is
obvious. The older segment of the population
is still growing but the widespread use of birth
control devices is reducing the proportion of
young people. The statistics are impressive : I n
1971 Canada had 2.5 million citizens aged 60
or over, or about 1 1 % of the population. This is
expected to rise to 1 8% by the turn of the
century. The United Nations predicts that by
ths year 2000 there will be 600 million people
in the world over 60, and the report adds,
"Aging may be one of the crucial policy
questions of the last quarter of the 20th
century."
A society that stresses "health," is also
likely to produce a different breed of old
person, more vigorous and alert than every
before in history. The "new" old will be the
same persons who made up the baby boom of
the 1940s, were responsible for the campus
confrontations of the 1 960s, and who changed
our entire moral and ethical standards. Soon
after the turn of the century they will be the
60-year-olds, and it is my opinion that it is
unlikely that they will accept passively any
attempt to consign them to geriatric ghettos.
The potential economic problems may be
serious. As the proportion of old people in the
population becomes larger , the younger,
working group grows smaller with a resultant
reduction in the tax-paying base that supports
the group at the top. Already rumblings are
being heard. A labor spokesman at a
conference in Florida suggested recently that
the American Constitution be amended to
provide for a maximum voting age, so that the
voting power of the old might be kept under
control.
Aside from the huge sums needed for
pensions and welfare, there will be an
overwhelming demand for more and better
nursing homes, extended care hospitals, more
provision for home care, and a growing need
for doctors and other medical personnel to be
trained in the special needs and problems of
the old.
A Sleeping Giant
y'The basic needs of the old are not
unreasonable — freedom from want,
affordable housing, the right to share in the
community's recreational, educational and
medical resources, the right to work for those
who want to wori< and are capable of working
and, above all. the right to be useful, respected
members of the community, with a voice in the
way society is run.
The elderly may be likened to a sleeping
giant, just beginning to stir and rub his eyes.
They have accumulated experience, wisdom
and vision during their many years on earth,
and the failure of society to make use of these
qualities is a waste of human resources,
destructive to the elderly themselves and
signifying an enormous loss to the country.
There are difficult, complex problems to
be solved, and people of all ages should be
wori<ing together now to find solutions. Time is
running out.#
John Duffie, (Victoria, B.C.) is a member of
the American Association of Retired Persons,
thie National Council on Aging, International
Federation on Aging, the B.C. Old Age
Pensioners, the Canadian Authors'
Association, and numerous other groups.
Retired from his position of Property Tax
f^anager with Canadian Pacific, Duffie has
channelled his energies into other areas:
"Believing strongly in varied interests for
retired persons. I am trying to develop a sorf of
second career as a free-lance writer,
specializing in the field of aging and
retirement. " His work has appeared in several
weekly papers in the Victoria area, and he has
had some speaking engagements and a
couple of T. V. appearances, all concerned
with problems of the elderly.
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bieing bt eat: nutrition
for SENIOR CITIZENS
Mike Grenby
Here's food for thought for nurses involved In
the care and feeding of the elderly:
Seniors (65 and older) appearto be one of
the most poorly nourished groups in the
country, according to the Nutrition Canada
survey.
Senior males in particular seem to be the
most vulnerable of any group to nutrient
deficits.
The cheerful side of this discovery is that
the only way we can go is up.
According to Wendy f\/lcDonald, public
health nutritionist for the Nova Scotia
Department of Public Health, diet in old age
appears to be more for maintenance than
change.
"As a person ages, " she says, "his needs for
calories decrease because of both reduced
physical activity and decreased cell mass.
"Data collected over the past decade have
indicated reductions in weight and height
beginning at age 55.
"Active protein tissue is slowly replaced by
fat even in a person who is not ovenweight. At
the same time, however, the needs for
nutrients do not decrease."
This means that while old people don't
need as many calories, they still need their
nutrients. In fact, the elderly need just as much
protein as the young.
"Also, sufficient roughage and water must
be consumed to preserve bowel regularity;"
Wendy tVlcDonald says.
"Avoid excessive salt to prevent fluid
retention and elevation of blood pressure. And
reduce intake of saturated fat and cholesterol
to prevent arteriosclerosis."
Although there is no clear evidence that
aging can be slowed down through nutritional
means, the aging process can certainly be
made a more pleasant one through adequate
nutrition.
"The aged have the highest prevalence
rates for illness and disability," Wendy
McDonald noted. "Although they represent
barely 10 percent of the total population, they
account for a far greater percentage of health
care dollars.
"The point here is that almost one half of old
people's health problems are related to
nutrition."
Compounding and often causing nutrition
problems are low income, loneliness and lack
of incentive to eat, food fads or cultural habits,
chronic invalidism and/or lack of mobility, poor
dental health and deteriorating or vanished
taste buds.
Studies have shown the most commonly
neglected foods are cheese, whole grain
cereals, citrus fruit, eggs, milk and vegetables
and fruit, according to the public health
nutritionist.
"Of those living alone, the women tend to
eat better than the men, while the men eat
better if living with family or relatives, " she
said.
"As people grow older, they may lose the
motivation to apply the knowledge they
already have.
"When you try to improve nutrition, you must
also try to improve the individual's desire to
help himself — as well as providing accurate
'EATS" IN MY FURNISHED ROOM
I
' Reprinted with permission of the Vancouver
Resources Board.
I can have nourishing meals and snacks in my
furnished room even though I have • no stove
• no refrigerator
• and only a little money for food
Occasionally I can have a guest, too!
^'Suggestions for Meals and Snacks
I Breakfast
Sliced orange or orange sections
Ready-to-eat cereal with milk
Melba toast with peanut butter or cheese
Glass of milk (fresh or dry-skim)
Instant tea or coffee (if the tap water is hot)
I Supper
Salad plate of
— salmon or tuna or cold cuts
— tomato slices or wedges
— green pepper rings
— canned peas or asparagus with lemon juice, salt,
pepper, or salad dressing
Milk, tea or coffee
Bread or crackers with cheese
Fruit in season
'I keep these foods on my shelf :
1-2 small cans
— tuna — asparagus
— salmon — carrots & peas
— sardines — green beans
— canned beef' — green peas
Vegetables
(8 oz. can
equals 1 cup)
I Bedtime or Afternoon Snack
Banana milk shake
Molasses milk shake
Fruit and cheese
Crackers and milk
Cereal and milk
2-3 wedges of portion-wrapped
cheese
4 fef.
B^^a^^
1 I
1 small jar
— peanut butter
— honey or molasses
— salad oil
— vinegar
1 box or package of dried fruits
— apricots — raisins
— dates — prunes
— figs —shelled nuts
— mixed fruits They re wonderful snacks !
— evaporated milk
— non-fat dry milk
— tea bags
— instant coffee
— instant cocoa
nutrition information. "
And always remember to consider the
wide variations in individual nutritional and
social needs, she added.
Arlene Tolensky. nutrition consultant with
the Vancouver Resources Board, observes
that "eating habits we have developed over
the years are hard to change. It takes a real
effort to modify our food choices to meet
energy needs."
Simple substitutions to reduce calories
and so avoid the problem of ovenweight
include the use of skim or two-per-cent rather
than whole milk, cottage instead of any other
sort of cheese, and yoghurt instead of ice
cream.
"Portion size is also important. Just because
a food is lower in calories doesn't mean you
can have twice as much," she warned.
You must be familiar with the basic food
groups, which foods are the most nutritious,
what substitutions can be made etc. This
information is readily available from the health
and welfare departments of practically every
1 box or package portion size
— ready-to-eat cereals
— Melba toast
— wtiole wheat bread
— rye
— white or plain
^^ I want fresh fruits and vegetables,
too, so:
I buy one pound of — apples
— bananas
— oranges
— fruits in season
I buy one-half — tomatoes
pound at a time — green peppers
— grapes
Occasionally I buy — strawberries
a small box of — blueberries
— raspberries
The Canadian Nurse April 1977
■evel of government in every province — but
you must ask for it.
The B.C. Department of Health, for
example, produces The Senior Chef with, for
example, such basic easy-to-understand
advice on buying vegetables as:
"Some vegetables are better buys than
others because they contain such a large
amount of some vitamins that only a small
serving is needed.
"Some examples are carrots, broccoli,
spinach, sweet potatoes and squash. Buy
small quantities of these often.
"Cabbage has much more vitamin C than
lettuce. Serve it often raw as coleslaw. It is
much less expensive than lettuce. '
Arlene Tolensky also touched on ways to
motivate seniors to use information on
nutrition.
" If an old person feels lonely or apathetic, he
or she isn't going to care much about food,"
she said. "The idea then is to make eating a
social event with other people.
"Loss of appetite can be countered by
serving regular meals at regulartimes, serving
hot food hot and cold food cold, including an
appetizer before lunch or supper, trying five
meals a day instead of three, and so on.
Sometimes, baby get^^
more air than formula.
i
(
\
That's why we make soothing,
peppermint-flavoured Ovol
Drops.
Ovol is simethicone, an
effective but gentle antif latu-
lent that relieves trapped air
bubbles in baby's stomach and
bowel without irritating gastric
mucosa.
Ovol works fast. And that's a
relief for baby. And for mother.
Also available in adult-strength
chewable tablets.
OVOL DROPS
FOR INFANT COLIC
«^|
m
^y
^
o HORriER
"If chewing is a problem, there are many
nutritious soft foods: fish, eggs, cheese,
hashes and stews, peanut butter, cooked
vegetables, canned fruits, soups, hot cereals,
puddings, etc."
Perhaps the nurse's approach to nutrition
for the elderly can best be summed up this
way:
Try to avoid the philosophy of merely
eating to live and encourage as much as
possible the idea of living to eat.*
Mike Grenby, author of "Making the
tVlost of the Golden Years" and "Living to
Eat: nutrition for senior citizens, " both of
which appear in this special issue, is on
the staff of the Vancouver Sun, lectures
and appears regularly on both local and
national radio and television, and has
done consulting work for the federal
government.
He is the author of a nationally
syndicated column that he says he writes
"to help ordinary people understand,
manage and get the most from their
money. " His last article in The Canadian
Nurse was a column which appeared in
the January issue on income tax tips.
A graduate of the University of British
Columbia and Columbia University
Graduate School of Journalism, he is the
author of "Mike Grenby's Guide to
Fighting Inflation in Canada"
(International Self-Counsel Press Ltd.).
He and his Australian-born wife, Mandy,
who is a nurse, live with their son,
Matthew, in West Vancouver
Suggested Reading List
The American Dietetic Association position paper on
nutrition and aging. J. Ame/-. Diet. Ass. 61:623, Dec.
1972.
Bechill, W.D. Nutrition for the elderly. Program
highlights of research and development nutrition
projects, by ... and I. Wolgamot. Washington U.S.
Department of Health Education and Welfare, 1 973.
(DHEW Pub. No. 73-20236)
Symposium on Nutrition in Old Age, Saltsjobaden,
Sweden, 1971. Nutrition In old age. Edited by Lars
A. Carlson. Editorial assistant Sylvia Molen.
(Uppsala, Almquist & Wiksell, 1972). 180 p.
(Symposia of the Swedish Nutrition Foundation, 1 0)
Christakis, George ed. Nutritional assessment in
health programs. Amer J. Public Health 63:Supp.,
Nov. 1973.
Howell, S.C. Income, age and food consumption, ...
and M.B. Loeb. Gerontologist 9:3:1-122, Autumn
1969.
Rao, D.B. Problems of nutrition in the aged. J. Amer
Geriatr. Soc. 21:8:362-367, Aug. 1973.
Nutrition: a national priority. A report by Nutrition
Canada to the Dept. of National Health and Welfare.
Ottawa, Information Canada, 1973.
Watkin, D.M. Nutrition and aging. Introduction.
Amer. J. Clin. Nutrition 25:809-811, Aug. 1972.
Wilson, C. Special needs: aging-nutrition education
programs. J. Nutr Educ. 5:1:Supp. 2, 1973.
I
R n^UJ UURV OF H€LPinG
For many of our "senior citizens, " the decision to enter a residential or care home is not based on
medical reasons, but rather on problems arising from social isolation, financial insecurity, or the lack
of availability of a "caring person" to help look after them. In Canada, "home help" care workersare
almost non-existent compared, for example, to Sweden where more than a quarter of the elderly
population receive some form of in-home assistance. ' flaking "home help" more readily available is
just one approach to the question of care that is now being studied by a variety of experts at all levels
of government.
Richard McAlary
Many observers consider Canada to be less
advanced than other Western countries in the care
alternatives that it presently offers its elderly citizens.
If, as seems inevitable, the number of people over
the age of 65 (now estimated at 1 ,975,000) and the
ratio of senior citizens to the rest of the population^
(currently 8.7 percent of the total)^ both increase at
the rate that is predicted, there is little likelihood of
significant improvement in this standard of care
unless all of the agencies concerned are prepared to
give this problem the attention it deserves. Already,
attempts to shift responsibility from one level of
govemment to another, from one agency to another,
have begun.
O What resources are currently available?
"Homes for the aged' are now the most
frequently used method of providing care for the
elderly. Federal-provincial govemment agreements
divide these into five levels or classifications of care:
TYPE I — Often called "personal care" and the most
common type of home. These are staffed by
non-medical attendants under a medical supervisor.
TYPE II — commonly referred to as "nursing home
care," offers intensive personal care using
professional nursing supervision.
In 1976. facilities classified Type I or Type II
provided a combined total of 134,791 personal care
beds in a total of 2,252 homes. This included 48,183
beds in 826 Type II nursing homes."
TYPE III — provides for care of chronically ill patients
under 24-hour technical nursing supervision.
Generally, these patients must show potential for
rehabilitation through a slow-paced program.
TYPE IV — homes providing care for patients and
requiring rehabilitation.
TYPE V — acute hospital care.
The most popular alternative to institutionalized
health care \scarein the home and, in countries such
as Sweden, this is already a viable alternative. In
Canada, Saskatchewan leads the way among the
f^' '.'^"^^l
■rnwrn
mm
The Canadian Nurse April 1977
Author. Richard McAlary, ;s
currently working for the federal
government as a policy planner in
the housing field. His main area of
interest is urban economics.
provinces in promoting care at home. Instead of
continuing to build more special care homes offering
Type I and Type II care, the Saskatchewan
Department of Social Services is endeavoring to
work with the Saskatchewan Housing Corporation
(S.H.C.) and the provincial Department of Health to
provide a more flexible approach to accommodation
combined with personal care services in the form of a
Home Care Program.
For senior citizens who wish to remain in their
homes, Central Mortgage and Housing Corporation
(C.M.H.C.) offers help in upgrading individual homes
through the Residential Rehabilitation Assistance
Program (R.R.A.P.) which gives partly forgivable
loans to families, individuals and landlords who
reside in specific sections of most Canadian cities
(Neighbourhood Improvement Areas (N.I. P.)) and
communities of under 2,500. To date those over the
age of 65 have been the largest beneficiaries of this
program. The "retrofit" program to assist in the
upgrading of homes to conserve energy is also
expected to attract many senior citizens.
Since 1967, the federal government, through
C.M.H.C, has made loans and contributions of
approximately $1.5 billion to senior citizen housing
projects of one type or another. Now federal
officials have announced that they intend to obtain
reassurance that they are providing the type of
shelter and aid to the elderly of Canada that is most
needed. As a step in this direction, Urban Affairs
Minister Andre Ouellet has called for a dialogue
between senior citizens and representatives of the
federal government.
Last year. Central Mortgage and Housing
Corporation commissioned a study to investigate its
role in this area. Among the questions the crown
corporation asked itself were:
1 . What are the needs and/or demands for health
care facilities?
2. What location, design, and operational guidelines
for care facilities should C.M.H.C. adopt?
3. What is the relationship between federal funding
and provincial health funding in the field of geriatrics?
4. What level of care should the federal housing
agency fund, considering it is a "housing agency" not
a health care organization?
In the report, Non-Profit Housing for the Aged
and Other Special Care Groups by George Hart,
Consultant released in the Fall of 1976, he
recommended, among other things, that:
• the government take steps to ensure that most
of the elderly become financially independent in their
own right, especially through a greatly strengthened
Canada Pension Plan and flexible retirement.
• C.M.H.C. confer nationally and regionally with
social service and health authorities on the timing
and force of the new social service program and its
implications for housing.
• C.M.H.C. question and propose on the social
side of housing as well as legal, financial and
architectural aspects: it should not react passively to
proposals for certain kinds of unneeded but costly
institutions.
• As the new community-based home-helps
program takes effect, C.M.H.C. should:
a) continue building self-contained housing, not in
too large segregated islands but as small and as well
integrated into the community as possible;
b) work with appropriate provincial and municipal
authorities to develop sheltered housing adopted
perhaps from the British model;
c) fund no more boarding residences as such
(without care services or close connection to a care
home):
d) fund no more homes providing light personal care
only;
e) try to hold down the size of congregate institutions
and multi-functional complexes;
f) make suitable exceptions and adaptations in cases
of sparse populations, isolated communities, and
harsh climate.
• C.M.H.C. continue to capital fund nursing
homes providing Type II care.
• C.M.H.C. not classify as health facilities homes
receiving support from a provincial health insurance
plan because, however they are financed and
supervised operationally, they are in fact intensive
personal care facilities with nursing supervision.
• C.M.H.C. continue capital funding of care
homes where insurance obtains, even though some
well-off elderly will pay low fees, because poor to
low-moderate income is the present lot of most aged.
0 Summary
Whatever the outcome of the various
government decisions, one thing is certain, a
great deal of investigating remains to be done and
many important questions remain to be answered.
We must find the best way of helping our senior
citizens today while, at the same time, remaining
flexible in our approach to the changes that will be
required in years to come.*
References
1 Hart, George. Non-profit housing for the aged and
other special care groups. A policy study for Central
IVIortgage and Housing Corporation. Ottawa, Central
Mortgage and Housing Corporation, 1976. p. VIII.
2 Statistics Canada. Population projections for
Canada and ttie provinces, 1972-2001, Catalogue 91 -51 4
Occasional, Ottawa, Information Canada, 1974. p. 121.
3 Statistics Canada. Vital statistics. Catalogue 84-201 ,
Ottawa, Information Canada, 1974. p. 12.
4 Hart, op. cit. p. 37.
C€M/HlJNITy
CC$€UCCE$ f €C
THE CLECCLy:
2 prcaraitis
The number of choices available to an individual, including alternatives for care, seem to
diminish dramatically with age, illness, and disability. For many elderly people, maintaining
an active life within their own homes or communities, is impossible. Because they need some
assistance, they turn to what is offered to them, and in many cases, this means
institutionalization.
Here, two authors descrit>e some services which help maintain people in their
communities. Both the Day Therapy Centre in Hamilton, Ontario, and the Day Hospital in
Edmonton, Alberta offer the elderly person and his family a choice ... both have helped to give
the elderly a greater chance to live productive lives in their own homes, their own
communities.
Day Hospital
Hazel Schattschneider
CASE STUDY
Mrs. A. is an 88-year-old lady living In her
own home, the home she has lived in for
over 50 years. She Is a former teacher
who had been married for 32 years when
her husband died in T956. They had no
children. Mrs. As brother, now 86 years
of age. and sister, now 83 years of age,
have lived with her for many years and
are now managing the home. They are
Mrs. A's principal helpers. They have
found the task an Increasingly
demanding one, particularly when Mrs.
A 's sister became III and required surgery
last summer They have been receiving
support from the Edmonton Home Care
Program for nearly two years, primarily
through weekly home help services, and
periodic V.O.N, services.
Mrs. A. came to the attention of the
Day Hospital staff when an application
was completed requesting short-term
holiday nursing home placement for Mrs.
A. so that her brother and sister could
have a rest. At the time of assessment, it
was felt that in addition to short-term
relief. Day Hospital support would be
most appropriate in assisting this family
to continue coping in this situation and in
allowing Mrs. A. to continue living in her
own home.
On Mrs. As admission to Day
Hospital the following problems were
Identified and plans made:
• Unsteadiness with walking and lack
of a wareness of her right side as a result
of a stroke two years earlier. A
physiotherapy program of active
exercises and assistance with walking
encouraging her to walk independently
with a walker was planned.
• Need for assistance with bathing
and personal care. Plans were made for
Mrs. A. to have tub baths at Day Hospital.
She had been unable to have tub baths at
home because of difficulties in getting
upstairs to the bathroom.
• Arteriosclerosis, and Congestive
Heart Failure. She presented with pitting
edema of her legs and right arm. Her
medications (digoxin and lasix) were
reviewed and the dosage adjusted.
• Ulcers on her legs. Plans were made
for regular observation and dressing of
areas.
• Moderate confusion. Through
involvement in activities, social
The Canadian Nurse April 1977
interaction, reinforcement of reality, tfie
stimulation and encouragement
provided in the Day Hospital program, it
was fioped tfiat Mrs. A. would be
motivated and encouraged to increased
awareness of reality and increased
independence.
• Family's need for support and
assistance with l\Ars. As care. Through
tvlrs. A's attendance at the Day Hospital
twice weekly, her brother and sister are
not only given relief from her care but also
the reassurance that her needs are being.,
identified and attended to. They are also
encouraged to discuss any of their
concerns with the Day Hospital staff
Now, after attendance at the Day
Hospital for nearly three months, Mrs. A.
has shown significant improvement in a
number of areas.
She is walking more independently
with her walker at home. The edema in
her arm and legs has decreased
markedly. The ulcers on her legs are
healing well. She is showing a greater
awareness and interest in activities
around her. Her brother and sister report
that with this support they are able to get
a break and are therefore better able to
cope with their responsibilities.
It is apparent that Day Hospital is
providing significant care and support for
The Edmonton and Rural Auxiliary Hospital
and Nursing Home District No. 24 has
provided a Day Hospital program for up to 25
individuals per day for the past three years at
the Norwood Auxiliary Hospital in Edmonton.
The program gives each participant, each with
his or her own individual needs, the
opportunity to come together with others who
have similar problems. As a group, they work
together towards a common goal — to become
and remain as independent as possible and to
continue living in their own homes and
communities.
The program began in May 1973 as part
of a pilot project of the Alberta Hospital
Services Commission. The main goals of the
project were:
1 . To provide an alternative and more suitable
form of care, other than institutional care for
handicapped persons, particularly in olderage
groups.
2. To enable these persons to function more
independently in the community.
3. To reduce the costs of providing health ,
services to persons in older age groups. "'
Plans forthe project began in 1971 as the
possibilities for the development of such a
program were examined. In reviewing the
experience of others in implementing a similar
program, evaluators found that the "Day
Hospital" concept has been utilized in Britian
since 1 962 in response to a need to release
this lady and her brother and sister. Plans
are to continue in the present plan of
care, working towards continued
improvement of Mrs. A's health and
activity level. Together with the home
help services provided by the Edmonton
Home Care Program, Day Hospital is at
this point contributing significantly to the
quality of life for this family and allowing
Mrs. A. to remain living at home — the
hospital beds and to assist the individual to
remain in his own community.^ Since then,
several hospitals in the United States and
Canada (including the tvlaimonides
Psychogeriatric Day Hospital in Montreal)
have introduced similar programs.^'"
Often there is confusion about the terms
"day hospital" and "day care center." In the
context of the Canadian health care system, it
is important to distinguish between these two
types of care. A Day Hospital is a therapeutic
setting with professional staff working with
patients and families towards a therapeutic
goal of reaching and maintaining a maximum
level of independence. AOay Care Center, on
the other hand, functions in a somewhat
different way — providing care and
supervision, recreation and social activities
but not necessarily by professional
medical/nursing staff. In this way, it meets the
needs of people who no longer require Day
Hospital care but who might require support in
a social setting. As well, it provides care and
supervision to individuals who are unable to
remain at home alone while family members
are at work.
Initially, the Alberta program was called a
Geriatric Day Hospital. Today, it has widened
its scope to include the needs of younger
individuals but the program is still primarily
geared towards the older person. Those
attending the Day Hospital have a variety of
medical problems and disabilities; the most
common ones are those associated with
strokes, diabetes, arthritis, multiple sclerosis,
Par1<insonism, arteriosclerosis, organic brain
disease and depression.
C Planning for the individual patient
At the Nonfood Day Hospital, a program
of care is planned for each patient. His
individual physical, social and emotional
needs are considered by the patient care team
that includes medical and nursing staff along
with the patients themselves, their families and
related community agencies. Team
conferences are held regularly for assessment
and review purposes; family conferences are
held on admission and as indicated.
Community agencies are encouraged to
participate in the patient's plan of care and in
its implementation.
Patients attend the program for a period of
six hours, one, two or three days a week
arriving by 9:00 a.m. and leaving after 3:00
p.m. They travel either by taxi (on a pool
basis), the Disabled Transportation System
operated by the City of Edmonton or by
transportation provided by family or friends.
The Day Hospital staff consists of the
coordinator who is a nurse, one staff nurse,
one certified nursing aide, one occupational
therapy aide, one part-time medical consultant
and one part-time clerk typist. As part of a
larger complex consisting of an auxiliary
hospital and nursing home, the Day Hospital
utilizes the physiotherapy, occupational
therapy, dietary, housekeeping, laundry and
maintenance services of the larger unit.
The services provided in the program
include medical and nursing assessment, care
and supervision. This would include
monitoring of the patients' medical status such
as observation of general health status, vital
signs, blood tests and other diagnostic
procedures and the review and supervision of
diet and medication. Teaching {he Activities of
Daily Living is an integral part of the program
as patients are encouraged towards
self-responsibility. Patients are assisted withi
nersonal care including bathing as necessary,
xjiatry and dental services are also
-vailable.
C Special activities
Physiotherapy and occupational therapy
services are available from the auxiliary
hospital on an outpatient basis. When
indicated, the physiotherapist and the
. -.41 »-.«{ f-,rr>il>(,
' I 'Mffhipili|iiii!;hti!i:|
shuffleboard are demonstrations of the value
of such activities. The excitement of planning
and anticipating special events such as
picnics, teas, Klondike festivities, Day Hospital
birthday and Christmas celebrations are high
points of excitement and involvement for both
patients and staff. Through all these activities,
emphasis is placed on the patients'
capabilities rather than his disabilities. The
patients support each other in the group and
as a result, friendships have been established
rand the Day Hospital setting.
Jficant aspect of the Day
is its family-centered
involves, the family as much
lie program of care. Many
! ble to remain in their own
:he support and care given by
By listening, teaching and
ing when needed, the Day
I pports families in continuing
nsibility. At the same time,
^ H/T^J2^
their community. Other patients may require
care in a nursing home or an auxiliary hospital.
The need for some elderly persons to receive
continuing care and support in order to remain
at home remains apparent.
Since its beginning, the Norwood Day
Hospital has grown and developed through the
involvement and contributions of patients,
family and staff. Besides having t)een
evaluated officially as a pilot project, the
program has been evaluated on an ongoing
basis by all involved in the experience. While
participation in that experience has not been
without frustration and occasional
discouragement, it has also proved to be most
rewarding and we hope that as a result others
too may benefit. ♦
r-
r
Hazel Schattschneider received her basic
nursing diploma from tiie University of Alberta
Hospital School of Nursing, Edmonton. She
has also received diplomas in Outpost
Nursing and Public Health Nursing, Dalhousie
The Canadian Nurse April 1977
Day Therapy
Centre: The Role
of The Primary
Care Nurse
M. Ann Morlok
Mr. Thomson first attended the Day Therapy
Centre at St. Peter's just after the death of his
wife. Because of peripheral circulatory
problems involving his hands, he had recently
resigned his job as a brick layer.
A social worker referred him to the Centre
when she saw that his life seemed so
meaningless to him, that he was lonely, and
very depressed. She thought that some
association with others, some involvement in
recreational activities at the Centre, might be
of help to him.
From his first day at the Centre, Mr.
i Thomson began to find support from the other
I men that he talked to. At coffee breaks, he was
quick to join in lively discussions about sports,
politics, and the good old days.'
The occupational therapist discovered
that Mr. Thomson was a man of many talents,
whose interests Included carpentry,
I mechanics, plumbing and cooking. With the
encouragement of the staff and other clients at
St. Peters, life began to fall into place for Mr.
Thomson.
The Day Therapy Centre
The Day Therapy Centre is located in
Hamilton, Ontario, within St. Peter's Centre, a
hospital devoted to the care and rehabilitation
of ttie chronically ill. The programs and
I organizational structure of the Day Centre are
i closely affiliated with those of the hospital, so
that the clients enrolled in the Day Therapy
I program can take advantage of the
' therapeutic benefits of the hospital, as well as
I taking part in some of the hospital activities.
From its beginning, the geriatric day
centre was seen as an active means to ensure
the maintenance of the elderly within the
community, to encourage the use of as many
of their physical and emotional strengths as
possible, and to build on their talents, by these
means renewing purpose and meaning in their
lives. The purposes outlined for the centre are:
• to provide for assessment of the disabled
and/or senior person's ability to function at
home, with the support of a program focusing
mainly on group activity
• to provide continuing support and therapy
in order to assist the client to remain in the
community, living in his own home setting
• to provide an opportunity for
resocialization of the isolated and/or disabled
seniors within the community.
In order to become enrolled in the Day
Centre, the client is referred by the community,
through a family physician, social worker, or
community nurse. As soon as he is accepted
into the Centre, a program of recreational and
therapeutic activities is scheduled by the
coordinator and Day Centre staff. The
schedule is organized so that the client
becomes involved in activities that are
interesting and stimulating to him, with the
purpose of renewing his feelings of usefulness
and worth. Once the- appropriate team
members have assessed and worked with the
client, they compose a problem list to be used
as a guide in assisting the client in his
rehabilitation.
The staff of the Day Centre, consisting of
a coordinator, community planner, social
worker, recreation assistant, and myself, a
primary care nurse, work very closely with the
multidisciplinary hospital team to ensure that
the client receives the benefits of the
therapeutic resources appropriate to his '
needs. The hospital team includes a family
physician, physiotherapist, occupational
therapist, social worker, and recreation
worker.
During our association with the client, the
Hospital and Day Therapy team functions as a
unit, so that each member is cognizant of the
others' ideas, plans, management and
difficulties encountered. Through the team
function, the client is the recipient of shared
knowledge and resources.
V.O.N. Input
The role of the nurse within the Day
Centre evolved with the program itself. While
the program was still in its infancy, it became
obvious that this type of setting was an ideal
focus for an experimental program of the
Hamilton-Dundas Branch of the Victorian
Order of Nurses — to explore the greater use
of their services in prevention of health
deterioration among elderly people living at
home.
Many V.O.N, patients have reached some
stage of deterioration in their health and many
are facing the prospect of a major change in
their living style and accommodation. When
health breakdown can be prevented or slowed
down, the nurse has played a significant role in
assisting the senior citizen to remain a part of
his family within his own home setting.
Familiar with all facets of nursing within
the community setting, the V.O.N, nurse was
seen as an ideal person to assume the role of
primary care nurse within St. Peter's Geriatric
DayTherapyCentre. As a V.O.N, nurse, I was
enthusiastic about taking on this new role, a
role that expanded quickly.
The Primary Care Nurse
As primary care nurse I function as team
leader at an admission conference held after
the client has been attending St. Peter's
program long enough for all of us on the team
to have assessed him. At this conference,
treatment plans and goals are discussed with
the client and his family. When this conference
is completed, a review conference is
scheduled for a later date to assess areas of
progress and those that need further attention.
Hopefully by the time of the review conference,
the client will have taken some steps in
reaching a greater degree of independence
within tfie community, with less dependence
on St. Peter's Centre.
Other facets of the nurse's responsibilities
at St. Peter's may perhaps biest be illustrated
by returning to my discussion of Mr. Thomson:
Mr. T. progressed quickly and took on
many activities at St. Peter's. However, with
this dramatic increase in his activity, I noted
increasing dyspnea on exertion, some
bilateral ankle edema, and increasing fatigue. I
referred him to his family physician, who in turn
directed him to a cardiologist. Mr. Thomson
was started on a regime of diuretics and
cardiotonics, but the treatment was not very
successful.
One day he arrived at the Centre in
obvious respiratory distress, with pulmonary
congestion and bilateral ankle edema. I
contacted his doctor, and he was immediately
admitted to the coronary unit of an acute care
hospital. With further assessment and
management of his cardiac status by the
hospital team, he began to show some
improvement. While Mr. Thomson was in the
hospital, I was able to report pertinent details
to the hospital team concerning his home
situation, his progress at the Day Centre, and
the ease with which nursing care services
could be implemented in his home, if
necessary, upon his discharge from hospital.
Following three weeks of Home Care
management, including V.O.N, and
Homemaker services, Mr. T. was able to return
to regular attendance at the Day Centre. This
time, his treatment program was more
successful. During his attendance at the
Centre, I was able to monitor important
aspects of his medical management: his diet,
daily weight, medication compliance, and
activity level.
All of us at the Day Centre were pleased to
see both physical and mental improvement in
Mr. Thomson. We felt even more satisfaction
when Mr. T. stated that he had accepted a job
offer as a security officer in a downtown office
complex. He arranged to see his family
physician for his medical opinion and advice,
and once he received approval, he began work
on a part-time basis. He dropped into the Day
Centre when he could, reporting any weight
changes, diet and medication compliance and
his tolerance of his gradually increased
exercise regime.
By the time Mr. Thomson was discharged
from the Day Centre, he had returned to
full-time employment with regular health
supervision being provided through referral to
the Hamilton-Wentworth Health Unit.
One of my important tasks as primary
nurse at the Centre lies in assessment of the
client s needs. At the time of his admission. I
assess the client's health status and his home
environment, along with health services
available to him. From there, I contact the
clients physicians and other services that he
may need, and begin to compile a problem list.
As primary nurse, I am also responsible
for implementing emergency nursing
nrteasures as necessary, and for instructing
other staff and volunteers in appropriate
response to emergencies. I provide ongoing
education to volunteers through organized
workshops.
Occasionally assistance with personal
care and treatments is provided duhng the
client's attendance at St. Peter's if the facilities
for such treatments are not available at home,
or if the family situation is not conducive to
such care.
Referrals are an important component of
my duties. I make referrals to visiting nurse
agencies for nursing care in the home, to
health units, and/or other allied disciplines for
family and clientfollow-up, especially upon the
client's discharge from the program.
When the client has achieved some of the
goals worked out between himself and the Day
Therapy team, and gained enough
independence to function in the community
without the Day Therapy Program, I notify his
physician of his progress and eventual
discharge. Liaison with appropriate
'immunity health resources is organized so
at the client will have suitable health and
social backup.
Education of client's families, staff and
volunteers make up a large part of my
responsibilities. This may consist of group
and/or individual discussion about:
health problems
knowledgeable approaches to care
information about medications
food and fluid intake
disabilities and the restrictions that they
impose on life-styles.
Patient's advocate
As primary care nurse at the Day Therapy
Centre, I have found an opportunity to provide
ongoing support to the client and his family in
conjunction with the social worker when major
changes have to be made, changes such as
admission to a nursing home or hospital. I am
also in a position to provide data about the
client's needs to that admitting institution.
Evaluation of the program is an ongoing
process. While I provide input into the activities
of the Centre, I also monitor the effect of the
program on the client and the benefits derived
by his family, and report this information to the
team and related medical personnel. I hold a
unique liaison position between the Centre
and the community on behalf of the client and
his family, acting as advocate for both.
The Day Centre is still growing rapidly. All
members of the team feel that they play a
significant part in assisting the seniorcitizen to
remain very much a part of his own community
through the Day Therapy Program. «
CASE STUDY
Mr. 0. was originally referred to the Day
Therapy Centre for socialization and
assessment of his health status He had
no family, and had been assisted by a
community social service agency for a
number of years. Due to an accident
some years ago, and a chronic alcohol
problem, Mr. C. had developed a degree
of brain damage.
From my first contact with Mr. C, at
the Centre, he looked to me for support
when he was frightened, attentiveness
when he needed to talk, and a liaison
between the community and St. Peter's
when life wasn't going very well at home.
I soon found out that Mr. C's home
was not all it might have been, and that for
him, life wasn't really going well at all. He
had a room at the top of a long, bare,
winding staircase with no handrails, in a
house owned by a young couple who
fought regularly.
One day Mr. C. arrived at the Centre
crying, shaking and afraid to return home
because his landlord had threatened him
when he had complained during the most
recent battle. It was evident that Mr. C.
had to move immediately, and so I made
a number of calls to find suitable
accommodation for him. His move also
meant finding a volunteer to assist Mr. C.
to pack his few possessions and drive
him to his new 'home. '
Once established in his home, Mr. C.
needed help to adjust to the new setting,
and to other lodgers under the same roof.
Fortunately, his landlady was a kind,
understanding person, and although her
broken English initially made
communication between herself and Mr.
C. difficult, there was plenty of good will,
something that had been lacking in Mr.
C's 'home' until that time.
It didn 't take long for the three of us to
establish a workable relationship, a
relationship that provided the
atmosphere for me to do some health
teaching. I taught some fundamentals
about balanced diet, about more
economic food shopping, about the
necessity for good body mechanics to
avoid back strain. My assessment of their
situation led me to direct some of my
teaching to these areas. Eventually,
gentle persuasion convinced the
landlady of the need for more regular
medical check-ups, for herself and for
her lodgers.
During Mr. C's visits to the Day
Centre, I was able to monitor his weight,
diet, and vital signs (he had problems
with hypertension). Some months after
his move, while routinely checking his
blood pressure. I suggested that he visit
his family doctor for his routine
examination. A regular volunteer with our
program went with him.
The volunteer came back with the
news that a mass was detected in the left
side of Mr. C's throat. After a discussion
with his family doctor, Mr. C. was referred
to an otolaryngologist, and the volunteer
took him to this appointment. Mr. C. made
20 visits to the Cancer Clinic for radiation
treatments. At this time I kept in touch
regularly with Mr. C's family doctor, the
Cancer Society, Cancer Clinic, and his
social service agency.
During this time, I also took time to
explain skin care, dietary precautions,
and side effects of radiation to Mr. C. Our
discussions took place in his home and at
the Day Centre. Mr. C. his landlady, and
myself spent a long time talking about
cancer The positive aspect of his early
diagnosis seemed to allay some of the
worries that Mr. C. and his landlady
shared. Our discussions also opened the
door to some healthy talks about their
attitudes about cancer.
A small informal teaching session
also took place among the staff,
volunteers, and other clients at the Day
Therapy Centre. They were all concerned
to know how they could help Mr. C. They
learned about pertinent observations that
they could make, about how to support
Mr. C. Our discussions enabled
everyone to express their fears, to talk in
an open and positive way, and to receive
the information they needed in order to
help Mr.C.
References
1 Flathman, David P. and Larsen. Donald E.,
Evaluation of three geriatric day hospitals in Alberta.
U. of C, 1976, p. 3. (Restricted publication).
2 Koval, Barbara, "Geriatric day hospitals are
medical-social halfway houses," Mod. Hasp.
116:4:114-115, Apr. 1971.
3 Gibbons. Kathleen Sister. "A new era of day
care programs for the elderly," Hosp. Prog.
52:11:47-49, Nov. 1971.
4 Goldstein, S. et al Ttie establishment of a
psychogeriatnc day hospital.' Canad. Med. Ass. J.
98:955-959, May 18, 1968.
M. Ann Morlok (R.N., B.Sc.N., University of
Western Ontario) has worked as a general
duty nurse and as a nurse educator in two
basic nursing education programs in Ontario.
At present, she is employed by the Victorian
Order of Nurses and provides nursing input
into St Peter's Day Therapy Centre, Hamilton,
Ont.
The Canadian Nuise April 19/7
Saycrest ^Geriatric 'Centre
A Continuum of Care
Photo story by Suzanne tmond
Keeping the options open and maintaining optimum quality of life is
wfiat it s all about at Baycrest Centre for Geriatric Care in Toronto.
The Centre provides, under the umbrella of one central
administration, a continuum of care that ranges from facilities for
social and recreational activities for people still living in their own
homes, to sub-acute medical care for patients suffering from chronic
diseases, and terminal care for those who need it.
For the older person who qualifies for the services the Centre
provides, this means that, as his needs change over a period of time,
they can be matched and met somewhere within the total concept of
the Centre. Until a year ago, this package consisted of:
• Baycrest Hospital — a 1 54-bed chronic care hospital with
outpatient facilities, specializing in physical medicine, rehabilitative
therapy, audiology, preventive medicine and geriatric research.
• The Jewish Home for the Aged — providing accommodation
for 375 people (average age: 82.5) for people who can no longer
manage in the community due to social, psychological or medical
problems.
• Baycrest Day Care Centre — providing rehabilitative
programs for elderly citizens who cannot participate in other
community programs because of physical or mental problems.
In IVIarch, 1976, an extra dimension was added to these
services in the form of Baycrest Terrace, a minimal care institution
intended to permit persons over the age of 65 to continue to maintain
a large degree of independence in their living arrangements, while
providing, at the same time, 24-hour professional nursing
supervision and one main meal a day.
Residents, in turn, are expected to accept responsibility for
taking their own medications, arranging for laundry and light
cleaning of their suites, shopping, etc.
Both residents of the Terrace and senior members of the
surrounding community can take part in the activities of Joseph E.
and Minnie Wagman Centre which is attached to the 11 -storey
residence. Facilities here include a library, lounge, dining room,
convenience stores, beauty and barber shops, and boutique that
provides a sales outlet for materials produced in the craft areas of the
Centre. The emphasis is on new roles in retirement years and there s
a hobby, craft or activity to suit almost everyone's taste, whether he
wants to become a photographer, gardener or wood carver.
Recreational facilities include a swimming pool, exercise room,
billiard and games room.
Linking the Centre even more closely with the community, are
two additional services for non-residents — Meals on Wheels
cooked in the Centre's main kitchens and a Sheltered Workshop.
"The average stay at Baycrest Hospital is about 91 days —
compared to the 1972 Canadian average for chronic hospitals of
246 days. We think that one of the reasons for this, is the fact that we
get connected up with our patients very quickly on admission. This
means identifying the mental or social problems involved and
determining our management of care almost immediately."
"One of the things we've learned is that the nurse needs to
understand the healthy aged in terms of normal loss of vision and
hearing, the gradual slowing down of gait, circulation, etc. This is a
normal process.'
"We run Reality Orientation classes for five or six residents half an
hour each day. The nurses use boards containing key words and
repeat information abouttime, next meal, lastvisit, day of the week,
etc. They also discuss current events, Jewish holidays, the weather
— anything the patient can relate to. The program relieves a lot of
the agitation of the impaired aged. Our floor used to be confused
and upset — now there's a noticeable improvement in the way
residents feel about themselves. "
"We help the family to talk with their relatives about death and dying.
If they don't, the patient could die alone — in isolation from his
family. "
"From the standpoint of the welfare and happiness of the elderly residents themselves, as well
as the standpoint of benefit to the community, the success of housing for the elderly can be
measured largely by the extent to which it helps residents to maintain their independence."
U.S. Department of Housing and Urban
Development, Washington, 1968
f
"Doctors, social workers, interns, student nurses and nurses all
attend our patient care conferences to keep our lines of
communication open. This way. the patient doesn't get lost in the
language mechanisms of each discipline."
"We believe very firmly that a family has rights and responsibilities
too. If we see that a patient has no visitors, the head nurse will call
the family to find out what the problem is. If they need help, then our
social worker steps in. It's extraordinarily important for patients to
have this contact Having so many visitors, especially children,
around makes for a higher noise level but the patients appreciate
this as long as it's pleasant noise. "
"The patient's family comes in for an interview with the head nurse.
We try to put our goals and those of the family together. The
atmosphere is completely open: the patient or any member of his
family can ask questions at any time and receive an answer "
"We feel that children should maintain their relationship with their
grandparents. The patient shouldn't experience another loss,
especially while he is sick. Many of our patients have already faced
so many losses — their spouse, friends, home, health. They can't
lose their family too. " ♦
The Canadian Nurse April 1977
\pm
V
ki
1
■El
1
AND THE DEPRESSED ELDERLY
In the 1930's, Dr. J.L. Moreno, a Viennese psychiatrist, introduced psychodrama to North America.
As a young medical student, he had been impressed by the spontaneity of plays enacted by children,
and later began to realize that the play medium could be used to help patients resolve their conflicts.
For the depressed elderly person — often a forgotten person in our society — psychodrama as an
adjunct to individual psychotherapy has been found to be of positive value in helping him to work
through frustrations, fears and anxieties and to renew interest in life.
Dorothy Burwell
"The frustrating frictions of figtiting the unavoidable, and the effort to perform
tasks beyond our capacity, are the greatest sources of wear and tear. But the
stress of using our mind and muscles within the limits of their capacities is
healthy, pleasant and indeed indispensable to keeping fit. h/lan s noblest aim is to
express himself as fully as possible according to his own lights. Each of us must
find his own innate stress level and live accordingly. Compulsory inactivity may
cause more stress than normal activity. When suitably handled, stress can not
only produce but also prevent disease." (leaner, Cowgill).
In the care of the disturbed aging person, there
are two major problems to be dealt with —
motivation of the elderly person himself, and
promotion of attitudes of acceptance on the
part of the psychiatric staff. All too often, in
desperation, staff resort to argument or advice
when talking to the elderly depressed person.
This kind of exhortation is seldom effective in
motivating the person to change and usually
leaves the helper feeling more frustrated and
guilty. In turn, this can increase the guilt
feelings of the patient, leading to a further loss
of self-esteem ... And, thus, the cycle of
depression is perpetuated.
For the past thirteen years, I have been
engaged in group therapy using the method of
psychodrama. This form of group
psychotherapy involves a "structured,
directed and dramatized acting out of the
patient's personal and emotional problems, as
well as his social problems, using definable
techniques.'* It encourages individuals to
spontaneously act out their conflicts in life
situations, and to release fears, anxieties, and
frustrations in the milieu of a supportive group.
For the elderly person who is depressed,
for whatever reason — be it loneliness, loss of
self-esteem, fear of death — the kind of
positive support a group can provide may help
him to see his world in a different light and
perhaps motivate him to change. Here's how it
works ...
In these two case studies psychodrama
seems to have benefited two elderly
depressed men. Other factors could be
considered to have helped these patients but it
is my belief that psychodrama provided the
initial motivating experiences for both Mr. B.
(Uncle J.) and for Horace.
Sixty -two-year old Uncle J., who had been
born in Scotland, was a retired wholesale
merchant. Enforced retirement was his
greatest "frustrating friction" along with
"unavoidable" fights with his wife. Aunt S. His
depressed behavior was misunderstood by
Aunt S. who insisted that he could at least
"clean out the garage instead of sitting around
and feeling sorry for himself."
The director (left back corner)
encourages the protagonist
(center) to act out conflict
situations within a supportive
group setting. The double (left)
moves, acts and feels with the
protagonist and if necessary
speaks for her.
In reviewing Uncle J.'s past psychiatric
history, we found that he had been first
admitted to hospital in 1967 suffering from an
anxiety reaction. He had no previous history of
psychiatric illness. At that time, he was very
worried about his retirement and about his
employer giving him the brushoff concerning
the possibility of a part-time job. Three years
previously, the family had sold the wholesale
business to a larger firm. Since then, Uncle J.
had been despondent and complained of lack
of energy and interest in life. His depression
had grown steadily deeper, he became
forgetful and had experienced two blackouts in
the three months preceding his hospital
admission. He also exhibited increasing
fatigue at work and tended to fall asleep during
business meetings. His speech was slow but
clear and coherent when he was given time to
carry through a thought.
Treatment consisted of anti-depressants
and 7 electro-convulsive therapy (ECT)
treatments in one general hospital. Uncle J.
was then transferred to the Clarke Institute of
Psychiatry, Toronto because the treatment
was unsuccessful in relieving his depression.
At the Clari<e, both he and Aunt S. were
encouraged to join psychodrama — a form of
action therapy that encourages individuals to
work out the feelings and conflicts they have
♦ Rubins, Jack L. Psychodrama. In Freedman,
Alfred M. et al. Comprehensive textbook of
psychiatry. Wms. & Wilklns Co., 1967, Baltimore,
p. 1250.
Tha Canadian NivM Apra isr^
55
had with significant others with the help of a
director who is also the therapist. The
protagonist, in this case Uncle J., is given a
"double.' another member of the group, who
moves, acts and feels with the protagonist for
that session and, if necessary, speaks for him
in a spontaneous fashion. Other members of
the group, called "auxiliary egos," enact the
roles of the significant others.
Group session A
After a short interview with the
protagonist, the director instructs the patient to
"show the group" what happened by asking
such questions as: Show us what happened?
Where did it take place? What was the room
lll<e? Where was your wife sitting? And the
scene begins — a completely spontaneous
acting out. In the medium of the group, with
spontaneity as the key, and with the
assistance of the "double," the protagonist's
feelings of anger, frustration, fear, longing,
loneliness and confusion can emerge and be
shared.
When Mr. and Mrs. B. joined the group of
ten patients, they became affectionately
l<nown as "Uncle J." and "Aunt S " This
pleased Uncle J. who took great pride in
demonstrating the kind of high business
standards for which he was noted all his life.
He went through scene after scene, being able
now to tell Aunt S. what he thought about
"cleaning out the garage" etc. Aunt S.,
however, seemed to believe that any activity —
even cleaning out the garage would help his
state of mind immensely And after all, hadn t
she given up her golf games and bridge games
to be with him? Cleaning out the garage was
the very least he could do for her in return.
The group soon realized that Aunt S. was
far too anxious a person to actively participate
in psychodrama, especially when Uncle J. was
going downhill. Nonetheless, by using the
technique of role reversal Aunt S. tried to see
her husband through his eyes As a
consequence, she gained just a glimmer of
Uncle j.'s predicament.
The closure, the final scene, was about to
come — time was running out — and so a shot
in the dark' was attempted. The "double"
spoke: "Well, why the blazes should they put
me on the shelf? I'm still young! After all, Mr.
L.W.. head of that large supermarket, was in
diapers when I was in the wholesale business.
These young guys owe me something. I built
the business up from nothing for them! "
It worked. Uncle J. stopped his pacing
during this soliloquy. "You're right — dead on, "
he shouted at the 'double. ' "How did you
know? "
'Come on" said the double. ' "I still have
work to do! What am I going to do about it?"
"Do about it!" bellowed Uncle J. "I never
thought anything could be done ... That is it! I
will go and see L. tomorrow."
"What will I say," asked the "double"?
"Cut!" said the director.
This was the time to begin closure. In this
final scene the director helps the protagonist
and the group to experience positive feelings
that give the protagonist the courage to try new
patterns of behavior to help release his fears,
anxieties and frustrations and to cope with
life's crises.
Final Scene or Closure
Director: "Uncle J., you are going to rehearse a
scene with L.W. Who could be L.? "
In a few minutes we rehearsed the scene.
Of course the group congratulated Uncle J.
and supported him with their affection. His
self-esteem rose.
The next group meeting was in one
week s time. Everyone was on time for this
meeting — we wondered what he had done, if
anything! Uncle J. told us that he had girded
up his loins," had asked for an interview with
L.W. , and that the interview had been granted.
Uncle J. reported that he had landed a
part-time job! In a white coat he was to walk up
and down the local chain store seeing that the
girls on the cash desks were being looked
after. A more relaxed Aunt S. was able to go
back to her golf and her bridge games. The
conflict began to subside.
Therapeutic Effects:
In this instance, psychodrama had numerous
effects on the participants:
• The human encounter between
— Director/Protagonist
— Double/Protagonist
— Group/Protagonist
• The assertive training made it possible for
Uncle J. to move out on his own.
• The building of self-esteem that followed
one successful event.
• The attitudes of patient, group and staff
became much more caring and empathetic for
this couple — the women supporting Aunt S.;
the men supporting Uncle J.
• The space, time element made this more
of an experiential learning situation for the
patient — feelings long repressed were
liberated. Probably one of the greatest
benefits of psychodrama is the abreaction —
the release of tension and anxiety associated
with the emotional reliving of the past,
especially repressed events.
• Things went better in uncle J.'s
one-to-one therapy.
• Uncle J. s thinking and speech speeded
up.
Group Session B
Mr. Horace M.. 66 years old, is another
individual who seems to have benefited from
psychodrama. Horace, as the group called
him. a bachelor, had cared for his mother until
her death when he was in his sixties. He was
left bereft, and in a depressive state was
admitted to the Clari<e.
In his group session, we thought it would
be best to use a supportive approach to help
maintain his defences. But he would not have it
— he insisted on a scene with his mother. His
grief came flooding forth. His "double," one of
the women nurses, simply held him while he
sobbed. There was not a dry eye in the group.
What can one use for closure after a
scene such as this? The patient is the one to
decide. Horace decided that he would like to
leave his familiar surroundings for awhile. He
had a nephew in Manitoba he thought he
would like to visit. We arranged the scene. One
of his biggest problems was that of
remembering how one purchases a ticket for
the train. We went through this scene... and
then the trip... as he chugged his way Weston
the train, porters (nurses) came along and
waited on him hand and foot. Their task was to
ask Horace to describe the scenery through
which they were passing. In his younger days,
he had worked in the northern regions of
Ontario. When describing the scenery, his
impressions became more and more vivid as
he reached the head of the Lakes. And finally,
Winnipeg! Somehow the nephew drifted off in
his world of fantasy and we were back visiting
the old buildings of the city and the old cronies
who were his friends. We could feel the winds
of Portage and Main Street whip around our
ankles as he described the "coldest part of
Canada they say". We even agreed.
The trip would be called Gestalt Therapy,
no doubt, by those who wish to pigeonhole
therapies. Moreno, under whom I studied in
New York, would say that Gestalt arose out of
Psychodrama. Fritz Perls, after all. had
studied Psychodrama.
Horace never forgot that session. The
group surrounded him. Attitudes of staff and
patients change so dramatically towards a
more empathetic understanding after such
scenes.
The last time that I saw Horace he was in
the Clarke Coffee Shop. "Well, " he said. "' I
have just walked three miles. I do it every day
now. No. I never got to Winnipeg, but I take my
trip around here every day on foot.
Sometimes, some young girls join me. We go
on sightseeing tours. But now I must leave
you, Mrs. Burwell. You see my next group
starts in five minutes. It is yoga, but mind you
don't tell anyone, I fall asleep in it every time
after my walk! But, oh, it is good, Mrs. Burwell. "
Horace had come alive!
Therapeutic Effects:
Again a group of caring persons had
surrounded an elderly person in distress.
Horace had t)ecome the representative of the
group and they were able to share their
experiences of loneliness following his
session. The human encounter helps the
patient overcome this isolation that Adier
claimed was one of man's greatest fears.*
This article by Dorothy Burwell (R. N..M.A) is
based on a paper presented at the Annual
Meeting of the Psychogeriatric Association
of Ontario in September, 1975. Dorothy, a
graduate of the Toronto General Hospital
School of Nursing, the University of Western
Ontario, and Teachers' College, Columbia
University, New York, studied psychodrama
under Dr. Moreno. A former Director of
Nursing and Nursing Education at the Clarke
Institute of Psychiatry in Toronto, she is
presently Associate Professor, Faculty of
Nursing. University of Toronto, and Is a
Clinical Specialist and Consultant at the
Clarke Institute of Psychiatry and at the
Sunnybrook Medical Centre, Toronto.
The Canadian Nurse April 1977
Bernadette Walsh
years, s>nce ^ eterv \^^ ^ ^ vJe
died at *^°'r!cKnow\ed9ed ^'^ ° g^ns
sV«n^ ^^^^j^meVin^e o1 W^ ^*^3 regarded
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^^ ir \evine
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1'
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s^art^^ hS had slaved ^J';"^»,ev ^o^^^
His daughter n some^oNN ^^Qsp^^al
s-^>^^^Je,ad^«^<?v^assorrounded
vjhere ne ' g^\ierenew
Bernadette Walsh, Reg. A/., author of
One Gentle Man." works part-time in
Obstetrics at St Joseph's Hospital in
North Bay and is president of the local
Nipissing Chapter of the Registered
Nurses Association of Ontario. The
mother of four children, she will graduate
this Spring from Nipissing University in
North Bay with a Bachelor of Arts,
majoring in psychology. "One Gentle
Man, " she says, is one of many stones
she has written but is also her first
published work.
3'^" ' take Pernap-
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The Canadian Nurse
Canadian Nurses Association
Financial Statements
and Auditors' Report
Year ended December 31, 1976
Canadian Nurses Association
Balance Sheet
December 31, 1976
Assets
1976
1975
Current Assets
Cash in bank
$ 147,592
$ 148,119
Short term deposits plus accrued interest
211,770
536,357
Accounts receivable
44,314
58,824
Membership fees receivable
17,788
12,220
Prepaid expenses
10,968
11,519
Sundry Assets
432,432
767,039
Marketable securities — at cost (quoted value $12,314; 1975 $12,868)
4,933
4,065
Loans to member nurses plus accrued interest
10,093
11,289
15,026
15,354
Fixed Assets — nofe /
C.N.A. House — land and building — at cost less accumulated depreciation on building
456,199
488,066
Furniture and fixtures — at nominal value
1
1
456,200
$ 903,658
488,067
$1 ,270,460
Liabilities and Surplus
Current Liabilities
Accounts payable and accrued liabilities
$
18,459
$
39,146
Deferred revenue — subscriptions
35,300
21,900
— other
—
306
Mortgage payable within one year
—
324,534
53,759
385,886
Grants for Special Projects — unexpended portion — note 2
29,945
31,493
Reserve for support to the Northwest Territories
Registered Nurses Association — Note 3
—
11,000
Surplus
819,954
842,081
Approved on behalf of the Board:
Joan Gilchrist, President
Dr Helen K. Mussallem, Executive Director
$ 903,658 $ 1,270,460
ma
Canadian Nurses Association
Statement of Income — Testing Service
Year ended December 31 , 1 976
1976
1975
Revenue
Examination fees
$
649,896
$
401,534
Interest earned
4,153
649,896
405,687
Expenditure:
Salaries
242,230
176,493
Committee meetings
24,192
39,878
Item writing
10,237
23,457
Operations (data processing, printing and warehousing)
89,065
77,740
Consultants
—
5,239
Rent
37,002
28,570
Translation
1,342
5,478
Office supplies and stationery
6,242
8,726
Postage and express
3,040
3,612
Telephone and telegraph
5,160
4,046
Travel — non-committee
3,164
2,496
Equipment maintenance and rental
1,996
884
Books and periodicals
1,226
562
Furniture and fixtures
2,054
10,417
Miscellaneous
40
3,737
Leasehold improvements
—
22,338
Moving expense
—
787
Insurance
420
483
427,410
414,943
Surplus (Deficit) for year
$222,486
$( 9,256)
Auditors' Report
To the members of Canadian Nurses Association
We have examined the balance sheet of Canadian Nurses Association
as at December 31 , 1 976 and the statement of income and surplus for the
year then ended. Our examination was made in accordance with
generally accepted auditing standards, and accordingly included such
tests and other procedures as we considered necessary in the
circumstances.
In our opinion these financial statements present fairly the financial
position of the Association as at December 31 , 1 976 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,
Chartered Accountants.
January 20, 1977
Canadian Nurses Association
Notes to Financial Statements
December 31, 1976
1. Fixed Assets
It is the policy of the Association to
expense purchases of furniture and
fixtures in the year of purchase.
The C.N. A. House is being
depreciated over 20 years at the
rate of 5% per annum.
2. Grants for Special Projects
The Department of Health and
Welfare and the Canadian
international Development Agency
advances funds to the Association
in respect of grants for special
projects. The unexpended portion
of these grants at December 31,
1976 totalled $29,945.
3. Special Reserve
In 1 974 a special reserve of
$15,000 was established for
support to the Northwest
Territories Registered Nurses
Association. In 1975 a payment of
$4,000 was made to the
Association and the balance of
$1 1,000 was disbursed to them in
1976.
4. Retirement Income Plan
During 1975 changes were made
to the Association's retirement plan
resulting in additional benefits for
past service. Actuaries have
estimated that an annual amount of
$38,500 for the next 14 years will
be req ui red to f und the past service
benefits.
Canadian Nurses Association
Statement of Income and Surplus
Year ended December 31, 1976
1976
1975
Revenue
Membership fees
$ 1,014,066
$ 955,238
Subscriptions
39,196
38,922
Advertising
306,952
339,604
Sundry income
4,923
7,196
Expenditures
1,365,137
1 ,340,960
Operating expenses:
Salaries
796,680
759,924
Printing and publications
292,735
245,436
Design and graphics
23.835
14,399
Postage on journal
126,601
118,773
Computer service
45,835
44,894
Committee travel
25,247
36,272
Commission on advertising sales
39,117
33,546
Affiliation fees — I.C.N.
96,175
65,707
— Canadian Council on Hospital Accreditation
6,000
5,000
Professional services
24,762
14,121
Travel — non-committee
15,566
22,347
Office expense
36,690
36,614
Books and periodicals
9,820
10,238
Legal and audit
7,950
5,200
Building services
77,838
88,398
Sundry
6,052
13,725
Furniture and fixtures
1,387
2,954
Property improvements
6,900
189
Depreciation — C.N. A. House
31,867
31 ,867
Insurance
2,043
6,295
General meeting
—
1,661
Contingency for special projects
1,177
303
1,674,277
1,557,863
Non-operating expenses
1976 convention
(13,680)
Surplus (Deficit) for year before items below
1,660,597
(295,460)
1,557,863
(216,903)
C.N.A. Testing Service — per statement
222,486
( 9,256)
Investt nt income
50,847
61,423
Surplus (Deficit) for year
( 22,127)
( 164,736)
Surplus at beginning of year
842,081
1,006,817
Surplus at end of year
$ 819,954 $ 842,081
I ne kfBiiauian n\x sc
A^aiiies and Faces
Barbara Ellemers of Regina has
been appointed to the position of
Executive Director of the
Saskatchewan Registered Nurses
Association to be effective March 1 ,
1977. Born in Midale. Saskatchewan,
she is a graduate of the Regina
General Hospital School of Nursing
and has a Diploma in Public Health
Nursing from the University of
Saskatchewan, a Bachelor of Nursing
degree from McGill University, a Post
Graduate Diploma in Educational
Administration and a Master of
Education degree from the University
of Saskatchewan. She also holds a
Professional A Teaching Certificate
from the Saskatchewan Department
of Education.
She has had experience in
various fields of nursing: primary
nursing in hospitals, V.O.N, and public
health agencies, teaching experience
in both diploma and baccalaureate
nursing programs, as well as
consultative and administrative
experience. Ellemers has held the
position of Assistant Superintendent
of Nursing Education, Saskatchewan
Department of Education 1966-68,
during which time she was involved in
the phasing out of hospital schools of
nursing and the phasing in of nursing
education into post secondary
institutions under the Department of
Education. In the position of Program
Consultant in Health Sciences,
Department of Education 1970-72,
one of her concems was the nursing
assistant program. She was chairman
of the committee which designed a
bridging program for nursing
assistants desiring to continue their
studies towards an R.N. From
1973-77 Ellemers has been Director
of Public Health Nursing for the City of
Regina Health Department. This past
year, she has also been involved in
teachingas asessional lectureronthe
Regina campus for the College of
Nursing, University of Saskatchewan.
The SRNA Council is pleased to
announce the appointment of Marie
Lammer (B.Sc.N.. Queen s
University) to the position of
communications officer of the
Saskatchewan Registered Nurses'
Association effective January, 1977.
Her duties will involve
communications with the membership
and interpretation of nursing to the
public.
Lammer has been employed as a
Public Health Nurse I and II in
Saskatchewan and has taught in
schools of nursing in the province. Her
most recent appointment was that of a
nursing instmctor in communication
skills in the Health Sciences programs
at Wascana Institute of Applied Arts
and Sciences in Regina.
Carole Elliott has joined the staff of
the Registered Nurses Association of
Ontario as communications officer.
She has been in the public relations
field for seven years, most recently as
public relations officer for Alcan
Canada Products Ltd.. Toronto. She
holds a certificate of accreditation in
public relations (APR.) and is a
director and treasurer of the Toronto
Chapter of the Canadian Public
Relations Society. Inc.
Margaret Risk (R.N., Toronto
Western Hospital: B.Sc.N.. M.Sc.N. in
Community Health Nursing,
University of Toronto) was appointed
assistant director-practice in the
Nursing Division, Registered Nurses
Association of Ontario, effective
February 1st. She brings to this
position a varied background with a
particular focus on community
nursing. Her interest in practice and in
the proviskjn of a high quality network
of nursing services will contribute to
the forwarding of goals set by the
profession.
Official Notice
Annual General Meeting of the
Canadian Nurses Foundation
in accordance with By-law Section 36, notice is given of
an annual general meeting to be held Friday,
6 May 1977, commencing 14:00 hours at CNA House,
50 The Driveway in Ottawa, Ontario. The purpose of the
meeting is to receive and consider the income and
expenditure account, balance sheet, and annual
reports.
All members of the Canadian Nurses Foundation are
eligible to attend and participate in the annual general
meeting.
Helen K. Mussallem, Secretary - Treasurer,
Canadian Nurses Foundation.
Assistant Director of Nursing
Applications are invited forthe position of Assistant Directorof
Nursing at the Kirkland and District Hospital, a 138 bed fully
accredited hospital.
Duties will include In-service education and the development
and implementation of nursing-related policies and
procedures.
Applicant should have a baccalaureate degree in nursing and
a minimum of three years administrative experience.
Excellent salary and fringe benefits.
Please direct correspondence to:-
Director of Personnel
Kirkland and District Hospital
145 Government Road East
Kirkland Lake, Ontario
P2N 1R2
The Canadian Nurse April 1977
Library Update
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 by letter giving author, title and item number in this
list.
If you wish to purchase a book, contact your
local bookstore or the publisher.
Books and documents
1. Abel-Smith, Brian. Value for money in health
services: a comparative study. London,
Heinemann, c1976. 230p.
2. Aging and communication, edited by Herbert J.
Oyer and E. Jane Oyer. Baltimore, Md., University
Park Pr., c1976. 302p.
3. Argyris, Chris. Increasing leadership
effectiveness. Toronto. Wiley, c1976. 286p.
4. Austin, David. English for nurses, by... and Tim
Crosfield. Don Mills, Ont., Longman Canada, 1976.
138p.
5. — . English for nurses: teacher's notes, by... et al.
Don Mills, Ont., Longman Canada, 1976, 30p.
6. Bailey, Rosemary R. Mayes' midwifery: a
textbook for midwives. 9ed. London, Bailli6re
Tindall, c1976. 274p.
7. Barker, Philip Ann. Basic child psychiatry. 2ed.
Baltimore, Md., University Park Pr., c1976. 274p.
8. Barman, Aticerose. Helping children face crises.
New York, Public Affairs Committee, c1976. 24p.
(Public affairs pamphlet no. 541)
9. Bartilucci, Andrew J. Giving medications
correctly and safely, and Jane M. Durgin. Oradell,
N.J., Medical Economics Co., c1976. 128p.
10. Burgess, Ann Wolbert. Community mental
health: target populations, by... and Aaron Lazare,
Englewood Cliffs, N.J., Prentice-Hall, c1976. 276p.
1 1 . Catron, Donald G. The anesthesiologist's
handbook. 2ed. Baltimore, University Park Pr.,
C1976. 201 p.
12. Champion, John M. General hospital: a model.
Baltimore, Md., University Park Pr., c1976. 251 p.
1 3. Collective bargaining in the essential and public
service sectors, edited by Morley Gunderson.
Toronto, University of Toronto Pr., c1975. 159p.
14. Conference Internationale du Travail, 63e
session, Gen6ve, 1977. L'emploi et les conditions
de travail et de vie du personnel infirmier. Sixi6me
question d I'ordre du jour. Geneve, Bureau
international du Travail, 1977. 101 p. (Son Rapport
VI (1))
15. Curr\e, James. Professional organizations in the
Commonwealth. Revised edition. Edited by Norman
Tett and John Chadwick. London, Published for the
Commonwealth Foundation by Hutchison, cl976.
584p. R
1 6. Dion, G6rard. Dictionnaire canadien des
relations du travail. Quebec, Les Presses de
I'Universite Laval, 1976. 662p. R
17. Fix, A. James. Basic psychological therapies:
comparative effectiveness, by... and E.A. Haffke.
New York, Human Sciences Pr.. c1976. 285p.
(Psychotherapy series)
18. Friedman, Meyer. Type A behavior and your
heart, by... and Ray H. Rosenman. New York,
Knopf, 1974. 276p.
19. Frobisher, Martin. fAicrobiologie clinique, par...
et Robert Fuerst. Montreal, HRW, cl976. 507p.
20. Handbook of measurement and evaluation in
rehabilitation, edited by Brian Bolton. Baltimore,
Md., University Park Pr., c1976. 362p.
21. Hardy, Alan G. Practical management of spinal
injuries; a manual for nurses, by... and Reginald
Elson. Edinburgh, Churchill Livingstone, 1976.
162p.
22. Hasse, Patricia T. Nursing education in the
South 1973, by... and Mary Howard Smith. Atlanta
Ga., Southern Regional Education Board, 1973.
59p. (Pathways to practice, vol. 1)
23. — . A proposed system for nursing: theoretical
framework, part 2. Atlanta, Ga., Southern Regional
Education Board, 1976. 139p. (Pathways to
practice, vol. 4)
24. — . A workbook on the environments of nursing
theoretical framework, part 1, by Mary Howard
Smith and Barbara B. Reitt. Atlanta Ga., Southenr
Regional Education Board, 1974. 126p. (Pathways
to practice, vol. 3)
25. Hubbard, Charles William. Family planning
education. 2ed. St. Louis, Mosby, 1977. 241 p.
Students & Graduates
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To receive a free sample of our "needs no starch" cloth, and more
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The Canadian Nurse April 1977
63
26. Innis, Hugh R. Bilingualism and biculturalism;
an abridged version of the Royal Commission
Report. Toronto, McClelland and Stewart, in
co-operation with the Secretary of State Department
and Information Canada. c1973. 186p.
27. Jenicek, Milos. Introduction A I'epidemiologie.
St-Hyacinthe, Quebec. Edisem, 1976. 400p.
28. Kessel, Israel. Ttie essentials of paediatrics for
nurses. 5ed. Edinburgh, Churchill Livingstone,
1976 306p.
29. Kurdi, William J. /Modern intravenous ttierapy
procedures: a handbook for nurses and other allied
health personnel. Los Angeles, Ca., IVIedical
Education Consultants, c1975. 1976. 288p.
30. Letters of Florence Nightingale in the History of
Nursing Archive, Special Collections, Boston
University Libraries, edited by Louis A. f^onteiro.
Boston, l^a., Boston University, 1974. 69p. R
31. Management ofthe high-risk pregnancy, edited
by William N. Spellacy. Baltimore, M6., University
ParkPr.,c1976. 271p. Proceedings of a symposium
held in Disney World, Orlando, Fla., t^ar. 13-14,
1975.
32. Martinson, Ida Marie, ed. A guide to publishing
opportunities for nurses. Revised. University of
Minnesota, School of Nursing, Duluth, Mn., 1976.
71 p.
33. Martin, Susan K. Library networks 1976-77.
White Plains, N.Y., Knowledge Industry
Publications. c1976. 131 p.
34. Maternity nursing today, by Joy Princeton
Clausen etal. New York, McGraw-Hill,c1977. 883p.
35. Matheney, Ruth V. Le nursing en psychiatrie,
par... et Mary Topalis. St. Louis, Mosby, 1 976. 383p.
36. The midwife in the United States; report of a
Macy Conference. New York, Josiah Macy, Jr.
Foundation, 1968. 177p.
37. Murray, Malinda. Fundamentals of nursing.
Englewood Cliffs, N.J., Prentice-Hall, c1976. 530p.
38. National League for Nursing. Depl of
Baccalaureate and Higher Degree Programs.
Current issues affecting nursing as a part of higher
education. Papers presented at the Fifteenth
Conference of the Council of Baccalaureate and
Higher Degree Programs, Houston, Texas, March
1976. New York, 1976. 58p. (NLN Publication no.
15-1639)
39. National trade and professional associations of
the United States and Canada and labor unions.
12ed. Craig Colgate, editor. Washington, Columbia
Books, 1976. 378p.
40. Nordmark, Madelyn Titus. Scientific
foundations of nursing, by... and Anne W.
Rohweder. 3ed. Philadelphia, Lippincott, c1975,
1967. 426p.
41. O'Connor, Andrea B. Writing for nursing
publications. Thorofare, N.J., Charles B. Slack,
C1976. 99p.
42. Olendzki, Margaret. Cautionary tales.
Wakefield, Ma., Contemporary, c1973. 111p.
43. Pauling, Linus Carl. Vitamin C, the common
cold, and the flu. San Francisco, Freeman, c1971 ,
1976. 230p.
44. Phaneuf, Maria C. The nursing audit;
self-regulation in nursing practice. 2ed. New York,
Appleton-Century-Crofts, c1976. 204p.
45. Public Service Alliance of Canada. Grievance
collection. Ottawa, 1976? 4pts.
46. Resolving dilemmas in practice research:
decisions for practice. Proceedings of a symposium
held at the School of Nursing, University of North
Carolina at Chapel Hill, March 1 974, edited by Joyce
A. Semradek and Carolyn A. Williams. Chapel Hill,
N.C. University of North Carolina, c1976. IIOp.
47. Schaefer, Morris. L administration des
programmes de salubrite de I'environnement;
approche syst^mique. Geneve, Organisation
mondiale de la Sante, 1975. 256p. (Organisation
mondiale de la Sant6. Cahiers de sant6 publique, no
59)
48. Schaller, Warren E. Health, quackery & the
consumer by... and Charles R. Carroll.
Philadelphia, Saunders, 1976. 426p.
49. Slaby, Andrew Edmund. Handbook of
psychiatric emergencies: a guide for emergencies
in psychiatry, by Julian Lieg and Laurence R.
Tancredi. Flushing. N.Y., Medical Examination
Pub.. C1975. 191p.
50. Watson, Anita B. Care planning: chronic
problem STAT solution, by... and Marlene G.
Mayers. Stockton, Ca., K/P Co. Medical Systems,
C1976. 95p.
51 . Winter, Chester C. Nursing care of patients with
urologic diseases, by... and Alice Morel. 4ed. St.
Louis. Mosby, 1977. 366p.
Pamphlets
52. McMullan, Dorothy. The role of the nurse as
employee: a case of mutual responsibilities. New
York, National League for Nursing, c1976. 12p.
(NLN Publication no. 14-1644)
53. National League for Nursing. Biennial
Convention, New Orleans. May 18-22, 1975
Community health agency evaluation. Papers
presented at an open forum at the 1975 NLN
Convention. New York, 1 976. 24p. (NLN Publication
no. 21-1643)
54. — . Council of Home Health Agencies and
Community Health Services. Directory of home
health agencies certified as Medicare providers
1976. New York. 1976. 1v. (NLN Publication no.
21-1648)
55. National League for Nursing. Council of Hospital
and Related Institutional Nursing Services.
Pathways to quality care. Papers presented at a
Workshop... May 6-7, 1976. Newport, Rhode Island.
New- York. 1976. 40p. (NLN Publication no.
20-1636)
56. — . Dept. of Diploma Programs. Today's issues:
Tomorrow's achievements. Papers presented at the
1976 annual meeting of the Council of Diploma
Programs held in Chicago, II. May 1 976. New York,
1976. 43p. (NLN Publication no. 16-1635)
57. Ontario Hospital Association. Guidelines for the
development of a nursing sen/ice policy manual.
Toronto, 1976. 23p.
58. Reich, Carol. A study of interest in part-time
employment among non-teaching employees ofthe
board. Toronto, Board of Education, Research
Dept.. 1975, 24p. (Research Service Report no.
132)
59. Order of Nurses of Quebec. Code of ethics.
Montreal, 1976. 7p.
60. L'Ordredes Infirmifereset Infirmiers du Quebec.
Code de deontologie. Montreal, 1976. 7p.
61. Royal College of Nursing of the United Kingdom.
What the Ren stands for London, c1976. 12p.
62. Southern Regional Education Board. SREB's
nursing curriculum project: summary and
recommendations. Atlanta. Ga., 1976. 18p.
Government Documents
Canada
63. Advisory Council on the Status of Women.
Matrimonial property; towards an equal
partnership. Ottawa, 1976. 16p. (The Person
Papers series no. 1)
64. Centre de recherches pour le d6veloppement
international. Rapport annuel 1975/76. Ottawa,
1976. 1v.
65. Le Conseil Consultatif de la Situation de la
Femme. Les avar7fages soc/aux Ottawa, 1976.
16p. (Dossiers Femmes no 3)
66. — . Les biens conjugaux: vers une association
d'^gaux. Ottawa, 1976. 16p. (Dossiers Femmes no
1)
67. Economic Council of Canada. Unemp/oymenf/n
Canada: the impact of unemployment insurance, by
Christopher Green and Jean-Michel Cousineau.
Ottawa, Economic Council of Canada, 1976. 148p.
68. International Development Research Centre.
Projects 1975. Ottawa, 1975. 56p.
69.— .Report 1975/76. Ottawa, 1976. 1v
70.— .Review 1975/76. Ottawa, 1976. 31p.
71. Labour Canada. Legislative Research. Human
rights in Canada 1976. Ottawa, Minister of Supply
and Services Canada, 1976. 55p.
72. National Library of Canada. Task Group on the
Canadian Union Catalogue. Final report. Ottawa,
Minisrtyof Supply and Services Canada, 1976. 86p.
73. Parliament. Senate. Standing Senate
Committee on National Finance. Canada
manpower: an examination of the Manpower
Division, Department of Manpower and
Immigration, 1975. Ottawa, 1976. 141 p.
74. Travail Canada. Recherches sur la legislation.
Droits de I'homme au Canada 1976. Ottawa,
Ministre des Approvisbnnements et Services
Canada, 1976. 60p.
United States
75. Centerfor Disease Control, Atlanta, Ga. Currenf
literature on venereal disease 1976, no. 2. 171 p.
76. Dept of Health, Education, and Welfare. Public
Health Service. Drug utilization review in skilled
nursing facilities; a manual system for performing
sample of drug utilization. Bethesda, Md. 1975.
125p. (DHEW Publication no. (HSA) 76-3002)
(Continued on p. 66)
An authoritative
collection of
articles that look
at the profession
in the context of
Canada's health
care system.
and M. Ruth Elliot
6"x9" 224 pp. $6.25 paper
ISBN: 013-506238-1
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References
1 . Nutrition Canada National Survey A report
by Nutrition Canada to the Department of
National Health and Welfare, Ottawa,
Information Canada, 1973 Reproduced by
permission of Information Canada.
2. R. R. Strelff, MD, Folate Deficiency and Oral
Contraceptives, Jama, Oct. 5, 1970,
Vol.214, No. 1.
C I B A
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Studies deposited in the
CNA Repository Collection
77. Anderson, C. Marylin. The continuing learning
activities of graduates of two diploma nursing
programs in Ontario. Guelph, Ont., c1976. 104p.
(Thesis (M.Sc.) — Guelph) R
78. Assessment of the Plains Health Centre twelve
week orientation program for nurses in their initial
employment following completion of a basic
nursing education program. Rev. ed. Prepared by
Margaret J. Rosso. Regina, Plains Health Centre,
1976. 72p. R
79. D'Amour-Nadeau, Albertine. Guide pour
I'^laboration d'un programme de formation en
cours d'emploi pour le personnel hospitaller
Moncton, N.-B., Universite de Moncton, 1976. 46p.
R
80. Flett, Darlene. Health status of elderly people in
public housing. Ottawa, 1976. 149p. (Thesis
(M.H.A.) - Ottawa) R
81. Laing, Gail Pa\ncia. Relationship of self esteem
and the myocardial infarction experience. Toronto,
C1976. 77p. (Thesis (M.Sc.N.) — Toronto) R
82. Lamoureux, tVlarvin E. The first nursing class:
administration of the research design's preliminary
stage. Surrey, B.C., Douglas College Health
Services Division, Surrey Campus, 1975. 8p.
(Multiple criteria development for the selection of
community college nursing programme students;
tech. rep. no. 2) R
83. Lamoureux, Marvin E. A comparative analysis
of all students who first entered the Douglas College
nursing programme. Surrey, B.C., Douglas College
Health Services Division, Surrey Campus, 1976.
lip. (ibid. tech. rep. no. 8) R
84. — . A descriptive analysis of group I students
who first entered the Douglas College nursing
programme (September, 1975). Surrey, B.C.,
Douglas College Health Services Division, Surrey
Campus, 1976. 25p. (ibid. tech. rep. no 5) R
85. — . A descriptive analysis of group II students
who first entered the Douglas College nursing
programme (September, 1975). Surrey, B.C.,
Douglas College Health Services Division, Surrey
Campus, 1976. 25p. (ibid. tech. rep. no. 6) R
86. — A descriptive analysis of group III students
who first entered the Douglas College nursing
programme (September, c1975). Surrey, B.C.,
Douglas College Health Services Division, Surrey
Campus, 1976. 25p. (ibid. tech. rep. no. 7) R
87. — A multiple discriminant classification of
nursing students in a two-year diploma program:
persisters vs. non-persisters, by... and Craig
Johannsen. Surrey, B.C., Douglas College Health
Services Division, Surrey Campus, 1976. 29p. (ibid,
tech. rep. no. 9) R
88. Leonard, Linda Gaye. Husband-father's
perceptions of labour and delivery. Vancouver,
1 975. 1 65p. (Thesis (M.Sc.N) — British Columbia) R
89. Macdonald, Myrtle Ida. Remotivation-therapy; a
group method that promotes rehabilitation, by...
Peter Steibelt and Claire Elek. Montreal, Association
of Remotivation-Therapistsof Canada, 1975. 163p.
R
90. Nemetz, Emma. Education in health care in an
intercultural maternity service. Edmonton, 1976,
1977. 93p. (Thesis (M.Ed.) - Alberta) R
91. Royal Victoria Hospital, Montreal. Palliative
Care Sen/ice. Pilot project Jan. 1975 - Jan. 1977.
Montreal. Royal Victoria Hospital; McGill University,
C1976. 515p. R
92.—. Sen/ices de soins palliatifs. Projet pilote,
janv. 1975 - janv. 1977. Montreal, Royal Victoria
Hospital, McGill University. c1976. 51 5p. R
93. Smith, Susan Dawn. Knowledge reported by
chronic renal failure patients in four areas related to
self-care. Toronto, c1976. 82p. (Thesis (M.Sc.N.
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Hospital. Box 269 Hardisty, Alberla. TOB 1V0
British Columbia
OA Head Nixse requred tor 98-t>ed hospital, located on the Douglas
Channel in the mountains of Northwest B.C.. with a variety of summer
and winter recreational activities available. O.R. and Supervisory
expenence desirable. Salary range from $1,312.00 per month lo
$1.546. 00 per month depending upon expenence. For more informa-
tion please contact : Mrs P Janzen. R.N , Director of Nursing. Kitimat
General Hospital. 899 Lahakas Blvd., Kitimat. British Columbia. V8C
1E7.
Fftculty — New positions (4) m 2-year post-basic baccalaureate
pn>gram m Victoria, B.C., Canada Generalist in focus, clinical em
phasis on gerontology in community and supportive extended care
units. Public Health nursing and Independent study provide opportu
nity to work ckssely with highly-qualified and motivated R.N. students
Teaching creativity and research are strongly endorsed. Masters
degree, teaching and recent clinical experience in gerontology/ med
surg. /psychology/rehabilitation preferred Salaries and fringe bene
fits competitive: an equal opportunity employer for qualified persons
Positions available NOW. Contact: Dr. isabei MacRae. Director,
School of Nursing. University of Victoria. Victoria. British Columbia,
V8W 2Y2.
Help Wanted — Registered Nurses — The British Columbia Public
Service has vacancies for Registered Nurses in the Greater Vancou-
vwand Other Areas. Positions are m mental health, mental retarda-
tion, and psycho-genatric institutions Salanes and fringe benefits are
competitive (1976 rates: $1,086 to Si. 267 for Nurse 1) Canadian
atizens are given preference. Interested applicants may contact the
Public Service Commission, Valleyview Lodge, Essondale, Bntish
ColumtHa VOM 1J0. Quote Competition No. 77:449.
Nurses registered or eligible for Registration tn B.C. are invited to
submit applications for employment for General Duty positions on the
staff of the Royal Jubilee Hospital, 1900 Fon Street, Victona, B.C.,
VSR 1J8 Vacanaes are anticipated in all areas of this 975-bed
hospital which includes Psychiatric and Extended Care. Applications
for part-time, ful-time. or casual employment will be considered.
Literal benefits exist under the RNABCcontract. Apply to the : Direc-
tor of Nursing.
Operating Nurse required for an B7-bed acute care hospital in Nor-
thern B.C Residence accommodations available, RNABC policies in
effect. Apply to: Director of Nursing, Mills Memorial Hospital. Terrace,
British Columbia, V8G 2W7
Experienced General Duty Nurse for modem 10-bed hospital situa-
ted on the beautiful West Coast of Vancouver Island- Accommodation
$100.00 per month. Apply; Administrator, Tahsis Hospital. Box 398,
Tahsis, Bntish Columbia. VOP 1X0.
Manitoba
Director of Nursing . Applications invited for the position of Di rector of
Nursing tor 23-bed, gen. hospital (accredited) Preference given to
applicants with formal administrative education and expenence. Sa-
lary in line with qualifications and MHSC approval. For details apply to:
Administrator, Shoal Lake Distnct Hospital, Shoal Lake. Manitoba,
ROJ 1Z0. Phone; 759-2336,
New Brunswick
Instructors requred for two year lr»dependent Diploma Program in
Nursing Enrollment 230 students. Faculty requred June-July 1977,
Contact Miss Anne D. Thome, Director, Saint John School of Nur-
sing, P.O. Box 187, Saint John, New Bmnswick. E2L 3X8.
Ontario
RN for 6-week co-ed camp in Northern Ontano; attractive salary,
pnvate room & board, approx. 75 campers ages 14& 15 June 20 to
Aug 10, Wnte/phone Camp Solelim. 588 Melrose Avenue, Toronto.
Ontano. M5M 2A6; (416) 781-5156.
An experienced nurse interested m admmstrative work is requred tjy
a national organization located m Ottawa The position entails, prima-
rily, the reviewing of medical records and files, and assisting with the
preparation of disability and death claims ansing from military service.
Salary commensurate with qualifications. Fringe benefits available.
Please apply including resume of training and expenence to ; Domi-
nion Secretary. Royal Canadian Legion. 359 Kent Street. Ottawa.
Ontario K2P 0R7.
Demanding but rewarding — Registered Nurse required for co-ed
summer camp for mentally retarded children and adults in Branchton
(5 miles south of Cambndge). June 9 to September 2, 1977. Ten
weeks — $1 10.00 per week plus room and board One day off per
week. Call (416) 766-1775 or wnte to : Charlein Wilson. 9 ThornhHI
Avenue. Toronto, Ontario M6S 4C3.
SIX REASONS WHY
NURSES CHOOSE GALVESTON
REASON NO. 1
EDUCATION
Professional nurses know the value of continuing education.
That is why many choose employment at The University of
Texas Medical Branch.
Our eight university hospitals and six health care schools
assure our nurses that advances in their field will not pass
them by. In fact, Texas' oldest nursing and medical schools
are here on campus.
There are more reasons why nurses are choosing Galveston.
Write for them today.
Name
Address _
Phone _
Specialty
Gary Clark
Department of Nursing
THE UNIV. OF TEXAS MEDICAL BRANCH HOSPITALS
Galveston, Texas 77550 Cf\t
-Zip.
RN D Student a
-Please send me your pay scale D
- An equal opportunity m/f affirmative action employer-
The Canadian Nurse April 1977
Quebec
Uganda Mission has mobile climc, dnver, interpreter, sick and needly,
but no nurse- Offers austere life without recreational facilities with
room and board, and very small salary to 2 njrses (friends) in ex-
change for the opportunity to serve in a setting of natural beauty in a
developing country. Contact: Mary Power, 5672 Sherbrcoke St, W-,
Apt. 6. Montreal. Quebec H4A 1W7.
Registered Nurse required for co-ed children s summer camp in the
Laurentians (seventy miles north of Montreal) from late June until late
August 1977. Call (514) 487-5177 or write: Camp MaroMac. 5901
Fleet Road, Hampstead, Montreal. Quebec, H3X 1G9.
Registered Nurses (2) for children s co-ed camp. June 16 to August
27th approximately. Prefer season. $900.00 plus travel. Laurentian
region. Doctoron staff. Excellenifacilities. Wnte: Joe Fnedman. Direc-
tor, YM-YWHA and NHS. 5500 Westbury Avenue. Montreal, Quebec.
H3W 2W8,
Saskatchewan
University of Saskatchewan. Term and regular appointments in
Maternal -Child, Pnmary Care. Community arid Mental Health Nur-
sing. To teach in four-year basic and three-year post-diploma pro-
grams and implement revised curriculum, Master's or higher degree
and experience in clinicai field for appointment at professonal ranks,
Baccalaureate degree and experience for appointment as lecturer.
Starling date. Summer 1977. Contact: Dean. College of Nursing,
University of Saskatchewan. Saskatoon. Saskatchewan, S7N OWO.
UNITED STATES
OPPORTUNITIES
FOR REGISTERED NURSES
AVAILABLE NOW
IN CALIFORNIA
FLORIDA
MISSISSIPPI
NEW ORLEANS
TEXAS
WE PLACE AND HELP YOU WITH:
STATE BOARD REGISTRATION
YOUR WORK VISA
TEMPORARY HOUSING - ETC.
A CANADIAN COUNSELLING SERVICE
Phone: (416) 449-5883 OR WRITE TO:
RECRUITING REGISTERED NURSES INC.
1200 LAWRENCE AVENUE EAST, SUITE 301,
DON MILLS, ONTARIO M3A 1C1
J^RN-
NO FEE IS CHARGED
TO APPLICANTS.
OPEN 7 DAYS A WEEK.
McMASTER UNIVERSITY
EDUCATIONAL PROGRAM
FOR NURSES IN
PRIMARY CARE
McMaster University School of Nursing in
conjunction with the School of IVIeclicine,
offers a program for registered nurses
employed in primary care settings who
are willing to assume a redefined role in
the primary health care delivery team.
Requirements Current Canadian
Registration. Sponsorship from a medical
co-practitioner. At least one year of wori<
experience, preferably in primary care.
For further information write to:
Mona Callln, Director
Educational Program for Nurses
in Primary Care
Faculty of Health Sciences
McMaster University
Hamilton, Ontario L8S 4J9
R.N. "8 reqmrecf immediately — 2 General Duty R.N.s for modern
hospital in Porcupine Plain, Sask, Salary and fringe benefits as per
S.U N contract. Active general hospital doing surgery, obstetncs,
general medicine and emergency work. Near provincial summer re-
son. Apply in writing to: Administrator, Porcupine Carragana Union
Hospital, Box 70, Porcupine Plain. Saskatchewan or phone Bus.
278-2233, Res, 278-2450.
United States
Registered Nurses — Flonda and Texas — Immediate hospital ope-
nings in Miami. Fori Lauderdale, Palm Beach and Stuarl, Flonda and
Houston, Texas. Nurses needed for Medical-Surgical. Critical Care,
Pediatrics, Operating Room and Orthopedics. We will provide the
necessary work visa. No tee to applicant. Medical Recnjiters of Ame-
rica, Inc., 800 N.W, 62nd St.. Fort Lauderdale, Florida 33309, U.S.A.
(305) 772-3680.
Registered Nurse — is now the time to consider a move SOUTH?
Our professional nursing programs are superb, salaries competitive,
benefits excellent and location ideal. We have special needs for RN's
interested in intensive Care, Pediatrics Intensive Care, Rehabilitation
and other special areas as well as General Medical/Surgical Nurses.
Wnte today for our Information Package, Employment Manager,
Greenville Hospital System. 701 Grove Road. Greenville, South
Carolina. 29605. U.S.A.
United States
Registered Nurses — Dunhill. with 200 offices in the USA., has
exciting career opportunities for both new grads and expenenced
R.N.s. Send your resum6 to: Dunhill Personnel Consultants. No. 805
Empire Building, Edmonton. Alberta, T5J 1V9. Fees are paid by
employer.
Nurses — RNs — Immediate Openings in Florida —Arkansas —
California — If you are expenenced or a recent Graduate Nurse we
can offer you positions with excellent salanes of up to $1160 per
month plus all benefits Not only are there rra fees to you whatsoever for
placing you, but we also provide complete Visa and Licensure assis-
tance at also no cost to you. Write immediately for our application even
if there are other areas of the U.S. that you are interested in. We will
call you upon receipt of your application in order to anrange for hospital
interviews. Windsor Employment Agency Inc., P.O. Box 1 133, Great
Neck, New York 11023. (516-487-2818)
Public Health and Nurse Educators — Overseas: Project HOPE is
projecting openings in Public Health Nursing and Nursing Education
for programs in Guatemala. Brazil, Tunisia and Egypt. Requirements
include B.S-N- (Masters preferred), language facility, formal/informal
teaching experience depending on position, 24 month (renewable)
assignments. Full benefits, paid relocation expenses and salary
commensurate with training and experience. Send resume to: Per-
sonnel Department. Project HOPE, 2233 Wisconsin Avenue., N.W..
Washington. D.C. 20007. E.O.E.
United States
Registered Nurses — Hurley Medical Center is a well equipped,
modern. 600-bed teaching hospital offering complete and specialized
services for the restoration and presen/ation of the community's
health. It also offers orientation, in-service and continuing education
for employees. It is involved in a building program to provide better
surroundings for patients and employees. We have immediate ope-
nings tor registered nurses in such specialty units as Cardie- Vascular.
Operating Rooms, Nursenes. and General Medical-Surgical areas.
Hurley Medical Center has excellent salary and fringe benefits. Be-
come a part of our progressive and well qualified work force Today.
Apply: Nursing Department, Mr. Garry Viele, Associate Director of
Nursing, Hurley Medical Center, Flint, Michigan 48502. Telephone
(313) 766-0386.
Switzerland
Thirty-two year-old Swiss Registered Nurse with several years of
practice with babies and children and mother of a four-year-old
daughter wishes to find a job m an English-speaking family that is forxJ
of children. The employment should begin about May 1977, Contact:
Marie-Theres Oesch, c/o Kuecholl. Kantstrasse 20, CH-8044 Zurich,
Switzerlar>d.
Head Nurse
with preparation and/or
demonstrative competence in
Psychiatric Nursing and
Management functions, required for
Head Nurse appointment. To be
responsible for participation in the
organization, initiation, and the
management of a New Psychiatric
In-patient Unit.
Please apply, forwarding
complete resume to:
Director of Personnel
Stratford General Hospital
Stratford. Ontario
N5A 2Y6.
School of Nursing
Assistant Director
required in a 2 year English
language diploma Nursing
program
Qualifications:
Master's degree in Nursing Education,
preferred, with experience in Nursing
Education Administration and teaching
and at least one year in a Nursing Service
position.
Eligible for registration in New Brunswick.
Apply to:
Harriett Hayes
Director
The Miss AJ. MacMaster
School of Nursing
Postal Station A, Box 2636,
Moncton, N.B.
Etc 8H7
O.R. Supervisor
Required immediately by an active 100
bed acute care and 40 bed extended care
hospital. Must be eligible for B.C.
Registration. Post graduate training and
experience necessary. Salary $1,346 to
$1,585 per month (1976 rates).
Apply in writing to:
The Director of Nursing
G.R. Baker Memorial Hospital
543 Front Street
Quesnel, British Columbia
V2J 2K7
Don't be afraid of me
even if you are not a
psychiatric nurse
(You can learn
to be one!)
If you are interested in finding out
about a speciality that is different,
cfiallenging and very worthwhile, you
may be the person we are looking for
and you are invited to join a 9 month
POST-GRADUATE course in
Psychiatric Nursing.
Our programme is designed
especially for R.N.s. whether you
desire a stepping stone or further
expertise in Mental Health.
The course includes theory and
clinical experience in hospital and
community settings with stress in the
primary therapist concept,
successful completion leads to
eligibility for licensure with the
R.P.N.A.M.
Our Nursing is progressive and
challenging, with a deserved
reputation for professionalism. There
are wonderful opportunities for
nursesatevery level of care . . . The
top education and practice for people
like you.
Successful candidates may apply for
financial assistance through various
bursary systems.
Our countryside is unbeatable with
beautiful lakes and parks. Summer
and winter sports are readily
accessible.
For further information please write
no later than June 15, 1977 to:
Director of Nursing Education
School of Nursing
Brandon Mental Health Centre
BRANDON, Manitoba.
R7A 5Z5
MANIT
Hospital Affiliates
International Inc.
NURSING
CAREERS
United States
Hospital Affiliates International, the leader
in the field of hospital management, has
over 70 hospitals in operation or under
construction in 23 States, with major
requirements in:
ILLINOIS - LOUISIANA
TENNESSEE-ARKANSAS
TEXAS
Please contact our Canadian
representative who will be pleased to
discuss your specific needs. All enquiries
will be treated in confidence and shoukl
be directed to:
DOW-CHEVALIER
SEARCH CONSULTANTS
365 Evans Ave., Toronto M8Z 1K2
416-259-6052
Registered
Nursgs
THE HOLLYWOOD
PRESBYTERIAN MEDICAL
CENTER, a progressive 389-bed
teaching hospital located in the
heart of Hollywood, Ca. is presently
seeking nurses in the following areas:
• MED. /SURG. . O.R. - E.R.
• I.C.U./C.C.U. . DELIVERY RM.
• NURSERY .O.B.
Salary Range
812,384.00 to $15,060.00/year
For further information write:
NURSE RECRUITER
1316 Wilshire Blvd., Suite 12
Los Angeles, Ca. 90017
• Without obligation, please send me
more information and an Application
Form.
Name
Af1firRs«s
City
Telephone: {
Prov
>
?ip
License*:
.<5Decialty
Year Graduated
Prnu
Public Health Nurse
$14,800 — $17,500
The MINISTRY OF HEALTH, Northem Ontario Public Health
Service, seeks an experienced individual to identify and
assess the health needs of the Pickle Lake and Savent Lake
communities in Northem Ontario and take steps to meet these
needs. Duties: maintain school health and home visiting
programs; organize and operate immunization and
communicable disease control programs; direct emergency
nursing. Location: Pickle Lake and Savent Lake.
Qualifications: registration as a nurse in Ontario and a
recognized certificate in public health nursing, preferably
BScN: two years acceptable public health nursing experience.
Supervisory experience would be an asset.
Please submit application or resume by April 29, 1 977 to:
Senior Personnel Officer, File HL-65-27/77, Human
Resources Branch, Unit "B", 7 Overlea Blvd., 3rd Roor,
Toronto, Ontario, M4H 1A8.
This position Is open equally to men and women.
Ontario
ontaro PublJc ServJce
meQVL
School of Nursing
Th« Canadian Nursa AprH 1977
Research Unit in Nursing and IHeaith Care
NURSE RESEARCHER
To undertake research or to participate in ongoing research
related to the demonstration and evaluation of a new type of
nursing service in various primary care settings. The service
and research will focus on family health including health status
and health behaviour.
Preferred applicants for this position will have a strong clinical
background and academic preparation at the masters or
doctoral level.
Applications are encouraged from individuals presently
associated with university schools or health service agencies
who wish to spend a sabbatical in the Research Unit. In
addition, funds are available for the exceptionally well
prepared person to be employed on the project.
Send curriculum vitae and references to Irving Rosenfeld,
School of Nursing, McGill University, 3506 University St.,
Montreal, P.Q. H3A 2A7
BRANDON GENERAL HOSPITAL
BRANDON GENERAL HOSPITAL
SCHOOL OF NURSING
FACULTY POSITION: PROGRAM CO-ORDINATOR
Position open in Manitoba Association of Registered Nurses
approved Two-year Diploma program of 130 students for
experienced Nurse Teacher.
Interested in Curriculum Planning and Development.
To work with Faculty of 1 5 teachers as Assistant to Di rector of
Nursing Education.
Baccalaureate Degree in Nursing required.
Experience in Nursing Practice and Education required.
Salary range — $16,000 - $18,000
Negotiable, commensurate with
preparation and experience.
Write, giving resume of preparation and experience to:
Mrs. S.J. Paine, Director of Nursing Education
School of Nursing, Brandon General Hospital
150 McTavish Avenue
BRANDON, Manitoba R7A 2B3
THE UNIVERSITY OF ALBERTA
FACULTY OF NURSING
FACULTY POSITIONS
Faculty members will be required for
positions in expanding four-year basic
and two-year post-R.N. baccalaureate
programs. Applicants should have
graduate education and experience in a
clinical area and/or in curriculum
development or research.
Short-term or visiting appointments may
also be available in some areas to replace
staff on leave.
Salary and rank commensurate with
qualifications and experience, in accord
with University policies.
Positions are open to male and female
applicants.
Please make further inquiries, or
submit application and curriculum
vitae to:
Amy E. Zelmer, Ph. D.
Dean
Faculty of Nursing
The University of Alberta
Edmonton, Alberta
T6G 2G3
Professional Services
Co-ordinator
The Juan De Fuca Hospital
Society, Victoria, B.C.
If you have at least five years of nursing
experience, and a baccalaureate degree
within the past five years, a challenging
opportunity is awaiting you to:
• Co-ordinate the services of a team of
professionals, in providing health care
for seventy-five elderly persons
requiring assistance in daily living, in
one of four hospitals i.e. Ttie Priory,
Aberdeen, Mt. Tolmie and Glengarry.
• Guide a systematic process of health
care for each Resident, that
encompasses the dignity and worth of
aging persons.
• Participate in a programme of geriatric
care which strives to provide a
home-like and reality oriented
environment.
• Promote the study and growth of
gerontological knowledge and
practice.
Apply in writing to:
Mrs. V. Mclver
Director of Health Services
Juan de Fuca Hospital Society
567 Coldstream Avenue
Victoria, B.C. V9B 2L3
Associate
Executive Director
Applications are invited for the position of
Associate Executive Director, Canadian
Nurses Association, Ottawa.
Candidates must be members of the
Canadian Nurses Association, have a
master's degree or equivalent, have at
least five years' administrative
experience, and be bilingual.
Interested applicants are asked to submit
their curriculum vitae, in confidence, to;
Executive Director
Canadian Nurses Association
50 The Driveway
Ottawa, Ontario
K2P 1E2
wish
you were
here
...in Canada's
Health Service
Medical Services Branch
of the Department of
National Health and Welfare employs some 900
nurses and the demand grows every day.
Take the North for example. Community Health
Nursing is the major role of the nurse in bringing health
services to Canada's Indian and Eskimo peoples. If you
have the qualifications and can carry more than the
normal load of responsibility. . . why not find out more?
Hospital Nurses are needed too in some areas and
again the North has a continuing demand.
Then there is Occupational Health Nursing which in-
cludes counselling and some treatment to federal public
servants.
You could work in one or all of these areas in the
course of your career, and it is possible to advance to
senior positions. In addition, there are educational
opportunities such as in-ser\ ice training and some
financial support for educational leave.
For further infomiation on any, or all, of these career
opportunities, please contact the Medical Services
office nearest vou or write to:
Medical Services Branch
Department of National Health and Welfare
Ottawa, Ontario K1A 0L3
Name
\
Address
City
l«
Health and Welfare
Canada
Prov.
Sanle el Bien-elre social
Canada
Clinical Co-ordinator
Surgical Specialities
Responsible to the Assistant Director of
Nursing for planning, co-ordinating and
supervising patient care.
Applicants should be university graduates
with Ontario registration and with a minimum
2 years experience at the Head Nurse level.
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 Partonnel Ot1\c»
TORONTO GENERAL HOSPITAL
67 COLLEGE STREET, TORONTO, ONTARIO, M5G 1L7
HEALTH SCIENCES
CENTRE requires
STANDARDS
CO-ORDINATOR,
NURSING
Applications for the position of Standards Co-ordinator,
Nursing, are invited from nurses who seek opportunity for
challenge, responsibility, and creativity. The successful
applicant will plan, direct, implement, and evaluate a quality
assurance program In nursing at the Health Sciences Centre.
He/she will also participate in the development of an
Interdisciplinary program.
The Health Sciences Centre is a 1300-bed teaching hospital
affiliated with the University of Manitoba.
Applications are welcome from nurses with:
• educational preparation at the graduate level
• demonstrated teaching and leadership skills and
competence in working with interdisciplinary groups
• eligibility for registration in the Province of Manitoba
An active interest In research Is essential.
Interested applicants may apply in writing to:
Mr. Eugene F. GerbasI
Co-ordinator Employment & Training
Health Sciences Centre
700 William Avenue
Winnipeg, Manitoba
R3E 0Z3
The Canadian Nurse April 1977
Chairman, Nursing Diploma Program
(QUO VADIS APPROACH)
Duties:
To be responsible for providing academic administration and offering
of a unique diploma nursing program for adult nurse learners in a
peer-oriented setting which has been designated as a Health
Sciences adult education centre. Will also be involved in the
development and offering of a vi/ide variety of continuing education
and other programs and courses for nurses, various health personnel
and for the community.
Qualifications:
Will be a nurse registered or eligible for registration in Ontario with a
Master's degree and broad experience in adult education, nursing
and/or educational administration. Preference will be given to
candidates with experience in developing programs for working with
adult learners.
Apply in writing with resume to:
®Humber
Pnllono P«''so""el Relations
V^QIiege Refer to: Ad. # 77- U
Box 1900, Rexdale, Ont.
M9W SL7
Centre
8
l^e are interested ir) Male and /or Female applicants
Memorial University of
Newfoundland
School of Nursing
Growing baccalaureate program has faculty positions
available Sept. 1, 1977 or Jan. 1, 1978. Senior appointments
in Maternal Child Nursing and Nursing of Children. Also
appointments in Community Health and Mental Health
Nursing. Applicants should have doctoral or masters degree.
Send resume to:
Miss Margaret D. McLean
Director, School of Nursing
Memorial University of Nfld.
St. John's, Nfld. A1C 5S7
Canada
Index to
Advertisers
April 1977
Burroughs Wellcome & Co. (Canada) Ltd
2
The Canadian Nurse's Cap Reg'd
62
CIBA 65,
Cover 4
Collier Macmillan Canada, Ltd
16
Connaught Laboratories Limited
10
11
Equity Medical Supply Company
41
Health Care Services Upjohn Limited
66
Hoi lister Limited
17
Frank W. Horner Limited
44
Kendall Canada
65
J.B. Lippincott Company of Canada Ltd 35, 36
1,37
38
Lowell Shoe Inc.
1
The C.V. Mosby Company Limited 18, 1£
), 20
21
Mostly Whites Ltd
8
J.T. Posey Company
66
Prentice-Hall of Canada Ltd
63
Procter & Gamble
7
Reeves Company
15
W.B. Saunders Company Canada Limited
13
G.D. Searle
22
Simpsons-Sears Ltd
5
Staff Builders, Inc.
6
Standard Brands Canada Limited
9
Stiefel Laboratories (Canada) Limited
64
White Sister Uniform Inc. Cover 2,
Cover 3
Advertising
Gerry Kavanaugh
The Canadian Nurse
50 The Drivew^ay
Ottawa, Ontario K2P 1 E2
Advertising Representatives
Richard P. Wilson
219 East Lancaster Avenue
Ardmore. Penna. 19003
Telephone: (215) 649-1497
Gordon Tiffin
2 Tremont Crescent
Don Mills, Ontario M3B 281
Telephone: (416) 444-4731
Member of Canadian
Circulations Audit Board Inc.
QEID
Carelle.
Because no one's all work.
style No. 48943
Sizes: 3-15
Royale Dupreme 100% textured woven polyester
White only about $39.00
Co^dlJL
A different appearance-
A common need
Both may benefit from SIOW-F& fOlfC
Prophylactic iron and folic acid supplementation
during pregnancy is now an accepted practice
among Canadian physicians. It has also been
established, through the publication in 1974 of
Nutrition Canada \ that many Canadian women
may not be obtaining the necessary nutritional
requirements from their diets. For instance, 76.1%
of adult women (20-39) had inadequate or less than
adequate intake of iron and 67.9% were at high or
moderate risk of low serum folate levels. More
recently, a number of physicians have queried the
effect of oral contraceptives on serum folate levels
in women. Dr. Streiff reports: "This complication
(of oral contraceptive therapy), however, may be
recognized more frequently in the future... Folate
deficiency associated with oral administration of
contraceptives does not necessarily require
discontinuance of the drug regimen but folic acid
therapy is definitely indicated."^
C I B A
Dorval, Quebec
tHo eawBadiawB
MBMmso
May 1977
ES76076l5g35 '^
HR<; EH HCCUE ^' 0^"
5R HARMER AVE N APT ^?^\>
CTTAk»A CM
K
;V
White Sister
'ItH^r-'
hardest when you do
i/M
m
^«|P
A) style No. 48890
— Pant Suit. Sizes: 3-15
Royale Seersucker
; 1 00% woven polyester
White, Mint: about $35.00
B) Style No. 8502
ikMtdress. Sizes: 12-20
' '^" Pristine Royale
100% textured polyester warp knit
White. Blue: about $24.00
r
^h ^
^4
/>*
//
^
#Ji0 eanadiawB
May. 1977
The official journal of the Canadian
Nurses Association published
monthly in French and English
editions.
Volume 73, Number 5
^^^^^^^^^^^^^^H
Input
4
News
10
Calendar
50
Frankly Speaking:
Govemment for Whom?
Unda Gosselin
19
Names
51
Yoga, Especially for You Nurse
Stella Weller
20
Books
54
Cuddle Bathing Can Be Fun
J. Penny lies
Marcia McCrary
24
Library Update
55
Practical Guide to Preventing
Neonatal Heat Loss
Joann K. Williams
28
Idea Exchange
Francine LeBlanc
Anne Schultz
29
Programmed Leaming:
Cardiac Depressants
Eleanore Warkentin
30
Autotransfusion
Margaret Anne Halward
38
Clinical Wordsearch #5
Mary Bawden
42
Connection
Rebecca Inns
43
Ready for any Emergency
Sandra LeFort
45
Cover photo — for 8.000 elementary
school children, the highlight of
National Safety Week (May 23-29)
this year will be a visit to the nation's
capital to attend the 18th annual
School Patrol Jamboree. The
Jamboree is a yearly avent staged by
the Canadian Automobile Association
in recognition of the contribution that
these chNdren make to the health and
safety of their friends and classmates.
In Ottawa, Constable Andr6 R.
Boucher coordinates the activities of
fellow members of the Ottawa Police
Force who supervise school patrol
activities. On the cover. Const.
Boucher with a group of patrols from a
school located near CNA House.
(Photo by Studio Impact).
The views expressed in the articles
are those of the authors and do not
necessarily represent the policies of
the Canadian Nurses Association.
ISSN 0008-4581
Indexed in International Nursing
Index. Cumulative Index to Nursing
Literature, Abstracts of Hospital
Management Studies. Hospital
Literature Index. Hospital Abstracts.
Index Medicus. The Canadian Nurse
IS available m microform from Xerox
University Microfilms. Ann Arbor.
Michigan. 48106.
The Canadian Nurse welcomes
suggestions for articles or unsolicited
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The Canadian Nurse May 1977
For Nursing Practice Made Perfect
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By Vary K. Asperheim, MD, Medical Univ. of South Carolina; and Laurel A.
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Designed to prepare the student for state board examinations, this
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By Lisa Robinson, RN. PhD, Univ. of Maryland School of Nursing; and
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The Canadian Nurse May 1977
The Canadian Nurse invites your
letters. All correspondence is subject
to editing and must be signed,
although the author's name may tie
withheld on request.
Input
An open letter to M.E. Murray, author
of "The Quality of Our Caring,"
(Marcti 1977)
It makes me sad to read your
letter. Really sad. I wish there were
some way to apologize for your being
treated as though you are not a human
being. More and more I believe that
patients should be asked what needs
they have, what suggestions they
have, whether they understand their
treatment and agree with it. Regarding
your illness youare the most important
person to consider. We nurses should
consider your feelings at every
moment so as not to add to your
suffering.
I have two things I would ask of
you. Please show your letter to the
nurses where you go for treatment. I
think the directors of nursing should
see it. The second thing is. please
send it to the Canadian Medical
Association Journal. On second
thought, never mind; I will. Thank you
for writing to us.
— Nora Briant, Fredericton. N. B.
A long way from fiome
I have received my Canadian Nurse
for the months of January and
February. I enjoy reading your articles
because it keeps me in touch with
home, Canada. I will be looking
forward to receiving my next month's
Issue. Thank you.
— Domenica Formica, New Orleans.
La.
Fig fit for life
I wish to say how sad it is to see
that such services as "abortion
counselling" (January, 1977), are
necessary in our society. We should
rarely need such services if abortions
were only done for 'therapeutic "
reasons.
Reactive depression in
pregnancy is the reason given for 95%
of abortions authorized by hospital
therapeutic abortion committees. And
yet, it is seldom that in any normal,
healthy pregnancy the woman doesn't
experience depression at some time.
Where do we place our concern
and value for human life, be it ever so
tiny? We as nurses are to fight for
"life", not help to destroy it.
—Helen Stang, R.N., Macklin, Sask.
A cfiance to share
Since the summer of 1975 great
strides have been taken toward the
development of MATCH —
International Centre. This is a fledgling
organization created to provide a
direct link for action in social
development projects between Third
World women and Canadians. The
organization exists to supplement
current governmental and
non-governmental programs
designed to promote the effective
involvement of women.
To date MATCH has received
some "seed" money from UNESCO,
another donation from a women's
group and a commitment for matching
funds from CIDA. The magnitude of
funding from CIDA will be determined
by the amount of money and personal
involvement MATCH can attract.
Realization of the MATCH program
will rely on the procurement of funds
but an even greater reliance will be
placed on the availability of the skills,
talents and experience of Canadian
women for international development.
Through your journal, I would
earnestly appeal to readers to advise
of their interest in participating in the
program. At the same time I urge
readers to make a financial
commitment. A major portion of our
financial requirements would be met if
each one would send a dollar bill to
MATCH.
— Jane E. Henderson, Executive
Director, MATCH — International
Centre. 204 A 151 Slater, Ottawa,
Ontario, KIP 5H3.
Father's view
Regarding the December article
by John B. Allan, "Difficult Babies, " it
would seem to me, that the most
devastating blow to any mother-child
relationship, is the standard maternity
ward procedure. There is a general
policy of separating mother and
newborn, while other specific policies
add to the detrimental effect on the
relationship. For example, application
of silver nitrate to the infants eyes,
frustrates eye contact at birth. The
wide use of analgesics limits both
mother and child in all their responses
to each other. Not allowing the child to
suckle at birth and administration of
bottles in nurseries, weakens the
sucking response.
The studies of Klais and Kennell
("Maternal Infant Bonding") clearly
show the need for mother and child to
be together i n the hours and days after
birth.
It seems, when our whole way of
birth alienates mother and child (not to
mention fathers, brothers and sisters),
to send out a Public Health Nurse to
undo the damage, and call it
"'Prevention" is quite irrational.
— H.G. Thaddous, Fattier,
Vancouver. B.C.
Feeding is for mothers
The cover on your February issue
enhances the common belief that
breast-feeding is a rather unusual
activity! Yes! Let Father be a part of a
"shared birthing," let him be
comfortable and knowledgeable in the
handling of the baby but let's leave
baby's feeding to mother! As nurses
we must help them understand how
natural and beneficial breast-feeding
is.
The February cover looks like
free advertising for those
unecomonical nursers that, when
discarded, contribute to pollution. I
protest!
— Lois B. Hard. B.A.. R.N.. St
Andrews, N.B.
A father's place
Maternity nursing staffs appearto
be bending over backwards, to the
point of being ridiculous, in attempting
to correct the so-called error of
excluding fathers from labor and
delivery of their child (February,
1977). No, I am not against fathers
being allowed to give their support
when it is agreeable to them but I do
believe that many parents are
subjected to unnecessary
embarrassment by the prevailing
free-for-all attitude exising today.
Small wonder most mothers have
cause to say, "You surely lose your
modesty when you have a baby! ", but
why should they? Clinical
assessments, which can usually be
done in a matter-of-fact manner to
reduce embarrassment, are being
turned into emotional circus-type
spectacles.
I am a midwife and, having
practiced domiciliary midwifery,
midwifery in a primitive country, and
hospital maternity nursing, I am not at
all enchanted with the modern
concepts of "birthing. "
— Name withheld, Stettter, Alta.
Bravo for involving the father in
the care of the infant! But why must he
be bottling the baby? Changing the
diapers, playing with the baby or
rocking him would be lovely. The
pictures inside were gems. Surely a
more appropriate cover picture could
be chosen for a magazine aimed at
professionals who should know that
breast-feeding is the superior way of
feeding an infant.
— Susan J. Lawrance, Philadelphia,
Pa.
A difficult decision
I read with interest the article
"Peter — an infant with a
myelomeningocele," (January, 1977)
but I also felt some distress when I
finished the article. Why? Because
nowhere in the article was mention
made of someone having spoken with
both parents to tell them about the
condition, prognosis and probable
future of their child so that they could
decide with the doctors their child's
future.
In April, 1976 I gave birth to a
""Peter " but I was fortunate in having a
very understanding pediatrician who
saw me in the delivery room. The three
of us decided, after much discussion,
on no treatment and our wee one diec
a little while later. Perhaps my traininc
at the Hospital for Sick Children made
my decision a little bit easier.
While talking with the pediatrician
he mentioned that doctors here in
Melbourne are now questioning
whether they've been right to rush ir
and do surgery and then leave the
parents to cope with an invalid child
who may also be retarded.
If the parents wish surgery
knowing the pros and cons then so b<
it but I feel strongly that they should be
given some understanding of what lie;
ahead for them AND their child befor«
surgery proceeds.
— J. Grant, Brighton, Vic. Australia, i
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The Canadian Nurse May 1977
Input
pnmiiiiiiff
^SC#-.-,^.. ..X
i
Call for help
The Gander & District Home Care
Program, (Newfoundland) which is
now in the planning stages is having
problems ordering equipment
adaptable for use in the home.
We have been unable to find
• companies which supply bed rails
for non-hospital beds:
• safety toilet frames that can easily
be removed from the toilet when the
patient no longer requires them;
• bath tub grip rails that clamp onto
the edge of the bath tub;
• some sort of monkey bars that
can be set up at home.
Maybe some of your readers
have suggestions about making their
own home care equipment or
improvising equipment that is readily
available. We would appreciate any
help that anyone could give us.
— Sandra Kelly. Home Care Nurse
Co-ordinator, James Paton Memorial
Hospital, Gander. Nfld. AlV 1P7
"Difficult Babies"
— Cerebral Palsy?
The article "Difficult Babies, "
(December, 1976) was drawn to my
attention by the Assistant Director of
Nursing of the Edmonton Health
Department.
After reviewing the article I
thought it worthwhile to point out that
the term "difficult baby" as used by Dr.
Allan would certainly encompass
many infants who exhibit one or more
features of cerebral palsy.
Identification of infants with cerebral
palsy is of major importance.
Therefore it is mandatory that any
infant with "disturbances in the five
major reflexive behaviours ' as
outlined by Dr. Allan, be assessed by a
pediatrician, following which
intervention by a trained occupational
therapist and/or physiotherapist might
well be necessary.
The five behaviors designated as
characteristic of the "difficult baby"
may well lead to difficulty in
maternal-infant bonding. However,
the reason for appearance of the type
of behavior described may be due to
central nervous system damage.
Identification of neurological
abnormality is essential, e.g.:
1 . A problem with sucking or a poor or
weak smiling response may be due to
poor control over facial muscle
movement because of neurological
abnormality.
2. Eye contact may be poor due to
problems with ocular alignment or
difficulties with control of fine muscle
movements of the eye.
3. An infant may be rigid due to
excessive extensor tone due to
neurological damage. It is important
that mothers of such infants are not
taught to support the back of the
child's head as this reinforces the
tendency to extension. Of course
advice regarding handling of a rigid,
irritable infant should be sought from
medically trained persons.
4. The passive, limp or hypotonic baby
may exhibit these characteristics as a
consequence of neurological
damage. Specific programs for such
infants should be developed by a
physiotherapist and/or an
occupational therapist in conjunction
with a pediatrician.
The public health nurse is indeed
in a position to advise parents
regarding methods of enhancing the
maternal-infant relationship. However
an infant exhibiting any of the
characteristics described in the article
"Difficult Babies ' should be examined
by a pediatrician. Children exhibiting
the tiehaviors described in this article
will need continued medical
supervision and, in addition, many will
require therapy by an occupational
therapist and/or physiotherapist.
— R. Brenda Schmidt. M.D..
F. R. C. P. (C), Community Pediatrician,
Edmonton, Alberta.
Under alien flag
When my March issue of The
Canadian Nurse arrived,
the"richness ' of the cover held my
attention longer than usual. Never
before, except on the chest of an old
general, had I seen such a display of
honors!
Even more gratifying was the
sight of that familiar badge in the upper
left-hand corner, the one reserved for
graduates of Saint Sacrement
Hospital in Quebec City — a red cross
bracketed by laurel leaves and, on the
mini coat-of-arms at the bottom, the
three letters "HSS ". But this is not how
it was identified on page 41
Suddenly, I could see my
colleagues and instructors, and I
thought of all the others who would
have wanted to sign this letter with me.
— Jocelyne Dionne,(HSS, 1962-1965)
Quebec City, Quebec.
Editor's note: Our reader is absolutely
correct. The pin is from Saint
Sacrement Hospital and was
presented to the CNA Archives by
Michele Kilburn, fdrmer CNA director
of information services.
Strength in numbers
The comments of one of your
readers (Krmpotich. Input, February)
on public health nursing are worth
commenting on... I agree that not
enough preventive nursing is done.
Doctors are often more interested in
people who are sick. They say they do
not have time for prevention because
of the pressure of work. Medical
students are more interested in the
drama of surgery and medicine than
prevention which often produces no
visible results.
Why are doctors not paid a salary
by the provincial governments instead
of an amount determined by the
number of patients seen and
conditions treated? Imagine nurses
filling in cards so that they can get paid
for each bath, medication given, bed
made, baby weighed, etc!
Governments concentrate on
acute conditions. That, Mrs.
Krmpotich, is one of the reasons that
public health nursing services are
undenjtilized. That is why there are no
midwives in Canada who can advise
during the prenatal, delivery and post
partum periods.
People can often relate betterto a
nurse than to a young doctor with
much theoretical knowledge but little
practical skill in solving problems of
daily living. Most doctors are from the
upper socio-economic classes. I do
not know of any study on this
regarding nurses, but I should imagine
that not many are from the upper
classes. In the past, the upper social
classes have been the ones to make
the rules for the country, and this is
how the doctors obtained their status
and rights.
Nurses have only recently begun
to unite for their rights and conditions
of employment. Nurses need to
understand the duties of their fellow
nurses, and be able to show the
medical profession, by words and
actions, that they are capable of being
members of the health team.
So often one hears
disagreements in the hospital —
between the nurses on different shifts,
for example. Very unprofessional.
One does not hear disagreements
between doctors aired in public
places. There should be a liaison
between the nurses in the different
hospital units, and those in the
community. Nursing cannot be strong
until it is united — a divided profession
falls.
Doctors have the advantage of
being able to follow the patient througl
all of his health problems. Public
health nurses have some of this
advantage as they get to know the
whole family and so can provide the
doctors and hospital staff with much
information.
A liaison, with willingness to learr
about the work of others, is needed by
all the members of the health team,
especially in these days of
specialization. Not until all members c
the health team are treated as equals
not just in words, but also in monetar
areas, and work as team members,
will each area be used to its full
capacity. We should all tie interesteCj
in the health of everyone in the
community. <
— Pearl Herbert, R.N.,
S.C.I^..P.H.N.,B.N., Halifax, N.S.
Nothing new under the sun i
One of our nursing problems is ol |
own nurses. We do not know what eac ,
other is doing. Mohammed Rajabally i|
his letter on "Social Preventive Nursing I
describes a proposed "new avenue ' fc!
nurses. This "new" field is, in fact, thij
present Public Health Nursing service ; <
I know it.
As a Public Health Nurse, I am
trying to interpret my services to the !
public, to politicians and to other healt,
workers, as well as to other nurses.
Rajabally wishes further details aboi '
my nursing role, I would be happy
answer any questions.
— Mara Foster, R.N., B.Sc.N.,
Toronto, Ontario.
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The Canadian Nurse May 1977
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1977 CNA Annual Meeting
Nurses from Yellowknife to St. John and a score or more of places in
between gathered in Ottawa's venerable Chateau Laurier Hotel on
March 3 1 of this year to stage the annual meeting of their professional
organization — the Canadian Nurses Association.
A total of 81 voting delegates, representing each of the eleven
provincial/territorial member associations, were in attendance for the
one-day business meeting. Annual meetings take place on alternate
years when no CNA convention is being held. The last biennial
meeting was in Halifax in 1976; the next is scheduled for Toronto in
June, 1978.
Highlights of the lengthy agenda included: the presidential
address (for excerpts, see this month's guest editorial); the report of
the executive di rector (see page 11); treasurer's report (see highlights
of CNA Board of Directors meeting); report of the CNA Committee on
Testing Service (see page 1 1); and voting on four resolutions (see
page 12).
In addition, delegates heard from two distinguished speakers in
the fields of economics and law; William E. Haviland, secretary of the
Economic Council of Canada, and the Hon. Justice Antonio Lamer,
chairman of the Law Reform Commission of Canada. Adding interest
to the day's proceedings, was a panel discussion on "Critical Issues in
Nursing" presented by CNA's four members-at-large, under the
chairmanship of CNA second vice-president, Sheila O'Neill.
Finding an acceptable definition of
death is primarily a moral and
philosophical problem rather than a
medical issue, according to the
chairman of the Law Reform
Commission of Canada.
Justice Antonio Lamer
luncheon speaker at the CNA annual
meeting, called on members of the
national nursing association to help
the commission in its task of defining
death, euthanasia, meaningful life and
lives worth saving.
The Law Reform Commission
has recently entered into a "protection
of life" three-year research project
which will deal with euthanasia, a
definition of death, human
experimentation, behavior
modification and control.
"This is a project which touches on
interests and concerns which many of
you nurses face, worry about, and
cope with — on a regular, even a daily
basis," the chairman said, "lamtelling
you about it because I hope that you
and your association will help the
commission with it. "
He said that contributions by
nurses to the Law Reform
Commission's project on the
protection of life would be considered
invaluable because "we are fully
aware that nurses are the segment of
the medical profession closest of all to
the sick and dying."
Law reform Is necessary because
judges and juries are concluding that
the law as it now applies to many acts
of euthanasia is outmoded and judicial
decisions are made by getting around
the law, he said.
"Great uncertainties will remain
as long as the law says one thing and
judges and juries do other things by
their decisions. Medical professionals
will continue to be underlain where
they stand with the law if they
undertake some treatments or omit
others. The public won't be sure that
its rights and its wishes are protected
or likely to be respected," Justice
Lamer explained.
Future increases in health care
spending must be tied to increases in
ttie economy, according to the
Secretary of the Economic Council
of Canada. William Ha viland warned
nurses attending the CNA annual
meeting that governments cannot
support further increases in health
care spending. Since World War II,
health care expenditures have been
rising at an annual rate of over 1 1
percent, and have now reached about
$12 billion a year, or about $520 per
Canadian. He noted that much of the
increase has occurred in hospital
costs due to improved methods of
treatment, and inflation.
According to Dr. Haviland, this
situation has reflected a general trend
in western countries, countries that
have relied increasingly on
government intervention as a means
of improving social welfare and
justice. In Canada, health care
spending now accounts for six and
a half percent of Gross National
Product, which is above the average
of some 20 industrial countries, but
does not exceed the United States.
But, he adds, total health care
expenditures have been rising faster
in Canada than in the U.S.
Dr. Haviland recalled that the
Economic Council had voiced its
concern about this trend six and a half
years ago in its Seventh Annual
Review. It pointed out that an
increasingly large proportion of
national resources were going into
health care activities. At that time, the
Council cautioned that this situation
was unsustainable. However, only
recently has there been widespread
questioning of social policies in
general and of the concomitant
government intervention and
regulation.
In light of these new doubts, the
Council's forthcoming Fourteenth
Annual Review to be published later
this year, will be devoted to a review of
the role of government in Canada.
Among the programs to be studied, is
the system of medicare, which
comprises roughly three-quarters of
health care spending. Dr. Haviland
noted that an important question to be
answered is whether free health care
really ensures equal access to health
care services, as was originally
intended. Who pays and who gains?
Dr. Haviland foresees some
slowing in health care spending over
the next ten years. Working in the
opposite direction, however, is the
aging process of the population, since
elderly people need relatively more
health care.
Rae Mclntyre Chittick,
recognized throughout the world as
one of Canada's most distinguished
nurses, was honored at CNA's annual
meeting for her tremendous influence
on the nursing profession. In her
introductory remarks, Thurley Duck,
president of the RNABC, highlighted
Dr. Chittick's career, a career that
includes; a formal education at Johns
Hopkins School of Nursing, Columbia
University and Stanford; receipt of a
Masters degree in Public Health;
appointment as Director of the School
for Graduate Nurses at McGill
University; full professorship at
McGill's School of Nursing; president
of CNA, AARN, and vice-president of
the ONQ; and membership in the
Order of Canada in 1975.
As a pioneer in establishing
courses and degrees in nursing
education in Canada, Dr. Chittick
insisted that they incorporate a strong
base in the humanities as well as the
biological and social sciences.
International ly, her i nf luence has been
felt in Ghana, Jamaica and New
Zealand where she helped to j
establishuniversity schools of nursing
with the World Health Organization.
After CNA president Joan
Gilchrist presented her with ajewelled
pin of CNA's emblem, the leaf and the
lamp, Dr. Chittick related many
anecdotes to the audience of her past
nursing experiences. Her gentle
humor and great dedication to nursing
and to humanity will be remembered.
The Canadian Nurse May 1977
[ Head table guests at the annual
meeting luncheon were (left to right):
Helen K. Mussallem, (CNA executive
director): William Haviland, Economic
Council of Canada: Shirley Stinson,
CNA first vice-president: Bruce
Rawson, Deputy Minister, Health and
Welfare Canada: Joan Gilchrist, CNA
president: Justice Antonio Lamer,
Law Reform Commission: Helen
Taylor. CNA president-elect: Rae
Chittick, CNA honorary member:
Sheila ONeill. CNA second
vice-president.
Photos by StudK? Impact
Report to membership
Delegates and participants at ttie CNA annual meeting heard
association executive director, Helen K. Mussallem, review the
program of CNA activities over the past eight months since the
1976 biennial meeting in Halifax.
The report, close to 50 pages in length, contains details of
action taken to implement the 28 resolutions approved by
membership in Halifax, information on the status of ongoing
association projects, liaison with other national agencies,
international, provincial and local official bodies.
Through these CNA activities, the "voice of organized nursing in
Canada" is now heard at conferences, committee meetings,
consultations and workshops of more than 1 00 agencies active in the
health field. As a result, nursing input has been achieved in projects
that range from the development of a Canadian Girl Guide health
evaluation form to be completed by nurses, implementation of survey
findings on cervical cancer screening programs, venereal disease
and abortion, to development of occupational health and health
promotion programs throughout Canada. In addition, members and
staff of the association have actively promoted progress within the
profession in the areas of nursing education, research, practice,
administration and social and economic welfare of its members.
Resolutions
Membership concerns, as expressed in the resolutions presented to
the last annual meeting, ( Canadian Nurse, August. 1976) have been
acted upon in a variety of ways, including communication with
appropriate government authorities, health and consumer
associations, representation at meetings, staff and executive
committee action.
Current CNA programs
• Standards for nursing education: final report of CNA ad hoc
committee scheduled for Fall, 1977.
• National standards for nursing practice: CNA assistance being
provided to Health and Welfare program aimed at development of
national standards.
• Director of Labor f^elations Consultation Service: Selections
committee to announce name of successful candidate shortly.
• National survey on expanded role nurses: data on 3,317
questionnaires returned by community-based nurses now being
analyzed; report scheduled for publication in June 1977.
• Research methodology workshop: sponsored by CNA in
cooperation with University of Ottawa school of nursing, will take place
November 9-11, 1977 in Ottawa.
• Nursing abroad program: Since June, 1976, a total of 185
requests have been processed from persons outside Canada wishing
to enrol in educational programs in this country. More than 160 nurses
from other countries who requested information on employment
opportunities through CNA have been advised of the current scarcity
of jobs. International visits and study tours were an'anged for 23
nurses from abroad.
• CNA Testing Service: final approval was given in November to
the first blueprint for a comprehensive examination to be developed
simultaneously in French and English. It is expected to be ready for
use by 1979.
The number of in-country, first-time candidates writing present
five-part examinations has remained fairly constant overthe past four
years (7,804 in 1975-76 and 7.650 in 1972-73). In that time, the
number of diploma candidates decreased by two percent (6,966 in
1 975-76) while the number of baccalaureate candidates increased by
58 per cent (838 in 1975-76).
International liaison
• International Council of Nurses: Canadian nurses will be well
represented at the upcoming ICN Congress in Tokyo. More than 400
CNA members have registered. CNA president Joan Gilchrist, a
voting member of ICN's Council of National Representatives, will
represent the association. CNA has nominated two Canadian nurses,
Vema Huffman-Splane and Nicole Du Mouchel for the pwsitions of
vice-president and member-at-large, respectively, and is supporting
two other nominations.
At the request of the international association, CNA has also
provided topics for two agenda items and names of Canadian nurses
willing to participate in the special interest sessions.
• IXth International Conference on Health Education: CNA was a
co-host and co-sponsor forthis conference in Ottawa last September.
More than 1000 delegates from 82 countries were in attendance.
• King's Fund College International Seminar for Nurses: Canadian
participants in this July meeting in London. England, included CNA
Board members Shirley Stinson. and Lorine Besel, past president
Huguette Label le, executive director Helen Mussallem, Ada McEwen
(VON) and Dorothy Kergin (McMaster University).
• Other international agencies: communication was maintained
with the Commonwealth Caribbean Regional Nursing Body.
Commonwealth Nurses Federation. American Nurses Association,
Royal College of Nursing, World Health Organization, Pan American
Health Organization, International Hospital Federation and others.
Other national agencies
Special interest nursing groups: CNA continues to provide support
and guidance through wori<ing relationships with numerous nursing
associations including: Canadian Association of Neurological and
Neurosurgical Nurses. Nurses Employed at National Level,
Registered Nurses of Indian Ancestry. Victorian Order of Nurses,
National Committee of Nurse Mid-wives, Psychiatric Nurses
Association of Canada and Canadian Nurses Foundation.
Canadian Council on Hospital Accreditation: CNA representation on
the CCHA Board of Directors has been increased to two persons
fol lowing a decision of the CNA directors in October. The new nursing
representative will be named shortly.
Other health-related groups: Liaison and collaboration at the national
level includes information sharing with groups such as: Canadian
Hospital Association. Canadian Public Health Association. Canadian
Medical Association, Health League of Canada and Canadian Council
on Smoking and Health.
Extension Course in Nursing Unit Administration: a joint CNA and
Canadian Hospital Association project, the NUA extension program
consists of a combination of workshops and correspondence
programs available in both French and English. Since 1960 when the
program was initiated, a total of more than 7000 nurses have taken the
course, including nurses in Zaire. Botswana. Haiti and Lebanon.
Announcement that the Canadian Hospital Association, which
now houses the NUA staff, will move its headquarters to Ottawa this
September has resulted in establishment of a sub-committee to study
the question of relocatinq NUA offices. — *-
The Canadian Nurse May 1977
Xew.s
Since June 1976 the five CNA representatives to the NUA Joint
Committee, at the request of CNA directors, have carried out an
evaluation of the NUA program. Their conclusion: enrolment has
increased significantly in almost all provinces and the numt)er of
graduates per year would indicate that the objectives of the course are
being met.
Government departments
Health and Welfare Canada: Meetings and consultation tal<e place as
needed between CNA staff and officials of Health and Welfare
Canada, including Minister Marc Lalonde, the Minister of State for
Fitness and Amateur Sport, lona Campagnolo, the new Deputy
Minister, Bruce Rawson, acting Principal Nursing Officer, Rose Imai
and various department heads.
CNA input into proposed legislative changes, task forces and
research programs has increased substantially in recent months.
Areas of consultation include: the new Social Services Act (replacing
current Canada Assistance Plan), proposed legislation for extended
health care services, Canada Health Survey, proposed physician
manpower data bank. Task Force on Cervical Cancer Screening
Programs and Working Group on Venereal Disease Control.
Canadian International Development Agency (CIDA). During 1976,
CNA was instrumental in securing and administering CIDA/NGO
funds totalling close to $65,000 for the development of nursing
programs in many countries around the world. Last year CNA was
granted funds for eleven projects in nine countries in the Third World.
CNA has just learned that a submission for funds to conduct a
feasibility study on producing an international French-language
periodical for developing francophone countries has received
CIDA/NGO approval. The total financial request for $22,500.00 has
been awarded.
At a meeting of all professional voluntary agencies called by
CIDA/NGO (2-3 March 1 977) , CNA's program was commended as an
example of what a national voluntary agency could accomplish.
National office personnel
Statistical program: The "Resource File" of Canadian nurses with a
baccalaureate or higher degree is being expanded to identify areas of
expertise, and determine availability for special international or
domestic assignments. A new questionnaire entitled, "Professional
Profile on Canadian Nurses," has been mailed to all Canadian nurses
holding a master's or doctoral degree. Basic information will be put on
the "in-house ' computer for ready reference and the completed
questionnaires will be retained in the library biographical files.
Information on baccalaureate nurses is being maintained for 1 977 and
will soon be computerized.
Canadian Nursing Statistics: which replaces CNA's Countdown, was
produced for the first time in 1976 by Statistics Canada. Although
publication is now the responsibility of this government department,
CNA still coordinates provincial inventory data collection, collects and
tabulates the necessary data and information.
Library: both services and resources have increased steadily. CNA
members have access, through the library to: Repository Collection of
Nursing Studies, foreign nursing journals, Canadian and foreign
nursing legislation, collective agreements, continuing education
programs, biographical files, foreign service records, photo collection
and the archives, in addition to 13,000 books and documents.
Journals: response to the new format which emphasizes visual unity
of both L'infirmi^re canadienne and The Canadian Nurse has been
enthusiastic and, almost without exception, favorable. Support from
CNA members, in the form of manuscripts submitted for editorial
consideration, has increased measurably within the past year. This
has enabled the editors to make a significant improvement in the
quantity and quality of articles presented to readers each month.
Information Services: Early in 1977, a director of public relations
services was appointed. Nicole Fontaine has worked as a journalist,
broadcaster and consultant for agencies that include Health and
Welfare Canada, Secretary of State and Treasury Board. Current
information services projects include publication of a bilingual
pamphlet on basic nursing education for the use of high school
students and guidance counsellors, an audiovisual slide presentation
on CNA and a newsletter for member associations.
Pictured during the 1977 annual meeting are (left to right) RNAO acting
executive director, Doris Gibney with Marjorie Hayes, director of the joint
St. John Ambulance /Canadian Red Cross project and, at the mike,
Thurley Duck, president of the B.C. nurses' association.
Voting delegates at CNA's annual meeting approved four
resolutions with implications that could affect all practicing nurses in
this country. The resolutions directed the association to:
1. strongly urge the Government of Canada to include the costs of
(professional) publications in their yearly income tax deductions.
2. re-emphasize the purpose of the (Canadian Nurses Association
Testing Service) scores to be solely the determination of eligibility for
licensure in a participating jurisdictbn, and discourage the use of
registration examination scores by educational institutions as a
criterion for admission into educational programs.
3. pursue the initiatives taken over the last year by giving Its full
support to the implementation on a national scale of the following
RNABC recommendations concerning rape:
• Inservice orientation programs for staff in hospital emergency
departments including information on treatment of victims of sexual
offences.
• An association position calling on all hospitals to treat all cases
alike, whether or not charges are to be laid.
• Making information on treatment of rape part of schools of
nursing curricula and make further representations to the Minister of
Justice to proceed with the adoption of all changes recommended by
the Law Reform Commission in relation to rape trials, as expressed in
its report on evidence.
4. be instrumental in the development of a Canadian Code of Ethics
for registered nurses.
Ife^
Highlights from CNA Directors' meeting
Organized nursing will be active on many fronts in months to come. Directors of the Canadian Nurses Association,
meeting In Ottawa at CNA House on March 30 and April 1, moved to fill some of the gaps they recognized in the area of
current nursing practice, research, education and administration. At the same time, they took a look outside the
profession at the ways that nurses could be contributing to the improvement of the health status of persons around them
and the potential for nursing involvement in the work of agencies with compatible goals. Highlights of their discussion
and decisions follow:
Nursing practice
An expert in the field will be selected from names submitted by
member associations to develop a preliminary definition of nursing
practice.
Registration / licensure
An expert will tie hired to develop a discussion paper on principles,
alternatives, implications and strategies in this area. Both this project
and the one on nursing practice will be carried out on a contract basis.
Canadian Association of Neurological and Neurosurgical
Nurses
Directors approved an application by CANNN for affiliate membership
with CNA. CANNN thus becomes the first affiliate member of CNA In
the association s history.
Doctoral preparation for nurses
Outside funding will tie sought for a proposed conference to
investigate problems and priorities in the area of doctoral preparation
for nurses in this country. At present, fewer than 50 of 115,000 CNA
members hold doctoral degrees. The vast majority of these were
obtained in the U.S. The proposed conference is planned for
December, 1977.
Workload measurement system for nursing in the
hospital field
Directors voted to accept the invitation of the Chairman of the Steering
Committee on Workload Measurement Systems to participate in its
wori< of promoting the development of adequate workload
measurement systems as they relate to hospital nursing. The steering
committee was set up in November 1975 by the federal-provincial
Advisory Committee on Health Insurance. Last year it provided
supervision, advice and assistance in relation to development of
workload systems for laboratory medicine, radiology, respiratory
technology, dietetics, and hospital pharmacy.
Directors pointed out that wori<load measurement in hospital
nursing has a direct bearing on current provincial concerns in the area
of fiscal constraints and quality assurance programs.
Protection of life
Dl rectors indicated interest in the invitation extended by offiaals of the
Law Reform Commission of Canada to participate in the
commission s current work in the area of protection of human life. The
project, dealing with euthanasia, a definition of death, human
experimentation and behavior modification and control, was
described to CNA members by the chairman of the commission,
Justice Antonio Lamer, at a luncheon during the annual meeting.
Meetings between CNA representatives and commission
officials will take place to explore possible nursing input.
Special Interest groups in nursing
CNA directors approved preliminary guidelines that will allow the
national association to take the initiative in providing both moral and
financial support to "emerging" groups representing special interests
within the nursing profession. Financial support will be limited to S500
in the initial year and goals of these groups must be compatible'with
those of the national association.
Principal Nursing Officer
Acting PNG, Rose Imai, reported on current programs and concems
within the federal department of Health and Welfare. These included:
• new cost sharing arrangements between the provinces and
federal government in the area of fx5spital and medical care insurance
and post-secondary education.
• federal/provincial nursing consultants meeting scheduled for
September 26-28 in Ottawa.
• government action to alleviate the current depressed market
situation for nurses and provide better long-term nursing manpower
planning.
• recognition of the need for a national policy on immunization and
work begun on this project.
• establishment with the Department of Labor of a National Center
for Occupational Safety and Heeilth.
Water resource planning and management
Acting on a resolution passed by CNA members at the 1976 annual
meeting when "quality of life" was the theme, directors supported
development of a "clean water campaign" among members of the
nursing profession in Canada. A variety of ways will be sought to
stimulate nursing interest in water supplies and water problems in this
country,
1977 Budget proposal
The Treasurers Report, presented to the annual meeting by
executive director Helen K. Mussallem, indicated that expenditures
for consolidated operations for the 1 976 fiscal year were S2,056, 1 40
which was S9,740 under consolidated revenues of 52,065,880.
The 1977 budget proposal approved by the directors at their
meeting on March 30 projects expenditures of $2,626,478 and
revenues of 52,281,158 producing a deficit of 5345,320.
This deficit was foreseen by the voting delegates at the 1976
annualmeeting when the fee unit of 518, required to support approved
programs, was adopted for phasing in over two years— Si 2 in 1977
and 51 8 in 1 978. The deficit generated by the 51 2 unit fee in 1 977 will
be recovered with the introduction of the $18 unit fee in 1978,
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The Canadian Nurse May 1977
Xews
Family planning moves into
high gear, nurses active in
federal program
Two nurses will be key members of the
team directing the more active role
that federal Health and Welfare
Minister Marc Lalonde envisions for
the Family Planning Division of his
Department.
Suzanne Brazeau, was
appointed Director of the Division in
July, 1975. A native of Kirkland Lake,
Ontario, Brazeau obtained her R.N. at
the Ottawa General Hospital. She is a
graduate of the University of Ottawa
(B.Sc.N.Ed., B.A., L.Th., and M. Th.)
and the University of Chicago (M.A.
and Ph.D dissertation not finished).
She was formerly Health
Education Consultant and Nursing
Coordinator with the Canadian
Tut)erculosis and Respiratory
Disease Association.
Pauline Chartrand was named
nurse consultant for the Family
Planning Division in mid-March of this
year. A graduate of the University of
Ottawa (B.Sc.N., B.A.), Chartrand is
now enrolled in the Master of Health
Administration Program at U. of O. Her
experience includes work as director
of Montforf Hospital School of Nursing
in Ottawa and as a Public Health
Nurse with the Ottawa-Carleton
Regional Health Unit where she was
one of two nurses seconded to a
three-year demonstration project
carried out by the Health Unit, "An
Investigation into the Health Care
Needs of the Elderly in Senior Citizen
Apartments."
The four-year-old family planning
division has been in existence since
January 1972, but until now has
maintained a low profile, restricting its
activities to responding to requests for
information, consultations and grants.
The new policy announced by the
Minister involves a shift to active
promotion and publicity of family
planning, in response to the findings of
the Committee on the Operation of the
Abortion Law (the Badgley Report). In
a statement released shortly after
publication of the Report, the Minister
noted that: "Although the federal
government does not consider
abortion to be an acceptable method
of family planning, it is accepted that
abortion counselling, meaning the
objective presentation of several
alternatives, lies within the laws of
Canada as defined by Parliament."
"Abortion counselling services
should be provided in family planning
facilities as long as all the possible
options are fairly and clearly
presented, and as long as the terms of
the Criminal Code are fully
respected. '
The Minister pointed out that it
was the government's intention to
highlight the federal perspective and
also to stress prevention and the
desire to improve lifestyles to a
significant extent."
"In keeping with the fundamental
objective that every shild should be a
wanted child, the Family Planning
Program will devote attention both to
conception and contraception, so that
Canadian couples may freely choose
to have a child when they want one."
In addition to a more active role in
promoting family planning
information, the division will focus its
advisory and consultative services on
assisting the provinces and voluntary
agencies to develop family planning
services.
Other initiatives include:
• Placing the issue of age of
consent relative to counselling and
treatment services on the agenda of
the next conference of ministers of
health and welfare.
• Assisting provincial officials with
the training of personnel.
• Encouraging provincial ministers
to create "approved" hospital services
and to provide the necessary staff and
supplies in order to offer the needed
family planning services.
• Discussing with the provinces the
feasibility of establishing women's
clinics affiliated with general hospitals.
• Making physicians more aware of
the terms of the legislation respecting
abortion.
Nursing groups are encouraged
to apply for training grants, teaching
fellowships, demonstration service
and education grants and research
grants.
Information is also available to
groups or individuals. Of particular
interest to nurses are the following:
• Family planning manual for
nurses;
• Communications in family
planning;
• Contraceptive technology (in
English only);
• A manual on establishing and
operating Community Family
Planning services;
• Sex Education — a teacher's
guide.
The division also has on hand a
broad range of pamphlets for the
general public.
Did you know ...
A unique brochure "Passion Food
Isn't Enough" has been released by
the division of Community Health,
University of Toronto and attempts to
answer questions about nutrition and
family planning. Copies available
from: The Family Planning Division of
National Health and Welfare, Room
662, Brooke Claxton Building,
Ottawa, Ontario, KIA IB5.
ICN announces 1977
3M Winners
The International Council of Nurses
has announced the names of the two
recipients of 3M Fellowships for 1977.
They are Hertta Kalkas of Helsinki,
Finland, andJean Grayson of Trinidad
and Tobago. The fellowships are
valued at $6000 (U.S.) each and are
awarded annually under a program
sponsored by the Minnesota Mining
and Manufacturing Company (3M)
and administered by the ICN. A total of
44 national nurses' associations
submitted names of candidates for the
1977 awards. CNA's nominee this
year was Denyse Latourelle of the
University of Montreal in Montreal.
Each of the national finalists receives
a prize of $200.
Last year's winners were from
Thailand and Mauritius. Canada's last
fellowship winner was Alice Baumgart
of Toronto and Vancouver who
received the award in 1973.
Health exchange program receives
official approval: Canadian-Cuban
opportunities for information sharing
in the health care field will continue to
expand over the next two years as the
result of a joint agreement signed
recently in Ottawa. Below, Canada's
Minister of Health and Welfare, the
Hon. Marc Lalonde, shakes hands
with the Minister of Public Health for
the Republic of Cuba following the
official signing of the agreement in
Ottawa, March 29.
Health Minister Jose A. Gutierrez
Muniz, in an interview following the
ceremony, paid tribute to the "very
high level of nursing education and
practice in Canada" and said that
Cubans "very much admire the
expertise and experience of nurses in
this country. " He pointed out that
Cuba had only recently acquired its
first university program in nursing and
that Cuban nurses involved in setting
up the program had relied heavily on
experiences acquired in Canada
during a study tour arranged through
the exchange program.
The new agreement provides for
continuation of a 1975 exchange
program between Canada and Cuba.
The latest agreement, according to
Health Minister Lalonde, is more
specific to nursing and offers nurses
in both countries greater
opportunities for collaboration and
co-operation.
Correction
Re CNJ's March news item page 16:
The newly elected Western
chairperson of CUNSA is Bonnie
Smith, University of Saskatchewan;
Kathy Toner, Atlantic Regional
Research Coordinator, is from the
University of New Brunswick.
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The Canadian Nurse May 1977
\i*\\H
Montreal nurse heads
accreditation body
Helen Taylor, president-elect of the
Canadian Nurses Association and
director of nursing at the Montreal
General Hospital has been appointed
chairman of the board of the Canadian
Council on Hospital Accreditation and
chairman of that association's
Executive and Finance Committee.
The appointment marks the first time
in history that a nurse has filled the
position of CCHA board chairman.
The Canadian Nurses
Association has held a seat on the
CCHA board since March 23, 1973.
Isobel MacLeod, then director of
nursing, Montreal General Hospital,
was the first CNA representative on
the board. She was succeeded by
Taylor in August 1974. CNA acquired
a second seat on the board in
February 1977 and has named
Fernande Harrison, Administrative
Professional Officer, Dept. of
Medicine, University of Alberta to fill
that position.
The Canadian Council on
Hospital Accreditation establishes
standards for hospital operation and
promotes high quality medical and
hospital care for patients. On a
voluntary basis, hospitals invite CCHA
surveyors to examine their hospital
services. At present, nearly 60 percent
of the 904 public general hospitals in
Canada are accredited by CCHA. This
accounts for 83 percent of all hospital
beds.
Ren Fellow named
acting ICN head
The former chief education officer of
the General Nursing Council for
England and Wales, Barbara Fawkes,
OBE, BSc, SRN, SCM, has been
named acting executive di rector of the
International Council of Nurses until
the ICN Board of Directors names a
successor to Adele Herwitz whose
resignation became effective March
31.
The acting executive director has
been a member of the ICN Board of
Directors since 1969. She has
resigned from this position to take up
the staff appointment.
An active member of the Royal
College of Nursing of the United
Kingdom throughout her career,
Fawkes was awarded a life
vice-presidency of the College and
was among the first group of ten
nurses to be made a Fellow of the
College. Fawkes is an Honorary
Fellow of the New South Wales
College of Nursing, Australia, the
country where she now resides.
University of Alberta
Graduate Scholarship
A graduate scholarship of $1,000 is
awarded annually by the University of
Alberta Hospital Board in recognition
of the 50th anniversary of the schools
of nursing of the University of Alberta
and University of Alberta Hospital. The
scholarship is awarded to a graduate
of the University of Alberta Hospital
School of Nursing who has been
accepted in a University program for
advanced nursing education at the
Baccalaureate, Master's or Doctoral
level.
Applications will be assessed
according to the applicant's potential
for leadership in nursing, contribution
to nursing and to the community,
references, and fulfillment of
educational criteria.
Applications for this year's
scholarship are to be submitted by
June 30, 1977 to; Vice-President —
Nursing, University of Alberta
Hospital, 112 St. and 83 Avenue,
Edmonton, Alberta, T6G 2B7.
St. John /Red Cross
multi-media project
A Canadian nurse with a background
in curriculum development,
classroom and clinical teaching as
well as administration of research
contributions and grants in the
Federal Government, has been
named project director for the joint St.
John Ambulance/Canadian Red
Cross multi-media home nursing
program. Marjorie Hayes (Reg. N.,
Cornwall General Hospital; B.Sc.N.,
University of Windsor; M.Sc.N.,
University of Western Ontario,
London;) heads up the three-year
research project directed towards the
teaching of basic home nursing skills
to a large segment of the Canadian
population.
Funding for the project has been
provided by National Health
Research and Development Program
of Health and Welfare Canada.
"What we're trying to do,"
according to Hayes, "is to find the
best way of helping the individual
provide care with confidence, not just
to members of his immediate family
but also to the "extended family " in
the community.
The multi-media program
involves the production of a total of
26, 1 6 mm films, half in French, half in
English for home television viewing
along with programmed learning texts
and additional instructional aids.
Each film will be thirteen and one-half
minutes in length and filmed in color.
The segments are to be centered
around personal situations, and the
case study approach will be used to
teach principles and skills of home
nursing.
The project which was originally
conceived nine years ago by another
Canadian nurse, Margaret Hunter,
chief nursing officer, St. John
Ambulance, is to last three years.
During the first 18 months, the
multi-media program will be produced
and the evaluation design and
procedures will t>e set. In the next 12
months, volunteers will enrol in the
program, and the evaluative research
will be conducted in nine communities
across the country. Province-wide
distribution of the new program will
begin in the Fall of 1979 from the two
agencies.
Hayes was formerly Project
Administrator for Research Prograrr
Directorate, Health and Welfare
Canada. In this capacity she planne(
organized, directed, examined and
analyzed applications for financial
assistance under the National Healtl
Research and Development
Programs to determine their
administrative and operational
feasibility. As director of the joint SI
John Ambulance/ Canadian Red
Cross project, she looks forward to
involving nurses in the community i
various components of the program i
it develops. "It is only through the
co-operation of nurses across Canac
that this project can succeed," she
says.
CNA appoints director I
of Labor Relations Service
At press time, CNJ learned of the
appointment of Glenna S. Rowsell i
CNA's first director of Labor Relation
Services. Most recently employed
with the Provincial Bargaining
Councils of New Brunswick and a
former member of the CNA board c
directors, Rowsell will establish ant
direct a labor relations service whic
includes collection and analysis of
data, preparation and distribution o
information and development of
relevant educational programs.
PEI nurses promote
changes in property laws
The Association of Nurses of Princ
Edward Island has submitted a brief t
Minister of Justice Alex Campbell,
urging that changes be made in
matrimonial property law to reflect tt
premise that the institution of marriac
is, in part, an economic partnership
equals, and that the family structure
in part, an economic unit.
The brief points out that the
existing matrimonial property law
regime of separate property results
inequities between men and wome
and that it fails to recogn ize the unpa
contribution of the spouse in the hon
and the contribution of wives in
unincorporated family farms and
businesses.
FIMNKLY SPMKING
\Linda Gosselin
For the past year and one half in Ontario,
public health nurses have faced a
problem that is now beginning to rear its
ugly head in other provinces, British
Columbia in particular.
Simplistically stated, the problem of
the Ontario public health nurse is: "Are
her services essential enough to rate
arbitration of contract disputes?" At
present, unless her collective agreement
fias an arbitration clause, or her employer
agrees to take unagreed issues to
arbitration, a public health nurse's only
recourse if she does not accept a contract
offer is to go on strike or be locked out by
the employer. The majority of the local
Boards of Health in Ontario have agreed
among themselves not to settle for
arbitration. The provincial government
has been noted for its lack of action to
solve the impasse. It seems they do not
wish to interfere with the autonomy of the
local Boards of Health. Petitions, letters,
strike action by the nurses, and prolonged
I lock-outs of nurses by their Boards have
been unable to move them.
Now in British Columbia, we see
another group of nurses faced with a
problem like the one in Ontario. The
nurses in British Columbia have been 18
months trying to settle a contract with the
B.C. Government Employee Relations
Bureau (G.E.R.B.). They too, wish to take
unsettled issues to binding arbitration.
G.E.R.B.'s response to arbitration is: "No:
accept the offer or be prepared to take a
strike. '
I find I cannot accept such
unreasonable positions from
governments elected to provide services
to the public within their provinces. In
Ontario, the government is risking a
cessation of public health nursing
services: in B.C.. the nurses being
pushed towards strike action provide
services in psychiatric and rehabilitation
hospitals and in community health
agencies. Whose interests are the
governments trying to protect? The
nurses' — obviously not: the public's? —
obviously not their interests either.
The nurses in both disputes have
gone on record backing arbitration as the
best way to settle contract disputes
PUBLIC HEALTH ^
NURSES
,/ff/** JUSTICE 'Nti
because of the patients who would and do
get caught in strike action . The difficulty is
getting the respective provincial
governments to act in a responsible
manner to provide the necessary
legislation to allow peaceful settlement.
Recently, the Ontario Nurses'
Association presented a brief to the
Ontario Government. In it, O.N. A.
highlights the "disastrous state " that
collective bargaining for nurses is in, in
Ontario. O.N. A. maintains that: "This
state has been created th rough the fail ure
of the Ontario Government to exercise its
supervisory role over collective
bargaining. The needs of the nursing
profession have ...been steadfastly
ignored and registered nurses remain
second class citizens in this province."
Is B.C. heading in the same direction? ^
Frankly Speaking is intended as a forum for nurses who want to speak out on
issues that may influence the future of nursing practice, research,
administration or education. Guest columnist this month is Linda Gosselin,
CNA member-at-iarge for social and economic welfare. If you have an
opinion or concern that you would like to share with your fellow nurses, why
not write to us. This is your chance to get involved, to participate in shaping
the destiny of your profession.
20
The Canadian Nurse May 1977
( €SPECIALLY FOR YOU, NURS€ ^
YOGA
for tired legs
and aching bacl^
Stella Weller
I often recall my early days as a student
nurse In England. The first three months
were spent In Preliminary Training School
where we sat in a classroom for several
hours a day. We listened to lectures,
made notes and wrote tests. Then we
went on to the wards, and what a
difference that was! I shall never forget
how hot, tired and aching my feet felt at
the end of an eight-hour day. Nor will I
soon forget how quickly I kicked off those
black, lace-up Oxfords when I got back to
my room at the nurses' hostel, and how I
flopped into bed, missing supper, "The
Boy Friend," and all the other shows and
concerts for which, often, there were free
tickets.
If only I had known about Yoga in
those days! But it was many years later, in
Trinidad, West Indies, that I discovered it
when I found a book on the subject in the
house of the friend with whom I lived. I
learned that Yoga was a practical science
that originated in India thousands of years
ago and that one branch of it, Hatha Yoga
(the Yoga of health), was rapidly gaining
popularity in the Western world as a
means of restoring and maintaining
mental and physical well-being. I read that
neither age, nationality nor creed were
barriers to its practice which included
physical exercises and breathing
techniques. What fascinated me most
was the way in which the exercises were
done — in a very aware manner, slowly
and smoothly, with breathing and
movement synchronized. There was a
"holding" period in which the pose was
maintained, in comfort, for several
seconds, while the breath was allowed to
flow freely. Finally, there was a rest period
to allow an absorption of energy and
elimination of fatigue poisons
accumulated through muscular activity.
I decided that this was for me, and by
the time I came to Canada I had begun to
practice Yoga asanas (postures or
exercises) with some regularity. My first
job was on a busy orthopedic ward that
was invariably short-staffed. After many
The Canadian Nirse May 1977
hours of bending and lifting and walking
back and forth, plus a ten-minute walk to
and from the bus stop, I was ready to
crawl into bed at my tiny apartment. Not
only were my feet and legs throbbing and
weary, but my back protested in the worst
way. I suppose that having a marked
scoliosis did not help matters. However,
instead of retreating to the tempting
comfort of my bed, I summoned up the
initial courage I knew I needed to do some
Yoga. Kicking off my shoes and removing
my stockings, I slipped out of restricting
garments and began. IVIyfirstthought was
of the Half Shoulderstand, an old
favorite. Its inverted position helps the
return flow of blood to the heart and
provides rest for the valves of the blood
vessels in the legs: it helps counteract the
many undesirable effects of the constant
downward pull of gravity. Moreover, it
encourages a better blood supply to the
upper body; the brain cells benefit, as do
the face, eyes, and hair.
Here's how to do it:
1 Lie supine on a floor protected by
blankets or carpet. Arms are close to you
and palms turned down. Breathe easily.
2. Exhale and raise straight legs until they
are perpendicular to the floor. Inhale.
3. Exhale and raise hips off the floor by
using the elbows and hands as levers,
while simultaneously swinging the feet
backward (See figure 1). Continue
breathing normally.
4. Keeping the upper arms on the floor,
support the hips with the hands, thumbs
in front (See figure 2).
5. Hold the completed position for as long
as you are comfortable, letting your
breath flow smoothly.
6. To come out of position, replace the
forearms and and hands on the floor,
slowly lower the torso until the hips are
down; lower the legs on an exhalation.
Rest until respirations are normal.
The Dog Stretch is another favorite of
mine for relieving tension in feet and legs,
and for bringing an overall feeling of
refreshment. The head-down position is
beautifying as it brings a better blood
supply to the upper body.
_
'
4
r T
-1
msm?
y ^^^^'^^mmm^.
7. Get on "all fours," thighs at a right
angle to the torso, toes tucked under, and
arms sloping. Breathe normally. (See
figure 3).
2. Inhale. Exhale, press on palms and
toes, lift knees and straighten legs; press
heels toward the floor and push the hips
up. The head hangs down and arms are
straight (See figure 4).
3. Hold the position for several seconds,
breathing rhythmically.
4. To come out of position, inhale and
rock forward on the palms: lower knees
and slowly resume your starting position.
Sit on the heels or In any other
comfortable position for several seconds,
and rest until breathing normally.
On days when even the Dog Stretch
seems to require too much effort, simply
lie on a bed or padded floor, and rest your
feet against a wall or on a piece of
furniture. Close your eyes and practice
conscious relaxation. Mentally suggest to
each part of you, in turn, to release
tightness, to let go, to relax — toes and
feet, ankles and calves, knees and thighs,
working up to and including your scalp.
Finally,focus on your breathing, imagining
an intake of refreshment and energy with
each inhalation, and an outflow of
tiredness and everything negative with
each exhalation. I have practiced this
technique many times in five-minute
breaks during a hectic day. It has been a
boon at such times, helping to restore my
mental balance. I have even done it sitting
in a chair, with my spine supported, and
my feet on a prop.
One day at the local library, I found a
book that explained why primitive people
seldom suffer from tired backs or
backache and why degenerative disc
disease is virtually unknown among
them.' Apparently, in cultures where
people squat habitually rather than stand
for long periods or sit on chairs, the
lumbar arch of the spine is reduced, and
strain on the paravertebral muscles and
spinal discs is lessened. Perhaps that is
The Canadian Nurse May 1977
^^
why the exercises that follow are so
effective in relieving back fatigue and
strengthening the muscles supporting the
spine.
The Reverse Arch (combined with pelvic
titling).
1. Lie supine with arms near you and
palms turned down. Bend the legs and
put the soles of the feet flat on the floor, a
comfortable distance from the bottom.
2. Inhale. Exhale and press the small of
your back into the floor to reduce the
lumbar arch and tilt the pelvis upward.
3. Inhale and slowly raise hips then torso
in a smooth, controlled manner, until the
body from knees to chest is level (See
figure 5).
4. Hold the position, breathing evenly.
5. In reverse motion, lower the torso by
uncurling the spine into the floor Stretch
out the legs and rest.
The Cat Stretch (modified).
1. Get on hands and knees, like a table on
four legs. Breathe regularly.
2. Exhaling, lower the head, press on
palms to arch upper back, and tuck the
bottom down (See figure 6).
3. Hold for several seconds, letting the
breath flow freely.
4. Inhale and relax in your starting
position. Repeat several times.
5. Exhaling, lower head and bring a knee
toward the forehead (See figure 7).
6. Hold the position as long as
comfortable, breathing evenly.
7. Inhale and resume your starting
position. Repeat with the other leg.
8. Sit and rest until respirations become
normal.
The Knee Press
1. Lie supine with arms relaxed beside
you. Breathe regularly.
2. Exhale and bring a bent knee toward
the chest; clasp the lower leg and bring
the forehead toward the knee (See figure
8) . Keep your shoulders relaxed and hold
the position for several seconds,
breathing as evenly as possible.
3. Inhale and lower head, arms and leg.
I ne vanaaian Pfurs* may i9/7
jft:
4. Repeat a few times with the same leg;
rest and repeat the same number of times
with the other leg. Relax.
The Dancer's Pose
The Dancer's Pose, in addition to being
beneficial for the back, is excellent for
improving blood circulation in the legs, for
toning and strengthening them and the
feet, and for helping prevent varicosities.
7. Stand naturally erect
2. Inhale and rise on to the toes, raising
the arms overhead and bringing the
hands together (See figure 9).
3. Exhaling, slowly lower the bottom
toward the heels (See figure 10).
4. Unless you have varicose veins, hold
the position for as long as comfortable,
breathing normally.
5. If you have varicosities or do not wish to
hold, omit step 4 but repeat steps 2 and 3
several times.
6. Sit and rest.
Finally, for all of us who, at some time or
other, will sit hunched at a desk for several
hours, or spend much time bending
forward, here is a technique that is
marvellous for counteracting the effects of
faulty posture and relieving back strain;
for releasing tension from the shoulder
area and for bringing a better oxygen
supply to every cell. It is called the Chest
Expander, and has been modified.
7 . Stand naturally erect (you may sit also
on a stool, bench or box).
2. Inhaling, swing your arms behind you
and Interlace the fingers. Push the arms
upward, but resist the tendency to bend
forward; maintain an erect posture (See
figure 11).
3. Exhale and bend forward from the hip
joints, keeping the chin and arms up (See
figure 12).
4. Hold the position as long as
comfortable, breathing rhythmically.
5. When the impulse to come up appears,
do so, very slowly, keeping arms pushed
upward and torso straight.
6. Relax arms, shrug a few times or rotate
: ;-3^^
the shoulders, shake imagmary drops of
water from the hands, and rest.
It is not necessary to wait until you get
home after a tiring day to practice the
foregoing exercises. Do them, as I have
done and still do, during coffee and meal
breaks (before you eat), in the locker
room or elsewhere, and on any
convenient occasions you find or create
during the course of your busy day. Take
your shoes off, loosen your collar and belt,
and have a yoga break. It will help forestall
a build-up of tension and fatigue, and do
much to conserve needed energy for
physical and mental creativity. ♦
Reference
1. Fahrni, W. Henry, Backache Relieved
Through New Concepts of Posture.
Springfield, III., Thomas, 1966.
I
Yoga expert Stella Weller grew up in
Guyana, South America. Her nursing
education took place at Charing Cross
Hospital in London, England, where, she
says, most other experience was gained
through work on maternity wards,
prenatal and postnatal clinics. Her
Canadian nursing experience includes a
stint at Lion's Gate Hospital in North
Vancouver, and at Notre Dame Hospital
in Zenon Park, Saskatchewan. She lives
now in Surrey, B.C. with her two sons and
husband, Walter who took the
photographs that accompany this article.
The Canadian Nurse May 1977
The Rewards of Research
The researcher holds thebaby. whois
all dressed, alert, not tired and, we
believe, happy and comfortable after
his cuddle bath. Wofe the eye contact
he makes with the author.
riJDDLI!
Bathing can be
Fun
J. Penny lles/Marcia McCrary
A bath is often a welcome, relaxing
high-point of the adult's day. Not so for
the infant. Suspecting the method as
the cause for upset, these authors
compared a new technique with the
traditional one — and saw some
satisfying results.
Two harried clinical nursing instructors on a
busy university medical center maternity
service are among those least likely to have
heard the frequent challenge of
peer-professionals: Put a little excitement in
your life — try research! What we did hear
were squalling babies in the nursery,
particularly at bath time.
The anxious faces of their mothers told us
that they hadn't missed the apparent distress
of their infants, either. "Babies always cry at
bath time," we've heard seasoned mothers
reassure the new. "It's good for babies to cry; it
clears their lungs," they counsel. But most
young mothers aren't convinced, and neither
were we. Watching babies nakedly await the
brisk water and rub of diligent nursery staff,
one young mother suggested thoughtfully,
"Maybe they're simply cold. "
We felt she could be right. But if we were
to challenge, perhaps change, routine bath
procedures we would have to validate the
need, possibly offering a feasible substitute.
The need for change seemed obvious. For
adults a bath can be a relaxing, soothing
experience. Yet the babies' cries seemed
anything but relaxed. If we operated from the
assumption that these babies were
responding with distress (squalling, motor
excitement) to a stimulus (the routine bath
procedure) and hypothesized that this event
stressed the infants thermally as well as
emotionally, we had the skeleton of a
physiologically-related clinical study.
Acknowledging the well-sung need for such
nursing research, we eagerly made the
plunge.
What if we monitored babies before and
after routine bathing to detect changes in body
temperature which might be correlated with
the procedure? During baths we would
measure physical activity and intensity of
crying. The data so obtained might validate a
need to alter routine bathing practices so as to
reduce babies' thermal and behavioral stress.
Moreover, if we monitored babies who
experienced several different daily bathing
techniques in a variable sequence, would one
or more techniques be found substantially less
stressing? The use of such techniques could
thereby be justified clinically.
We struggled with the details of clarifying
our goals, formulating a plan of attack on this
"clinical problem." We shoveled through a
variety of library resources, extracting
previous research, sorting theories sifting out
variables, scrutinizing techniques related to
infant bathing. We unearthed information
suggesting the abilities of newborns to adjust
to changing environments, various methods
used in assessing the thermal status of infants,
controversies regarding the effect of thermal
stresses upon the metabolism and oxygen
consumption of the neonate, and correlations
between the presence of brown fat and
thermal regulation capabilities of infants.'"^
(For more information on thermal regulation
see Williams and Lancaster).
We discovered conflicting reports on the
effects of a variety of infant-bath procedures:
some argued against the necessity of such
practices while others decried the lack of
bathing procedures. '•^^^''^ Several affirmed
when and where to bathe infants: a few
suggested when and where one should not
complete the procedure. ^^ Data supporting
how to bathe infants ranged from those which
favored the use of no soap to one instance in
which even water was eliminated. ^'^^.m
Through this search of the literature we
identified the parameters for the "normal
newborn" in our study and the techniques by
which we would record the anticipated thermal
adjustment of study infants. We elected to
study thermal and behavioral data from infants
during three distinct procedures:
1 the bath routinely given by nursery
personnel;
2 the bathing technique we teach our
students during clinical experience In the
newborn nursery; and
3 a wrapped-bath technique we adapted
from the towel-bath procedure used for adults
in the study setting.'' =
Carefully wording our proposal, we
secured appropriate clearance for conducting
the study on the maternity unit and prepared
the tool upon which to record our data for
ensuing computer analysis. We scrutinized
our teaching schedules and, finding no ready
time for research, we made the time by
devoting 6 a.m. on weekdays, a time prior to
The Cuddle Bath — Step by Step...
The technique we developed in our
research to discover a better bathing
procedure for newborns is based on
the idea that exposure of the baby's
skin before, during, and after his bath
is what makes the baby so unhappy.
The new technique, which we have
affectionately nicknamed the "cuddle
bath," begins with the folding of an
old, soft towel into quarters. Then
starting with the folded edges, the
towel is rolled up and inserted into a
plastic sack, rolled edges first.
Warm water (99°F) is poured into
the sack, which is squeezed a few
times to thoroughly saturate the towel.
Then the sack is turned upside down
and squeezed to remove excess
water from the towel. The towel
should be damp, not wet.
The Canadian Nurse May 1977
arrival of clinical students, to collecting data in
the nursery. We quickly learned that
researchers have precious little time for their
work and we were going to make the most of it!
On we waded, through four months of
early-morning bathing. The information we
gathered was eventually punched onto
computer cards, which were sorted, resorted,
and correlated. Excitement surged as we
congratulated ourselves — slightly
prematurely.
We had almost forgotten the warning that
research can be frustrating as well as exciting.
That truth struck boldly as the computer
catabolized the dots and dashes, numbers
and codes it was fed. Nothing in our data
substantiated that babies were thermally
stressed by any of the three bath procedures
provided.
Were we frustrated!
A closer examination of the computer
printout, however, did reveal something
promising. One page was devoted to reporting
on babies who responded with the least
behavioral distress. These happier babies,
having experienced all three bath techniques,
showed the least crying and motor activity
during the same one technique — regardless
of the sequence of the procedures. The single
technique yielding the unique data was the
wrapped-bath procedure we had refined as a
third option in our bath study.
Excitement returned to renew us. We pored
over the data. Experiencing the technique we
affectionately nicknamed the "cuddle bath,"
babies were described as exhibiting quiet
contentment. Positioned face to face (en face)
with their care-givers, some infants
established eye contact with the adults right
from the start and followed them with their
eyes as the bath proceeded. Others cried
initially but were obviously comforted as the
procedure progressed. These babies seemed
Xolike the cuddle bath. Admittedly, we did, too.
Not only did it offer a change from routine, but
the babies responded more positively to us as
a result of it.
Back to the books and library shelves we
scurried in an attempt to clarify our findings.
We searched classic and current research
suggesting that feeling is as fundamental to
infants as food and that tactile and kinesthetic
contacts have the greatest potential for
stimulating responsive interaction in the
newborn.' S.18 We were reminded that the
warmth, cuddling, and en face positioning
characteristics of the cuddle-bath technique
are reinforcing to infants, often eliciting those
responses that mothers have been found to
highly value in the acquaintance process with
their infants. '^ The attending responses of
cuddle-bath babies reduced their crying and
behavioral distress which is so disturbing to
mothers. Mothers see such activity as
rejection, which thereby inhibits further
interaction between mother and child. '^''^
In short, it didn't matter that none of the
bath techniques demonstrated our
hypothesized thermal stress of infants. While
justifying the cuddle bath as harmless from this
The towel (still in sack to conserve
warmth) is carried to the crib and the
cuddle bath can start. Unrolling the
towel downward, the author covers
the undressed baby completely from
his neck down. The baby almost
smiles!
Unfolding the towel once, Marcia
h/lcCrary tucks hall of it to one side.
This is later used for the baby's back
and head. Starting with one corner of
the first half, the researcher bathes
the infant in the usual sequence,
starting with the lace and working
down.
I
Any soap (optional) is removed as she
goes along, making sure to change
the portions of the towel frequently.
The en face position shown here is
comfortable to use and allows the
nurse to talk to the quiet baby and
establish eye contact with him.
s^i'ewpoint, our data happily revealed babies to
be enjoying bath time more when we cuddle
bathed them, inviting us (and mothers
everywhere) to enjoy it, too!
Implications for babies, mothers, and staff
stimulated our imaginations:
• The technique appears safe — no thermal
stress involved and no soap required
(although it can be applied if needed or
desired).
• It's efficient, less time-consuming,
uncomplicated. New, tense mothers can learn
to handle previously slippery and squalling
babies more securely.
• It can be easily taught In hospitals, clinics,
doctors' offices, and homes: it's inexpensive
— no extra or unique supplies are needed.
• Above all. each mother can use bath time
to learn more about her baby's responses
amidst potentially less crying and behavioral
distress. This encounter should encourage
further positive mother-infant experiences
during baths.
Although these implications indicate the
great value of our findings, were not finished
yet. We've really only begun! Much needs to
be clarified, researched, and refined. We feel
that since our tool did not reveal thermal
stress, another study is indicated to research
this possibility. Our tool's design did not
account for the fact that the motor activity
involved in crying during a bath would
significantly raise the infant's body
temperature and thus counteract temperature
loss through evaporation and exposure.
Furthermore, thermal stress can be examined
from many angles. We studied only body
temperature. Drop in skin temperature, for
instance, can yet be researched.
We are, however, pleased with our
findings, and it seems that others are as well.
The cuddle bath will be adopted by staff at our
setting as soon as we complete a slide-tape
demonstration which we are currently
developing as a teaching tool for promoting
this bath throughout our city and state. We
have also presented a teleconference
program — which was beamed from Tucson to
Tempe and Prescott — in our efforts to share
this discovery with peer-professionals.
Already Kino Hospital in Tucson has
requested inservice on this bathing technique
which seems to suit the needs of the infant so
well.
The newborn is coming into his own these
days as a sensitive, aware person. We agree
with LeBoyer that the trauma of the newborn is
real. ''8 To give comfort and pleasure to this tiny
individual in need, as we feel have, is a delight!*
References
1 Phillips, C.N. Neonatal heat loss in heated
cribs vs. mothers arms. JOGN Nurs. 3:1 1-15,
Nov. -Dec. 1974.
2 Adamsons. K. Jr. The roleof thermal factors in
fetal and neonatal life. Pediatr. Clin. North Am.
j 13:599-619. Aug. 1966.
3 Whitner, Willamay, and Thompson. M. C.
Influence of bathing on the newborn infant's body
temperature. /Vurs. Res. 19:30-36, Jan. Feb. 1970.
4 Lutz L., and Perlstein, P. H. Temperature
control in newborn babies. Nurs. Clin. North Am.
6:15-23, Mar. 1971.
5 Miller D.L.. and Oliver T.K., Jr. Body
temperature in the immediate neonatal period: the
effects of reducing thermal losses. J. Am. Obstet.
Gynecol. 94:964-969. Apr. 1, 1966.
6 Hill., J.R., and Rahlmtulla K.A. Heat balance
and the metabolic rate of newborn babies in relation
to environmental temperature; and the effect of age
and weight on basal metabolic rate. J. Physiol.
(London) 180:239-265, Sept. 1965.
7 Oliver T.K., Jr. Temperature regulation and
heat production in the newborn. Ped. Clin. North
Am. 12:765-779, Aug. 1965.
8 Perlstein, P.H., and others. Apnea in
premature infants and incubator-air-temperature
changes. N. Engl. J. Med. 282:461-466, Feb. 26.
1970.
9 Gandy G, M., and others. Thermal
environment and add-base homeostasis in human
infants during the first few hours of life. J. Clin.
Invest 43:751-758, Apr. 1964.
1 0 Freud. S. A quote from three contributions to
the theory of sex. Nen/. Ment. Disorders Monogr.
(New Yori<) p. 44. 1948.
1 1 Ribble. M.A. Rights of Infants. 2d. ed. New
York, Columbia University Press. 1965. pp. 54-64.
12 Dahm, L.S., and James, L.S. Newborn
temperature and calculated heat loss in delivery
room. Pediatrics 49:504-513 Apr. 1972.
As McCrary uncovers the baby's
torso, she uses a dry blanket to cover
him and opens it to cover more of his
body as she progresses dovt/nward
with the bath. The infant shown here is
actually falling asleep!
McCrary now uses the reserved half
of the towel for the baby's back and
head. If he has lots of hair the usual
method for a shampoo is used
instead.
13 Bims B., and others. The effectiveness of
various soothing techniques on human neonates.
Psychosom. Med 28:321-322 July-Aug. 1966.
1 4 American Academy of Pediatrics. Committee
on fetus and newborn. Skin care of newborns.
Pediatrics 54-682-683. Dec. 1974.
15 And now... a towel bath (Innovations in
nursing). Wurs. 75 5:44, Dec. 1975.
16 Yarrow, L. J., and Goodwin, M.S. Some
conceptual issues in the study of motiier-infant
interaction. Am. J. Orthopsychiatry 35A73-A8^ ,
Apr. 1965.
17 Krieger, Dolores. Therapeutic touch: the
imprimatur of nursingArr?. J. Nurs. 75:784-787, May
1975.
1 8 Leboyer, F. Birth without violence. New
Yort<, Alfred A. Knopf. 1975.
19 Kennedy, J.C. The high-risk matemal-infant
acquaintance process. Nurs. Clin. North Am.
8:549-556, Sept. 1973.
Penny lies, R. N. , M. S. , and Marcia McCrary,
R.N., l\^.A., are assistant professors in
maternal child health at the University of
Arizona College of Nursing since 1972. Their
previous background is in maternal child and
community heaitfi nursing.
Copyright Nov. /Dec. 1976, Ttie American
Journal of Nursing Company. Reprinted from
MCN, The American Journal of Maternal
Child Nursing.
The Canadian Nurse May 1977
Practici
al Guide to Pre\
/enting
Neonatal HEAT Loss
»,^y^\^\^
Heat Loss
Mechanism
Sources of Heat Loss
Preventive Measures
Conduction
Infant placed on cold sheet, scale,
table. X-ray plate, etc.
Place a warm blanket between the infant's body and the cold surface.
Have warm blankets available, especially in the delivery room, where
heat loss may be rapid and severe.
Convection
Cold delivery room or nursery
Keep heat in delivery rooms and nurseries adequate or provide infants
with adequate protection from convective heat loss while they are in
these areas.
Drafts from air-conditioner vents,
Arrange nursery to avokl placing infant in drafty areas.
windows, doors
Administration of cold oxygen
Warm oxygen prior to administration.
Transporting infants from delivery
Place babies in prewarmed incubators to transport them from delivery
room to nursery through cold corridors room to nursery. If an incubator is not available, wrap the baby (whose
skin has been thoroughly dried) in a thick, warm blanket before
transferring him from the delivery room.
Radiation
Proximity of cold windows or walls
Avoid placing bassinets, radiant warmers, and incubators near cold
outside walls and windows.
Cold incubator walls
Some clinicians recommend placing a vented plastic (Plexiglass)
shield around the baby inside the incutator. But this impedes rapid
access to the infant. Two plastic oxyhoods placed overthe baby in an
isolette will also decrease heat loss by radiation.
Evaporation
Baby remains wet in delivery room
Dry the baby immediately after delivery with a wann blanket. Be sure
to dry the baby's head well. Never leave an infant wrapped in a wet
blanket. Then:
1) Wrap the infant in a warm, dry blanket before handing him to his
parents in the delivery room to hold for a short while, or
2) Place the dry infant in a prewarmed incubator, or
3) Place the dry infant under a radiant warmer.
Bathing procedure
Do not bathe the baby after delivery until his temperature has
stabilized within the range of normal. Whenever bathing an infant,
wash and dry only a small area at a time, keeping the rest of the
infant's body covered.
Solution (or wet soaks) applied to
If a solution or soak must be applied, warm it prior to application and
infant's skin
keep it warm during the procedure.
Increased heat loss via the lungs of
a Oxygen must always be warmed and humidified prior to
tachypneic infant
administration.
Copyright Nov. /Dec. 1976, The American Journal
Joann K. Williams /Jean Lancaster
of Nursing Company. Reprinted from t\ACN, The
American Journal of tVlaternal Child Nursing.
1
Idea Exchange
«
-ranclne LeBlanc, Anne Schultz
Close to 5,000 persons, running the fuH gamut
of the lifespan, live in the area of rocky, south
shore Nova Scotia near Pubnico. Until a few
years ago, their health needs were met by one
physician v^/hose offrce was in Pubnico Head
and one part-time public4warth"mirse working
out of nearby Yarmouth. ,. ^.
Contact between the two was rninimal.
In 1 973, the medical director and nursing
I supervfsorof the Western Health Unit, Dr. V.K.
i Rideout and Irene Stafford, along with the
practicing physican at Pubnico Head, Dr. A.M.
Clark agreed to a new approach to serving the
people of the area. A nursing office was
■\
ubnico
established in the existing medical center, the
nurse's area was adjusted to correspond to the
medical practice area, and PHN Francine
LeBlanc came to work full-time in the
community.
The experiment has succeeded — thanks
largely to the co-operative and professional
attitude of everyone involved. In the three
years that the program has been in operation
there have been noticeable changes:
• There has been a definite increase in the
demand for public health nursing services and
acceptance of public health staff as part of the
community.
• Besides regular public health duties, the
public health nurse has taken over some of the
doctors'duties, including physical assessment
at well-baby clinics and immunization.
• Through the public health nurse and
certified nursing assistant, physicians in the
center have obtained an overall view of their
patients as family members, and insight into
the community organizations available to
assist them in their practice.
Implementation
The idea of a coordinated service suits the
Pubnico area well; the program provides 4 .
quality of care experienced by few
conQmunities in the province. Since it was
introHyced, services have expanded
considferably and now include three
physicians, Dr. Clark, Dr. Peter Loveridge, and
Dr. Nicholas Mattiqson, as well as Francine
LeBlanc and Carol yliWEQjp, a certified nursing
assistant. Both nursing personnel are
bilingual, making it easier to serve both the
French and English communities in the area.
Because the nursing office is immediately
adjacent to that of the physician, continual
referral and exchange of information is
possible. This, in turn, provides immediate
feedback on patients between doctor, public
health nurse and nursing assistant. In addition
to her regular duties, Francine LeBlanc has
taken over some of the health care previously
provided by the doctor, such as: physical
assessment at well-baby clinics, general
immunizations, selected home visits and
individual family counselling. A physician is,
liowever, always available for consultation
and referral.
Physicians at the center have found that
more time can be allocated to serious medical
mattei^, since the public health nurse
counsels patients on less serious problems.
She, in turn, has more time to listen to patients
— a definite advantage from a mental health
viewpoint. Health problemsthat many patients
feel the doctors are too busy to be bothered
with, can now be discussed with the public
health nurse, then referred and discussed with
doctors as necessary.
Because she is community oriented, the
public health nurse visits many people in the
community whom the doctor would never see.
She and the certified nursing assistant are also
the major coordinators with outside agencies,
making use of the wealth of knowledge and
contacts that public health nursing staff have.
Through these activities, doctors in the center
have become more aware of the community
and able to perceive the patient as a member
of his family.
Communication within the center is
excellent; the setup, according to Francine
LeBlanc, is "one of the best she has
experienced across Canada." All health staff
share mutual files and equipment within the
center. In the exchange of information and
professional knowledge, the physician and
staff can obtain a total family outlook rather
than just individualized facts on their patients.
Although there is an increase in nursing
care, the education aspects of public health
nursing are not diminished. In fact, with more
office and home visits, there is even more
Q^ortunity to discuss prevention and
eddcfitional aspects.
NdtAiJon Services
SiQce'ieya, the services of a public health
nutritionist fr(S^ Yarmouth have beerw
incorporated inio the center. Nutritionist
Beverley Dagley visits the center twice a
month for counsetWng of patients referred by
the doctors or pubfic tiealth nurse, as well as
handling norm,^ requests for information .
With a nutritionist at the center, there seems to
be an increased awareness of prevention, and
a definite demand for more nutritional
services.
Conclusion
Morale and support in a situation such as
this does not filter up, it filters down. The
Pubnico organization offers encouragement to
all who are skeptical about public health staff
and physicians working side by side.
For doctors who are thinking of sfmilar
steps towards improving health services in
their own community, Drs. Clari< and
Rideout offer the following advice:
• Get to know your iocal health unit director,
supervisor of public health nurses, and
all public health staff.
• See what they can do tor you and what you,
in turn, can offer them.
• Regard the public health nursing staff as
professionals; that is what they are.
• Start slowly and work things out together
step by step.
• Don't expect immediate results. *
earn
r^
Eleanors Warkentin
CARDIAC
Learning about the drugs that we as nurses give to patients is a must if we are to
administer them safely. Knowledge of the pertinent physiology and
pharmacological action of the drug is an essential part of our understanding of how
the drug works, when and why it should be given, what is a therapeutically safe
dose and what complications and side effects to expect. Such essential information
bears review from time to time just to iieep us on our toes. The following
programmed learning module on one significant group of drugs — cardiac
depressants — is designed to do just that.
DEPR ES,
Instructions
In programmed instruction, the student builds a
structure of knowledge in steps. These steps are small
units of information called frames. Most of the frames in
this program ask you to write a response.
Immediately after writing a response, compare it
with the correct answer on the right. A correct response
is immediately confirmed and the point just learned is
reinforced. If the answer is incorrect, you can determine
immediately why the response was wrong. This
eliminates the possibility of building knowledge on a
faulty structure.
Use an overlay to cover the answers in the right
hand column. After each response, slide the overlay
down to expose the next answer.
Programmed instruction is designed to facilitate
comprehension and retention through a self-teaching
technique. This method of presenting facts in a simple
fashion promotes retention through self-motivation and
self-pacing.
Lidocaine
Cardiac depressants are used extensively in the
management of patients wittn arrtiythmias. The
cardiac depressants to be discussed here include
Lidocaine, Procainamide, Quinidine, and Dilantin.
Lidocaine, procainamide, quinidine, and dilantin can
be classified as
cardiac depressants
Lidocaine, commonly known as Xylocaine, is a
widely used local anaesthetic and antiarrhythmic
agent.
Automaticity is a characteristic exhibited by
pacemaker cells of the specialized conduction
system. Automaticity is defined as a gradual process
in which a spontaneous loss of diastolic potential
occurs, reducing transmembrane resting potential
levels to threshold levels. This leads to
depolarization.
A spontaneous los3 of diastolic potential is known
as
Excitability is a characteristic exhibited by
myocardial muscle fibers, which require an external
stimulus to initiate depolarization. The strength of
the stimulus, necessary to reduce transmembrane
resting potential to threshold level, defines the
excitability of the cell.
IVIyocardial muscle fibers are ,
automaticity
whereas pacemaker cells have the characteristic
property of
The major action of cardiac depressants is the ability
of these dnjgs to decrease automaticity of the
myocardium. Decreasing automaticity may result in
decreased incidence of arrhythmias.
An antiarrhythmic, then, is a drug which decreases
ectopic formation by decreasing myocardial
Lidocaine acts by depressing Purkinje fiber
automaticity. The drug does not appear to alter
myocardial excitability.
Following lidocaine administration, Purkinje fiber
automaticity is
(increased, decreased)
and myocardial excitability is unaltered.
An action potential records the sequence of rapid
ionic changes occurring within the myocardial cell,
during the processes of depolarization and
repolarization.
The recording of intracellular ionic changes
occurring with depolarization and repolarization, is
known as an
excitable
automaticity
automaticity
decreased
i
action potentiai
Lidocaine decreases the action potential duration
(APD) in both Purl<inje and ventricular muscle fibers.
The APD in both Purkinje and ventricular muscle
fibers is decreased
(increased, decreased)
by the action of lidocaine.
The specific effects of lidocaine on the atrial muscle
are unknown, and the drug is not recommended for
the treatment of atrial arrhythmias.
Lidocaine is not recommended for the treatment of
arrhythmias which are
in origin.
atrial
(atrial, ventricular)
— accelerate sinus pacemaker
— increase or decrease PR interval
— prolong QRS interval
— prolong QT interval
When used in therapeutic doses, the effect of
lidocaine on the EKG is
(minimal, excessive)
Following completion of drug absorption, the time
required to reduce serum concentration to 50%, is
known as the half-life (tV2) of the drug.
An understanding of the
of a daig is essential in order to achieve a
therapeutic patient response to the dosage
schedule.
Lidocaine is known to be a desirable antian-hythmic
agent because of its short half-life, which is less than
two hours. This helps in establishing and
maintaining therapeutic blood levels, as well as
allowing dose titration according to ectopic activity.
The V/2 of lidocaine is less than .
hours.
The half-life of lidocaine is dependent upon
adequate liver function. Lidocaine is hydrolyzed by
the liver to para-aminobenzoic acid, which is then
excreted in the urine. Less than ICo of the dnjg is
excreted unaltered by the kidney.
The organ responsible for the metabolism of
lidocaine is the
Lidocaine is, therefore, administered with caution to
patients with liver, renal and/or cardiac failure.
minimal
half-life or t'/a
two
liver
Intervals of variable cellular excitability have been
identified within the cardiac cycle, and are
considered to be a function of the recovery time of
muscle cell fibers. The effective refractory period
(ERP) is defined as the time period that must elapse
following a response, before a second propagated
action potential can be initiated. Lidocaine
significantly decreases the ERP of Purkinje fibers.
The ERP of Purkinje fibers is significantly
_by lidocaine. decreased
(increased, decreased)
When used in therapeutic doses, left ventricular
end-diastolic pressure is minimally affected by
lidocaine. Therefore, lidocaine produces little
alteration in stroke volume or blood pressure in
either the normal or failing heart.
Although large doses of lidocaine have been known
to produce hypotension, lidocaine characteristically
has a low
(high, low)
incidence of adverse hemodynamic effects.
Lidocaine has minimal effect on the
electrocardiogram, however excessive doses may
do the following:
In summary, then, properties such as minimal EKG
effects, a low incidence of adverse hemodynamic
effects, and a short half-life, make lidocaine a/an
(desirable, undesirable)
drug for the therapeutic treatment of acute
arrhythmias.
Absorption of lidocaine from the gastrointestinal
tract is irregular, resulting in unreliable drug action.
Oral preparations of the drug are not presently
available in Canada.
The difficulty in achieving reliable blood levels with
oral lidocaine therapy, is likely a direct result of its
(regular, irregular)
absorption from the G.I. tract.
Lidocaine may be administered intramuscularly or
intravenously. When injected intramuscularly, the
drug is rapidly absorbed and therapeutic blood
levels are present in 10 - 15 minutes, lasting
approximately two hours. Despite this, the use of
intramuscular lidocaine is restricted to those
situations in which intravenous infusion is
impractical.
desirable
irregular
32
The Canadian Nurse May 1977
Therapeutic blood levels of lidocaine are present in
to minutes after
intramuscular drug injection.
In the critically ill patient who develops an acute
ventricular arrhythmia, a continuous intravenous
infusion of lidocaine is preceded by a loading or
"bolus" dose, in order to achieve an immediate
blood level. The loading dose is administered
directly into the intravenous line over a 30 - 60
second time period.
10- 15
Rhythm disturbances resulting from the premature
depolarization of ventricular muscle fibers should be
treated with in order to
prevent the development of lethal arrhythmias such
as ventricular tachycardia and ventricular fibrillation.
Lidocaine has been used successfully to treat
digitalis-induced arrhythmias of atrial and/or
ventricular origin.
lidocaine
A loading dose of lidocaine is administered in order
to achieve an
blood level.
An adequate loading dose for the average adult is
50-75 mg. (or 1 - 2 mg/kg)*. This may be repeated
every five minutes until either ectopics are abolished
or a total dose of 150 mg has been given.
The usual initial loading dose of lidocaine
is to
mg in the average adult.
A continuous intravenous infusion of lidocaine, via
intravenous drip or preferably, via an infusion pump,
is established to maintain a therapeutic blood level
when clinical evidence of ventricular irritability
exists. The drug should be infused at a rate of 1 - 3
mg/kg/hour until irritability subsides, resulting in a
therapeutic serum level of 2 to 5 mcg/ml.
The continuous infusion rate of lidocaine is
usually to
mg/kg/hour in the adult patient.
Following abolition of ventricular rhythm
disturbances, the lidocaine infusion is gradually
discontinued. Patient monitoring for recurrent
rhythm disturbances is essential during this time, as
well as throughout the entire course of lidocaine
therapy.
The principal toxic effects of lidocaine are
extracardiac. A frequently observed adverse effect
is drowsiness. Toxic effects can include muscular
twitching, irritability, hallucinations, and generalized
convulsions. Cardiac effects such as hypotension
and rhythm disturbances are rarely seen.
The most frequently obsen/ed adverse effect of
lidocaine is
immediate
50-75
1 -3
Ventricular escape beats are not treated with
lidocaine. A ventricular escape beat is a myocardial
response to decreased cardiac output. In relation to
the previous cardiac cycle, the ventricular ectopic
occurs late (rather than premature), and usually
follows a pause in basic cardiac rhythm,
■ is the
In summary,
antiarrhythmic used in the treatment of any rhythm
disturbances caused by premature discharge of an
irritable ventricular focus.
Procainamide
Procainamide, also known as Pronestyl, is a cardiac
depressant with local anesthetic and cardiac
properties similar to those of lidocaine.
Procainamide, like other cardiac depressants
decreases myocardial automaticity. Pronestyl also
decreases myocardial excitability by raising
stimulation and fibrillation thresholds on atrial and
ventricular muscle fiber.
The effect of pronestyl on both atrial and ventricular
muscle is to
(increase, decrease)
automaticity and to.
{increase, decrease)
cellular excitability.
■2 Procainamide is a more potent suppressant of
is cardiac conduction than is lidocaine. Pronestyl
g. decreases conduction velocity significantly in the
J atria, but also in Purkinje and ventricular muscle
^^ fibers. This may be recognized on EKG by
I prolonged PR, QRS and QT intervals.
S Pronestyl therapy has been known to
(increase, decrease)
atrioventricular conduction time, and thus should not
be used in the presence of AV block.
lidocaine
decrease
decrease
increase
drowsiness
Toxic effects of lidocaine resolve rapidly because of
the drug's short half-life. Treatment of toxicity,
therefore, consists simply of supportive care until the
drug has been metabolized.
Lidocaine, then, is the drug of choice in the treatment
of ventricular ectopics. Rhythm disturbances, due to
discharge of irritable ventricular foci, may appear in
EKG as unifocal PVC's, multifocal PVC's or
ventricular bigeminy and trigeminy.
Procainamide also has a vagal-inhibiting effect, this
possibly resulting in enhanced atrioventricular
conduction. Therapeutic doses of digitalis inhibit this
effect.
A paradoxic increase in cardiac rate may be seen
because the dnjg blocks or _
S the vagus.
(inhibits, stimulates)
Procainamide may produce myocardial tachycardia
and/or fibrillation. This is protsably because it
increases action potential duration as well as the
inhibits
; ^^aiKiuiaii
effective refractory period. Tfiis effect is seen to a
greater extent in tfie atria thian in ttie ventricle.
Procainamide
{increases, decreases)
both refractory time and action potential duration,
this effect being more evident in the
(atrial, ventricular)
myocardium.
The action of pronestyl on ERP and APD is
to that of lidocaine.
(similar, opposite)
Procainamide may decrease left ventricular
function, leading to an increase in left ventricular
end-diastolic pressure and a significant decrease in
cardiac output. This occurs more often in the patient
with existing myocardial damage and is usually
associated with intravenous drug therapy.
) Pronestyl therapy may be complicated by
hypotension, because of its effect of decreasing .
Comparable doses of lidocaine do not have this
effect.
Procainamide may be given orally, intramuscularly,
or intravenously, f^ronestyl is readily absorbed from
the G.I. tract. Management of arrhythmias with
procainamide therapy is preferably achieved with
oral dosage of 500 - 1000 mg every six hours.
increases
atrial
opposite
Usual oral dosage of pronestyl
IS to
six hours, maximal absorption occurring in
approximately I'/z hours.
When administered intramuscularly or
intravenously, significant blood levels are present in
1 5 minutes. Due to adverse hemodynamic effects of
giving pronestyl parenteral ly, however, these routes
of administration are reserved for life-endangering
cases or when the arrhythmia is refractory to
lidocaine therapy. Average intravenous dose is 1 50 -
300 mg/kg/hour.
Procainamide is preferably administered by the
route .
(oral. I.M., I.V.)
Because of its half-life of 3'/2 hours, procainamide
has a longer duration of action than does lidocaine.
Pronestyl, in contrast to lidocaine, has a
(shorter, longer)
duration of action.
Plasma levels of 3 - 8 mcg/ml are usually effective in
controlling atrial and ventricular arrhythmias. Toxic
effects are seen when seaim drug levels exceed this
range.
Therapeutic serum pronestyl levels are in the range
of to
mcg/ml.
Metabolism of procainamide tai^es place in the liver,
however 60% of the drug is excreted unaltered in the
urine. A higher incidence of toxicity, due to drug
cardiac output
mg. every 500 - 1000
oral
longer
3-8
accumulation, is associated with poor renal function.
Careful monitoring of serum levels, particularly in the
patient with inadequate renal function, will help
prevent drug
With oral pronestyl administration, the most frequent
untoward effects observed are anorexia, nausea,
and vomiting.
Frequent side effects following oral pronestyl
therapy include ,
, and-
Cardiac side effects of procainamide, as mentioned
above, may include hypotension and occasionally,
shock. Paradoxic increases in cardiac rate may
occur, as well as the appearance of escape and
ectopic ventricular arrhythmias.
Hypotension, a complication of pronestyl therapy, is
seen more frequently when the drug is given via the
route.
(oral. I.M., I.V.)
Because of this, the drug should be infused slowly,
with continuous EKG and BP monitoring.
Toxic extra-cardiac effects that may be observed
include somnolence, hallucinations, convulsions
and occasionally coma, due to anaesthetic
properties of the dnjg. Agranulocytosis, severe
anemia and thrombocytop<>nia have been reported,
and usually subside spontaneously.
Hypersensitivity reactions have also been observed.
Extra-cardiac toxic effects of procainamide therapy
include
Drug infusion is discontinued when the arrhythmia
subsides, with excessive widening of the QRS
complex, or with the development of myocardial
toxicity symptomatology.
Management of procainamide toxicity consists of
discontinuing drug therapy and initiating supportive
therapy, eg. blood pressure elevation.
In summary then, procainamide is used to manage
difficult and/or dangerous arrhythmias.
Procainamide is used orally, usually in conjunction
with digitalis, to suppress atrial arrhythmias such as
atrial fibrillation and paroxysmal atrial tachycardia. It
will convert atrial fibrillation to sinus rhythm, but will
merely slow the atrial rate of an atrial flutter rhythm.
A drug frequently used, in conjunction with
procainamide to suppress atrial arrhythmias
is
Arrhythmias of junctional or ventricular origin, such
as premature systoles, ventriculartachycardias, and
other life threatening arrhythmias, may also be
managed with intravenous procainamide.
Arrhythmias of junctional or ventricular origin, when
toxicity
anorexia, nausea,
vomiting
I.V.
CNS disturbances,
blood dyscrasias
hypersensitivity
reactions
digitalis
The Canadian Nurse May 1977
unresponsive to lidocaine therapy, may be managed
with
The effect of procainamide therapy on
digitalis-induced arrhythmias can be unpredictable.
Quinidine
Quinidine is a myocardial depressant with
antiarrhythmic actions similar to those of
procainamide.
Quinidine, like procainamide, decreases myocardial
automaticity throughout the atrial and ventricular
myocardium, and is therefore used clinically to
prevent and control both atrial and ventricular
arrhythmias.
Quinidine and procainamide are utilized in the
management of both atrial and ventricular
arrhythmias because of their action of
Quinidine depresses excitability, conduction
velocity and contractility properties of cardiac
muscle.
Excitability of cardiac muscle is depressed by
quinidine because the drug increases the
stimulation threshold of the muscle cells. This may
be recognized clinically, when following quinidine
administration, the energy required to produce atrial
and ventricular stimulation is increased.
pronestyl
decreasing myocardial
automaticity
The antiarrhythmic properties of quinidine are based
on the drug's ability to increase action potential
duration and increase the effective refractory period.
This action is useful in managing ectopic impulses
occurring due to a reentry mechanism.
The incidence of ectopic impulses due to a reentry
mechanism, is
(increased, decreased)
when treated with quinidine and/or procainamide.
Quinidine increases the conduction time in atrial,
Purkinje and ventricular muscle fibers. Quinidine's
action of increasing refractory time may be
recognized clinically by the appearance of
prolonged QRS and QT intervals, sinus bradycardia
and prolonged AV conduction.
The direct action of quinidine on the heart's
conduction may be observed by
(shortened, prolonged)
QRS and QT intervals and by the appearance of
sinus bradycardia and
(shortened, prolonged)
AV conduction.
Quinidine is a general cardiac depressant and may
reduce stroke volume and cardiac output. This leads
to an increased left ventricular end-diastolic
pressure. Clinical manifestations of decreased
cardiac output such as hypotension then become
evident.
Reduced myocardial efficiency, secondary to
quinidine therapy, may be manifested by an
(increased, decreased)
left ventricular end-diastolic pressure.
decreased
prolonged
prolonged
Increased
Adrug which increases stimulation threshold makes
it
(more, less)
difficult to excite or stimulate the muscle cell.
Reentry ectopics occur at fixed coupling intervals to
the preceeding impulse. This can occur whenever
two areas of uneven conduction exist (one area is
ischemic), in adjacent myocardial fibers. The result
is an initial normally conducted impulse (A), followed
at a fixed interval, by an abnormally conducted
impulse (B) occurring after the ischemic area has
recovered, and been reentered by the initial impulse.
more
Ventricular muscle
Purkinje fiber
NORMAL
CONDUCTION
Quinidine is an effective, yet dangerous myocardial
depressant. The severe hypotension, due to
quinidine's adverse effect on myocardial
contractility, is most often seen with intravenous
drug administration. Astute clinical patient
assessment is mandatory whenever quinidine is
used, regardless of mode of administration.
Severe hypotension, secondary to quinidine
therapy, is seen most often after
administration of quinidine.
(oral, I.M., I.V.)
Both quinidine and procainamide have a vagal
inhibiting effect, that is, they inhibit vagal
I.V.
REENTRY
The Canadian Nurse May 1977
innervation. Adequate digitalization is essential prior
to Initiating quinidlne therapy for control of atrial
arrhythmias. Quinidine, when used without digoxin
and in small doses, may actually improve
atrioventricular conduction. This may be an adverse
response, allowing the ventricle to respond on a 1 :1
basis to the rapid atrial activity.
Prior to commencing quinidine therapy, the
physician should ensure adequate
patient
Idlosynchratic responses to quinidine are frequent,
therefore an initial test dose of the dnjg should be
jKlministered. Symptoms of such an immunological
respKinse include confusion, dizziness, headache,
syncope, visual disturbances, skin rash, and
generalized muscle weakness.
Prior to administering therapeutic doses of
quinidine, a is always
administered.
Signs of cardiovascular toxicity may include
repetitive ventricular extrasystoles, runs of
ventricular tachycardia and rarely, intermittent
ventricular fibrillation. Hypotension may be a
precursor of, or accompany EKG signs of toxicity
such as abnormally prolonged PR, QRS, and QT
intervals and bundle branch block.
Signs of cardiovascular toxicity, secondary to
digitalization
test dose
Quinidine is usually administered orally, and
occasionally intramuscularly. It is rapidly absorbed
from both these routes.
Dosage range for oral administration, following a
test dose of 200 mg, is 200 - 600 mg every six hours.
The dose is increased daily according to patient
need and tolerance. Maximal absorption after oral
administration occurs in 1 -2 hours, the half-life being
approximately 4-6 hours.
Following oral administration of quinidine,
1 therapeutic effects of the drug may be observed as
j long as to hours after instituting 4 •
drug therapy.
Intramuscular administration of quinidine is chosen
whenever the oral route is contraindicated. The
intramuscular test dose is usually 100 mg, followed
by 200 mg given every six hours. The dose may be
increased up to 400 mg q6h depending on desired
patient response and patient tolerance.
Usual dose of intramuscular quinidine
is to mg every six 200 - 400
hours.
The most common toxic manifestations following
quinidine therapy are gastro-intestinal. Diarrhea,
nausea and vomiting are relatively common, and
when mild, are not a contraindication to therapy.
Mild diarrhea, nausea and vomiting are not
(are, are not)
an indication to discontinue quinidine therapy.
quinidine therapy include rhythm disturbances
which originate in the
(atna. ventncle)
and EKG signs of toxicity such as
prolonged , , and
block.
- intervals, as well as bundle branch
Idiosyncratic immune responses to quinidine have
been discussed briefly. More serious
hypersensitivity reactions known to occur are
respiratory embarrassment, vascular collapse, and
convulsions, necessitating appropriate resuscitative
measures.
Uncertainty in individual patient response requires
caution when initially administering quinidine.
Because of this a
of the dnjg is always administered prior to initiating
aggressive dmg therapy.
Quinidine is used with extreme caution when any
degree of block exists, or when hypotension or
congestive heart failure are present. Quinidine is not
used to treat digitalis intoxication.
Contraindications to quinidine therapy
include ,
and .
On occasion patients with arrhythmias and CHF
have to be treated with quinidine. These patients are
usually also receiving digitalis, to ensure adequate
contractility. The depressant effects of quinidine on
myocardial contractility indicate that the dnjg must
be used with caution in these patients.
Quinidine is a cardiac depressant, frequently used in
conjunction with digitalis, in the treatment and/or
prophylaxis of sustained atrial ectopic rhythms such
as atrial tachycardia, flutter and fibrillation. It is also
used to control ventricular rhythm disorders that
have been found to be unresponsive to lidocaine
and procaine therapy.
When used to treat sustained atrial ectopic rhythms,
quinidine is always used in conjunction
with .
Although lidocaine remains the drug of choice for
treating most ventricular arrhythmias, quinidine has
been used with success in ventricular rhythm
disorders that have been found to be
to lidocaine therapy.
In the liver, 80% of quinidine is metabolized, with
approximately 20% being excreted unaltered in the
urine. Serum quinidine levels are useful to monitor
drug levels, particularly in patients with congestive
heart failure or renal insufficiency. The therapeutic
range for serum quinidine levels is 3 - 8 mcg/ml,
toxic symptomatology occurring with increased
frequency above this level.
The therapeutic range for serum quinidine levels
is to mcg/ml.
Ventricular fibrillation and syncope have, however,
been reported at quinidine levels within the
therapeutic range, therefore careful clinical
ventricle
PR, QRS, QT
test dose
heart block,
hypotension,
congestive heart failure
digitalis
unresponsive
3-8
36
The Canadian Nurse May 1977
assessment of the patient and EKG monitoring is
essential to recognize early signs of toxicity and
prevent serious resulting complications.
Toxic manifestations, secondary to prolonged
quinidine therapy, may be of 24 - 48 hours duration.
Diphenylhydantoin
Diphenylhydantoin, or dilantin, is a non-sedative
anticonvulsant drug, which has been used with
increasing frequency to control rhythm disturbances
caused by digitalis intoxication.
The antiarrhythmic actions of dilantin are most
similarto those of lidocaine, and can, in some areas,
be contrasted with the actions of pronestyl and
quinidine.
Dilantin and lidocaine have
antiarrhythmic actions.
similar
(similar, opposite)
Dilantin is useful in the management
of rhythms, reentrant
due to intraventricular conduction disorders.
Dilantin tends to shorten the PR interval, although it
is not thought to have any significant vagal-inhibiting
effect.
Dilantin therapy has minimal EKG effects. Changes
which may be observed include shortened
(shortened, prolonged)
PR and QT intervals.
Dilantin causes less depression of myocardial
contractility, than do comparable antiarrhythmic
concentrations of quinidine and pronestyl. Arterial
pressure reductions also occur less frequently with
dilantin therapy, txjt hypotension may be associated
with the rapid infusion of any of the myocardial
depressants studied thus far.
Dilantin is comparable to other cardiac depressants
in that it decreases myocardial automaticity by
directly depressing diastolic depolarization. This
effect is particularly evident in the Purkinje fibers,
even with small doses, and is thought to be
responsible for the successful reversion of
ventricular ectopic rhythms occurring in
digitalis-intoxicated hearts. A similar depressant
effect can be observed in the SA node, when large
doses of dilantin are utilized.
Even when used in small doses, the depressant
effect of dilantin on diastolic depolarization is
particularly evident in the
fibers.
(atrial. Purkinje)
Purldnje
Of the cardiac depressants studied thus far, the two
which significantly alter contractility and arterial
pressure are
and
Diphenylhydantoin is almost completely inactivated
by the liver, and is closely bound to plasma proteins.
Less than 5% of the drug is excreted unmetabolized
in the urine.
Reduced doses of dilantin are necessary when the
drug is given to patients
with
- disorders.
procainamide
& quinidine
liver
Diplifi'.ylhydantoin, like lidocaine, does not appear
to significantly alter myocardial excitability.
Both dilantin and lidocaine
(increase, decrease)
automaticity, but do not appreciably
alter
decrease
excitability
Because of its long half-life, approximately 24 hours,
and slow absorption, a single daily dose is often
satisfactoryforadults. Gastric intolerance, however,
may dictate divided dosage or at least indicate meal
time administration to minimize Gl disturbances.
The half-life of diphenylhydantoin is
approximately hours.
24
Dilantin decreases both action potential duration
and the effective refractory period. This can be
recognized on EKG by a shortened QT interval.
A shortened QT inten^al Is a manifestation of
dilantin's action of
both APD and ERP.
(increasing, decreasing)
The effect of dilantin of APD and ERP is
(similar, in contrast)
to that of lidocaine, and
(similar, in contrast)
to that of procainamide and quinidine.
Diphenylhydantoin does not prolong intraventricular
conductbn, even when used in very large doses.
This is again in contrast to the actions of pronestyl
and quinidine. Dilantin, by reducing the chance of
impaired conduction, as well as by increasing
membrane responsiveness in Purkinje fibers, is
useful in managing reentrant rhythms.
decreasing
similar
in contrast
Dilantin may be given orally, intramuscularly or
intravenously. A loading dose of approximately 200
mg is frequently given, since it may take several
days to achieve a therapeutic blood level.
To facilitate rapid achievement of therapeutic blood
levels, an initial
of dilantin is often administered.
Oral administration, used in the control of cardiac
rhythm disorders, consists of giving 1 00 - 1 50 mg of
dilantin (3 - 4 mg/kg) twice or three times daily.
In order to achieve control of cardiac rhythm
disorders, to mg of oral
dilantin is given two or three times a day.
loading dose
100- 150
[ ne uanaoian nurs«
Intramuscular drug doses are comparable to those
listed for oral therapy. Following intramuscular
injection, the drug tends to precipitate at the injection
site and is absorbed slowly.
Diantin is given intravenously when rapid effects are
necessary to treat acute arrhythmias. A slow
Injection of 50-100 mg of dilantin is given initially.
This dose may be repeated twice, at ten minute
intervals, to achieve acute rhythm stabilization.
Maximum adult dose should not exceed 10-15
mg/kg. Continuous dilantin infusions are not
recommended.
Dilantin is administered
(orally, I.M.. I.V.)
to treat acute arrhythmias.
Therapeutic senjm dilantin levels are in the range of
10 - 18 mcg/ml. These levels are achieved by
regular, intennittent administrations of the dnjg.
The therapeutic serum dilantin level
Is to mcg/ml.
Cardiac effects of dilantin toxicity Include
hypotension, severe bradycardia, ventricular
arrhythmias and cardiac arrest.
Cardiovascular manifestations of drug toxicity
Include
, and •
The most consistent effect of dilantin intoxication Is
manifested by CNS disorders. Signs such as
nystagmus, diplopia, and vertigo are seen, as well
as behavioural disorders such as confusion,
silliness, drowsiness, hyperactivity and
hallucinations.
A frequent indication of an overdose of dilantin is
some type of disorder.
I.V.
10- 18
hypotension,
bradycardia,
ventricular
arrhythmias,
cardiac arrest.
atrial fibrillation. As well, dilantin is useful in treating
ventricular arrhythmias, whether or not they result
from digitalis intoxication.
In summary, then, dilantin is considered to be the
drug of cfroice to manage _ _
(atrial, ventricular)
rhythm disorders secondary to digitalis intoxication. 4
Bibliography
1 Atkinson, A.J. Clinkjal use of blood levels of
cardiac drugs. Mod. Concepts Cardiovasc. Dis.
42:1:1-4, Jan. 1973.
2 Bilitch. Michael. A manual of cardiac
arrhythmias. Boston, Little Brown & Co., 1971.
p. 102-111.
3 Braunwald, Eugene ed. The myocardium:
failure and infarction, edited by . . . with the
collaboration of Amy Selwyn. New York, HP Pub.
Co., 1974. p. 130.
4 Goodman, LS. Pharmacological basis of
therapeutics, by . . . and A. Gllman. 5ed. New York,
Macmillan, 1975. p. 683-702.
5 Lowenthal. Werner. Factors affecting drug
absorption. Programmed instaiction. A/Der. J. I\lurs.
73:8:1391-1408, Aug. 1973.
6 Mayer, Gloria Gilbert. Arrhythmias and
cardiac output, by . . . and Patricia Buchnolz Kaelin.
Amer. J. Nurs. 72:9:1597-1600, Sep. 1972.
Author, Eleanore WarkentinfRA/., Winnipeg
General Hospital School of Nursing: B.N.,
B.A. University of Manitoba) is a specialist in
intensive care nursing. At present, she is
instructor of the post-basic Intensive Care
Nursing Course at the Health Sciences
Centre. Winnipeg, Manitoba where she
developed this programmed learning unit for
her students. She is a member of MARN, The
Canadian Council of Cardiovascular Nurses,
and the Winnipeg Association of Critical Care
Nurses.
ventricular
CNS
Hypersensitivity reactksns to the drug are indicated
by the following:
— skin eruptions
— exfoliative dermatitis
— bone marrow depression
Skin eruptions, dermatitis, and bone marrow
depression are signs of hypersensitivity reactions
to
dilantin
Treatment of dilantin toxicity consists of supportive
therapy, since there is no specific antidote available.
Toxic manifestations may persist for hours or days,
because of the dnjg's long half-life.
DIphenylhydantoin is particularly effective when
used to manage digitalis-induced ventricular
arrhythmias. It has been used with some success to
treat atrial and junctional arrhythmias, secondary to
digitalis toxicity, but has little effect In atrial flutter or
The Canadian Nurse May 1977
A new look at blood transfusion therapy
>1UTOTRAN$FUSION
Be your own blood donor! That's the word from St. Joseph's Hospital in Hamilton, Ontario to
those who are about to undergo elective surgery. Using a simple, safe procedure known as
autotransfusion phlebotomy, the inherent risks involved in transfusion therapy are minimized
and greater patient safety is achieved. What follows is a history and description of St. Joseph's
autotransfusion program and how you could initiate it in your hospital.
Margaret Anne Halward
The traditional administration of blood
transfusions from one person to another will
always carry the risks of incompatibility
re?c. ons, antibody formation and
transmission of disease, fvloreover, it is
becoming increasingly difficult to attract
suitable blood donors to meet today's
increasing needs. Autotransfusion can
completely avoid these problems when used
before elective surgery.
Autotransfusion of the type I will describe
was first reported by Dr. Francis Grant to the
Philadelphia Academy in 1921.' The full
potential of autotransfusion has been
gradually recognized within the last few years
and several centers in the United States have
reported considerable success with
autotransfusion programs.
The autotransfusion program at St.
Joseph's Hospital was begun by a group of
physicians who were interested in making
transfusion therapy safer for patients. One of
those physicians was Dr. G.K. Ingham who
became the Program Director. The
well-structured administrative and technical
procedures for the program were established
by Helen Eaton. R.N., Head Nurse of I.V. and
Blood Collection Team (1 971 -1 974) and John
Waller, Methods Analyst from our Methods
Department. The necessary cooperation of
the surgeons, the Out Patient Department, the
Blood Bank, the I.V. and Blood Collection
Team and the Admitting Department was also
secured. Contact was made at this time with
the other hospitals in Hamilton, so that patients
having surgery in any of these hospitals could
also receive the benefits of autotransfusion.
The Program
Briefly, the autotransfusion program
consists of the collection of up to three units of
a patient's blood over a one, two or three week
period just prior to the date of that patient's
elective surgery. The estimated number of
units required for the patient during surgery
determines how far in advance the patient will
donate blood . For example, if one unit of blood
is required, the patient will donate one unit of
blood one week prior to surgery and hence it
MRS. B.'s SCHEDULE Figure 1
Date of arrival Stage
Procedure
Time
inOPD
Involved
' April 7
First stage
— collect one unit of
30 ^
0930 hours
autotransfusion
Mrs. B.s blood
minuies
phlebotomy
|.
April 14
Second stage
— collect one unit of
2-2 1/2
, 0930 hours
autotransfusion
Mrs. B.s blood
hours
phlebotomy
— return April 7th unit
of blood to her by infusion
— collect a second unit
of Mrs. B.'s blood
April 21
Third stage
— collect one unit of
2 1/2-3
0930 hours
autotransfusion
Mrs. B.s blood
hours
phlebotomy
— return first unit from
April 14 to her by infusion
— remove a second unit of
Mrs. B.s blood
— return the second unit
of blood from April 1 4 to her
by infusion
— remove a third unit
of blood
April 28
Mrs. B.'s O.R. day
— 3 units of blood, 1 week
old, are on hand to be
infused during or after
Mrs. B.s surgery.
would be stored for one week at time of
surgery.
When more than one unit of blood is
required, a recycling maneuver is used in
order to minimize the known deterioration of
red blood cells during storage, a deterioration
which is especially marked after one week.
Thus, if 2 units are required, the patient will
donate one unit of blood 2 weeks (14 days)
prior to surgery. Seven days later, the patient
donates a second unit of blood, the first unit is
infused back into the patient, and a third unit of
blood is removed. This provides a net of 2 units
of blood, both of which, at the time of surgery,
will have been stored for one week. If 3 units
are required, a further projection of this
recycling process results in a net of 3 units, all
of which have been stored one week, at the
time of surgery. Even 4 units of blood can be
secured this way under special
circumstances. Again, in this case, all of the 4
units of blood will be only a week "old" at the
time of the operation.
There are no specific contraindications fr
participation in the autotransfusion program
The only stipulation is the ability to tolerate th«.
removal of one or two units of blood.
Case study
The best way to illustrate exactly how th
autotransfusion program works is to follow
patient's progress through the program.
Mrs. B., a 28-year-old female, is having
laminectomy and spinal fusion on April 28tli
In February, Dr. A., Mrs. B.'s Orthoped
Surgeon, tells her about her back surgery ar
states he would like three units of her blood oi
hand for her surgery in April. The
autotransfusion program is explained to Mr
B. She is very positive about having the
autotransfusions as most of our patients art
At this time. Dr. A. sends an Autotransfusic
Request Form to the Head Nurse of the l.\
and Blood Collection Team.
Figure 2
The Head Nurse schedules Mrs. B. s
procedures (see Figure 1) and notifies her of
the schedule by phone and letter. Copies of
this notification letter are also sent to Dr. A.,
Mrs. B. s family physician, the Blood Bank, the
O.P.D. Department, and the I.V. and Blood
Collection Team.
Prior to Mrs. B. s visits, a file is set up for
her containing the following:
• Dr. A. s Autotransfusion Request Form
• Mrs. B. s notification letter
• a recording sheet for the autotransfusion
procedures
• a laboratory requisition for bloodwork
taken during the procedures.
On completion of the procedures, the file
iS sent to the admitting department of the
particular hospital where the surgery is to be
done and becomes part of Mrs. B.'s
permanent chart when she is admitted to that
hospital.
First stage autotransfusion
phlebotomy
Mrs. B. arnves on April 7th, in the Out
Patient Department as scheduled for her first
procedure. She is made comfortable in one of
the treatment rooms on either a stretcher or a
lazy-boy chair by the nurse in our Out Patient
Department. The nurse checks and records
Mrs. B.'s blood pressure, pulse, weight, and
notifies the program director. Dr. Ingham, and
an I.V. nurse of the patients arrival.
Dr. Ingham interviews Mrs. B. and does a
bhef physical examination, gives Mrs. B. a
prescription for iron tablets which are taken
throughout the course of the procedures, and
explains all of the autotransfusion procedures
to her. It is important that she understands all
of the procedures and has all of her questions
answered to alleviate any apprehension she
A. Basic equipment (required for all autotransfusions) — specimen tubes, adhesive tape,
tourniquet, antiseptic swat), blood donor scales, scissors, blood tubing clips and clamp. Kelly
forceps, identification bracelet, identification numbers, and a file.
B. First stage autotransfusion ptilebotomy
— single donor pack
C. Second stage autotransfusion ptilebotomy
— double plasmaphoresis doutile donor pack
— blood warming coils
— basin and thermometer
— V-type recipient set
— 250 cc bag of Normal Saline
— an I. V. pole (not shown)
6 & C. Third stage autotransfusion phlebotomy
— combination of both the equipment used for a first and second stage autotransfusion.
Fourth stage autotransfusion phlebotomy
— 2 double plasmaphoresis double donor packs
— an I. V. pole
— blood warming coils
— basin and thermometer
— Y-type recipient set
— 2 bags 250 cc Normal Saline.
may have. Dr. Ingham will also see Mrs. B.
prior to all of her visits, and remains available
duhng the procedures if problems arise.
An identification bracelet is given to her to
wear on her wrist during all of the procedures
and during her hospitalization. It states her full
name, the name of the program director and
identification number which is placed on her
file and on all the units of blood she donates.
All the autotransfusion procedures are
performed by a registered nurse who is a
memberofthel.V. Team.lnourhospital,allof
the nurses on the I.V. Team have t)een
specially trained to do these procedures and it
is part of their daily assignment.
The equipment is made ready, using all
the basic equipment plus a donor pack as seen
in Figure 2. After explaining the procedure, the
I.V. nurse applies a tourniquet, selects a large
vein in the antecubital fossa of Mrs. B.'s arm,
preps the site with an antiseptic, inserts the 1 5
gauge needle as pre-attached to the donor
pack, and removes one unit (approximately
500 cc) of Mrs. B. s blood (see Figure 3). When
this is completed, the nurse calls a blood bank
technician who clamps off and cuts the unit of
blood from the needle, attaches the
identification numbers to Mrs. B.'s bracelet, file
and unit of blood and then takes the unit of
blood back to the Blood Bank where it is
refrigerated until next week s procedure.
Blood specimens are taken from the same
needle for a complete blood count, VDRL,
Australian Antigen and serum ferritin level . On
Mrs. B. s second and third stage
autotransfusion phlebotomies, only complete
blood counts will be done.
Once the blood specimens are taken, the
needle is removed and pressure applied to the
site until there is no further bleeding.
Following autotransfusion phlebotomy,
Mrs. B.'s blood pressure and pulse are
checked by an Out Patient Department nurse
until they are stable. She is given a warm drink
and may go home as soon as she feel s settled.
Second stage autotransfusion
phlebotomy
Mrs. B. s second visit to the Out Patient
Department includes the same care as
outlined for the first stage autotransfusion
phlebotomy. For this procedure, a double
plasmaphoresis double donor pack set is used
(See Figure 4). This contains one needle with
three connectors. A blood donor pack is
attached to the f i rst connector and clamped off
The Canadian Nurse May 1977
i>
^
¥
Figure 5
A second stage autotransfusion phlebotomy — close-uf:
of the blood bank technician clamping of the first unit
of blood removed during today's procedure.
Figure 3
Mrs. B. having a first stage autotransfusion phlebotomy where one unit of blood is collected.
Figure 4
Double plasmaphoresis double donor pack set.
with a Kelly forcep. The second connector i
attached to a 250 cc bag of Normal Saline
which has flushed through the Y-type recipien
set and the blood warming coils. The coils
function to increase the temperature of the
cold infusing blood to body temperature. It too
is then clamped off with a Kelly forcep. The
third connector, already attached to a dono
pack, remains ready for use. A venipuncture!:
done in Mrs. B.'s left arm and the first unit o!
blood is collected in this pack. The I.V. nursi
calls the blood bank technician who brings '
Mrs. B.'s unit of blood collected at the first |
stage procedure one week ago. The
technician clamps off and cuts from the need!
the first unit of blood removed in today's
procedure (See Figure 5). This unit is then
placed in the Blood Bank refrigerator for
storage.
The I.V. nurse now unclamps the
connection leading to the Normal Saline ar:
flushes the entire tubing. The unit of blood
removed from the patient during her firststagj
autotransfusion phlebotomy is checked anci
plugged into the second Y-connector of thjj
recipient set; the warming coils are placed in
basin of water (36.5= C — 37° C); thefvJorm
Saline is shut off and the blood is infused ov
a 15-20 minute period (see Figure 6).
Following this, the Normal Saline is again usi
to flush all the tubing and is then clamped. Th
second donor pack is undamped and a
second unit of blood is collected. It is then
sealed, cut off from the needle, and
ine i;anaaian Nurse may 1»//
Figure 6 ^ second stage autotransfusion phlebotomy. The I. V. nurse adjusts the rate of flow of Mrs. B. s
blood taken during the first stage procedure. The blood is being reinfused through the Y-type
recipient set and the warming coils.
i
refrigerated in the Blood Bank along with the
first unit until the next weel<'s procedure.
Third stage autotransfusion
phlebotomy
Mrs. B.s third stage autotransfusion
phlebotomy occurs on April 21st, her pre-care
and equipment set up just as it was for her
second stage autotransfusion. The second
stage procedure is repeated and includes the
infusion of the second unit of blood removed
the previous week. Mrs. B. has another
venipuncture (usually the opposite arm) to
remove the third unit of blood and once her
post-care is done, the autotransfusion
program is complete.
The Blood Bank now has 3 units of blood
on hand collected on the 21st of April for her
surgery on April 28th. Mrs. B.s hemoglobin is
1 1 gms after her procedures, and this is
reported to the orthopedic surgeon along with
the exact amount of blood collected. When the
blood is needed by the patient in the operating
room or after surgery, the blood is sent from
the Blood Bank and infused into the patient. If
the surgery is performed at another hospital,
the blood is transferred from our Blood Bank to
the other hospital on the day before scheduled
surgery.
If a fourth stage autotransfusion is
requested by her doctor, the patient follows the
same procedure through the first, second and
third stages of autotransfusion phlebotomy.
Then, for the fourth stage, the entire second
stage autotransfusion phlebotomy is done in
one arm and is then repeated, usually in the
opposite arm. The units of blood removedfrom
the patient during her third stage
autotransfusion phlebotomy will be returned to
the patient during this procedure.
Discussion
Mrs. B. is just one example of over 225
patients who have had up to four stages of
autotransfusion phlebotomy done since the
program was initiated in 1972. Operative
procedures of patients who have utilized the
autotransfusion program have been varied.
e.g. total hip replacement, Harringtons
Procedure, laminectomy and spinal fusion,
bilateral reduction mammoplasty, abdominal
hysterectomy, aorta-bilateral femoral graft and
three vessel heart graft with pump. Most of
these patients have not encountered any
problems resulting from the procedure. A few
patients have had physical problems, e.g. poor
veins, poor circulation, lowered blood
pressure or excessive apprehension about the
procedures. In these cases, the procedures
were modified and in one instance
discontinued.
Conclusion
We have found that the autotransfusion
program is workable, is relatively simple and
that the program is utilized by hospital
surgeons at all the community hospitals in our
area. In our experience, we have found that
the patient cooperates readily and usually
welcomes the idea of autotransfusion. Most
important of all. it makes transfusion therapy
safer for patients.*
Author Margaret Haiwardffl.A/.. St. Josepti's
Hospital School of Nursing, Hamilton. Ont.)
has been the Head Nurse of the I. V. and Blood
Collection Team at St Joseph's Hospital In
Hamilton since 1 974 and Is a member of the
Canadian Intravenous Nurses Association
and the American Association of I. V.
Therapists, Inc.
References
1 Grant. Francis C. Autotransfuston. Ann Surg.
74:253-254, 1921.
The Canadian Nurse May 1977
Clinical Wordsearch no.5
This is another in a continuing series of clinical
wordsearch puzzles relating to different areas of
nursing, by f^ary Elizabeth Bawden (R.N.,
B.Sc.N.j who presently works as Team Leader
in the Rheumatic Diseases Unit, University
Hospital, London, Ontario.
Solve the clues. The bracketed number
indicates the number of letters in the word or
words in the answer. Then find the words in the
accompanying puzzle. The words are in all
directions — vertically, horizontally, diagonally,
and backwards. Circle the letters of each word
found. The letters are often used more than once
so do not obliterate them. Look for the longest
words first. When you find all the words, the
letters remaining unscramble to form a hidden
answer This month's hidden answer has five
words. (Answers page 47)." ^
G K T
C
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E A H
1 A crescent-shaped red blood corpuscle (6,4)
2 Thrombus (4)
3 A protein essential for coagulation, formed
from fibrinogen (6)
4 Blood replacement (7 7j
5 A loss of blood which, if severe, produces
shock n?;
6 Pertaining to the largest of R.B.C's. (10)
7 An acid, member of B vitamins which, if
deficient, produces anemia. (5)
8 Contusion (6)
9 Color of erythrocytes (3)
1 0 Plymh (anagram)
1 1 Important source of whole blood (5)
12 Disseminated intravascular coagulation (3)
13 A laboratory test showing the number of
various leukocytes, usually expressed as a
percentage of total white count. (12)
14 An anemia caused by a disease of the bone
marrow. (8, 6)
15 A malignant disease affecting the bone
man-ow, spleen and lymph nodes,
characterized by a decrease in R.B.C's and
platelets, a tendency to bleed and increased
susceptibility to infection. (8)
16 Condition characterized by an over-
abundance of W.B.C.s (12)
17 Thrombocytes (9)
18 Plasma-free centrifuged blood. (6, 5)
19 Thin layer of leukocytes adhering to R.B.C's
in centrifuged blood. (5, 4)
20 Caused a staining problem for Lady
Macbeth (5)
21 Protective measure for patients with severe
neutropenia. (7. 9)
22 Decreased number of platelets (16)
23 Extravasation of blood in 22. (7)
24 Spalam (anagram)
25 Mineral necessary for the production of
haemoglobin (4)
26 You'll be blue in the face without it. (6)
27 A neutral-staining granulocyte. (10)
28 A real shame in Britain. (8)
29 Foreign proteins which stimulate a protective
response in the body. (8)
30 One of many types of agglutinogens found in
the erythrocytes of 85% of Caucasians.
(2.6)
31 They form in response to 29. (10)
32 Site of haematopoiesis. (4, 6)
33 A malignant disease of 32. (8, 7)
34 Total iron binding capacity (4)
35 System of blood typing used as the basis for
whole blood transfusions (3)
36 Measurement of the average haemoglobin
concentration /100 ml. of packed red
cells. C4;
37 Haemoglobin (3)
38 Haematocrit (3)
39 Partial thromboplastin time (3)
40 Kilogram (2)
41 Measurement of the average volume of
individual red cells C3;
The Canadian Nurse May 1977
connGCtion
Rebecca Inns
We all know the sensation of being caught up
in a microcosmic slice of life that is made
unforgettable by the intensity of our subjective
awareness of what is happening around us.
Afterwards, we can recall these situations with
unusual clarity, almost at will, and thus they
serve as excellent learning resources.
For me. as with many other nurses, one of
these occasions involved the sudden death of
one of my patients ... It was during my fourth
year as a nursing student on my first day
assigned to a neurology ward.
I listened to morning report and
proceeded down the hall to greet my patient,
Mr. L. On arrival, I was puzzled for a moment
by the number of people in the room until I
realized that the cardiac arrest code I had
heard was for my patient.
Panic struck at me! What was I supposed
to do now? I wandered around in confusion
trying to stay out of everyone's way.
About this time, someone phoned Mr. L. s
family and told them that he had taken an
unexpected turn for the worse.
After what seemed a long time, Mr. L. was
pronounced dead and the horde of people
dispersed to continue with their individual
tasks. I stood there and looked at my patient.
This was my first close contact with death. In
the past, when I had thought about how I would
feel in this situation, I had expected to be sad
and, probably, frightened but I wasn't. I felt like
an empty shell, an unconcerned onlooker. I
packed his belongings as I was asked to. and
marvelled at my detachment as I waited for the
family to arrive. Perhaps, I thought, I have
become cold and methodical in my nursing
even before my graduation day.
Mrs. L., her daughter and son-in-law
arrived and were directed into a quiet room
afterthey had been informed of Mr. L.s death.
I thought I would leave; I rationalized that they
would rather be alone. I had read that people
like supportive company in times of stress but I
wanted to believe otherwise. Perhaps I was
afraid of that unknown enemy "death. " I feared
to share in the expression of those raw
emotions brought about by grief. My instructor
caught up with me as I was half running up the
corridor. She "suggested' I go in and sit with
the L.'s in their grief.
I entered the room with cups of coffee for
Mrs. L and her daughter. The son-in-law had
returned to his office for an hour leaving
definite instructions that the other two were not
to see Mr. L. s body until he returned. I sat
down with the two women wondering what to
do or say next. I knew little about death, next to
nothing about the patient and not a thing about
The first couple of minutes were uneasy
as I tried to establish some rapport. I was
nervous because I wanted to help them but I
didn't know how to go about it, where to begin.
As we became a little more familiar with each
other I began to relax and not worry about
every word. After a while, even the silences
became more comfortable and I found I was
forgetting about myself in the situation and
empathizing with the L.'s, wondering how I
would feel in their situation.
Mrs. L.'s behavior changed from a period
of depressed withdrawal during which she
cried and stared out the window, to edging
around on her chair and listening to her
daughter and me. Finally, she began to
participate in the interaction, giving a complete
description of Mr. L.'s illness and revealing
much anger in doing so.
At the time I remember thinking how
controlled the daughter was. AftenA/ards,
however, I wondered whether perhaps she
was a little too assured, too gay. and that this
was her way of coping with her father's death
and her mother's obvious grief.
I feel that this incident raises a number of
points pertinent to nursing today.
Nursing education emphasizes a
"holistic" approach to patient care. Thus, if a
patient dies suddenly, helping the famly cope
with their grief is an extension of caring for the
patient. One might ask if this duty should be
included in the already busy schedule of the
hospital nurse but I think that it is the nurses
who have come to know the patient and his
family who are best equipped to help the
survivors deal with their immediate reaction to
their loss.
Another query that comes to mind is
whether such a short involvement after death
is beneficial. There are programs in operation
that include ongoing services to bereaved
families but unfortunately these are not always
available.
All in all. even a short-term involvement
on the nurse's part can be helpful to the family
who infer from this that she considers them
and their loss important enough to sit down
and grieve with them. By taking time to be with
the family she is also showing them she cares
about them and what they will do now. She can
also help them begin to acknowledge and
accept their loss.
Dr. Elisabeth Kubler-Ross identifies five
stages of reaction to grief:
shock and denial
anger
bargaining
depression
acceptance.
it is unrealistic to hope that the family will
The Canadian Nurse May 1977
®)
time immediately following the death of their
loved one. But if they spend some time with a
nurse who gives them the impression that she
cares about someone they were so close to,
and who accepts his death, they can begin to
progress through these stages.
My third concern is the conflict that I felt
existed between the hospital's needs and those
of the patient and his family. During the time I
spent with Mr. L.'s family, two interruptions
occurred. The first involved a staff nurse who
came in to ask the family whether they would
consider changing their minds about refusing
to have an autopsy done. The second was the
same nurse who returned to request that the
family see "the body " right away.
In the first instance, a staff nurse entered
and stated that the doctor would like very much
to do a post mortem on the patient. She asked
whether the family would consider changing
their decision. The wife looked lost. The
daughter looked first to her mother and then to
me for guidance.
ME: "You don't want an autopsy?" in a
surprised tone as I did not know the topic had
already been discussed.
DAUGHTER: "Well... we thought ... why
bother? He's gone. " She sounded surprised
that anyone would consider having an
autopsy.
STAFF NURSE: "Well. It would aid medical
research and help us a great deal." She
remained standing in the doorway and looked
impatient.
There was an uncomfortable silence. I did
not know whether to speak or not. I
empathized with both the doctors and the
family. On one hand, I agreed with the family
that it seems an unnecessary violation to
subject their loved one's remains to a
pathologist's knife. On the other hand, I knew
that Mr. L.'s cause of death was unknown and
that, in the past, autopsies have resulted in
major contributions being made to medicine,
including the discovery that appendicitis may
cause death and that a simple appendectomy
could rectify the situation.
I pondered over whether I had any right to
try to influence the family's decision. At the
same time, I was conscious of being acutely
uncomfortable because of my ambivalent view
of the situation, and the feeling that I wanted to
do what was best for the family but also to
please the hospital.
In the second instance, the same nurse
entered the room to ask if the family would like
to see "the body." A look of shock and pain
passed over the wife's face. (I had never
thought about the use of the word "body '
before but remembering that look will certainly
make me reconsider before using it in the
future!) The daughter looked around for
support and said she was not sure if she
wished to see her father.
ME: "Do you think it could wait until the
son-in-law returns? He should be back in
about five minutes."
STAFF NURSE: "It'sjustthattheother patient
wants back in his room. " There was an
uncomfortable pause.
I vascillated between complying with the
nurse's request and thus enabling the
hospital's routine to run more smoothly,
leaving the decision with the family or
defending them against the bureaucracy.
ME: "Well, the son-in-law said he'd be back in
half an hour, twenty-five minutes ago."
STAFF NURSE: "Okay. "
In each of these situations, there was an
element of conflict that is present throughout
nursing practice and which, I feel, every nurse
needs to resolve. My feelings of ambivalence
during the two encounters made it clear to me
that throughout my nursing career I must
continually re-examine my professional
standards, and help to ensure that the
hospital's and the nurse's goals are the same
— i.e. to provide care for the patient and his
family.
Spending even that brief time after the
death of a patient with those who were close to
him shows that you do care and leaves the
family feeling not quite so alone.
Nursing is a caring profession and the
nurse must help those who need her
assistance in whatever capacity she can. ^
A June 1976 graduate of the University of
Ottawa's baccalaureate course in nursing
science, Rebecca I nnssayss^e "loves living
in California", where she works as a staff
nurse on the Orthopedic Surgery ward at
l^arina IVIercy Hospital in l\/larina del Rey. She
plans to transfer soon to Harbor General
Hospital in Los Angeles to work on a general
surgery ward.
Before moving to California, Rebecca
worked as a Camp Nurse near Huntsville,
Ontario. She has also done volunteer work at
Red Cross Blood Donor Clinics.
She enjoys California but plans to return
to Canada someday. This is her first published
story.
Ready
ff€r ^"^emeraency
2CCbed
li€$pital*in*a*b€X
Sandra LeFort
If a major emergency situation
involving a large number of
casualties occurred in your
community, what would you do?
Do you know enough first aid right
now to be able to treat victims until
further help is available? Doesyour
local hospital have a disaster plan?
The Idea of a disaster or
large-scale emergency Is far from the
minds of most of us living out our
day-to-day lives in Canada. If we think
about it at all, we agree that disasters
do happen — but they happen in Latin
America, or China, or the South
Pacific. We seldom think in terms of
earthquakes or major floods in relation
to ourselves. It seems to be part of the
"it can't happen to me: it only happens
to the other guy " syndrome.
Large-scale disasters know no
geographic bounds. They can and do
happen anywhere, and when they
occur It Is to the health professions
that survivors look for help.
Within the last 25 years,
Canadians have witnessed several
major disasters, Including the one In
the coal mines in Springhill, Nova
Scotia in 1 958, the collapse of the
Second Narrows Bridge linking
Vancouver to North Vancouver that
same year, and Hurricane Hazel In
southern Ontario In 1954. In recent
years, television has Immeasurably
increased the immediacy of such
events and the memory of them is
vivid in the minds of many people.
The more advanced and complex
technology taking over every facet of
living has increased by leaps and
bounds the possibilities for
unforeseen disasters that Involve
dozens or even hundreds of people.
Jumbo jets, trains, buses and the
ubiquitous automobile, huge
construction projects, tankers
transporting hazardous products all
have the potential for creating extreme
emergency situations. All carry with
them the threat of large numbers of
casualties occurring simultaneously
within one community. What happens
when the strain that an event of this
scale places on a community's
hospital emergency services is too
great?
(astoragLedaf®
P Aiperta
.o,«".t:>°""
jooBf/flS^a"
rgencV^^dVer
The Canadian Nurse May 1977
This Star-shaped formation is utilized in the 10-bed Post- Operative
Recovery Area. As the Emergency Hospital will function in a high school, the
other 5 beds, not shown in this photo, would be set up along the wall
perimeter
Disaster planning
Lorraine Davies, Director of
Emergency Health Services. Health
and Welfare Canada since February
1976, was formerly the nursing
consultant for the province of Nova
Scotia s Emergency Health Sen/ice.
She sees the need for a more
organized and coordinated way of
dealing with the type of emergency
situation that may result in an
unusually large number of dead and
injured people and tselieves that it is
necessary for hospitals and health
professionals to be prepared to deal
with an extreme emergency situation.
Emergency Health Services in
Ottawa, a Division of the Medical
Services Branch of Health and
Welfare Canada, provides expertise
and assistance to provinces in the
area of emergency health planning as
well as allocating equipment to be
used for specified disasters. This
equipment is then pre-positioned
throughout the provinces. It includes:
casualty collecting units; advanced
treatment centers; blood donor packs;
hospital disaster supplies such as
additional stretchers, dressings,
intravenous solutions etc. Hospital
disaster supplies are forwarded by the
province to hospitals with approved
disaster plans. Some of this
equipment has been utilized, at
various times, by different hospitals in
emergency situations when they
required augmentation of their normal
emergency supplies.
Hospital-in-a-box
On a larger scale, Ixjt part of the same
Health and Welfare Package, is the
"Two Hundred Bed Hospital" — a
completely functional hospital that can
be utilized anywhere that the need
occurs in Canada. Emergency
Hospitals are to be used only in the
event of a disaster of major magnitude
necessitating the reinforcement or
replacement of local hospital facilities.
On Ivlay 22, 1966, the Stanton
Yellowknife Hospital burned to the
ground and a portion of the
Emergency Hospital including X-ray,
Laboratory, Pharmacy. Operating
Room, Central Supply and Ward
supplies and equipment was used in
the town of Yellowknife for nearly
seven months. Emergency Health
Services, Alberta, as directed by the
Government of Canada, flew the
equipment by R.C.A.F. Hercules to
the town. With the supervision of a
member of Alberta Emergency Health
Services, the equipment was
assembled in the Elk Hall and within
four hours of its arrival, the hospital
was operational. The staff found the
equipment to be of high quality,
fulfilling all the requirements
necessary for a hospital. This was the
first time that an Emergency Hospital
I This photo shows the star-shaped formation of the stretchers around the
oxygen supply with the five-way adapter and the Wagensteen gastric
suction apparatus in the area of Pre-Operative Resuscitation. This stretcher
arrangement provides a small intensive care unit.
had been functionally utilized in
Canada. The hospital equipment is
packed in 594 boxes designed for
long-term storage. The total weight of
the hospital is 42,000 lbs. and requires
two 40' vans, one freight car, or one
Hercules plane to transport it. It is
self-sustaining for seven days. In time
of disaster in Canada the Emergency
Hospital would probably be
assembled and function in a school or
other selected shelter. Classrooms,
for instance, would provide space for
the operation of the functional areas. It
takes approximately one hundred and
twenty man hours for the hospital to be
made operational — i.e. 30 skilled
people working for four hours to
assemble it. A staff of 263 people are
required to provide the services within
the Emergency Hospital.
Everyttiing you really need
This hospital is complete in every
respect:
• There are ten wards made up of
eight general wards and two special
wards that serve as pre- and
post-operative areas. The beds in the
wards are constructed of a lightweight
tubular metal, with a nylon-cotton
waterproof deck which is held in place
by a non-stretchable nylon cord.
• The three Operating Rooms each
contain a lightweight folding table,
surgical lamp, anesthetic apparatus,
utility tables. Mayo stands, electrical
suction machine and oxygen
cylinders.
• The Central Supply Room, also
well equipped, contains two portable
autoclaves and a water boiling
sterilizer. The autoclaves can function
from a variety of heating sources;
propane gas. natural or mixed gases,
steam or electricity. Is is here that the
surgical trays and equipment are
sterilized. Also, some Ward supplies
are obtained from this area, along with
surgical instruments.
•A large Pharmacy and Pharmacy
stores, provide the medication,
dressings, intravenous solutions,
anesthetic supplies and the special
equipment and supplies necessary for
the efficient operation of an
Emergency Hospital.
• The Hospital has its own
Laboratory with the basic equipment
to perform 500 basic laboratory tests.
A blood donor kit is sometimes stored
with the Emergency Hospital with
supplies to obtain 100 pints of whole
blood.
• The x-ray area contains an x-ray
machine, portable film processing
machine and other equipment
necessary for the provision of a sound
x-ray service. Polaroid film is used to
take the x-rays and only ten seconds is
required to process the film.
An overall view of an area of the 200 Bed Emergency
Hospital, showing part of a 20 bed general ward,
post-operative recovery, operating room, pre-operative
resuscitation, and admitting areas.
A three-kilowatt portable,
gasoline-powered generator is
supplied as an auxiliary power source
for the x-ray unit. Besides the basic
areas, there is a Utilities Area which
contains a fifteen hundred gallon
water storage tank. An electrical pump
gives pressure from the tank to three
taps within the hospital. Auxiliary
electrical power is obtained by means
of a ten kilowatt gasoline powered
generator. Twenty of these hospitals
were provided to the Govemment of
South Vietnam to assist in the
provisksn of medical and surgical care
for the civilian population. A team of
experts from the Federal Emergency
Health Service trained the
Vietnamese personnel in the use of
the equipment. The Canadian
govemment also provided four
Emergency Hospitals to Nigeria after
the war in Biafra. *
Thanks go to Carolynne E. Ross,
Nurse Consultant for the Alberta
Emergency Health Services and to
Lorraine Davies, Director of
Emergency Health Services. Health
and Welfare Canada for their help in
the preparation of this article.
Clinical Wordsearch
Answers
Puzzle no. 5 (appears on page 42).
1 Sickle Cell
20 Blood
2 Clot
21 Reverse Isolation
3 Fibrin
22 Thrombocytopenia
4 Transfusion
23 Purpura
5 Haemorrhage
24 Plasma
6 Ivlacrocytic
25 Iron
7 Folic
26 Oxygen
8 Bruise
27 Neutrophil
9 Red
28 Bleeding
10 Lymph
29 Antigens
1 1 Donor
30 Rh Factor
12 Die
31 Antibodies
13 Differential
32 Bone Marrow
14 Aplastic Anemia
33 Multiple Myeloma
15 Leukemia
34 T.I.B.C.
16 Leukocytosis
35 A.B.O.
17 Platelets
36 M.C.H.C.
18 Packed Cells
37 Hgb
19 Buffy Coat
38 Hct
39 P.T.T.
40 Kg
41 M.C.V.
Hidden Answer: Give blood, it's so vital
AYERST ANTISEPTICS...
Hibitane"^
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• cleansing and
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Hibitane'-' Gluconate
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A multipurpose broad-spectrum antiseptic
concentrate. Diluted as directed it is ideally suited for
• preoperative patient
preparation
• an effective general
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intact skin and mucous
membranes, wounds,
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• disinfecting respiratory
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Salvon'' Hospital
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Sonacide*
(potentiated acid glutaraldehyde 2%)
A disinfecting and sterilizing solution for processing
respiratory and anesthetic equipment.
• bactericidal, fungicidal,
sporicidal, virucidal
• may be used on plastics
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• may be used in existing
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machines, ultrasonic
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' achieves complete
disinfection after 20
minutes at room
temperature, and
sterilization in 1 hour at
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' good for 4 weeks'
continuous use
,A increasing number o^BlWBtiian TWilbitals rely
on Ayerst Laboratories to look after their antiseptic
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:>r complete and return this coupon.
r
TO
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The Canadian Nurse May 1977
Calendar
May
Life, Death and Freedom, a
residential workshop held May 27-29,
1977 in Devon, Alberta. Open to
members of the helping professions
who are involved with any reaction to
loss. Contact: Grant MacEwan
Community College Continuing
Education Division. 10045-156 Street,
Edmonton, Alberta.
June
Canadian Council of
Cardiovascular Nurses Nova
Scotia Branch: Annual Two-Day
Workshop to be held June 2-3, 1977
at the Tupper BIdg.. Halifax. Contact:
Donna Rhodes. 706 — 5681 Rhuland
St., Halifax, N.S. B3H 4J6.
8th Annual Meeting of the Canadian
Association of Neurological and
Neurosurgical Nurses to be held at
the Loews Concorde Hotel in Quebec
City on June 15-17, 1977. Contact:
Ms. Beth Cook. 59 Warren Road,
Toronto, Ontario. M4V 2R9.
68th Annual Conference of the
Canadian Public Health
Association to be held in Vancouver,
B.C. on June 28-30, 1977. Contact:
CPHA, 1335 Carling Ave., Suite 306,
Ottawa, Ontario, K1Z 8N8.
Canadian Paediatric Society 54th
Annual Meeting to be held at the
Bonaventure Hotel in Montreal on
June 25-29, 1977. Contact: Dr. Victor
Marchessault, Executive Secretary,
Canadian Paediatric Society, Centre
Hospitaller, Unlversite de
Sherbrooke, Sherbrooke, P.O.
J1H 5N4.
International Conference on
Medical Device Regulation
sponsored by Health Protection
Branch, Health and Welfare Canada
and the Association for the
Advancement of Medical
Instrumentation. To be held June
14-16, 1977 in Ottawa. Contact:
Director, Bureau of fJledical Devices,
Health Protection Branch, Health and
Welfare Canada, Ottawa, Canada.
Canadian Guidance and
Counselling Association National
Conference to be held in Montreal on
June 14-18, 1977. Theme: Toward
the development of human resources"
with keynote speakers, Hans Selye,
Viktor FrankI and Marie-Andrde
Bertrand. Contact: Secretariat, 1895
avenue de La Salle, /Montreal,
Quebec, HIV 2K4.
Developing Learning Modules for
Nursing Instruction. To be held at
the Holiday Inn, Calgary, Alta., on
June 28-30, 1977. Contact: /nsWufeo^
Nursing Consultants, Fay Bower,
1820 Portola Road, Woodside.
California, 94062.
First Congress of Nurse Healers to
be held in San Francisco, California on
June 10-12, 1977. Theme: The nurse
healer of tomorrow: a futuristic view.
For information contact: £asf West
Academy of Healing Arts Council of
Nurse-Healers, Congress, 33 Ora
Way, San Francisco, Calif. 94131.
July
Class of '67 Ten Year Reunion of
Registered Nurses of the St.
Boniface General Hospital, Winnipeg,
Manitoba. To be held July 9-10,1 977.
For information contact: Doreen
Pattie, 34 In wood Crescent,
Winnipeg, Manitoba, R2Y 1A3.
Futuration ' 77. The 12th Annual
Conference of the Canadian
Foundation on Alcohol and Drug
Dependencies, Winnipeg, Manitoba
on July 10-15, 1977. Information:
Conference Manager. Futuraction
77. The Alcoholism Foundation of
Manitoba, 1580 Dublin Ave.,
Winnipeg, Man., R3E 0L4.
August
Health Care Evaluation Seminar. A
one-week seminar for those
interested in health care evaluation to
be held at Memorial University of
Newfoundland, from August 29-Sept.
2, 1977. Applications due June 1.
Contact: Patricia Bruce-Lockhart,
Division of Community Medicine,
Faculty of Medicine, Memorial
University of Newfoundland, St.
John's, Newfoundland, AIB 3V6.
Strategies for Curriculum Change.
To be held in Winnipeg, Man. on
August 1 8-20, 1 977. Contact : /nsWufe
of Nursing Consultants, Fay Bower,
1820 Portola Road, Woodside,
California, 94062.
Canadian Society of Respiratory
Technologists Annual Education
Forum to be held at the Holiday Inn,
Winnipeg, Manitoba on August 30 -
Sept. 2, 1977. Contact: Kathy Irving,
Registration Chairman, P.O. Box
1841, Winnipeg. Manitoba, R3C3R1.
Fourth Annual Meeting/
Educational Workshop of
the American Association of
Diabetes Educators. To be held in
Denver, Colorado on Aug. 14-15,
1977. Contact: /*mertcan Association
of Diabetic Educators, 3553 W.
Peterson Ave. , Chicago, IL 60659.
World Fedeiation for Mental
Health - 1977 Congress, "Today's
Priorities in Mental Health," to be
held in Vancouver, B.C. from August
21 - 26. 1977. The focus of the
meeting will be on finding ways to
make health systems work for all the
people, including the mentally ill.
Techniques of Health By The People
will be emphasized. For further
information contact: Secretariat,
World Federation for Mental Health,
Health Sciences Centre Hospital,
2075 Wesbrook Place, The University
of British Columbia, Vancouver, B.C.
V6T 1W5.
Symposium on Canada and
World Food to be held at Carleton
University, Ottawa on August 22-24,
1977. Multidisciplinary topics
discussed. Contact: The Royal
Society of Canada, 344 Wellington
St., Ottawa, Ont., KIA 0N4.
September
Emergency Nurses Association of
Ontario Annual Conference to be
held September 12-14, 1977 at the
Skyline Hotel, Ottawa, Ontario.
Contact: Helen McPhee, Supervisor,
Emergency Department., Ottawa
Civic Hospital, 1053 Carling Ave.,
Ottawa, Ontario.
70th Anniversary Reunion of the
Holy Cross Hospital Nurses
Alumnae to be held on Sept. 17 to 18
1977 in Calgary, Alberta. For furthe
information, contact: Mrs. Ella
Benner, 2007 — 23rd Ave. N.W.,
Calgary, T2M 1W2
Spinal Cord Injury Workshop — I
Multidisciplinary Approach. To b£
held on Sept. 19-21,1 977 at the Siste
Kenny Institute in Minneapolis, Minr
Contact :D/anr)e Talbot, R.N., Nursim
Education. Sister Kenny Institute, 8 1
East 27th Street, Minneapolis,
Minnesota, 55407.
American Cancer Society Seconc
National Conference on Human
Values and Cancer to be held
September 7-9, 1977 in Chicago,
Illinois. For information contact:
American Cancer Society, Second
National Conference on Human
Values and Cancer, 777 Third
Avenue, New York. N.Y. 10017.
October
Sixth Annual General and Scientifi
Meeting of The Canadian
Association on Gerontology to b€
held October 13-16,1 977 in Montrea
at Loews "La Cite" Hotel. Contact:
Blossom T. Wigdor, Ph.D.. Director,
Psychology Services, Queen Mary
Veterans Hospital, 4565 Queen Mar
Road, Montreal, Quebec, H3W 1W5
Colloquium on Bio-Medical Ethici
to beheld Oct. 27-30, 1977.
Sponsored by the Faculty of Medicin
and the Department of Philosophy c
The University of Western Ontario.
Papers on various topics are invitee
For further information write to:
Professor John Davis, Department c
Philosophy, The University of Westen
Ontario, London, Ontario, N6A 3K7.
12th Operating Room Nurses
Conference to be held by the O.R.
Nurses of Nova Scotia on Oct. 18-2C
1977 in Halifax. Contact: Miss L
Hirtle. R.N., Halifax Infirmary (OR),
1335 Queen St., Halifax, Nova Scotia
The Canadian Nurse IMay 1977
xVaiiies and Faces
M. Josephine Flaherty has resigned
her position as dean. Faculty of
Nursing, University of Western
Ontario, to accept the appointment of
Principal Nursing Officer,
Department of National Health and
Welfare. A native of Toronto,
she received her B.Sc.N.. B.A.,
and M.A. degrees from the
University of Toronto and was
awarded a Ph.D for her work in
statistics and measurement in
education. Extensively involved in
adult education, she has conducted
studies into the need for continuing
education for registered nurses in
Ontario and into the academic
potential of mature students. Her
nursing background includes general
duty nursing, public health nursing
and teaching in university and diploma
nursing programs. She is a past
president of the Registered Nurses
Association of Ontario, and a former
director of the Canadian Nurses
Association and the Canadian Nurses
Foundation. She was associate
professor at the Ontario Institute for
Studies in Education and the
University of Toronto before her
appointment as dean. Faculty of
Nursing, University of Westem
Ontario in 1973. She will assume her
new duties as Principal Nursing
Officer this summer.
Roselyn Smith (R.N., St. Pauls
Hospital School of Nursing.
Vancouver: B.N., McGill University)
has been appointed director of
nursing. Children s Hospital,
Vancouver, B,C. Previously, she was
director of nursing at Montreal
Children's Hospital in Montreal.
Quebec.
Adele Herwitz, past executive
director of the Internationa] Council of
Nurses and a former associate
executive director of the Amencan
Nurses' Association has been
appointed executive director of the
Commission on Graduates of Foreign
Nursing Schools. The organization,
formed nine months ago, will establish
a screening program for foreign nurse
graduates seeking to enter the United
States. Herwitz assumed her new
duties on April 1.
Phyllis Burgess (R.N , Toronto
General Hospital School of Nursing)
recently retired from her position as
director of nursing at the Ontario
Cancer Institute. Princess Margaret
Hospital, Toronto. After working with
cancer patients for 37 years she was
honored by the City of Toronto and
was the recipient of an Award of Merit.
She plans to have a productive
retirement and to continue as a
volunteer In Coping with Cancer
groups where patients are
encouraged to discuss their feelings
about cancer.
V
t
J. Patricia Holder has been
appointed Director of Nursing at The
Princess Margaret Hospital following
the retirement of Phyllis Burgess.
Holder was previously with the North
Yori< General Hospital in Toronto.
Corine Marlatt (R.N., Edith Cavell
Regional School of Nursing, Belleville,
Ont.) recently arrived in Afghanistan to
serve a two-year tour of duty with
MEDICO, a service of CARE. She is
stationed at a new 250-bed hospital in
the Afghan capital of Kabul where she
will be working in supervisory and
teaching capacities in the surgical
wards, intensive care units and
recovery room. Her main duty will be
to upgrade the training of local nurses
and students.
Prior to joining CARE/MEDICO,
Marlatt was a staff nurse at the
University of Alberta Hospital in
Edmonton and at the Belleville
General Hospital, Belleville, Ont,
The Health Sciences Department of
Grant MacEwan Community College
has announced the appointments of:
B. June Colberg, (R.N., B.Sc, M.
Ed.) as Instructor of the Extended
Care Nursing Certificate Program.
She has past experience in nursing
service and in education, her most
recent post being Chairman,
Department of Nursing, Cariboo
College, Kamloops, B.C.
r :":.-''^»i
.^- V
Elizabeth Dawson (R.N.. B.Ed.) as
Instructor of the Occupational Health
Nursing Certificate Program. She has
had previous experience in
occupational health, teaching and
social work.
The Canadian University Nursing
Student Association (CUNSA) is
sending two representatives — Peggy
Wareham (above), national
chairperson of CUNSA, Memorial
University, St. John's, Newfoundland
and Mary Comer national research
coordinator. Mount St. Vincent
University, Halifax, N.S — to the 1977
ICN Congress in Tokyo later this
month. A student assembly held at the
Congress on May 30 will give student
representatives from across the world
the opportunity to discuss topics of
interest to all nursing students.
Virginia A. Lindabury, former editor
of The Canadian Nurse, is now
managing editor of two magazines in
Naples, Florida — the Naples Guide,
a 112-page magazine published
monthly for tourists, and Naples Now,
a new publication for southwestern
Floridians.
Lindabury. a graduate of Toronto
General Hospital School of Nursing
and the University of Western Ontario,
left The Canadian Nurse in 1 975, after
13 years with the magazine. She
vacationed in Florida — where most of
her family live — for a year, then
accepted the position last July as
advertising sales representative with
Reynolds Enterprises. She was in that
job six months before being appointed
managing editor.
Glennyce Sinclair, (R.N . B.Sc.N.)
has been appointed Director of the
Diploma Nursing Program at The
College of New Caledonia. Prince
George. B.C. This is a new College
program and will commence in
September.
The Canadian Nurse May 1977
Selectln
texts
for ^
next semester?
Consider these neiv and revised
Mosby books.
MEDICAL
SURGICAL
6th Edition! MEDICAL-SURGICAL
NURSING. By Kathleen Newton Shater.
R.N. 1^ A . Janet R Sawyer, R.N..
Ph.D.. Audrey M. McCluskey. R.N..
MA.. Sc.M. Hyg.; Edna Lifgren Beck.
R.N.. M.A.: and Wilma J. Phipps. R.N..
A.M.: with 28 contributors. The revised
and expanded edition of this text
focuses on individualized total patient
care Throughout, you'll find increased
emphasis on physiology, patho-
physiology, and nursing assessment.
1975. 1.048 pp .608 illus Price. $19.90.
New 2nd Edition! THE SURGICAL
PATIENT: Behavioral Concepts for
the Operating Room Nurse. By Bar-
bara J. Gruendemann. R.N.. B.S.. M.S.:
Shirley B Casterton. R.N.. B.S.: Sandra
C. Hester ly. R.N.. B.A: Barbara B.
Minckley. R.N.. BS . M.S.. D.N.Sc.:and
Mary G. Shelter. R.N.. B.S.N This new
edition presents behavioral concepts
that can be applied to patient care in a
variety of surgical situations. Updated
discussions incorporate current Stan-
dards of Practice and v^/ays to imple-
ment the nursing process. April. 1977.
Approx. 160 pp.. 72 illus. About $7.10.
New 3rd Edition I THE PROCESS OF
PATIENT TEACHING IN NURSING. By
Barbara Klug Redman. R.N.. B.S.N. .
M.Ed.. Ph.D. This expanded new edi-
tion offers important principles and
methods for patient teaching. Discus-
sions present timely information on be-
havioral objectives, care plans, legal
aspects, and other topics' June. 1976.
282 pp.. 14 figs Price, $8.15.
A New Book! HEALTH ASSESS-
MENT. 8y Lo/s Ma/asanos, fl./V., Prt.D.,
Violet Barkauskas. R.N.. C.N.M..
MP. hi.: Muriel Moss. R.N.. M.A : and
Kathryn Stoltenberg Allen. R.N.. M.S.N.
Written by nurses for nurses, this
comprehensive text describes and il-
lustrates the techniques and proce-
dures necessary to obtain a complete
health history and perform a thorough
physical examination. July. 1977. Ap-
prox. 576 pp.. 683 illus.. 239 in 2-color.
About $22.00.
FUNDAMENTALS
A New Booki LIFTING, MOVING,
AND TRANSFERRING PATIENTS: A
Manual. By Marilyn J. Rantz, R.N.,
B.S.N, and Donald Courtial. R.P.J. , BS.
This valuable new book describes and
illustrates the safest and easiest
methods for handling and transferring
patients with special problems or in-
juries. January. 1977. 148 pp.. 250 illus.
Price, $7.30.
A New Book! INTRODUCTION TO
NURSING ESSENTIALS: A Hand-
book. By Helen Readey. R.N.. M.S.:
Mary league. R.N., M.S.N.:and William
Readey III. BS. This concise handbook
synthesizes basic information essential
to all beginning nursing students. Top-
ics range from communication and
terminology to P.O.M.R., mathematics,
nursing process, and legal aspects.
April. 1977. Approx 176 pp., 19 illus.
About $5.80.
3/-c/£d/f/on.' THE FOUNDATIONS OF
NURSING: As Conceived, Learned,
and Practiced in Professional Nurs-
ing. By /.////an DeYoung, R.N.. B.S.N.E..
M.S., Ph.D.: with 4 contributors.
Examine the many dimensions of mod-
ern professional nursing — oppor-
tunities, responsibilities, and personal
and social roles with this informative
text. 1976, 316 pp., 43 illus. Price,
$9.40.
A New Book! TECHNOLOGY FOR
PATIENT CARE: Applications for To-
day, Implications for Tomorrow. By
Joseph D. Bronzino. Ph.D. Particularly
helpful for students with a limited
background in advanced mathematics,
this unique book provides up-to-date
information on the major technological
advances which affect contemporary
health care. July, 1977. Approx. 288
pp.. 135 illus. About $10.00.
Th« Canadian Nur«« May 1977
S3
BEHAVIORAL
SCIENCE
BEHAVIORAL METHODS FOR
CHRONIC PAIN AND ILLNESS. By
WilberlE. Fordyce.Ph.D- This valuable
book explores new approaches to
control of pain through behavior mod-
ification techniques Topics include:
concepts of pain and technology for
treatnnent planning, 1976. 248 pp . 31
illus Price. $10.00.
New 2nd Edition! BEHAVIOR MOD-
IFICATION AND THE NURSING PRO-
CESS.By RosemananBernLR N.M.N.
and Wllbert E. Fordyce. Ph.D. The new
2nd edition of this widely known text
presents practical, up-to-date
guidelines which help students apply
behavioral modification techniques to
a wide variety of deviant or disordered
behaviors. May, 1977, Approx. 160 pp..
10 illus About $5.80.
BASIC SCIENCE
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. The 9th
edition of the most widely adopted
anatomy and physiology text has been
updated and expanded. You'll find new
discussions on the nervous system,
brain waves and biofeedback training,
liver functions, and other topics. 1975,
608 pp., 336 figs. (145 color), incl. 239
by Ernest W. Beck and an insert on
human anatomy containing 15 full-
color plates. 6 in transparent Trans-
Vision* Price, $15.25.
nth Edition! MICROBIOLOGY AND
PATHOLOGY. By Alice Lorraine Smith.
AB.. M.D.. F.C.A.P., F.A.C.P. The new
extensively revised and expanded edi-
tion of this classic text offers your stu-
dents the most recent information on
general and specialized pathology and
microbiology. You'll find updated and
expanded information on: biologic
classification of microbes: lymphoid
systems role in immunity: and serologic
diagnosis of metazoal and protozoal
diseases. 1976, 698 pp., 564 illus.
Price, $16.30.
New 4th Edition! MICROBIOLOGY
LABORATORY MANUAL AND WORK-
BOOK. By Alice Lorraine Smith, A.B.,
M.D., F.C.A.P., F.AC. P. April. 1977.
Approx. 192 pp.. 46 illus. About $7.30,
New 2nd Edition! BIOCHEMISTRY: A
Case-Oriented Approach, By Rex
Montgomery, D Sc: Robert Dryer.
PhD,; Thomas E. Conway, Ph.D.; and
Arthur A. Spector, M.D April. 1977.
Approx. 720 pp , 266 Illus. About
ADMINISTRATION
& EDUCATION
New 2nd Edition' REVIEW OF
LEADERSHIP IN NURSING. By Laura
Mae Douglass. RN . BA. MS This
concise, well-organized review crystal-
lizes a wealth of information on varied
aspects of nursing management and
leadership. Updated discussions re-
flect contemporary practices and think-
ing for nursing management in all cur-
rent systems of care February. 1977.
184 pp Price, $6.60.
New 8th Edition! HISTORY AND
TRENDS OF PROFESSIONAL NURS-
ING. By Grace L. Deloughery. R.N..
M.P.H.. Ph.D. The new edition of this
established text surveys the history of
nursing from its ancient beginnings to
the present Emphasis is on the parallel
evolution of professional nursing and
the women's role in society. This
revision features new material on re-
cent nursing history (since 1945) and
legal aspects of nursing. June. 1977,
Approx 288 pp , 37 illus. About $8.95.
New 2nd Edition! NURSING AND
THE PROCESS OF CONTINUING
EDUCATION. Edited by Elda S, Popiel.
R.N., B.S.. M.S.. with 31 contributors.
This convenient book describes re-
sources for implementing and evaluat-
ing all types of continuing education
programs in nursing. May. 1977. Ap-
prox 272 pp . 8 illus. About $8.20.
A New Book' NURSING CARE
EVALUATION: Concurrent and Re-
trospective Review Criteria. By Sharon
Van Sell Davidson. R.N.. B.S.N. . M.Ed.;
with 3 coordinating authors. The au-
thors provide guidelines and model
criteria for both concurrent and retro-
spective nursing audit of more than 250
disease and medical conditions. They
present systems compatible with Pro-
fessional Standards Review Organiza-
tions. August, 1977. Approx 600 pp
About $15.70.
COMMUNITY
NURSING
/Vev\ Volume /' CURRENT PRAC-
TICE IN FAMILY-CENTERED COM-
MUNITY NURSING. Edited by Adina
M Reinhardt. Ph D. and Mildred D
Ouinn. R.N . MS; with 24 contributors.
This provocative collection of articles
describes a wide variety of alternatives
for coping with community health situa-
tions Topics range from methods for
individualized care and family as-
sessment to broad concepts of health
administration — including details for
planning and implementing specific
community programs January 1977.
376 pp . 30 illus Price, $8.95 (P);
$12.10 (H).
NUTRITION
A New Book I NUTRITION IN IN-
FANCY CHILDHOOD. By Peggy L.
Pipes. R D.. MP H With this new text,
students can gain the knowledge
needed to counsel parents and others
about nutritional concerns and goals
for children Discussions present prin-
ciples of nutrition and development
(including recommended dietary in-
takes for children), along with current
strategies for dealing with specific
clinical problems. April, 1977, Approx.
240 pp . 14 Illus About $7.30.
A New Book! NUTRITION IN PREG-
NANCY AND LACTATION. By Bonnie
S Worthington. Ph D.; Joyce Ver-
meersch. Dr.P H ;andSueRodwell Wil-
liams. MP.H.. MR Ed.. Ph.D.; with 3
contributors. This unique text inte-
grates scientific rationale with specific
clinical techniques for maternal and
child health nutritional assessment and
education. Your students car, learn
about the pregnant adolescent, the
value of breastfeeding, and other top-
ics. July. 1977 Approx. 240 pp., 34
illus. About $7.30.
l^eVe built a reputation for quality and diversity in nursing publishing.
MOSBV
TIMES iviirtRon
THE C. V MOSBY COMPANY, LTD.
86 NORTHLINE ROAD
TORONTO. ONTARIO
M4B 3E5
The Canadian Nurse May 1977
Books
A Note to Our Book Reviewers
If you have been scanning this page for months,
wondering what happened to your book review,
please don't be too discouraged. Unfortunately,
space for book reviews is limited, and we have a
good numtier of well-written reviews on hand. So,
your reviews have not been considered
unsatisfactory; they are merely waiting for space.
.Your patience is appreciated.
Health Care Dimensions: Health Care
Issues, edited by Madeleine Leininger and
Gary Buck. 1 63 pages, Philadelphia, F. A. Davis
Company. 1974. Canadian Agent: Toronto.
IVIcGraw-Hill, Ryerson.
Reviewed by Jean E. Innes, Associate
Professor, College of Nursing, University of
Saskatctiewan, Saskatoon, Saskatchewan.
"Health care providers and consumers are
concerned about improving health care services, but
many are not clear about the issues, goal s. barriers,
and facilitators Involved in the provision of care.
Before one can change any health care system the
changers must first understand some of the major
issues, historical facts, and the forces influencing
our health care system. "
The purpose of this publication is to share such
knowledge and different viewpoints with an attitude
of "let's share and discuss together" in an
interdisciplinary climate and with an interdisciplinary
perspective. Eleven papers are presented for study,
most of which are relevant to the delivery of health
care in Canada. Issues dealing with emerging
priorities, equity of access, and technology as a
means of improving health conditions and
increasing options should interest professionals
concerned with improved delivery of service.
The book begins on a philosophical base and
moves quickly into discussions on crises in health
care, humanistic issues in health care, humanism,
health, and cultural values and their influence on
care. These papers identify major issues currently
causing concern in Canada, e.g.. evaluative
research in health, a conceptual analysis, social
organization of health and the myth of free choice,
and an analysis of the health and illness care
system.
The papers presented on the political context
and health legislation, emerging health services
projects, and abortion in the United States have
some interesting points to make, but generally may
not interest the Canadian reader and, in some
instances (as the paper on abortion), seem out of
place. University researchers and teachers will find
the paper on universities and future health care
challenging and debatable in a political context, but
the major point of the paper deals with the fact that
the potential of universities to contribute to improved
health care has not been fully realized. Factors
contributing to this state are discussed.
In general, this seems to be a very worthwhile
text. The papers are well written and well presented ,
and the purpose of the publication is realized. True
to the cause, the papers do not single out one group
of professionals to harass or challenge, but present
an overview of the issues influencing the total health
system. Major concepts are presented and a good
deal of knowledge can be shared with the reader.
The text would be valuable to teachers of health
care classes at the university level, as well as for
students in their senior year. Health professionals
generally would benefit from reading and discussing
many of the papers presented in this text.
Nursing Service Administration: Managing
the Enterprise by Helen M. Donovan, The C.V.
Mosby Company. St. Louis, 1975. 265 pages.
Approximate price $7.10. Reviewed by Doreen
Little, Director of Medical Nursing. University
Hospital, Saskatoon, Saskatchewan.
The author has directed this book to all nurses
who are responsible for the work of others. Her
premise is that all nurses are responsible for
achieving the goals of nursing service and as such,
all are administrators to some degree.
Although this book is directed primarily to the
nurse in an institutional setting, application is
possible in other settings.
This book is divided into three parts. Part I is
titled, "Administration in Nursing. " It deals with a
definition of administration, patient's rights, nurses'
rights, and the relationship between administration
and nursing care.
Part 1 1 is titled. "Framework for Study of Nursing
Service Administration." The component parts of
administration are dealt with in this section. There
are chapters on planning, organizing, staffing,
directing, controlling, coordinating, reporting and
budgeting.
POEMS WANTED
The National Society of
Published Poets is compiling a
book of poems. If you have
written a poem and would lil<e our
society to consider it for
publication, send your poem and
a self-addressed, stamped
envelope to:
National Society of Published
Poets, Inc.
P.O. Box 1976
Riverview, Florida 33569
U.S.A.
Part III looks at, 'Adjuncts to Nursing Service. "
In this section, the author looks at inservice
education, personnel policies and contracts,
equipment, research and public relations.
The author meets her objective in reviewing the
administrative process broadly. Such a broad
overview by nature overlooks specific details. For
example, the chapter on staffing discusses different
patient classification systems. The reader may use
the information presented as a base to look further
but there is not sufficient information to choose a
suitable system.
At the end of each chapter there is a thorough
reference list for the readers' use.
Although this book is addressed to nurses at al
levels, I doubt that the general duty nurse would
select this type of text as her choice of reading. It
would seem to me that this text could be used by a
student nurse studying the various aspects of
nursing administration.
As a n urse involved in administration at a senior
level for several years, I found the text lacking in
depth. However, the book is designed to provide a
fundamental structure to be examined, which it does
successfully.
Primary Anatomy (7th edition) by John V.
Basmajian. 405 pages. Baltimore: The William:
& Wilkins Co.. 1976.
Approximate price $15.45. Reviewed by
Charlotte Curtis, Sydney City Hospital Schoc
of Nursing, Sydney, N.S.
The aim of this book is to "provide non-medicJ
university students ... with a professional textbook c
gross and functional anatomy."
Subject matter is presented in the convention;
way by the individual systems approach. For the
beginning student, this type of approach is often th'
easiest.
General organization of material is done ver
well, especially with the use of headings and
sub-headings, making items easy to locate.
One of the outstanding features of the text is r
widespread use of illustrations, diagrams and
tables. These are of great value to the beginner I
understanding basic anatomy. New features of th
seventh edition include:
1 ) a 26-page color atlas with excellent illustrations*
such items as muscles, lymphatics, arteries, vein
bones, viscera and nerves;
2) a new Chapter 16 on Regional Anatomy; thisi
concluding chapter redirects the reader's focus t
the body as an integrated whole;
3) metric measurement is used throughout.
This book is very suitable for use by the
beginning anatomy student, where physiology w
be covered later in a separate course. Because of '
excellent diagrams, often missing in more detail!
texts, it should be an addition to every nursing sch( |
librarv. i
The Canadian Nurse May 1977
Library Update
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 by letter giving author, title and item numt)er in this
list.
If you wish to purchase a book, contact your
local bookstore or the publisher.
Books and documents
1. Aguliers. Donna Conant. Review of psychiatric
nursing. St. Louis. Mosby. 1977. 157p.
2. Anthony. Robert N. Management control in
nonprofit organizations, by... and Regina E.
Herzlinger Homewood. II., Inwin, 1975. 355p.
3. Benson, Herbert. Ttie relaxation response. New
York, William Morrow, 1975. 158p.
4. Boyer, John Marcus. Employee relations and
collective bargaining in health care facilities, by...
Carl J. Westerhaus and John H. Coggeshall. 2ed.
St. Louis. Mosby, 1975. 295p.
5. Brandjes, Jan. F. Health informatics: Canadian
experience. Amsterdam, North Holland Pub. Co..
1976. 237p.
International Nursing Index 1976
Cumulation, New York, American Journal of
Nursing Company. 1977.
Price $30.00
Just off the press, this 1 976 cumulated volume of
nursing's own periodical index is the largest yet,
reflecting the increasing nursing coverage in
literature.
Published since 1 966 as a joint effort of the
National Library of Medicine of the United States
and the American Journal of Nursing Company,
the Intemational Nursing Index (INI) is a printout
from MEDLARS and covers the contents of over
200 nursing journals around the world in any
language, and the nursing content of 2,200
non-nursing journals.
The only nursing index that covers both
English and French language journals, the INI is
a must for all Canadian health science libraries
for access to nursing material.
The INI is published quarterly, the fourth
issue being the annual cumulation.
Subscriptions are $40.00 per year, or $30.00 for
the annual cumulation alone. Subscribe now for
1977 to be sure to receive the first quarterly issue
which usually appears by the end of May. Send
your prepaid orders to: International Nursing
Index, American Journal of Nursing Co., 10
Columbus Circle, New York, NY 10019.
6. Brooke, Eileen M. Le suicide et les tentatives de
suicide. Gen6ve, Organisation mondiale de la
Sante, 1975. 143p. (Organisation mondiale de la
Sante. Cahiers de Sante Publique no 58)
7. Canadian Teachers Federation. Bibliographies in
education, Ottawa, 1976.
no. 56 Open area schools. 27p.
no. 57 Industrial relations in
Canada. 59p.
no. 58 Pre-service teacher
education in Canada. 29p.
8. Conference on the State of the Art in
Management Information Systems, 2nd,
Washington, DC. March 1976. State of the art in
management information systems for public
health /community health agencies: a report. New
York. National League for Nursing, 1976. 166p.
(NLN Publication no. 21-1637)
9. Copeland, Mildred. Occupational therapy for
mentally retarded children: guidelines for
occupational therapy aides and certified
occupational therapy assistants, by... Lana Ford
and Nancy Solon. Baltimore, Md., University Pari<
Pr., C1976. 226p.
1 0. Current practice in family-centered community
nursing edited by Adina M. Reinhardt and Mildred D.
Quinn. St. Louis. Mosby, 1977. vol. 1.
1 1 . Deschler. Lewis. Deschler's rules of order
Englewood Cliffs, N.J., Prentice-Hall. c1976. 228p.
1 2. Detection of developmental problems in
children: a reference guide for community nurses
and other health care professionals edited by
Marilyn J. Krajicek and Alice I. Tearney. Baltimore,
Md., University Park Pr.. c1977. 204p.
13. Guilhaume.B. £ndocono/og/e. Diabete, par.et
L. Periemuter. Paris, Masson, 1976. 160p. (Cahiers
de rinfirmi6re, 5)
14. Hynes, V. Barbara. Orthopedic and
rehabilitation nursing: continuing education review:
529 essay questions and referenced answers.
Flushing. NY.. Medical Exam. Pub. Co.. c1976.
171p.
1 5. Hart, Laura K. The arithmetic of dosages and
solutions; a programmed presentation. 4ed. St.
Louis, Mosby, 1 977. 74p.
16. International Labour Office, 63rd session,
Geneva, 1 977. Employment and conditions of work
and life of nursing personnel. Sixth item on the
agenda. Geneva, Intemational Labour Office, 1977.
97p. (It's Report Vl(l))
17. Intervention strategies for fiigh risk infants and
young children edited by Theodore D. Tjossem.
Baltimore, University Pari< Pr., c1976. 787p.
18. Lemoine, J. P. Obstetrique, par... Ch.
Strich-Mougeot et M. Tescher. Paris, Masson, 1976.
187p. (Cahiers de linfirmifere, 13)
19. McConkey, Dale D. IVIBO for nonprofit
organizations. New York. AMACOM. c1975. 223p.
20. Mosby's comprehensive review of nursing. 9ed.
St. Louis, Mosby, 1977. 609p.
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The Canadian Nurse May 1977
21 . The nurse as caregiver for the terminal patient
and his family edited by Ann M. Earle, Nina T,
Argondizzo and Austin H. Kutscher. New York,
Columbia University Pr., 1976. 252p.
22. On-line sen/ices reference manual f^arch 1975.
Bethesda, Md., National Library of Medicine,
MEDLARS Management Section; Distributed by
National Technical Information Service, U.S. Dept.
of Commerce, 1975. 302p.
23. Pierog, Sophie H. f\/ledical care of the sick
newborn, by... and Angelo Ferrara. 2ed. St. Louis,
Mosby, 1976. 368p.
24. Plantureux, G. Gynecologie, par...E. Michez et
M. Moulinet. Paris, Masson, 1976. 114p. (Cahiers
de rinfirmi6re, 8)
25. Pugh, Eric. Third dictionary of acronyms and
abbreviations: more abbreviations in management,
technology and information science. Hamden,
Conn., Archon Books, c1977. 208p.
26. Quality patient care and the role of the clinical
nursing specialist edited by Rachel Rotkovitch. New
York. Wiley, c1976. 189p.
27. Rantz, Marilyn J. Lifting, moving and
transferring patients; a manual, by... and Donald
Courtlal. St. Louis, Mosby, 1977. 138p.
28. Ryan, Sheila A. Handbook of practical
pharmacology, by... and Bruce D. Clayton, St.
Louis, Mosby, 1977. 235p.
29. S6n6chal, G. O.R.L Ophtalmologie, par... J.J.
Berlrand et E. Michez. Paris, Masson, 1976. 181 p.
(Cahiers de linfirmiSre, 14)
30. Sultz, Harry A. Longitudinal study of nurse
practitioners. Phase I, by... Maria Zielezny and
Louis Kinyon. Bethesda, Md., U.S. Public Health
Service, Division of Nursing, 1976. 144p. (U.S.
DHEW Publication no. (HSA) 76-43).
31. Treece, Eleanor Mae Walters. Elements of
research in nursing, by... and James William
retelast
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Treece. 2ed. St. Louis, Mosby, 1977. 349p,
32. Western Interstate Commission for Higher
Education. Communicating nursing research:
critical issues in access to data edited by Marjorie V.
Batey. Boulder, Colorado, 1975. 303p.
Pamphlets
33. College Entrance Examination Board. CLEP
North Carolina nursing equivalency examinations.
Princeton, N.J., 1975. 11p.
34. Dickman, Irving R. Behavior modification. New
York, Public Affairs Committee, c1 976. 28p. (Public
affairs pamphlet no. 540)
35. Imai, Hisako Rose. Cours de recyclage
(nouvelle orientation) a t'intention des infirmi^res
canadiennes autorisees. Ed. rev. Ottawa, Sante et
Bien-etre social Canada, 1976. 3p.
36. — Refresher (reorientation) courses for
registered nurses in Canada. Rev. ed. Ottawa,
Health and Welfare Canada, 1976. 4p.
37. Kergin, Dorothy J. University education for
nurses — for what purpose? Sydney, Australia,
Florence Nightingale Committee for Education,
1975. lip.
38. National League for Nursing. Government
relations pamphlets. New York, 1976.
no. 1 Guidelines for meeting with
legislators.
no. 2 Guidelines for writing to
congressmen.
no. 3 Guidelines for presenting
testimony on legislation.
39. National Library of Medicine. Literature
searches. Bethesda, Md., U.S. Dept. of Health,
Education and Welfare, 1976. R
no. 76-32 Ambulance service. 23p.
no. 76-35 Informed consent 24p.
40. Ogg, Elizabeth. /(deaf/7 /nfhe^am//y. New York,
Public Affairs Committee, c1 976. 24p. (Public affairs
pamphlet no. 542)
41. — One-parent families. New York, Public Affairs
Committee, c1 976. 28p. (Public affairs pamphlet no.
543)
42. LOrdre des Infirmi6res et Infirmiers du Ou6bec.
Commentaires et recommandations du Bureau a la
suite de la publication par le minist^re des Affaires
sociaies en Janvier 1976 du rapport du comite
d'etude sur I'im plantation des services
ambulatoires specialises. Montreal, 1976. 34p.
43. Registered NursesAssociation of Ontario. Open
Forum for Public Health Nurses, Apr. 10, 1976,
Toronto. Report. Toronto, 1 976. 33p.
44. World Health Organization. Regional Office for
Europe. The definition of parameters of efficiency in
primary care and the role of nursing in primary \
health care: report of two Working Groups,
Reykjavik, 14-18 July, 1975. Copenhagen, 1976.
38p.
Government documents
Canada
45. Institute for ScientificandTechnical Information
Directory of federally supported research in
universities. Ottawa, National Research Council o
Canada, 1975/76. 1v. in 2. (NRC. no. 15300) R
46. Committee on the Operation of the Abortion
Law. Report. Ottawa, Supply and Services, c1977
474p.
47. Health and Welfare Canada. Emergency
departments: design considerations. Ottawa, 1 976
51p.
48. — . Sex education; a teacher's guide. Ottawa
1976. 6 pts. in 1.
49. Nutrition Canada. Food consumption patterns
report. A report by Bureau of Nutrition Sciences
Health Protection Branch. National Health and
Welfare. Ottawa, Supply & Services Canada, 1976
248p.
The Canadian Nurse May 1977
: statistics Canada. Mental health statistics: v. 1 ■
-titutional admissions and separations; v. 3.
^titutional facilities, services and finances, 1973.
tawa, 1976. 2v. (Catalog no. 83-204: 83-205)
Statistique Canada. La statistique de I'hygi^ne
entale: v. 1 ■ Admissions et radiations des
stitutions: v. 3 - Installations, services et finances
^s etablissements. 1973. Ottawa, 1976.
:atalogue no. 83-204; 83-205)
Great Britain
" : Dept. of Health and Social Security and Welsh
•ice. Central Health Services Council. The
^anization of the in-patient's day, report of a
mmittee of the Central Health Sen/ices Council.
ndon. Her Majesty's Stationery Office, 1976.
2p.
Ontario
53. Council Of Health. Nutrition and dietetic
services. Toronto, 1975. 56p.
'- Dept. of Health. Directory of nursing personnel
:harge of official public health nursing services in
Ontario: listed according to counties and districts.
Toronto, 1976. 3p. R
55. Ministfere de la Sante. Comity d'action sur les
Services de Sant6 en Langue Franpaise. "Pas de
probieme". Rapport du Comite... Toronto, 1976.
264p.
56. Ministry of Health. French-Language
Health Services Task Force. "No problem". Report
■ the Health Services French Language Task
'ce. Toronto, 1976. 255p.
Ministry of Labour. Hourly wage rates for
acted occupations under Ontario agreements
covering nursing homes and homes for the aged,
1975. Toronto, 1975.
58. Ministry of Labour. Equal pay for work of equal
value: a discussion paper. Toronto. 1976. 106p.
59 — . Job vacancies by major occupation and
industry groups, Ontario and six Canada
Manpower Centre (C.M.C.) management regions,
first quarter 1976 and job vacancies by major
occupation group for Ontario fourth quarter 1975.
Toronto, 1976. 35p. (Employment information
series, no. 18)
60. — . Job vacancies by major occupation and
industry groups, Ontario and six Canada
Manpower Centre (C.M.C.) management regions,
second quarter 1976. Toronto, 1976. 26p.
(Employment information series, no. 19)
61 . Ministry of Labour. Overtime compensation and
meal allowances in Ontario collective agreements.
Toronto, 1976. 12p. (Bargaining information series,
no. 17)
62. — . Selected provisions in Ontario collective
bargaining agreements September 1976 -
reporting, call-back and stand-by pay-shift.
Saturday and Sunday premiums - work ck>thing,
safety equipment and tool allowances. Toronto,
1976. 14p (Bargaining information series, no. 19)
63. — . Research Branch. Sick leave plans and
weekly sickness and accident indemnity insurance
plans in Ontario collective agreements. Toronto,
1976. 13p. (Bargaining information series, no. 18)
Quebec
64. Regie de lAssurance-maladie. Sen/ice de la
Recherche etdes Statistiques.Les consommateurs
etlescoutsdelasanteauOuebecdel971 a 1975.
Prepare par: Jean-Guy Boutin et Jean Bisson.
Quebec (ville), 1977. 30p.
Portugal
65 Ministerio de Saijde. Diregcao-Geral dos
Hospitals. Letters no. 105, Assunto:-Nursing
legislation. Lisboa, 7Jan. 1977. -Collection of
nursing legislation concerning the practice of
nursing in Portugal." 13p.
Studies deposited in CNA
Repository Collection
66. Charter, Christine E. Attaching a visiting nurse
to a group medical practice to change hospital stay
patterns, by...Stephany Grasset, Ernest F.
Ledgerwood and Heather F. Clari<e. Vancouver,
B.C. Victorian Order of Nurses, Richmond-
Vancouver Branch, 1975. 246p. R
67. Field, Betty Carol. Orientation and inservice
programs for teachers in Canadian two year
schools of nursing and services of satisfaction and
dissatisfaction as perceived by these teachers.
Fredericton, 1976. 101 p. Thesis (M.Ed.) - New
Brunswick. R
68. Gigu6re-Dessureault, Use. Les therapies
behaviorales. Montreal, 1976. 37p. R
69. The human aspects of treatment in emergency
departments and outpatient clinics. Toronto,
Canadian Hospital Association, 1976. 99p. A
translation of... Humanisatlon des soins aux salles
d'urgence et aux cliniques extemes' by Elizabeth
McCabe." R
70. Lamoureux, Marvin E. A combined descriptive
analysis of the students who first entered the
Douglas College nursing programme (September,
1975). Surrey, B.C., Douglas College Health
Services Division, Surrey Campus, 1976. 24p.
(Multiple criteria development for the selection of
community college nursing programmes students;
technical report no. 4) R
71 . — . The first nursing class: preliminary analysis
of the students' first semester academic
performance. Surrey B.C., Douglas College Health
Services Division, Surrey Campus, 1976. lOp.
(Multiple criteria development for the selection of
community college nursing programme students;
technical report no. 3) R
72. Leonard, Linda Gaye. Husband-father's
perceptions of labour and delivery. Vancouver,
1975. 165p. Thesis (M.Sc.N.) - British Columbia R
73. National Conference on Research in Nursing,
3rd, Toronto, May 21 -23, 1 974. Decision making in
nursing research. Proceedings of... held... under
the sponsorship of the Faculties of Nursing. Univ. of
Toronto and Univ. of Western Ontario and the
School of N:..rsing McMacter Univ. JchnO. Godden,
Margaret C. Cahoon, Editors. Toronto, University of
Toronto, 1976. 218p. R
74. Ontario Hospital Association. Health care in big
cities. Metropolitan Toronto study, Toronto, 1976.
47p. (IHF project paper) R
75. Peitchinis. Jacquelyn. Nursing unit-centered
orientation program for newly hired registered
nurses, by... Madeline de Hamel and Phyllis Kober.
Red Deer, Alta., Nursing Services Dept., Red Deer
General Hospital, 1976. 197p. R
76. Robinson, S.C. A study to determine the scope
of a care by parent unit in a children's hospital.
Prepared by... M.J. Hicks, R.N., M.S. Connaughty,
R.N., et a!.. Vancouver, B.C., Dept. of Paediatrics,
Univ. of British Columbia and Children's Hospital,
1976. 1v. (various pagings) R
77. Saskatchewan. University. Hospital Systems
Study Group. Community health services study.
Saskatoon, Sask., 1972. 94p. R
78.—. The development of a research tool to
evaluate and compare the standards of patient
care, by Kay Sjoberg and MR. Bicknell. Saskatoon,
Sask. 1971. 77p. R
79. — . Evaluation of the unit assignment system of
nursing at Holy Family Hospital, by K. Philips.
Sas.katoon, Sask. 1975. 117p. R
80. Saskatchewan Registered Nurses Association.
Performance expectations of diploma nursing
graduates. A SL:rvey conducted by... Regina, 1976.
104p, R
81. Jones, Phyllis E. /A soAfeyo/r7!jrse-attac/imenfs
to medical practices in Ontario. Toronto, University
of Toronto, Faculty of Nursing, 1976. 49p.
Students & Graduates
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The Canadian Nurse May 1977
riassiriiHl
Advert IseiiUMits
British Columbia
British Columbia
United States
Faculty — New positions (4) in 2-year post-basic baccalaureate
program in Vtctona, B.C., Canada. Generalist in focus, ctinical em-
phasis on gerontology in community and supportive extended care
units. Public Health nursing and Independent study provide opportu-
nity to work closely wtth highly-qualified and motivated R.N. students.
Teaching creativity and research are strongly endorsed Masters
degree, teaching and recent cimcai experience m gerontology/med -
surg/psychology/rehabilitation preferred Salanes and fnnge bene-
fits competitive; an equal opportunity employer for qualified persons.
Positions available NOW, Contact Dr Isabel MacRae. Director,
School of Nursing. University of Victona. Victoria, British Columbia,
V8W 2Y2.
Psychiatric Head Nurse required for an 16-bed Psychiatnc Unit
located m the Northwest of B.C R NA.BC. contract ts in effect.
Qualifications: Mustbe eligiblefor registration in B.C. Previous Head
Nursing experience essential. Baccalaureate degree preferable. Ap-
ply in wnting to fvirs, F Quackenbush. R,N,, Director of Nursing. Mills
Memonaf Hospital. Tenace. Bntish Columbia. V8G 2W7,
General Duty Nurses for modern 35-bed tiospital located in sojih-
ern B C, s Boundary Area with excellent recreation facilities, Salan/
and personnel ooiraes m accoroance with RNABC. oomforlable
Nurse s home Apply Director o' Nursing, Boundary Hospital, Grand
Forks. Bntish Columbia, VOH 1H0,
Experienced General Duty Nurse for modem 10-bed hospital situa-
ted on the beautiful West Coast of Vancouver Island, Accommodation
S100,00 per month. Apply: Administrator, Tahsis Hospital. Box 398,
Tahsis. Bntish Columbia. VOP 1X0,
Experienced Genera) Duty Nurses required for 134-bed hospital,
Basic Salary Si, 122 -Si. 326 per month. Policies in accordance with
RNABC. Contract Residence accommodation available. Apply in
writing to: Director of Nursing. Powell River General Hospital. 5871
Arbutus Avenue, Powell River. Bntish Columbia, V8A4S3.
Registered Nurses — Dunhill, with 200 offices in the U.S.A., has
exciting career opportunities for both new grads and expenenced
R N. s. Send your resume to: Dunhill Personnel Consultants, No 805
Empire Building, Edmonton. Alberta, T5J 1V9. Fees are paid by
employer.
Registered Nurses — Hurley Medical Center is a well equipped,
modern, 600-bed teaching hospital offering complete and specialized
services for the restoration and preservation of the community's
health. It also offers orientation, in-servtce and conltnumg education
tor employees. It is involved m a building program to provide better
surroundings for patients and employees We have immediate ope-
nings for registered nurses m such specialty units as Cardio- Vascular,
Operating Rooms, Nursenes. and General Medical-Suroical areas.
Hurley Medical Center has excellent salary and fringe benefits. Be-
come a part of our progressive and well qualified work force Today.
Apply Nursing Department, Mr Garry Viele, Associate Director of
Nursing, Hurley Medical Center. Flint. Michigan 48502. Telephone
(313) 766-0386.
The Royal Jubilee Hospital is seeking Nursing Instructors for the
basic three year Diploma Programme in Nursing Qualifications:
Minimum - Baccalaureate Degree in Nursing plus clinical expenence
as a Nurse Salary and perquisites: According to the RNAB.C-
Coniract. Applications should be addressed to. Director of Education
Resources, Royal Jubilee Hospital. 1900 Fort Street. Victoria. British
Columbia. VSR 1J8.
Manitoba
O.R. Head Nirse required for 98^3ed hospitat. located on the Douglas
Channel m the mountains of Northwest BC. , with a variety of summer
and winter recreational activities available, OR. and Supervisory
expenence desirable Salary range from $1,312,00 per month to
Si ,546 00 per month depending upon expenence. For more informa-
tion please contact Mrs, P Janzen, R.N,. Director of Nursing, Kitimat
General Hospital. 899 Lahakas Blvd,, Kitimat, Bntish Columbia, V8C
1E7.
Operating Room Supervisor required for 230-bed acute general
hospital in South Okanagan Apply in writing, listing qualifications and
expenence, to: Director of Nursing. Penticton Regional Hospital, Pen-
ticton. Bntish Columbia. V2A 3G6,
Operating Room Nurse required for an 87-bed acute-care hospital
located m Northern B C R.N. A B C contract is in effect Residence
accommodations available. Apply in writing to: Mrs. F. Quackenbush,
R.N., Director of Nursing, Mills Memonal Hospital, Terrace, Bntish
Columbia. V8G 2W7,
Registered and Graduate Nurses required 'or new 41 -bed acute
care hospital, 200 miles north of Vancouver, 60 miles from Kamloops.
Limiled furnished accommodalion available. Apply Director of Nurs-
ing, Ashcroft & District General Hospital, Ashcrofl. British Columbia,
Help Wanted — Registered Nurses — The British Columbia Public
Service has vacancies for Registered Nurses in the Greater Vancou-
ver and Other Areas. Positions are m mental health, mental retarda-
tion, and psycho-genalnc institutions Salaries and fringe benefits are
competitive (1976 rates: Si. 086 to 31,267 for Nurse l). Canadian
citizens are given preference. Interested applicants may contact the
Public Service Commission, Valleyview Lodge, Essondale, Bntish
Columbia, VOM IJO. Quote Competition No. 77:449.
Registered Nurses — Required for a 340-bed accredited hospital in
the Central interior of Bntish Columbia, Registered nurses interested
tn nursing positions at the Prince George Regional Hospital are invited
to make inquines to Director of Personnel Sen/ices, Pnnce George
Regional Hospital. 20000 - 15Ih Avenue Pnnce George. Bntish Col-
umbia. V2M 1S2,
Nurses registered or eligible for Registration in B.C. are invited to
submit applications for employment for General Duty positions on the
staff of the Royal Jubilee Hospital. 1900 Fort Street, Victoria, B,C.,
V8R 1J8 Vacancies are anticipated in all areas of this 975-bed
hospital which includes Psychiatnc and Extended Care, Applications
for part-time, full-time, or casual employment will be considered.
Liberal benefits exist under the RNABC contract. Apply to the : Direc-
tor of Nursing
Applications are invited for positions in the Faculty of a newly initiated,
progressive, enlightened health-oriented undergraduate nursing
program. Subject to budgetary constraints, positions are open for
community and mental health and psychiatnc nursing. Expertise in
pnmary care skills a requisite Positions are also open for faculty with
skills in rehabilitation and amelioration nursing, especially as related
tochildrenandadutts. Apply to: Helen P, Glass. Ed, D., Professor and
Director, School of Nursing, University of Manitoba. Winnipeg, Mani-
toba, R3T2N2,
Ontario
Supervisor of PuWtc Health Nursing for progressFve generalized
public health program Salary commensurate with expenence Ad-
ministrative experience essential Send resume to: MF Webster,
M.D . D.P.H,, Director Elgin-St Thomas Health Unit, 2 Wood Street,
St. Thomas, Ontano, N5R 4K9.
Overnight camp in Ontano (near Ottawa) requires FULL-TIME
NURSE from July 5 • August 21, 1977 For inlormation contact; L
Hams, PC. Box 5288. Station F , Ottawa, Ontano. K2C 3H5 Tele-
phone Office (613) 232-7306 between 3-5 P M,, Mondays — Thur-
sdays; Evenings; (613) 225-6557
Childrens summer camps in scenic areas of Norlhern Ontano 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, Ontano, MSN 1E6. or call (416) 783-6168.
RN or RNA, 5 7 or over and strong, without dependents, to care for
160 pound handicapped executive with stroke Live-m. ' ; yr in To-
rontoand ' j yr inlVfiami. Preferably a non-smoker. Wage; S200. 00 to
$220.00 weekly NET, depending on expenence plus Miami bonus-
Send resume to; M.D.C., 3582 Eglinton Avenue West, Toronto. On-
tano, M6M 1V6
Australia
We have many vacanaes for Registered Nursing Sisters and other
para-medical staff. For details wnle to: Hospital Staff Agency, 388
Bourke Street, Melbourne. Victona 3000. Australia,
This
Publication. . . .
is Available in
MICROFORM
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The Canadian Nurse May 1977
United States
_:;tical Care Nurses — Lcioking for experienced nurses to staff a
new ICU/CCU in a small, community onented. hi-desert frospital.
Located one tiour from Los Angeles If interested, please write to
Barbara Bruno. R.N.. Director of Nursing. Palmdale General Hospital.
1212 East Avenue S. Palmdale. California 93534. USA
Nurses — RNs — Immediate Openings in Florida — California —
Aritansas — If you aie experienced or a recent Graduate Nurse we
can offer you positions with excellent salanes of up to Si 300 per
month plus all benefits Not only are there no fees to you whatsoever
(or placing you, but we also provide complete Visa and Licensure
assistance at also no cost to you. Wnte immediately for our application
evenif there are other areas of the U.S that you are interested in We
will call you upon receipt of your application m order to arrange for
hospital interviews. Windsor Nurse Placement Service. P.O. Box
1133. Great rJeck. New Yort< 11023 (516-487-2818)
Registered Nurses — Florida and Texas — Immediate hospital ope-
nings in Miami. Fort Lauderdale. Palm Beach and Stuart. Flonda and
Houston. Texas. Nurses needed for Medical-Surgical. Critical Care.
Pediatrics. Operating Room and Orthopedics. We will provide the
necessary worit visa. No fee to applicant Medical Recruiters of Ame-
rica. Inc., BOON W. 62nd St.. Fort Lauderdale. Florida 33309. U.S.A.
(305) 772-3680.
Head Nurse
with preparation and/or
demonstrative competence in
Psychiatric Nursing and
Management functions, required for
Head Nurse appointment. To be
responsible for participation in the
organization, initiation, and the
management of a New Psychiatric
in-patient Unit.
Please apply, forwarding
complete resume to:
Director of Personnel
Stratford General Hospital
Stratford, Ontario
N5A 2Y6
UNITED STATES
OPPORTUNITIES
FOR REGISTERED NURSES
AVAILABLE NOW
IN CALIFORNIA
FLORIDA
MISSISSIPPI
NEW ORLEANS
TEXAS
WE PLACE AND HELP YOU WITH;
STATE BOARD REGISTRATION
YOUR WORK VISA
TEMPORARY HOUSING - ETC.
A CANADIAN COUNSELLING SERVICE
Phone: (416) 449-5883 OR WRITE TO:
RECRUITING REGISTERED NURSES INC.
1200 LAWRENCE AVENUE EAST, SUITE 301,
DON MILLS, ONTARIO M3A 1C1
j^/^/\r
NO FEE IS CHARGED
TO APPLICANTS.
OPEN 7 DAYS A WEEK.
PROVINCE OF BRITISH
COLUMBIA
PUBLIC HEALTH
NURSE
Community Mental Health
Centre
Nelson
$1,395 — $1,608
(under review)
The Mental Health Programs, Ministry of
Health, urgently requires a person to
function as a member of the
multi-discipline mental health team in
providing diagnostic, assessment,
treatment, consultation and education
services to the community: to conduct
individual, marital and group therapy, and
liaise with the community and allied
agencies. Requires registration or eligible
for registration as a Nurse in B.C. and,
preferably, a Master's Degree in Nursing,
with emphasis in behavioural sciences
and/or community mental health;
extensive experience and skill in family
and marriage therapy.
Canadian citizens are given preference
Obtain applications from the Public
Service Commission, Valleyview
Lodge, ESSONDALE VOM 1J0 and
return immediately.
COMPETITION NO. 77:451A
Head Nurse
Child Psychiatry
The Izaak Walton Killam Hospital for
Children is a new modern, progressive,
324 bed complex located in downtown
Halifax, Nova Scotia, Canada's Ocean
Playground.
The IWK is a full-accredited teaching
hospital affiliated with Dalhousie
University and is the pediatric referral
centre for Canada s Maritime Provinces.
Applications are invited for the position of
Head Nurse for our ten bed child
psychiatry unit.
Qualifications:
Eligibility for registration in Nova Scotia.
Demonstrated skills in teaching and
administration. Previous psychiatric
experience and emotional stability to
make accurate, quick decisions in
emergency situations.
Please apply In writing to:
Personnel Office
IZAAK WALTON KILLAM HOSPITAL
FOR CHILDREN
P. O. Box 3070
Halifax, N. S.
B3J 3G9
Hospital Affiliates
International Inc.
NURSING
CAREERS
United States
Hospital Affiliates International, the leader
in the field of hospital management, has
over 70 hospitals in operation or under
construction in 23 States, with major
requirements in;
ILLINOIS - LOUISIANA
TENNESSEE-ARKANSAS
TEXAS
Please contact our Canadian
representative who will be pleased to
discuss your specific needs. All enquines
will be treated in confidence and should
be directed to;
DOW-CHEVALIER
SEARCH CONSULTANTS
365 Evans Ave.. Toronto M8Z 1K2
416-259-6052
Associate
Executive Director
Applications are invited for the position of
Associate Executive director, Canadian
Nurses Association, Ottawa.
Candidates must be members of the
Canctdian Nurses Association, have a
iiidsters degree or equivalent and have at
least five years administrative
experience. Bilingualism an asset.
Interested applicants are asked to submit
their curriculum vitae, in confidence, to;
Executive Director
Canadian Nurses Association
50 The Driveway
Ottawa, Ontario
K2P 1E2
The Canadian Nurse May 1977
Foothills Hospital, Calgary,
Alberta
Advanced Neuroiogical-
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, September
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
Sudbury and District Health
Unit requires a Public Health
Nurse for service in Chapleau
and surrounding area,
preferably bilingual.
Qualifications:
Baccalaureate degree in nursing
with Public Health content or
equivalent post basic nursing
preparation.
Reply to:
Miss F. Tomlinson
Director of Nursing
Sudbury & District Health Unit
1300 Paris Crescent
Sudbury, Ontario
P3E 3A3
Applications for the
position of
Supervisor
Operating Room and
Recovery Room
are now being accepted by this
300 bed fully accredited hospital.
We offer an active staff
development programme.
Salaries and fringe benefits are
competitive, based on
educational background and
experience. Temporary
accommodation available.
Apply sending complete
resume to:
The Director of Personnel
Stratford General Hospital
Stratford, Ontario
N5A 2Y6
Applications for the
position of
Head Nurse
Rehabilitation and
Extended Care Unit
are now being accepted by this
300 bed fully accredited general
hospital. We offer an active staff
development programme,
competitive salaries and fringe
benefits based on educational
background and experience.
Apply sending complete
resume to:
Director of Personnel
Stratford General Hospital
Stratford, Ontario
N5A 2Y6
Nursing Care
Co-ordinator
We require the services of a Nursing
Care Co-ordinator for our 100 Bed
Auxiliary Hospital. The applicant
should have 3 to 5 years experience
in nursing with a Bachelor of Science
Degree and a background in
Administration and Teaching. Must
also be interested in Rehabilitation
Medicine and Extended Care.
This position is available May or
June.
Please apply to:
Director of Personnel
Red Deer General Hospital
Red Deer, Alberta
T4N 4E7
O.R./P.A.R. Head
Nurse
Required immediately by an
active 1 75 bed acute and 62 bed
Extended Care Hospital. Must be
eligible for B.C. Registration.
Operating room experience
essential. Previous experience in
a supervisory capacity preferred.
Salary $1 ,290 - $1 ,524 per month
(1976 rates).
Apply in writing to the:
Assistant Administrator
Trail Regional Hospital
Trail, B.C.
V1R4M1
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
Closing date for copy and
cancellation is 6 weeks prior
to 1st day of publication
month.
The Canadian Nurses
Association does not review
the personnel policies of the
hospitals and agencies
advertising in the Journal.
For authentic information,
prospective applicants
should apply to the
Registered Nurses'
Association of the Province
in which they are interested
in working.
Address correspondence
to:
The Canadian
Nurse
50 The Driveway
Ottawa, Ontario
K2P 1E2
The Canadian Nurse May is"
Ryerson Polytechnical Institute will sponsor a
15 week course aimed at producing general staff
nurses qualified to work in medical, surgical, or
general intensive care areas starting in
September 1977. Emphasis is placed on
pathotherapeutics and assessment skills and an
integrated clinical experience. Clinical experience
offers ample opportu nity for immediate application
of new knowledge and testing hypotheses.
For further information, contact:
Admissions Office
Ryerson Polyteclinical Institute
50 Gould Street
Toronto, Ontario
M5B 1E8
Grant MacEwan Community College
Edmonton, Alberta
C I il 'f^vites applications for tine Position
CHAIRMAN,
HEALTH SCIENCES DEPARTMENT
The College
Opened in 1971 as a multi-campus institution. The Health Sciences
Department is located on Mill Woods Campus, South East,
Edmonton.
The Chairman
Assumes responsibility under the Campus Director for the following
programs:
• Basic Nursing (R.N.) Program
• Supplementary Nursing Program for Psychiatric Nurses
• Occupational Health Nursing Certificate Program
• Extended Care Nursing Certificate Program
• Refresher Program for nurses.
• Other courses and workshops in Continuing Education for
nurses.
Enrolment
Total of 400 full time and part time students.
Faculty
Full Time — nineteen, including four Section Heads.
Part Time — ten — twelve.
Required Qualifications and Experience
A nurse with a minimum of a Masters Degree in Nursing or
Educational Administration. Several years of nursing, teaching and
administration experience. Community College experience desirable.
Salaries and Benefits
Highly competitive.
Applications plus curriculum vltae to:
P.G. Otke, Ph.D.
Director, Mill Woods Campus
Grant MacEwan Community College
7319- 29 Avenue
Edmonton, Alberta
T6K 2P1
can go a long way
...to the Canadian North in fact!
Canada's Indian and Eskimo peoples in the North
need your help. Particularly if you are a Community
Health Nurse (with public health preparation) who
can carry more than the usual burden of responsi-
bility. Hospital Nurses are needed too... there are
never enough to go around.
And challenge isn't all you'll get either — because
there are educational opportunities such as in-
service training and some financial support for
educational studies.
For further information on Nursing opportunities in
Canada's Norttiern Healtti Service, please write to:
Medical Services Branch
Department of National Health and Welfare
Ottawa, Ontario K1A0L3
Name
Address
City
Prov.
\
1^
Health and Welfare
Canada
Sante et Bien-etre social
Canada
The Canadian Nurse May 1977
EMPLOYMENT OFFERS
New positions to be filled in the nursing sector at
the Head Office of the Order of Nurses of Quebec.
TITLE: Consultant In nursing care programmes
Principal responsibilities
Under the authority of the director of the nursing sector, this
person will act as nurse consultant in matters relating to
nursing care programnnes and the utilization of nursing
manpower; develop new nursing care programmes and
methods of utilizing nursing manpower and participate in the
activities of the sector,
TITLE: Consultant In nursing care
Principal responsibilities
Under the authority of the director of the nursing sector, this
person will act as nurse consultant in matters relating to
nursing care and the role of nurses in various work settings;
clarify the various functions of nurses; and participate in the
activities of the sector.
Qualifications required
• be a member of the Order of Nurses of Quebec
• possess a master's degree in nursing or the equivalent
• have seven years' experience in the field of nursing
• be able to work within a team
Curriculum vltae to be forwarded to:
Executive-Director and secretary of the Order
4200 Dorchester Boulevard West
Montreal, Quebec.
H3Z 1V4
NURSING DIRECTORS
required for
Medicine Hat and District Hospital
This is the active treatment, rehabilitation and extended care portion
of a 567 bed total health care complex in Medicine Hat, Alberta.
A complete reorganization and major expansion of all facilities of the
247 bed active treatment hospital is in progress with concomitant
organization of nursing care programs. Medicine Hat & District
■Hospital is involved in a number of pilot projects in Alberta.
Positions Open
(1) Clinical Nursing Director - Active Treatment Centre
(2) Inservice Director - Staff Development
These are senior nursing positions. Directors report to the Assistant
Executive Director - Patient Services.
A cross appointment in the college nursing program may be
recommended.
Qualifications
A Master of Science Degree in Nursing is preferred.
Advanced clinical knowledge and expertise are required.
Salary
Negotiable,
Submit Resume To
Mrs. Gwynneth Peterson
Assistant Executive Director • Patient Services
Medicine Hat & District Hospital
666 Fifth Street, South West
Medicine Hat, Alberta
T1A4H6
Brandon General Hospital
Department of Nursing Services
Positions Open
CLINICAL TEACHERS:
• Rehabilitation — Extended Care Area
• Maternal — Child Area
To be responsible for the planning and implementation of educational
programs within the defined Area.
Qualifications:
• Advanced preparation and/or experience in the Clinical
Nursing Specialty with a baccalaureate nursing degree
preferred.
• Eligible for registration in Manitoba.
UNIT COORDINATOR:
• Rehabilitation — Extended Care Nursing Unit
To be responsible for the total management of nursing care within this
67 bed Unit.
Qualifications:
• A minimum of two years nursing practice experience in this
Nursing Specialty.
• Advanced educational preparation in this Nursing Specialty
and/or Nursing Administration — a baccalaureate nursing
degree preferred.
• Eligible for registration in Manitoba.
Our hospital is a 433 bed complex including Intensive, Acute,
Maternal-Chikj, Rehabilitation, Extended and Ambulatory Services.
Interested applicants are requested to submit a current resume
outlining experience and educational history to:
Director of Employee Services
Brandon General Hospital
150 McTavish Avenue East
Brandon, Manitoba
R7A 283
DIRECTOR OF NURSING
La Verendrye General Hospital, 107-bed Acute Care
hospital, located on the beautiful International Border at
Fort Frances, Ontario requires a DIRECTOR OF
NURSING.
The hospital is embarking upon an expansion program,
which will include a 37-bed Chronic Ward and
Rehabilitative Program. This position provides an
excellent opportunity to work with a young
administrative team.
Position will include responsibilities for all Nursing
Departments, ana reports directly to the Administrator.
Applicants should have their Bachelor's Degree in
Nursing, and Nursing Administration experience would
also be an asset.
Excellent starting salary and fringe benefits.
Reply to:
K. W. White
Administrator
La Verendrye General Hospital
110 Victoria Avenue
FORT FRANCES, Ontario
P9A 2B7
The Canadian Nurse May 1977
63
O
O
c
o
Associate Co-ordinator —
Community Health Nurse
The City of Vancouver Health Department is seeking
a Community Health Nurse to assist in co-ordinating
a unit nursing programme for one segment of the
City. The Community Health Nurse II will plan, train
and counsel nursing staff and assist in the
administration of the unit. Considerable focus will be
placed on responding to the needs of the community
and to developing nursing staff in order to provide
better nursing services.
Qualifications:
Baccalaureate degree in nursing included or
supplemented by training for community health
nursing practice and completion of post basic
courses in a clinical/functional aspect of nursing.
Preferably a Masters degree with a major in the area
of clinical/functional expertise. Some experience as
a Community Health Nurse.
Salary:
S1380 — S1638 per month (1975 rates) depending
upon qualifications and experience.
Applications should be obtained from and
returned, preferably together with a detailed
resume of education and experience, to the
Director of Personnel Services, Vancouver City
Hall, 453 West 12th Avenue, Vancouver, B. C.
Please quote competition number R-1860.
APPLICATIONS ARE INVITED FOR THE POSITION OF
EXECUTIVE DIRECTOR
The Executive Director is responsible for the ad-
ministration of a staff of 35 persons involved in the
statutory functions and professional affairs of the
provincial association. This includes activities rel-
ated to registration of nurses, educational and nurs-
ing practice issues, and communication with mem-
bers, the public, government officials and others.
Applicants should have a broad nursing background,
proven administrative ability and university pre-
paration, preferably at the master's level. Eligibility
for registration in British Columbia is essential.
The successful applicant will serve as Assistant Ex-
ecutive Director on an interim basis from August 1 .
1977. The interim appointment will continue until
the retirement on September 1 , 1 978, of the incum-
bent Executive Director.
Inquiries and confidential applications which in-
clude resumes and salary expectations may be sub-
mitted to:
Search Committee
Registered Nurses' Association
of B.C.
2130 W. 12th Ave.
Vancouver, B.C. V6K 2N3
PRESTON INSTITUTE
of TECHNOLOGY
Plenty Road. Bundoora. 3083.
Victoria. AUSTRALIA.
Lecturers in Nursing
The Institute offers a tertiary course for basic nursing students, in
conjunction with one of Melbourne's larger general hospitals.
The Institute campus, on 40.5 hectares ( 1 00 acres), is situated 20 km
from the centre of Melbourne, the capital city of Victoria. The Institute
offers Degree and Diploma courses in Applied Science. Art and
Design, Business Studies, Physical Education and Social Work.
The Nursing Department within the School of Applied Science,
offers the Diploma in Nursing, a post-graduate Diploma in Community
Health Nursing, and is developing further courses.
Applications for lecturers in the nursing programme are invited. Each
lecturer will have an area of responsibility, related to his/her particular
interest and expertise. All lecturers will share in the general teaching
activities within the programme, and will be expected to teach and
supervise nursing students within the hospital and community setting.
Applicants must be willing to actively participate in the development of
a new department of nursing.
For two of the positions it is essential to have current expert
knowledge in medical and surgical nursing, and for one of the
positions in paediatric nursing.
Relevant teaching experience would be an advantage.
For all positions it is essential to be eligible for registration as a nurse in
the State of Victoria.
Positions available
Senior Lecturer
(1 position)
Salary range
$A18,795-SA22,010
annually.
Lecturers (4 positions) Salary range
$A11,851-SA18,389
annually.
Appointments will be made in this range depending on qualifications
and experience.
Senior Lecturer:- Shoukl be in possession of a Degree in Nursing. The
appointee to this position will teach and be responsible for part of the
organisation of the first and second year of the programme.
All other positions: A Degree in Nursing is desirable, but applicants
with other Degrees and/or Diplomas who have relevant nursing
experience, may be considered.
ApF>ointments are available on a long term basis or, if desired, on a 2-3
year teaching contract basis.
The salary for an overseas appointee, will be calculated from the
agreed date of embarkation.
Re-location assistance
The Institute has established schemes covering relocation expenses
tor family and household goods, an immediate superannuation
insurance cover, and assistance with accommodation.
Closing date for application is June 17. 1977.
Appointees are expected to take up duties after 1st July, 1977.
Applicants should forward a curriculum vitae, including
personal details, qualifications, experience and references to the
Staffing Officer (Ref. 225), Preston Institute of Technology,
Plenty Road, Bundoora, Vic, 3083, Australia.
The Canadian Nurse May 1977
Health Sciences Centre
requires
Senior Teaclier
ihiensive Cars Nursing Course
Position
Challenging toaching position available immediately for one year
post-basic Intensive Care Nursing Course planned for staff working in
Medica'-Sygical Ir'-nsivs Ca-o Units in two University-affiliated
fiospitals.
Qualifications
De"'0'~straiod oy^'^^'^cn in Intensive Gnre Nursing and teactiing
skills: B.N. with post-basic study in intensive Care Nursing; must be
eligible for registration with the Manitoba Association of Registered
Nurses.
Responsibilities
Incumbent will have opportunity to:
• provide leadership in administration and development of
post-bas'c courfe and continuing education programs.
• collaborate w^h nursing sen/ice to improve patient care.
• participate in didactic and clinical teaching and evaluation of
student progress.
Information
Health Sciences Centre is a 1 300 bed teaching hospital affiliated with
the University of I\/lanitoba.
Salary commensurate with experience and education.
Interested applicants apply in writing to:
Knanager Employment & Training
Manpower Division
HeaKh Sciences Centre
700 William Avenue
Winnipeg, Manitoba
R3E 0Z3
Closing Date: May 27, 1S77
Director of Nursing - Psychiatry
University of British Columbia Health
Sciences Centre
Applications are invited for the position of Director of Nursing for this
progressive university psychiatric unit offering a variety of inpatient
and outpatient prog'ar^mss. This 50-bed unit is part of a projected
600-bed university health sciences centre complex. The position of
Director of Nursing offers a challenging opportunity to exercise
administrative skills in collaboration with colleagues from a variety of
disciplines. An appointment in the School of Nursing accompanies
this position.
Qualifications:
Candidates should have a Master's degree in nursing with
considerable administrative and clinical experience in psychiatric
settings. Candidates must also be eligible for licensure in British
Columbia. Salary will be commensurate with qualifications and
experience.
Please apply c/o:
Dr. Beverlee Cox, Chairperson
Search Committee
University of British Columbia
School of Nursing
Vancouver, B.C.
V6T 1W5
Index to
Advertisers
May 1977
Abbott Laboratories
Cover 4
Ayerst Laboratories
48, 49
The Canadian Nurse's Cap Reg'd.
57
The Clinic Shoemal<ers
2
Connaught Laboratories Limited
14, 15
Equity Medical Supply Company
17
Health Care Sen/ices Upjohn Limited
55
Hollister Limited
Kendall Canada
Lowell Shoe Inc.
17
Cover 3
The C.V. Mosby Company Limited
National Society of Published Poets, Inc.
52, 53
54
Nordic Pharmaceuticals Limited
56
Reeves Company
W.B. Saunders Company Canada Limited
Simpsons-Sears Limited
5
White Sister Uniform Inc.
Cover 2
Advertising
Gerry Kavanaugh
The Canadian Nurse
50 The Driveway
Ottawa, Ontario K2P 1 E2
Advertising Representatives
Richard P. Wilson
219 East Lancaster Avenue
Ardmore, Penna, 19003
Telephone: (215) 649-1497
Gordon Tiffin
2 Tremont Crescent
Don Mills, Ontario M3B 2S1
Telephone: (416) 444-4731
Member of Canadian
Circulations Audit Board Inc.
nmn
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Naturally, it took
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much lightness,
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Even more
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That's how you'll recog-
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with the light look you'd
expect from Day-Lites^.
The people who make shoes
for individualists. Who happen
to be in uniform.
DAY LITES ' AVAILABLE AT:
HALCO SALES, Mississauga, Ont.
MELONEYS LTD., No. Sydney, N.S.
LADY MAE UNIFORMS LTD., Vancouver, B.C.
THE SHOE TREE, Sydney N.S.
SALON DUCHES. La Turque, Quebec
UNIFORM WORLD. Renfrew, Ont.
LADY MAE UNIFORMS LTD., Victoria, B.C.
C T L UNIFORMS LTD., Toronto, Ont.
SHOELAND LIMITED, Battiurst. N.B.
PAUSH FINE SHOES, Edmonton, Alberta
SEARLES SHOES, Courtenay B.C.
MCRAES SHOE STORE, Campbellton, N.B.
LECHAT, Shedias, N.B.
PEACE VALLEY SHOES LTD., Peace River, Alta
For the Indixidualist.
Who IlaiJiJens to be in t nifi)mi.
Lowell Shoe Inc.
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AVAILABLE AT LEADING DEPARTMENT STORES AND SPECIALTY SHOPS ACROSS CANADA
tHe eanatiiaMB
ntBmmo
June, 1977
The official journal of the Canadian
Nurses Association published
monthly in French and English
editions.
Volume 73, Number 6
^^^^^^^^^^^^^^H
Input
4
News
6
Names
12
Calendar
39
Whafs New
40
Frankly Speaking:
Nora J. Briant
13
Audiovisual
42
Cystic Fibrosis
— Camp Couchiching
J. Karen Scott
14
Research
43
A Quiet Day
Sharon McKenna
20
Books
45
Anorexia Nervosa
Barbara Butler,
Mary Jane Duke, Tony Stovel
22
Library Update
48
We Took Physical Fitness
to the County Fair
K. Desai. P. Hotchkiss,
G. Fletcher. B. McCann
26
Nursing the Alcoholic Patient
Arlee McGee
30
Idea Exchange: Cored Particles
Michel C. Bessette
34
Care vs. Custodialism
J. Berezowsky
36
Clinical Wordsearch#6
Mary Bawden
38
That's camper Norbert Kratz smiling at
you from the cover of this months
issue. Norbert was a camper at C.F. —
Camp Couchiching, a camp for
adolescents with cystic fibrosis. The
author of Four Summers, J. Karen
Scott, has been nurse-in-charge of
C.F. — Camp Couchiching since its
opening four years ago. Karen shares
some of her experiences with you in
an article beginning on page 14.
The views expressed in the articles
are those of the authors and do not
necessarily represent the policies of
the Canadian Nurses Association.
ISSN 0008-4581
Indexed in International Nursing
Index. Cumulative Index to Nursing
Literature, Abstracts of Hospital
Management Studies. Hospital
Literature Index. Hospital Abstracts.
Index Medicus. The Canadian Nurse
IS available in microform from Xerox
University Microfilms. Ann Arbor.
Michigan, 48106.
The Canadian Nurse welcomes
suggestions for articles or unsolicited
manuscripts. Authors may submit
finished articles or a summary of the
proposed content. Manuscripts should
be typed double-space. Send original
and carbon. All articles must be
submitted for the exclusive use of The
Canadian Nurse. A biographical
statement and return address should
accompany all manuscripts.
Subscription Rales: Canada: one
year. S8.00: two years. S15.00.
Foreign: one year. S9.00: two years,
S17.00. Single copies: Si. 00 each.
Make cheques or money orders
payable to the Canadian Nurses
Association.
Change of Address: Notice should be
given in advance. Include previous
address as well as new. along with
registration number, in a provincial/
terntorial nurses association where
applicable. Not responsible for
journals lost in mail due to errors in
address.
Postage paid in cash at third class rate
Montreal, P.O. Permit No. 10,001.
' Canadian Nurses Association
1977.
^ Canadian Nurses Association.
"S* 50 The Driveway, Ottawa, Canada,
IXOD ^ CO
The Canadian Nurse June 1977
SOME STYLES ALSO AVAILABLE IN COLORS ... SOME STYLES 3"2-12 AAAA-E, About 26.00 to 37.00
For a complimentary pair of white shoelaces, folder showing all the smart Clinic styles, and list of stores selling them, write:
THE CLINIC SHOEMAKERS • Dept. CN-6 7912 Bon homme Ave. • St. Louis, Mo. 63105
The Cana<lian Nurse Jun« 1977
IVi'speelive
World Environment Day
— June 5, 1977
The United Nations Environment
Programme, established by the UN in
1972 and now located in Nairobi,
Kenya, points out that:
The environmental crisis has different
causes in different parts of the world.
In some nations it is the result of
inappropriate development: in still
others, a result of
under-development. Logically, the
symptoms of the crisis will vary
tremendously around the world: in
one area desertification, in another
contamination of water, in yet another
energy wasfe. Throughout the world,
however, there is one clear message
— sustainable development is
impossible if we are insensitive to our
environment
This month we opened u p our summer
cottage in preparation for the warmer
months ahead. Each year this
time-honored ritual gives me a quiet
satisfaction that lies almost forgotten
in my subconscious mind until next
years performance reminds me again
just how closely I am bound to this
particular few acres of rocky land with
its pine trees and bit of sandy beach.
This year I thought "this is what people
mean when they talk about your own
space and getting to know that
space.
After nearly four decades, there is
not a sound in that space that I can't
identify — from the whir of a partridge
on the hillside to the peeping of the
spring frogs. Not a rock I haven't
stubbed my toe on at one time or
another. Not a tree whose growth I
can't measure against the year before.
'Ves, this is my space and I know it
well. I can walk its paths on a
moonless night and find my way
among its natural obstacles.
This year as I renew my
knowledge of my space I wonder
about the space that children of the
next generation will inherit. I think of
the population centers of the workj —
Tokyo, New York, London — of the
way our own Canadian cities have
grown more crowded in recent years.
I remember that even now the
provincial government is debating
whether or not to ban sport fishing in
this lake and hundreds of others like it
in the province. A document prepared
by the Ministry of Natural Resources
and submitted to the Cabinet last
summer is supposed to have warned
that if it continues to permit fishing for
contaminated species "some of the
public will conclude the Government
has no concern for the health of the
general public."
I remember, too, that less than 25
miles away the residents of a small
town spent last winter fighting
attempts to turn the outskirts of their
village into a dumping site for nuclear
waste.
I wonder how many of the
cottages on our lake have inadequate
waste disposal systems and how
many cottage owners will neglect to
send a sample of the water from their
well for testing this year.
I remember that back at home
there is a strong probability that none
of the dozen beaches in the immediate
Ottawa area will be open for swimming
this year.
Wherever it happens to be, each
of us has a space that is uniquely ours
but our position in that space can no
longer be taken for granted. Our
environmental resources, like our
own physical resources, are finite:
they are ours to enjoy and to pass on
to our children only to the extent that
we preserve and protect them and
teach our children to do the same.
— M.A.H.
Editor
M. Anne Hanna
Assistant Editors
Lynda Ford
Sandra LeFort
Production Assistant
fi/lary Lou Downes
Circulation Manager
Beryl Darling
Advertising
Gerry Kavanaugh
CNA Executive Director
Helen K. Mussallem
lliM-eiii
One of Canadian novelist Margaret
Atwood s eariiest works, "The Edible
Woman " concerns itself with the
problems of a young woman who, a
willing member of a consumer society,
suddely finds herself identifying with
the things consumed.' The heroine,
Marian, tries to descnbe what has
happened to her: "I can t eat certain
things: I get this awful feeling ... things
I used to be able to eat. It isn t that I
don t like the taste: its the whole ..."
Self-starvation holds a degree of
fascination for all of us but it is of
spedal interest to nurses who find
themselves caring for a victim of
Anorexia Nervosa — like the nurses in
Vancouver who wrote the article that
begins on page 22 of this month's
issue.
Congenital dislocated hip is a
significant condition affecting 1.5 to
1 .7 infants of every 1 ,000 born. Unless
treated very early in the infant s life, it
has the potential to become a
seriously crippling disability. Next
month, author Celia Nichol talks
about early signs of the disease, its
treatment, and the supportive and
practical ways in which a nurse can
help parents of a child with CDH.
The Canadian Nurse June 1977
The Canadian Nurse invites your
letters. All correspondence is subject
to editing and must be signed,
although! the author's name may be
withheld on request.
Input
Editor's note: The following letter
from ttie Commissioner of the federal
Law Reform Commission was
received by the executive director of
the Canadian Nurses Association
following a meeting in mid-April.
Protection of life
The Law Reform Commission of
Canada will be u ndertaking a series of
research studies on the protection of
human life with a view to ascertaining
whether or not the present law, and
more particularly the criminal law, can
adequately meet the challenges
created by modem medicine and
science.
It is hoped that these studies will
also serve to encourage a frank
dialogue between the various
segments of the Canadian population
on certain topics which, as presented
by the press, are often misunderstood
or over-simplified due to ignorance of
many of the relevant implications and
complexities.
The project is entitled,
"Protection of Life, " and will have a life
span of at least three years in its first
phase.
This first phase will center around
four major issues:
• Legal definition of death: Should
the law define death for legal
purposes?
• Euthanasia: The right to refuse
treatment, the right to "die with
dignity," the termination of
extraordinary means of life support,
etc.
• Human experimentation: Its
legitimacy, its limits, the ways of
control, etc. ...
• Behavior and personality
control: Psychosurgery, drugs,
aversion therapy techniques; their
legitimacy, their limits, etc. ...
Other research will be done on
subjects, such as homicide, informed
consent and the philosophy of our
criminal law on the protection of the
human person.
I am aware that these subjects
are of direct interest to nurses. Their
privileged position in health care has
made them acutely and directly aware
and exposed to most of these
problems, both in their human and
scientific dimensions. The opinions,
suggestions and reactions of nurses
would for that reason be very useful to
us.
On the other hand, in order to be
accurate, credible and convincing, this
research and our eventual proposals
must be based uponprec/se facts. It is
therefore of utmost importance to us to
determine what exactly are the current
practices and procedures in Canada
in the subject areas indicated above.
We would be happy to consult
and hear from you. Individual
Canadian nurses should
communicate with their national
association directly. I might add that I
and the members of the project staff
would be very willing to travel to
various regions of Canada for
purposes of consultation, should you
deem it advantageous.
— Jean-Louis Baudouin.
Commissioner, Law Reform
Commission, i\/lontreal. Que.
A gut reaction
I would like to add my name to
those who are uncomfortable with
your present policy of using bare
surnames in The Canadian Nurse. I
get a very uncomfortable "gut feeling"
when this happens especially if this
relates to someone I especially admire
and hold in high esteem i.e. Dr. J.
Flaherty or Dr. M. Allan.
To me the u se of surnames only is
depersonalizing and disrespectful. I
am reminded of an instance when I
was a head nurse on a psychiatric unit.
A new student nurse on affiliation
wanted to get the attention of a
psychotic patient at the other end of
the corridor. She simply yelled
"Brown, come here." I have never
forgotten the look of shock on that
lady's face.
Like Bonnie Hartley I have not
adapted to the use of surnames only,
as I expected I would eventually. I
sincerely hope this practice can be
changed.
— Ivy H. Dunn, Ottawa, Ontario.
Congratulations!
Many changes have been noted.
The covers are colorful; the articles
are Informative and challenging; the
news items are exciting and a means
of good communication.
Best wishes for continued
success to you and your staff.
— Seffy l^acEachern, B.N.,
Associate Director of Inservice
Education, Prince Edward Island
Hospital, Charlottetown, P.E.I.
The natural way
I am disturbed by the conclusion
of. Fetal Monitoring — Why Bother? "
(March, 1977): "the evidence in favor
oi routine fetal monitoring is strong."
This article includes, as part of the
evidence, a table of 1973 Perinatal
Mortality Statistics showing Canada
behind seven other countries. (Six of
these countries also had lower
Perinatal Mortality Statistics in 1971
when Canada was fifteenth).
Surely if we are trying to "ensure
the welfare of our unborn children" we
should look at the childbirth practices
of these countries. Without exception,
the outstanding feature is the
conspicuous absence of drug-induced
labors, fetal monitors and other
tinkering with the natural process of
normal births. This combined with
prenatal training for both parents and
good support by professionals would
appear to offer more hope for a
healthier, happier childbirth
experience and outcome for all
concerned.
— Meg Purdy, North Bay, Ont
Hemophilia society
As national president of the
Canadian Hemophilia Society, I am
writing this letter in the hope that we
can locate all persons afflicted with
this condition.
Hemophilia can be a crippling,
life-threatening disease unless
prompt and adequate care is received.
In the last few years, new blood
concentrates and methods of
treatment have been announced
which can lead to a fully productive
life. The only barrier is knowledge.
We wish to encourage
hemophiliacs, or anyone knowing a
hemophiliac, to contact us.
During the summer of 1977, we
will be conducting a nationwide project
to ensure that all hemophiliacs are
made aware of current treatment
methods. All information thus
obtained will be confidential.
To help us control this crippling
disease, contact us immediately.
— Ronald E. George, President,
Canadian Hemophilia Society,
Chedoke Centre, P.O. Box 2085,
Hamilton, Ontario, L8N 3R5.
Offensive ads
I am a community health nurse
who finds at least one article in eac
issue of The Canadian Nurse that ha
direct application to my wori<. Other
are helpful in updating general
knowledge and nearly all are of
Interest to me..
I am disturbed by the fact that ir
the March issue two advertisements
appeared which I find offensive. On
of these shows two nail-polished
braceleted young women wearing
nurses' uniforms. Another shows a
child dressed as a nurse encouraginc
us to buy shoes.
Please, nurse are adult
professional people. We should neve
forget that and nor should our
magazine. I am appalled that The
Canadian Nurse accepts such
advertising.
— Heather J. Leighton, R.N.,
Vancouver, B.C.
Making hay ...
I was disappointed to read in "
Program that Dares to be Different'
(March, 1977) that Okanagan Col lee
has fallen into the trap of making
summer semester work in a nursini
setting compulsory. While I would
never discourage a student from
wori<ing in a hospital during her
vacations, I would also assure berth:
there are many other activities and
types of wori< which will not only het'
her mature, but also broaden her
horizons.
I think teachers have a
responsibility to encourage studen'
to use their youth and zest for
life to travel, try new activities, and
question their goals before they
become locked into full-time
employment. There's always time
after graduation to perfect manual
dexterity and efficiency!
— Margaret L Wray, R.N., B.N.,
Ob. iGyn. Nursing Instructor,
l\/lontreal, Quebec.
On the bright side
...The facelift surely makes th
magazine attractive. It gives you £
feeling of anticipation about the gc
reading inside. However I would lik(
make a suggestion: how about apa
or two devoted to the funny
experiences that nurses have?
— A. Catindig, R.N., Windsor,
Ontario.
When you rely on Saunders texts • . .
The Nursing Clinics of North America
These quarterly symposia keep you informed on the most important
changes in clinical nursing practice. The March 1977 issue focuses
on Peripheral Vascular Disease with Dorothy L. Sexton^guest
editor; and on The Minority Patient: Cultural and Racial Diversity.
Other 1977 symposia will discuss; Primary Nursing: Diseases of the
Liver; Patterns of Parenting: Diabetes; and other vital nursing topics.
By respected nursing authorities. Published quarterly: March, June, Sept..
and Dec. Hardtxjund. Contains no advertising. Averages 185 pp. Illustd.
$18.90 per year's subscription. (Subscriptions can be obtained at a saving
of $1.60 by sending a check for $17.30 along witli your subscnption
request.) Order#0003-3.
STRIKER: Rehabilitative Aspects of Acute and
Chronic Nursing Care, iVeiv 2nd Edition
In this particularly thorough revision, the author has integrated
important information on geriatrics into every chapter. She also
has included new chapters on Maintaining Human Sexuality, and
The Elderly in the Community, as well as vastly increasing the
pertinent coverage of psychological reactions to physical disability,
planning patient care, communications disorders, assisting with
bowel and bladder problems, and positioning and skin care.
By Ruth Stryker, RN, MA, School of Public Health, Univ. of Minnesota,
Minneapolis. About 305 pp., 105 il'. About $11.30. Ready June 1977.
Order #8637-0.
Du GAS: Introduction to Patient Care,
New 3rd Edition
This brand new edition contains additional material on the health
care system, major health problems, and the role of the nurse.
Entirely new chapters on Nursing Practice, Communication Skills,
and Sensory Disturbances, more than 70 new photographs, and its
considerably expanded glossary make this revision an even better
text to learn the fundamentals of nursing. A Teacher's Manual will
be available.
By Beverly Witter Du Gas, RN, MN, EdD, LLD. Health Science Educator,
Pan American Health Organization, Barbados, Regional Allied Health Proj-
ect. About 685 pp., 240 ill. (78 in color). About S12.40. Ready June 1977.
Order #3226-2.
LEIFER: Principles and Techniques in Pediatric
Nursing, New 3rd Edition
This comprehensive clinical nursing text and reference bridges the
gap between theoretical knowledge of and practical skills in pediat-
ric nursing. Completely up-dated and substantially expanded, you'll
find added coverage of new equipment, inhalation therapy, dietary
considerations, poisoning, drug interactions, and a whole new chap-
ter on The Pediatric Outpatient and the Clinic Nurse.
By Gloria Leifer, RN, MA, formerly of Hunter College of CUNY. 321 pp. 184
ill. April 1977.
Hardcover: $9.25. Order #5713-3.
Soft cover.- $7.75. Order #5719-2.
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SAUVE &■ PECHERER. Concepts and Skills in
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This book can save you valuable time in teaching the basics
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By Mary Jane Sau«6, RN, BSN, fyiSN, Asst. Prof, of Nursing, Calif. State
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tion. Spokane, Wash. 427 pp. Soft cover. $11.30. Feb. 1977.
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WOOD e- RAMBO: Nursing Skills for Allied Health
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The Canadian Nurse June 1977
^i*\VH
Jocelyn HezeKiah
RNAO delegates prepare
now for future shock
The many faces of reality — 1 977 style
— were tfie object of close scrutiny by
close to 1200 Ontario nurses and
student nurses who attended the 52nd
annual meeting of their professional
association in Toronto April 27 to 30.
On the minds of the RNAO members
were a variety of immediate concerns
that will have a direct bearing on the
future of nursing practice in that
province.
Acting on these concerns,
delegates gave their collective
approval to:
• collaboration with the medical
profession in plans to improve the
province's health care delivery
system;
• an educational program to inform
the public of the RNAO's historical
position supporting the principle of
collective bargaining for nurses and
the association's role in the
establishment of the Ontario Nurses
Association;
• protection of the public in the area
of non-prescription and
over-the-counter drugs;
• efforts to amend the new Ontario
Health Disciplines Act to provide for a
clause governing conflict between the
professions and to reach an
agreement with the medical
profession on the transfer and
delegation of medical acts to nurses;
• action by the Board urging the
Ministry of Health to more effectively
utilize community health workers in
the promotion of health and
prevention of disease;
• recognition of public health,
visiting nurses and occupational
health nurses as essential health care
workers;
• a program of public action
advising the consumer of the
advantages of receiving professional
care given by RNs and RNAs;
• amendment of regulations under
the Public Hospitals Act to ensure that
hospitals employ only RNs, RNAs
and/or nurses and nursing assistants
whose registration is pending;
• assuming leadership in
sensitizing health professionals to
moral and ethical issues related to
Protection of Life;
• participation in revision of
Standards of Nursing Practice at
provincial and local levels.
In addition, delegates learned
that two official statements concerning
the RNAO position on the role of the
nurse as a patient advocate and
competency in cardio-pulmonary
resuscitation had been approved by
members of the Board of Directors at a
meeting the day before the
conference opened . The statement on
cardio-pulmonary resuscitation
supports the College of Nurses in its
stand that all registered nurses must
possess competency in resuscitation
measures, including artificial
respiration (mouth to mouth) and
external cardiac massage. Basic life
support was declared a first aid
procedure rather than a medical act in
Ontario in November, 1976.
Citizens' Council
Helping nurses to keep in touch
with reality in the future will be a
Citizens' Advisory Council whose
membership includes a cross-section
of men and women from education,
business, the community, labor and
media. In announcing the names of
the new council members, RNAO
president Norma Marossi said:
"Input from the council is one way
we will ensure that the nursing
profession stays in tune with today's
needs. Members were chosen from
individuals who, because of their
particular interest, experience and
background, can provide guidance
thereby ensuring that the Association
and the profession remains aware of
and up-to-date on the health needs
and concerns of the community. " The
council will hold its first meeting in the
Fall.
RNAO members learned during
the meeting that Maureen Powers,
director of nursing at the Eastern
Ontario Children's Hospital in Ottawa,
had been named to succeed Laura
Barr as executive director of the
association. Powers will assume
responsibility for this position
September 6, 1977. (See page 12)
■Hi
Dealing with the realities of
achieving social change was the topic
of guest speaker Aileen Nicholson,
MPP, at the luncheon held on the
closing day of the convention. She told
the nurses in her audience that they
should make better use of the
advantage provided by their
professional training in dealing with
politicians. "Nurses-learn early to
combine the use of authority with
being helpful but the same easy,
pleasant assurance that characterizes
the nurse-patient relationship is not
always apparent in their work as
advocate on behalf of these same
patients. " Nicholson went on to outline
a number of tips members of
professional associations might
consider in order to increase the
effectiveness of their politicking.
These included: dealing openly and
amicably with the government of the
day, "even if it is not your favorite
political party," getting to know the civil
servants concerned, and developing
on-going constructive relationships
with various levels of government to
whom briefs are presented.
Briefs, she stressed, should be
based on systematic analysis and
incontrovertible facts. They should
offer constructive solutions and, most
important, specific alternatives on
contentious issues. "In conclusion,"
Nicholson said, 'don't let anyone tell
you that you are politically
inexperienced. If you have mastered
hospital or university politics,
parliament will present no problems."
At the conclusion of the
convention, Irmajean Bajnok, was
installed as president for the coming
biennium. The new president is
assistant professor in the Faculty of
Nursing at the University of Western
Ontario. During the convention,
delegates also elected a new
president-elect for the 1977-79
biennium. She is Jocelyn A.
Hezekjah, chairman of the basic
nursing program. Humber College of
Applied Arts and Technology in
Toronto.
Outgoing president Norma
Marossi, in her address to delegates,
stressed the unique position of RNAO
among the other ten member
associations of the Canadian Nurses
Association because of the
jurisidictional split between the RNAO,
the College of Nurses and the Ontario
Nurses Association. Leaders and
members of these three groups, she
said, should periodically pause to
discuss their respective objectives,
the relevancy of their programs and
accountability to members.
"While the goals of the three groups
may vary, " she said, "We are
members of the same league. We
must continue to demonstrate that this
tripartite model effectively serves the
citizens, the nurses and the profession
in Ontario."
Marossi called on nurses in the
province to develop a
"comprehensive quality assurance
program " encompassing standards of
nursing care, nursing education,
performance appraisal programs,
objective measurement of quality of
care, maintenance of competency and
professional accountability. She
described the proposed program as
"probably too grand and too important
to be attempted by any one body in
isolation" but stressed that the RNAO
should "take its rightful role of
leadership and coordination. "
Speakers at the concurrent
sessions on health and social issues
were; Shirley Wheatley, supervisor of
Family Planning Services,
Department of Public Health, Toronto;
Frederick Funston. consultant.
Addiction Research Foundation;
Catherine MacGregor Keyes, director,
Public Health Nursing,
Ottawa-Carieton Regional Health
Unit, Ottawa; Karyn Kaufman, clinical
nursing specialist, McMaster Medical
Centre, Hamilton.
"The individual copes with
today's realities" was the subject of a
growth and development session led
by two nurses. Gall Conner,
chairperson, Nursing Department,
Ryerson Polytechnical Institute in
Toronto, and Paula Goering, an
instructor in the Faculty of Nursing at
the same school.
An international overview of
nursing care was presented to the
delegates by the third vice-president
of the International Council of Nurses,
Verna Huffman-Splane. Splane, who
is currently a special lecturer on
national and international nursing at
the University of British Columbia's
School of Nursing, reminded her
audience that "more than half of the
world population now receives either
minimal or no health care. "
The Canadian Nurse June 1977
Toron:
Coping with Cancer:
a symposium for
everyone
A three-day Symposium on Coping
with Cancer brought over 400 people
from all parts of Canada to Toronto in
April. The meeting, sponsored by the
Canadian Cancer Society, involved
memtsers of the medical, dental and
lursing professions, social workers,
[heologians, and volunteers and staff
3f the Canadian Cancer Society, who
•net to take a comprehensive look at
[he many special problems related to
:oping with cancer.
Prevention was the first aspect of
Dancer to be discussed, with lay
sducation, industrial environmental
Droblems and screening being major
Donsiderations. The remainder of the
:onference dealt with the most
affective ways to help the cancer
Datient and his family, and it included
Sscussions on emotional problems of
ihose who work with cancer patients
an a voluntary or professional basis.
The often neglected human
aspect of cancer treatment was
3erhaps best presented by Henry
^iney, a radio and television
sportscaster from Calgary, Alberta.
His wife died of cancer two years ago.
Beginning "...Mine is not a pleasant
story," Viney described his painful
nability to support his wife when they
iioth realized that she was dying of
cancer "...and we both knew, and still
never discussed death."
Viney expressed the hope that
Derhaps his story might help others to
Jo a much better job of supporting the
Dancer patient and his family than he
lad been able to do. A social worker, a
Datient, a family physician and an
Dncologist discussed their
approaches to helping the newly
diagnosed cancer patient.
The practical problems of the
individual who has been successfully
treated for cancer were also
considered from a number of
standpoints. Emotional adjustment,
3mployment, insurance and
'ehabilitation. and the role of self-help
groups were discussed by those
nvolved in each sphere of cancer
'ecovery.
The conference also provided an
afternoon to discuss helping the
patient and family when curative
measures fail. How to tell the patient
was just one of the concerns
discussed. Palliative care, the role of
the clergy, the role of the friend and
family, were also considered.
Mary Vachon, a nurse and
sociologist with the Clarke Institute of
Psychiatry spoke about the stress
widows face when their husbands
die of cancer, those who must stand
by helplessly as their husbands cope
with pain, deterioriation, and the threat
of impending death. She spoke about
the feeling that these women have of
being left on their own as death
approaches. The information that she
gave came from the first in-depth
study of Canadian widows, a study of
Canadian widows, a study carried out
so that professionals could change
their approach to prevent or alleviate
suffering for future patients and their
families.
Topics for discussion were
arranged in units, and each topic was
followed by a question period, so that
those attending the conference were
able to voice their concerns about
coping with cancer. Certainly the
symposium met its objectives by
increasing the knowledge of the
delegates with regard to the broad
spectrum of problems surrounding
cancer, increasing their knowledge of
social and economic rehabilitation of
cancer patients, and providing a fonjm
for continuing education.
NLN elects man
as vice-president
The National League for Nursing in the
United States (NLN) has, for the first
time in its 25-year history, elected a
man to the position of president-elect.
Matthew F. McNulty whose election
was announced during the League's
recent convention and exhibition, is
chancellor of the Georgetown
University Medical Center in
Washington, D.C.
The new president of the NLN is
Sylvia R. Peabody. executive director
of the Visiting Nurse Association of
Detroit.
The NLN has its headquarters in
New York City and is a membership
organization dedicated to meeting the
health needs of the people by
improving nursing education and
nursing service.
OR nurses hold
10th conference
Approximately 500 nurses from
across Ontario, other parts of Canada
and some areas of the U.S. met in
Toronto to attend the Tenth
Conference of the Operating Room
Nurses of Greater Toronto held April
25-27. Those at the meeting took a
look at topics of current interest to the
O.R. nurse — what O.R. nursing is
now and what it could be in the future.
The conference, opened by Mary
Wakefield, began with a panel
discussion and question period that
looked into the problems of working in
a smaller hospital and trying to prevent
duplication of services, the difficulties
in setting up operating rooms in a new
hospital, how it feels' to be an OR.
staff nurse and, from the government
side, the problem of cost containment
in health care generally.
A wide variety of topics were
discussed at the three-day meeting,
everything from the latest
developments in reconstructive
surgery to a look at "working
relationships " in the O.R. between
nurses and doctors. Nurses also had
an opportunity to speak with over 60
suppliers and manufacturers of O.R.
equipment and to see their newest
products on the market.
The Operating Room Nurses of
Greater Toronto started as an interest
group in 1959. Now, with
approximately 1 85 members they hold
educational meetings four times a
year, and larger conferences every
one or two years. Their most important
project to date has been the
publication of a booklet on standards
of practice for operating room nurses.
Two-and-one half years ago, a
Standards committee, headed by
Faye Trouten, was formed
representing seven hospitals in the
Toronto-Hamilton area. Members of
the group were (from left to right, front
to back): Pat LeBlanc. Carol Potter.
Norma Williamson. Mable Kotyk. Flo
Bestic, Faye Trouten, Mary Barnes.
(Absent: Margaret Porter. Helen
Gibson. Bev Schmocker). The
booklet will serve as a useful guideline
for any operating room wishing to
establish standards of practice on
which to evaluate staff competency.
For copies, send S2.50 to: Mrs.
Jean Mitchell, President, Operating
Room Nurses of Greater Toronto,
North York General Hospital, 4001
Leslie Street, Willowdale, Ont.
M2K 1E1.
Operating Room Nursing groups
are active in every Canadian province
and will be meeting together next year
in Halifax at a national convention.
NBARN presents brief
to education committee
No major changes are needed in the
New Brunswick nursing education
system according to the province's
professional nursing association. The
conclusion is contained in a brief
presented recently by the New
Brunswick Association of Registered
Nurses to the Maritime Provinces
Higher Education Commission.
The brief points out that New
Brunswick now offers two types of
nursing education programs, the
two-year diploma and the four-year
university. These programs are
provided in educationally-controlled
institutions and in both languages.
According to the brief, the past year
has mari<ed the end of an era in
diploma nursing education, with the
completion of the transition from
three-year to two-year nursing
schools.
Although the present system is
adequate and able to meet the
challenges of evolving health
services, according to the brief, there
is work to be done to improve the
quality and relevance of the programs.
This is an on-going process and one
that is basic to the fundamental
purpose of the NBARN.
NBARN officials identify a
number of concems in the brief,
including the number of applicants to
schools, especially French-language
applicants ; facilities for the Saint John
School of Nursing: high cost of
education for university nursing
students: supportive research;
continuing education for nurses: and
nursing manpower and the
employment situation.
The Canadian Nurse June 1977
Xews
A group of Canadian delegates to the
1 977 Annual Meeting of tfie American
Association of Neurosurgical t\lurses,
held at the Hotel Toronto in April. The
Keynote Address for the meeting was
delivered by the Honorable Pauline
M. McGibbon, Lieutenant-Governor
of Ontario, to about 400 members of
the A.A.N. N. from all parts of the
United States and Canada. The
meeting was educational in nature,
covering a number of concerns faced
by nurses working in neurological and
neurosurgical units. It was held in
conjunction with a meeting of the
American Association of Neurological
Surgeons.
(Photo by S. Emond)
Roundup of
critical issues
CNA's March annual meeting wound
up on a lively note with a panel
discussion by five members of CNA's
Executive Committee.
The discussion, entitled "Critical
Issues in Nursing," was moderated by
second vice-president Sheila O'Neill
of Montreal. Each of the four panel
members identified developments
particular to their area that they
viewed as crucial to the future of the
nursing profession.
Helen Glass, of Winnipeg,
Manitoba, began the discussion by
identifying the need to examine all
present levels of nursing education
(including continuing education) with
the aim of incorporating change where
necessary. She brought to light a
number of questions facing nursing
education now, questions involving
the direction it will take, questions that
need answers that will keep in mind
the needs of the student and the
needs of society. One of the present
problems, she said, is the lack of
graduate schools for teachers or
practitioners in Canada.
Barbara Racine of New
Westminster, B.C., member-at-large
for nursing administration, spoke of
the important questions facing nursing
administration in a decade when
nurses "had taken the starch out of
their uniforms and put it into their
backbones." She said that the present
tendency to compartmentalize within
the nursing profession — for example
into management and union — had to
be overcome by recognizing intemal
indicators, those aims that are
common to all nurses. She spoke of
the necessity for the nursing
administrator to use her powers in the
best interests of nursing and the
patient. This could involve defending
the nursing budget in the face of
govemment cutbacks, using a
position on a hospital board to express
the needs of herstaff and concerns for
standards of care, and using a
collective contract as a legal means to
hold nursing accountable.
Linda Gosselin of Thunder Bay,
Ontario, member-at-large for social
and economic welfare, also spoke of
the need for a resolution of conflicts
between nursing management and
staff. The solution to the problem
between the two sides of the
bargaining table, she said, lay in the
realization that "we are all on the same
team," with the same goal, quality
patient care.
Member-at-large for nursing
practice Lorine Besel of Montreal,
discussed the moral issues presently
confronting nursing practice. Her
concern about fragmentation of
nursing care, professional honesty,
and the moral issues of nursing, was
beautifully illustrated through the use
of a case study of a particular patient
and the involved response of a student
nurse.
B.C. nurses accept
two-year contract
Nurses employed by the provincial
govemment have voted by 96 percent
to ratify a 1 976-77 contract negotiated
with the B.C. Govemment Employee
Relations Bureau (GERB).
The April ratification vote marked
the end of 18 months of on-and-off
negotiations. In March the nurses
threatened strike action before GERB
would resume the negotiations it had
broken off in December. The 2,600
nurses have been without a contract
since October 31, 1975.
The two-year agreement is worth
14 percent, the maximum allowed by
federal anti-inflation guidelines,
averaging 8 percent for 1976 and 6
percent this year. The compensation
package is a combination of salary
increases, benefits and cash
payments.
The agreement covers 1,600
registered psychiatric nurses and
1,100 registered nurses wori<ing in
provincial govemment psychiatric
facilities and public health units
throughout the province. They are
represented jointly by the Registered
Nurses' Association of B.C. and the
Registered Psychiatric Nurses
Association of B.C.
Alberta nurse educators
form new association
Directors of nursing in the province of
Alberta have joined forces to facilitate
improvements in education programs
in their province. The name of the new
group is the Consortium of Nurse
Educators (COSNE). Its members are
the persons responsible for
administration of professional nursing
education programs in the 13 Alberts
institutions that offer diploma,
baccalaureate or graduate programs
in nursing.
The purpose of COSNE is to
provide an opportunity for members to
share ideas, act as a resource group
and provide direction to appropriate
bodies in matters related to nursing
education in the province of Alberta.
Contact is invited and may be made
through any member or the current
chairman, Shirley Shantz,
Coordinator-Nursing, Red Deer
College, Red Deer, Alberta.
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10
The Canadian Nurse June 1977
Xews
Family life delegates
examine health care
One of the major stumbling blocks in
the path of development of an
effective health care system in this
country is a tendency to define the
caring function as existing only
outside the family, "Health policy and
practice," according to a University of
Calgary professor in the faculty of
social w/elfare, "is oriented to the
needs of the individual and perhaps
even more to the type of care and
method of practice which most suits
the health professions."
Professor Andrew Armitage was
one of two keynote speakers opening
up proceedings of a three-day
conference on Family Policy in
Ottawa, April 24 to 26. The
conference, sponsored by the
Canadian Council on Social
Development, was attended by more
than 350 representatives of social
service agencies across the country.
In a background paper prepared
for the conference, Professor
Armitage points out that the remnants
of the family support system remain
with the public health services —
clinics, school health services, home
visiting and care programs. "But
public health is the poor relation in the
health field and, further, it tends to
arouse professional opposition when
it tries to extend its role." Professor
Armitage believes there are
indications in the 1 970s of a return to
more family based health care
although "impulses at the political
level seem to have come from
escalating health costs rather than a
conviction about family policy.
Arguments in favor of family health
care," he says," have been used to
'sweeten the pill' for opponents of
change."
He cites as examples of renewed
Interest in family-oriented care, the
new status of public health programs,
particularly those geared to health
promotion, the development of
community health centers, and
attempts by the medical profession to
upgrade family practice. He says that
although home care programs are
gradually being extended to assist the
chronically ill, "there is as yet no policy
of consistent support to enable the
family to deal with illness and
continuing stress."
Dr. Fred R. MacKinnon, deputy
minister of social services for the
province of Nova Scotia, also stressed
the importance of a "familial
approach" to public policy in his
closing address to the delegates.
Such an approach, he said, implies
caring and sharing, whereas the
economic system is based on
competition and the acquisition of
material wealth.
The president of the Vanier
Institute of the Family, Dr. MacKinnon
said that "by their very nature, social
services cannot be more effective
than the dominant institutions in
promoting healthy personal and
familial development." He suggested
that our goal should be to "maintain
and build self-reliance and
self-respect which help to make usfull
persons instead of creating
dependence and destroying what little
we have of dignity."
Five sub-plenary sessions were
held during the conference on the
topics of housing, income security,
personal social services, health and
social justice. The speaker at the
health session was former CNA
president, Huguette Labelle, director
general, Policy, Research and
Evaluation Branch Department of
Indian and Northern Affairs in Ottawa.
ARNN launches
status study
The Newfoundland nurses'
association has launched a
province-wide study of the status and
environment of members of the
profession.
The investigation is intended to:
1 . promote job satisfaction among
nurses;
2. promote decision-making among
nurses;
3. provide a mechanism through
which nurses can assume a
leadership role;
4. enhance the ability of non-nurses to
view the nurse as a decision-maker;
5. promote changes in the perspective
of other categories of health personnel
regarding the role of the nurse;
6. enable nurses to help themselves in
improving the quality of their work
lives.
The project director will be Clarrie
Case. All nurses in Newfoundland will
be affected by the study which will
involve the use of questionnaires,
workshops, educational programs,
interviews and observation.
Did you know...
The CNA archives collection of school
nursing pins is richer by several fine
examples donated by readers since
publication of our March cover photo.
Geographical Analysis of CNA Journal Circulation
English
French
Newfoundland 3,197
1
P.E.I. 923
—
Nova Scotia 6,172
10
New Brunswick 4,374
388
Quebec 7,692
36,195
Ontario 21 ,408
296
Manitoba 7,985
7
Saskatchewan 7,591
6
Alberta/NWT 13,140
27
B.C./Yukon 15,304
21
Total — Canada 87,786
36,951
Outside Canada
United States 1,667
23
Other- 983
337
Total 90,436
37,311
■ The Canadian Nurse/L intirmiftre canadienne is distnbuted to more than 104 countries.
Women in
ambulance services
The Metropolitan Toronto Departmei
of Ambulance Services has droppe
its height and weight restrictions fo
candidates for jobs as
driver-attendants after a thorough
investigation by the Ontario Humar
Rights Commission.
Both parties agreed that the
ambulance service will devise a mor
accurate method of evaluating an
applicant's physical capabilities an(
will consider an on-going fitness
program for its employees.
The Ontario Women's Bureau i
the Ministry of Labour and the Ontar
Council on the Status of Women ha
expressed concern to the
Commission last fall overthe possib
discriminatory effect of the height ar
weight requirements on women am
some ethnic groups.
In its investigation, the
Commission found that Toronto's
ambulance service employed no
women ambulance driver-attendan
in a staff of more than 400. InJanuar
the Ambulance Services Departme
dropped its requirement from 5' 8 " ar
160 lbs. to 5'6" and 145 lbs.
"They have now dropped the
requirement entirely after we
demonstrated to them that there is n
evidence that a specific height and
weight standard is a valid measure
any individual's physical capabilities
said Naison Mawande, Director of
Conciliation and Compliance for th(
Commission. "We do agree that a
standard of physical strength and
fitness is a requirement for the job.
Penny Goldrick, an officer of tl
Commission, found that a good
proportbn of all the ambulance
services in Ontario do not have heig
and weight requirements and that
some do employ women.
The Ambulance Act now requir(
a job candidate to take a one-year
course, a course now offered in
Toronto at Humber and Centennial
Colleges, and soon to be available
Seneca College. Women are now
enrolled in those programs. Oneoftf
courses teaches techniques of liftir
which reduce the correlation betwec
the weight to be lifted and the size (
sex of the attendant.
(continued on page <
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The Canadian Nurse June 1977
JVaiiies and Faces
CNJ talks to
Maureen Powers
"The Registered Nurses Association
of Ontario (RNAO) has to represent
the vested interests of all of the
various groups vifithin nursing,
including such groups as public health
nurses, O.R. and psychiatric nurses. "
So says Maureen Pov^^ers, who
was appointed executive director of
the RNAO in Toronto on April 28. She
will assume office on September 6.
Currently director of nursing at
the Children's Hospital of Eastern
Ontario in Ottawa, Powers is 35 years
old and has gained a reputation for
being somewhat outspoken. She
says, "I don't like stepping on
peoples toes' but I do try to be very
honest in my feelings and in saying
those things which I feel need to be
said."
"I may be outspoken, or even
aggressive, but I would hope I seem
reasonable and interested in wori<ing
out and solving problems through
consultation, not confrontation."
Powers says she has always had
a great interest in nursing and In
nursing concerns. She describes
herself as someone who has been "an
interested and active member'" of her
professional association.
Powers is confident of her ability
to handle her responsibilities as
executive director. She says her
present position as director of nursing
has given her the experience
necessary to know she can "get
together with people, be sincerely
interested in them and make sincere
attempts to represent their interests. "
"One of my first objectives as
executive director will be to go to
individual chapters, meet with groups
of nurses and talk to them about the
issues which they feel are relevant to
us."
From these visits Powers
believes patterns of concern will
emerge which she, in turn, will point
out to the president and the
president-elect as directional
recommendations.
Powers knows she will meet with
difficulties and confrontations overthe
next few years but says "that's all a
part of life and part of wori<ing within a
successful and healthy organization. "
Powers says one thing that she is
very concerned about in terms of
RNAO Is membership. "The RNAO is
the professional nurse's association
which represents, should represent,
all nurses in Ontario."
"I find it very funny when I hear
people ask. What can my professional
organization do for me? I honestly,
and I say this in all modesty, have
always asked. What can I do for my
professional association? After all, the
RNAO depends on me, the
member."
"The function of the RNAO, as I
see it, is to be a leader and a
pacesetter in terms of establishing
priorities as to the direction nurses
should take. Members are very
Important in terms of the function of
the RNAO and I see myself as
executive director taking my direction
from the members."
Powers holds a Master of
Education (Psychopedagogy) from
the University of Ottawa in 1 975 and a
Bachelor of Nursing from McGill
University, Montreal in 1965. She also
holds a diploma in maternal and child
health nursing and is a 1962 graduate
of St. Mary's Hospital School of
Nursing, Montreal.
Powers says she finds
educational pursuits very exciting.
"Education Is Important for a
nurse's credibility but even more
important is the ability to reflect upon
what you're doing and to use the
resources that other people have
wori<ed up. Those are the abilities
learned through education and they
are very significant in terms of being
an effective practitioner."
Powers has worked in pediatrics
for many years now and she knows
her new position will require her to
widen her scope. '"Tve always been
Interested in the child, now III be
concerned with the person at all age
levels."'
She says It will necessitate
different emphasis but she is not
worried about making the transition. "I
have a genuine interest in health care,
and in people and how they will be
dealt with in relation to their care."'
Powers has loved pediatric
nursing and the organization of
nurses. She says she will, most
definitely, miss the practice of
"nursing" (giving care to a patient).
But, she also loves nursing itself, and
she'd like to be able to contribute to
some of the solutions and concerns
that nurses are involved with.
Powers believes there is a great
need in the profession for people who
are "willing to commit themselves and
be involved in decision-making about
where nursing Is going In terms of
health care."
Joan Bailey S.R.N. (Barnet General
Hospital, England), R.N. (Ontario and
Quebec) , has been appointed Nursing
Officer, The Prior of the Most
Venerable Order of the Hospital of St.
John of Jerusalem Priory of Canada
St. John Ambulance Brigade, Division
178, Margaret McClaren Corp.,
Quebec.
Joan has had experience in
various fields of nursing in Canada,
including assistant head nurse in
Gynecology, administration nursing
supervisor and assistant instmctor
nursing assistants, general duty staff
nurse in Case Rooms and Operating
Rooms.
Sharon Dawe R.N. has been
assigned to her first post in Latin
America where she will help
administerthe CARE/MEDICO public
health auxiliary nurses training
program at a hospital in Choluteca,
Honduras. She will teach community
health, maternal-child health,
epidemiology, and nutrition. She had
worked in Afghanistan, Algeria,
Malaysia and Indonesia prior to her
present assignment to Honduras.
Kathy Lauzon has been appointed
Executive-Secretary (part-time) of the
Canadian University Schools of
Nursing (CAUSN).
A graduate of St. Joseph's School
of Nursing, Hamilton and of the
University of Ottawa (B.Sc.N., B.Ed,
and M.Ed.), Lauzon has taught and
served as a Coordinator in the Ottawa
General Hospital School of Nursing,
the Vanier School of Nursing and
Algonquin College Health Science
Division in Ottawa. Since 1975 to the
present, she has been serving as
permanent part-time Nursing
Coordinator, Obs-Gyn Program,
Ottawa General Hospital. Among her
other professional activities, she has
served as President, Ottawa East
Chapter, RNAO (1971-76) and as
Ottawa regional representative on the
Provincial Executive Committee of
RNAO (1972-76).
Anne Marie Snook, a first year
nursing student at Memorial
University in St. John's,
Newfoundland, recently received the
Teagle Foundation Scholarship. The
scholarship is available to children of
employees of Exxon Corporation and
Is tenable for four years.
The Canadian Nurse June 1977
13
FIMNKLY SPMKING
What every reasonable and prudent
nurse should know
Nora J. Briant
Lately, in conjunction with a university course
that I have been talking, I have been reading a
great deal about the issue of mandatory
continuing education for nurses. I am writing
this article in the hope of getting some
response from readers who have opinions
about this matter.
When first I began my reading I was in
agreement with mandatory continuing
education. It just couldn't be right that initial
registration should qualify me for a lifetimes
practice. When I stopped reading I was
convinced tliat making education mandatory
after basic education would serve little or no
purpose.
The article that best summed up for me
the issues at stake was by Barbara Stevens.'
Some of the points she makes are as follows:
One of the objectives of mandatory education
might be to make nurses take up their
professional responsibility for learning.
However, the problem with nurses who do not
do so voluntarily is one of attitude. Making
them attend a specified number of educational
events to fulfill legal standards will do nothing
to give them a positive attitude towards
learning.
The objective of providing learning
opportunities through mandatory continuing
education is not valid either. The learning
opportunities could be either a) to stimulate
professional growth, b) to update the nurse, or
c) to improve job performance. Stimulating
professional growth is objected to forthe same
reason as above, i.e. it will not serve the
purpose.
Updating nurses by mandatory controls
would be awkward and of questionable value.
Who would decide what information is
required to keep abreast of changes? Would
this information be universally distributed?
Does a psychiatric nurse need to know the
latest development in urology and does an
O.R. nurse teach diabetics? What about the
different levels in nursing and the new roles?
Improving job performance would require a
multiplicity of specific programs only hinted at
in the two sentences before. Also, who
provides these required learning activities,
where, and with what money?
If the objective underlying mandatory
education were to improve patient care then
extreme difficulties and cost might be
acceptable. Again the answer does not suit the
problem. Proving that you have been to two
courses, a workshop, and a conference
doesn't say anything about how much you
learned or whether you are applying it. In my
reading I did not find any proof that continuing
education has a positive effect on patient care.
The only guarantee for quality care is to
actually assess the care in the clinical setting.
None of the laws or suggested laws for
mandatory education require this kind of
testing and so none of them guarantee
improved patient care.
In one article I read that personal reading
habits were correlated with the quality of
medical care given but attending specific
continuing education programs did not
correlate.^ Then I read that the American
Nurses' Association Standards for Continuing
Education says that general reading,
discussion groups and the like do not count as
continuing education units because they
cannot be uniformly measured.
Mandatory continuing education seems
to create a lot of problems and to provide very
few answers. We have enough problems now
and don't need to spend our energies on
ventures of questionable value.
The concern of all authors on the topic
was that nurses be accountable to the
consumer through continuing education. With
knowledge accumulating at great speed and
new technologies being developed every day
we certainly do need to take part in on-going
learning. As for being accountable to the
consumer, there should be no worry about
that. Weare accountable and there are no two
ways about it. Each of us is expected to do
what any other reasonable and prudent nurse
in similar circumstances would do or be held
liable in a court of law. That is accountability.
There are other ways of maintaining
standards besides making laws. At present
there is little direct interference by
governments or courts in the workings of our
profession and I think it is better for everyone
concerned if we keep it that way. To do so we
must take care of this problem ourselves.
Imagine the situation if we did decide that
nurses wanting to renew their registration
must have proof of, for example, forty
continuing education units per year. In
provinces where licensure is not mandatory,
(i.e. B.C., Alta., Sask., Man., Ont., N.B. and
N.S.) nurses who did not qualify could still
continue to wort<. An unregistered nurse is not
prohibited from practice; she simply cannot
use the title registered.' At one time it was not
uncommon to have unregistered nurses
working and we might find that becoming more
and more the case if our hypothetical situation
came true. Hospitals and agencies desirous of
quality personnel might not hire unregistered
nurse: but being able to pay them less — they
might. Having registration instead of licensure
makes mandatory continuing education out of
the question.
What can or should we do about
standards, keeping up-to-date, professional
obsolescence, and the information explosion?
I feel that one good way to help cope with
these problems would be to set up voluntary
systems of continuing education that would
acknowledge participation and achievement. I
have read and heard about the American
Dietetic Association, The College of Family
Physicians and others but I don't think
anything of the kind has been available to me.
To be a member of one of these societies each
person must have taken part in a specified
number of courses, workshops, study groups,
etc. over a number of years.
The implications of such a membership
should be publicized. Then if anyone wants to
hire or promote a nurse who is keeping abreast
of change and interested in learning they could
choose one of these with a degree of
assurance. In this way employers and the
public would grow to expect high quality
nursing care. This demand, combined with the
presence of learned societies to encourage
and provide educational stimulation, would
keep the standard of care up in spite of rapid
change in science and technology.
What every reasonable and prudent
nurse could be expected to know would be
influenced by the educational atmosphere
created. I see our provincial associations and
educational institutions being potentially the
most helpful in establishing these societies
and so I aim my suggestions and hopes in that
direction. *
References
1 Stevens. Bartaara. 'Mandatory Continuing
Education for Professional Nurse
Re-Licensure: What are the Issues? " J. Nurs.
Admin. 111:5:25-8.
2 Stuart, Corrine T. "Mandatory
Continuing Education for Re-Licensure in
Nursing and the Implications for Higher
Education. " J. Com. Ed. Nurs. 6:5:7-15.
The Canadian Nurse June 1977
CYSTIC FIBROSIS -CAMP
COUCHICHING...
FOUR SUMMERS
5s?3:ss~^,
J. Karen Scott
'"S.sf^o^inghis,
The Canadian Nurse June 1977
For the young person with cystic fibrosis, there are day-to-day problems and routines that make living a 'normal' life
difficult. But this summer, as for the four summers past, a camp at Lake Couchiching will provide a unique
opportunity for adolescents with cystic fibrosis to realize their potential, by learning about their disease, socializing
with other young men and women, developing independence from their families, and participating in a recreation
program that pushes them to their limits.
Girts preparing lunch while on canoe trip in Algonquin Park.
Th« Canadian Nursa
The nature of the defect causing cystic
fibrosis (CF) is unltnown. The disease is
characterized by an increased sweat
electrolyte concentration, pulmonary
disease, and pancreatic insufficiency
resulting in intestinal malabsorption.
Cystic fibrosis is a generalized condition; It
affects the entire body, and involves
abnormal mucous secretion of the
exocrine glands.
The treatment of the disease creates
many day-to-day problems for the cystic.
The routines required for inhalation and
physiotherapy are time-consuming,
usually taking a minimum of three hours
every day. This makes it necessary for the
child to arrange his activities around a
demanding schedule.
Many children with CF are
self-conscious about their condition, for
example, about taking pills in public; many
feel guilty about the time and money that
their parents spend on them. Some are
overprotected by their parents and
consequently resented by their siblings. In
the past, there have been severe
restrictions on their ability to travel, but
now the availability of portable equipment
makes it a possibility. Until recently, young
cystics were refused admission to any
'regular' summer camp; some could attend
the camps organized by the Ontario
Crippled Children's Society, but their
activities there were unnecessarily limited.
-?5>-.
The camp on Lake Couchiching for children
with CF was started in 1973 by Dr. Douglas
Crozier of the Cystic Fibrosis Clinic, The
Hospital for Sick Children, Toronto. Donald
Bradbury, past chairman of the board of Camp
Couchiching, agreed that for the month of
August, the camp was to be set aside for CF
campers. A physician (Dr. Crozier), four
registered nurses (including myself), a nursing
assistant, four registered physiotherapists,
and 1 6 student therapists were hired for the
month of August to augment the regular camp
staff. By the summer of 1975, the number of
campers had grown to 53 (23 boys and 30
girls) between the ages of 10 and 17; 17 staff
members, ages 17 to 25 years, also had CF.
Initially, certain changes were necessary
to make the camp suitable for CF campers. All
cabins were insulated; electric baseboard
heaters and hot and cold running water were
installed. The veranda of the camp lodge was
enlarged and rewired to accommodate
postural drainage boards and physiotherapy
machines.
The fee for campers is about $600. for the
month. Parents are asked to contribute what
they can to the cost ; the bal ance is covered by
service clubs, especially the Kinsmen Club
and local chapters of the CF Foundation, or by
donations from drug companies, private
individuals, the Toronto Star Fresh Air Fund,
and other sources.
Most of the activities normally available to
campers at Camp Couchiching are continued
as usual for our CF campers during the month
of August. Swimming lessons are compulsory,
and canoeing, tennis, water skiing, hiking,
campcraft, arts and crafts, sailing, archery,
and overnight trips are offered.
As each camper arrives, he is weighed
and his drug records are checked. Each
camper brings his own drugs to camp and with
a few exceptions, these are pooled and
shared. Enough antibiotics and vitamins for
24 hours are dispensed to the campers each
morning. Night medication is delivered to the
cabins with the boxes containing drugs for the
evening inhalation. These boxes are refilled
every 24 hours with bronchodilators.
antibiotics and Intal in a buffered solution. At
treatment time, each camper nebulizes the
solution and inhales it for 15 to 30 minutes.
Good nutrition is an essential part in the
careofthosewithcysticfibrosis. Our camp has
an unlimited budget for a diet high in saturated
fat and protein; butter is used rather than
margarine; whole milk instead of juice; and
there is plenty of fresh meat, eggs, and
cheese.
The pancreatic enzymes, Cotazymes,
called "greenies" by the campers, are
distributed at each meal. A counsellor ensures
that each camper takes enough enzymes, and
notifies a member of the medical team if there
is a reluctant pill-taker in the group.
Gentle Teaching ...
Staff members spend a great deal of time
teaching the campers about the need for
enzymes; that, for example, they need to take
eight "greenies" to digest a glass of milk, or 25
for a cup of shelled peanuts. We continually
emphasize that for them, food without
enzymes is almost like no food at all;
explaining to them why they might feel
constantly hungry although they are eating
large amounts. We try to relate this to their
everyday lives suggesting that they should
always take "greenies" with them to their local
hamburger stand so that a "Big Mac" will have
more than just sawdust food value. We also
teach them how to take "greenies"
inconspicuously, by putting them in a cup and
"drinking" them.
I remember one young cystic telling me
about the phenomenal amount of food he
usually ate, claiming he just didn't need
enzymes. After a consultation with Dr. Crozier,
I asked the boy to try an experiment, by
beginning to take 60 "greenies" with every
meal . A few days later he came back to tell me
that, for the first time in years, he was not
always hungry; generally he felt better, and he
began gaining weight.
As staff members, enzymes are far from
our only concern. Each cystic child requires
two or three physiotherapy treatments every
day after the inhalation of prescribed
bronchodilators and antibiotics. At camp, each
child is responsible for mixing his own mask
medication, and, for some, this always comes
as something of a shock. We also try to teach
the camper how to position himself on a
postural drainage board in order to gain the
greatest effect from clapping and percussing,
and loosen the thick mucus secretions that are
a constant cause of concern to him. A
physiotherapist, assigned to each cabin,
observes the therapy unobtrusively.
Canoe Trip
During the first summer at camp, we
included a canoe trip for the older boys. We did
two local canoe trips; the boys paddled one
way and were trucked back to camp in time for
their second inhalation. Our first trip was so
bad... The river wasn't deep enough, so the
boys had to pull the canoes up the river. Some
got lost; three circled an island twice before
they realized that they were off course. There
The Canadian Nurse June 1977
Reactions to Camp
The response of the campers, counsellors and parents to Cystic
Fibrosis-Camp Couchiching was measured in part by their replies to
questionnaires that we sent to them after our third summer.
All 1 6 campers who replied to the questionnaire had heard about the
campfrom their CF clinics; almost all had been to camp for more than one
summer. None of the boys said they were homesick, but five girls were
initially — they stated that they were not accustomed to being away from
home for any length of time.
Only one camper did not take his medication by himself before camp
but did so afterwards. The greatest improvement in the campers was in
their ability to give themselves physiotherapy; most of the boys could do
all clapping positions, including the posterior lobes, by the end of camp;
the girls still needed help here. The boys expressed great satisfaction at
being able to do their therapy independently, and many felt that they had
developed a better routine. Typical of the replies are the following
statements:
"/ used to do my therapy only where it hurt, and often for a longer time in
that area only. "
"/ realized that I must take better care of myself and not miss any
treatments. "
"Before, I didn't mind if I missed a masl< or didn't take my pills but after
camp I tried not to ..."
"While at camp I learned how to take care of myself better "
"Yeah, now I can do all my treatments by myself without having anyone
tell me what to do with them. "
Many cystics feel that they are "different," and are self-conscious
about their disease. Many of the campers' responses indicated that they
learned to overcome some of these problems at camp.
"/ don't get depressed as much after being with kids with CF. I know
other kids go through the same things as I do. "
"I learned I could do things other kids could do, kids that didn 'thave CF;
before I was in doubt, as everyone was worrying or protecting me. "
'Because everybody had CF, I felt that if I coughed or got out of breath,
everyone would understand. "
"In a way, it made me feel good taking my pills openly and having
someone to talk to while doing my therapy."
Champio"
CF camp
Most said that they have greater understanding of CF.
"Seeing kids with my disability and talking about our problems improved
my knowledge. "
"... being with other kids with CF and learning about them, discussing our
problems (such as how to take pills in a crowded cafeteha), getting away
from home."
"The canoe trip was the highlight of my life. I loved it so much and felt
great by being able to participate. "
The usual complaints were also voiced: swimming in cold water,
food, facilities, the "no phone" rule, and getting up at 8 o'clock in the
morning.
The responses of the campers indicated a general feeling of greater
maturity, independence, self-confidence, and less social isolation. As for
the future, all campers responding said they would like to join the camp
staff for all or part of the summer. Beyond that, most were positive about
theirf uture, with plans to study electronics, journalism, teaching, nursing,
secretarial work, etc.
All parents who returned the questionnaire had heard about the
camp through a CF clinic. Their answers closely agreed with those of their
children. Three had hesitated sending their child to camp the first
year — but none in subsequent years.
Most of the campers had never been away from home before, and
their parents womed: others had no hesitation ".../fe/f/7e was becoming
too dependent on me (mother)".
Some parents had trouble adjusting to their child's absence — "We
had a daily routine and while she was away we realized just how much
time was spent in treatment. " "I missed her and the house was very
lonely when she was away."
After camp, some parents sakJ. "He did his clapping without so
much complaining. "
"He saw ethers who were in worse shape than he is. He can do anything
without problems. He met cystics who were less fortunate. "
"She learned how to do her treatments better, and more frequently
without being told. "
"She seems to understand now that she is not the only one in the world
with CF.""
Most parents commented that they felt confident in leaving their child
with competent personnel for a month, and for many it was their first
relaxed holiday in years.
Two of five staff members with CF replied. Both were then spending
their third summer at Camp Couchiching, the first t\NO as campers: they
felt that being a staff member was much betterthan being a camper. One
stated that he enjoyed the extra privileges accorded the staff, as well as
being able to function much easier in this role without being held back.
The other said that he seemed to make friends more readily, and was
learning how much work is involved in keeping a camp running smoothly.
One staff member had held another job as a mail clerk: the other had
never been employed. Neither had been away from home this long
before, even for hospital admissions. Neither had had any problems
handling the responsibilities of cabin counsellor, in July with the usual
campers or in August with the CF campers. Each regarded time at camp
as a learning experience. Both thought their own daily treatments were
about the same at camp as at home. There was no conflict with the
program time but one stated that it cut into his free time consklerably.
One of the cystic counsellors stated:
"One month is just right for the CF camp. The kids take about a week to
get arranged and feel at ease and anything less would be too short. The
activities are quite well liked by the campers. They seem to like the
overnights and canoe trips the best since they really seem to conquer
being away in the woods and still being able to have their normal
treatments. "
The Canadian Nurse June 1977
was fog, followed by a heavy downpour. Only
because it was very warm and the biggest and
healthiest boys were along did we let them
stay out for the night. The boys were not
impressed, to say the least, with this kind of
camping.
The second summer, the canoeing
Instructor and I found a route which paralleled
Highway 60 in Algonquin Part<. With the help of
the assistant park superintendent, we worked
out the 'connection points' where a truck
carrying a nurse and all the inhalation
equipment would meet the canoes each night.
A physiotherapist travelled with the canoes as
part of the group.
The July campers tried out the route for us
and came back with glowing reports — enough
water in the river, good camp sites, etc. Our
next problem lay in convincing our boys that
they could do a five-day trip. Generally, they
expressed fear of failing ; they were afraid that
they wouldn't be able to complete the trip, or
that they would get sick on the way. One of the
main reasons for having a truck and a nurse
along was so that if someone did get sick, the
trip could continue, and only one person would
have to go back to camp.
In order to take part, the boys were
requi red to take campcraft lessons, and had to
be able to paddle a certain number of miles,
portage canoes several thousand feet, and
swim at intermediate level. Physically, they
needed to be in good shape for the trip so
beforehand they took all their pills, ate well,
and (most nights) got enough sleep. But the
fear of failure was always on their minds.
We covered every contingency twice with
the campers — from heavy rain, to a failure of
the power generator, and bears.
The boys were all very "city," had little
bush sense, and would have starved had they
ever got lost. Forthe first three days of the trip,
the staff did the cooking, usually while the boys
were doing theirtreatments. On the fourth day,
when the campers were required to do the
cooking, the fire wasn't lit, the cans of food
remained unopened, and they ate peanut
butter sandwiches. Several campers
wondered why this should be any different —
after all, they didn't have to cook for
themselves at home, or at camp. Fortunately,
this attitude has changed in subsequent years.
The park attendants were a tremendous
help to us that year. Our route was known at
the summer headquarters, and at each
connection point, the pari< staff, who had been
authorized to give any extra help we might
need, was notified of our arrival. On one night
of our trip, it started to rain heavily, and we had
to find a dry area for doing the treatments. The
only place available for our use was the park
attendant's tiny office. All the boys packed into
the office for their treatments and the noise, in
such a small enclosure, was deafening.
People checking into the park were startled at
the sight of kids in masks or percussors, and
camp hats, smiling and waving at them.
Several asked the park attendants if the boys
were divers.
After that evening, we certainly didn't
need to introduce ourselves; everyone knew
we were in the pari<. The boys started doing
their treatments openly — "Let's go and freak
the tourists! "
When the boys landed on the beach at
Whitney, the end-point of their trip, they were
euphoric, jumping up and down excitedly.
They had made it! They hadn't failed, no one
was sick, and the weather had been good for
the most part. Looking back, they said the trip
was "a snap, " with a happiness that I had
never seen them express. They roared into
camp to be congratulated for their fine work.
The stories they told were endless, about
trying to attract bears into their tents, looking
for girls, and on and on ...
As a member of the staff, I found that
helping to arrange this trip for the boys gave
me a great sense of satisfaction. We had
helped in opening a whole new world to boys
who had never been away from electricity
before, and there was no looking back.
,HoddyP°^
Four Summers
The four summers I spent at Camp
Couchiching as a staff member were very
satisfying. Our first summer was experimental
— just trying to smooth out the drug delivery
system and other aspects of having cystics at
camp was a challenge.
The second year, we took all the campers
to the Canadian National Exhibition in Toronto,
a first for many, even for campers from
Toronto. The five-day canoe trip was another
major event that summer, and it worked out
very well. Our baseball team beat every camp
in the area. We pushed the campers to their
limits, and although there were complaints,
they loved it.
By our third year, some of the girts
qualified to go on out-trips in Algonquin Pari<.
By this time, what had been such an anxious
ordeal for the campers was simply taken for
granted. I could see self-confidence growing
with every new skill.
Talking with the campers has led me to
believe that they have become more positive
in their Outlook on life through their experience
at camp. In the first summer, I remember one
camperasking Dr. Crozierwhether he thought
it was really worthwhile for him to continue in
school, as he wasn't going to live much longer
anyway. In contrast, the past summer saw
many campers making plans for further
education, and many of these plans were put
into motion. Now, two of our campers are in
nursing, another is at Trent University, another
is in electronics, and the list goes on.
Recently, I recall asking our first-year
water-skiing instructor, a cystic, how he got to
camp. He replied that he was only there to get
his mother, sister and Dr. Crozier off his back.
By the end of his second week at camp
however, he had improved his daily treatment
regime; he admitted to feeling better and
having a great time to boot.
When I talked to him last summer he said
that the CF camp was the greatest thing that
had ever happened to him, and that he was
grateful that Dr. Crozier had coerced him that
first year.
My pleasure came from being a part of the
support which gave this young man and others
the courage to strive to reach their potential, to
be happy, productive, and very much a part of
today's society.*
J
The Canadian Nurse June 1977
campers relaxing
''Sent dunng
---tSS^-:^"-
J. Karen Scott, (R.N. St. Thomas, Ontario;
B.Sc.N. University of Windsor, Windsor,
Ontario; Nurse Practitioner. University of
Toronto, Toronto Ontario) author of "Four
Summers ..." has been nurse-in-charge of
C.F. Camp Couchiching since its beginning in
August, 1973. Her nursing experience
includes general duty nursing, camp nursing,
V.O.N, experience, a position as a research
assistant and psychiatric, surgical, and
outpost nursing. Nursing has taken her as far
west as Vancouver and to many Ontario
communities, including Sioux Lookout. At
present, Karen is taking French language
retraining for a National Health and Welfare
post as Nursing Supen/isor at St. Regis
Reserve, Cornwall, Ontario.
Bibliography
1 Campbell. I.M. Complex formation and
reversible oxygenation of free fatty acids, by... et al.
Lipids 9:11:916-920, Nov. 1974.
2 Crozier, D.N. Cystic fibrosis: a not-so-fatal
disease. Pecy/afr. Clin. North Am. 21:4:935-950,
Nov. 1974.
3 Di SanfAngnese. P.A. Pathogenesis and
physiopathology of cystic fibrosis of the pancreas.
Fibrocystic disease of the pancreas
(Muscoviscidosis), by ... and R.D. Talamo. New
Engl. J. Med. 277:1287 passim, Dec. 14, 1967.
4 Friedman, M. Assessment of lung function
using an air-flow meter, by. ..and S. Walker. Lancet
1:7902:310-311, Feb. 8, 1975.
5 Report of the committee for a study for
evaluation of testing for cystic fibrosis. J. Pediatr
88:4: pt. 2:711-750. Apr. 1976.
6 Stern. Robert C. Course of cystic fibrosis in
black patients, by...et al. J. Pediatr 89:3:412-417,
Sept. 1976.
7 Stern, Robert C. Course of cystic fibrosis in 95
patients, by... etal. J. Pediatr 89:3:406-411, Sept.
1976.
Acknowledments: The author thanks Dr. D.N.
Crozier and Julie Trusz. R. N.. of the Cystic Fibrosis
Clinic, The Hospital for Sick Children (H.S.C.),
Toronto, and Lynn Molton. R.N., Camp nurse, for
their support at camp and in the wnting of this article ;
thanks also goes to the Medical Publications
Department, H.S.C. for help in prepanng the
manuscript.
The Canadian Nurse June 1977
The old man down the hall is a quiet
patient, a 'good' patient in the eyes of
those who care for him. Physically, his
care certainly isn't demanding and,
since his admission, he hasn't called
the nurse for any reason. But how does
he feel about being here? And what is
our role in helping him?
QUIET
DAY..
Sharon McKenna
He was an old man. The step that had once
measured farm fields and marched through
Flanders' mud was slower now and, at times,
unsteady. His work-worn fingers picked
nervously at the hospital pyjamas that he had
put on at the young nurse's instruction. Unsure
of what to do next, he sat in the armchair to wait
patiently.
He had little experience with hospitals;
until now, somehow, illness had never
required much more than home remedies. But
that time was past. He had slowly let go of his
hold on independence, had given in to what he
had been told was "forthe best. " He had come
for care.
Everything was neat, tidy and impersonal.
No matter who came or went through this
room, it seemed that it would remain the same,
untouched and anonymous. Shiny panels
above the bed attracted the man's attention
briefly. Not knowing what they were, he soon
lost interest.
The door opened at last. The young nurse
entered the room quickly and gathered up the
clothes he had left neatly folded on the bed. He
would have liked to speak, but he didn't know
her name. He had seen a tag of some sort on
her uniform and thought it must be her name,
but he hated to admit even to himself that with
or without his glasses, he just couldn't see very
well. And so he remained silent and alone.
The nurse was a first-year student, full of
ideas and plans for her life ahead. She had met
the old man at the admitting desk and,
glancing briefly at his diagnosis and room
number, had wheeled him with authority to his
new quarters. She had been polite enough.
But when she said "How are you?" he had
answered according to his perception of what
she expected: "Fine, thanks. "
The young nurse knew he would be
confused in this new environment — there
would be so many different faces. Certainly he
would never remember her name, even if she
had told him. When she took his clothes and
said matter-of-factly, 'We'll keep these in the
private clothes room, " he had felt bereft of all
identity. Only the band on his arm told who he
was.
Again, the door to his room was pushed
open. This time, a smiling middle-aged man
breezed in. "Hi Pop ... I'm Frank, the 3 to 1 1
orderly. Everything okay? I need a specimen,
if you need anything, just push the buzzer. I'll
be back in a while. Don't forget the specimen,
eh? The lab closes at four."
A look of incomprehension came over the
man's face, but before he could speak, Frank
had disappeared. All that was left was a glass
jar on the bedside table. The man rose slowly
to his feet, and quietly found his way to the
bathroom.
When he came back to his room, he saw
that someone had been in and turned down
the bed. He was tired now, and wearily climbed
into bed. His head was too low, so he tried to
connection
fold the pillow in half. The plastic cover
wouldn't stay folded, so he turned on his sid;
and dozed.
He awakened later with a start to see
another new face. For a moment he had
trouble remembering where he was, but then
all came back. It was dinnertime. The old maf
thought of being at home in his own kitchei
He remembered then that this was "for ttie
best."
A little boy came in with the evening n-
and the old man bought a paper. It was har
read in the fading light, but he didn't knc
where the light switch was. He remembc
that Frank had said, "Just push the buz.
He wondered where it was.
In the gathering darkness, the old n
slipped into other days, full of sun and 'i
laughter, and he smiled as he rememberec'"
And now? Now he was here, quiet and
uncomplaining. In time, the staff would grow t ,
appreciate him. He was a 'good' patient an
they could chart quite truthfully, 'quiet day'.'
But now he wondered who the studen'
nurse was. Where was the buzzer that Frar
had mentioned? And who was the ghost-lil'|
creature who had turned down his bed? Hi
had so many questions, so many fears. He hJ
been a strong and independent man. No.
had no idea what was in store for him.
When the night nurse brought in his
sleeping pills, she pretended not to notic
tear-rimmed eyes. She would help to cart
The Canadian Nurse June 1977
lim, his bed would always be clean, his room
idy, and an extra cup of breakfast coffee
irdered. But she didn't want to intrude, and
lesitated to embarrass him by asking him
ibout his feelings. She smiled gently as she
latted his hand. "Don't you worry about
inything now. We'll take good care of you, and
'ou'll see. It's all for the best."
Reaching Out...
Routine care of the old man on the day of
lis admission and the days that followed did not
)lace great demands on the ward staff. The
eal challenge was one that was never met
)ecause it was never recognized None of the
)eople involved in caring for him recognized
hat they were failing to communicate
jffectively. that they were frustrating each of
lis tentative attempts to reach out and touch
hem and that he, in turn, was not 'hearing"
what they thought they were saying. Probably,
Mch member of this staff felt that the care they
jave was adequate. They did not recognize
heir failure to communicate with him in any
Mgnificant way.
Communication can be defined as "...a
rpharing of information, signals or messages in
Ihe form of ideas and feelings."' What
messages were the staff members sharing?
How did they discourage the old man from
expressing himself, and thus leave him
deserted and in distress? And how could they
nave helped him?
The student nurse made an assumption
when she saw that the new patient was elderly.
Although this assumption led her to conclude
that the old man would be confused in his new
environment, she did nothing to orient him or
alleviate his bewilderment. She made no
attempt to confirm her assumptions through
conversation with him. And by neglecting to
introduce herself to him, she conveyed the
impression that he was of little importance as a
person in the routine of her hospital duties.
The student's adoption of the 'busy' role
can be seen as an attempt on her part to
sidestep a situation that somehow seemed
threatening to her. It may have served her
purpose, but simultaneously it effectively
blocked any attempt by the patient to establish
contact with her. If she had introduced herself
and her unit to the patient, she might have
found that her fears were groundless and at
the same time diminished the patient's
overwhelming sense of isolation.
By showing him how to operate the call
bell, overbed light switch etc., she could have
made him more comfortable with his
surroundings and given him a degree of
control. Sometimes showing the patient the
view from his window helps him to orient
himself physically. Acquainting a patient with
his environment requires veriDal
communication, but there are non-verbal
implications as well. They may be that the
nurse is open and approachable, that the
patient is recognized as an individual, and as
such, important and respected.
The orderly was presumptuous in
addressing the old man as "Pop." His
familiarity may have been offensive or
belittling to the patient, a man he had never
met before.
Although he told the old man what he hac
come in for, he didn't give him more than a
cursory explanation. His terminology, howeve
familiar to him, was incomprehensible to the
patient.
He failed to give the patient an opportunit>
to become acquainted with him and he failed t(
confirm that the patient knew what was
required of him. His message, "The lab closes
at four. " had little meaning for the patient, anc
may have been perceived by the old man as £
cause for anxiety. By spending a few minutes
with the old man, the orderly might have
helped the patient to feel more at home, migh
have begun an open cooperative relationshif
with him.
The night nurse preferred to ignore any
evidence of the old mans emotional distress
perhaps communicating that his tears were
inappropriate or unacceptable. Because she
did not encourage him to express his fears,
she missed an opportunity to help him to work
through his feelings. Herglib reassurance may
have helped her to avoid a painful situation.
But she could have been prepared to listen, tc
accept his feelings and encourage him to
translate them into words, perhaps alleviating
his distress. Such phrases as "You appear... ",
'I notice thatyou...", "You seem to be..., "offer
provide the opening that the patient needs to
begin a more productive, meaningful
communication pattern with a nurse.
All three staff members were basically
kind to the old man, but none made an attempt
at more than routine care. If any one of them
had spent a few minutes to assess and
understand the situation that confronted the
old man, he might have felt that his life still
contained some measure of worth and dignity.
References
1 tVlurray, Ruth. Nursing concepts for
health promotion, by ... and Judith Zenter.
Englewood Cliffs, N.J., Prentice-Hall, 1975.
p.45.
Sharon McKenna, aufA;oro/Ou/ef Day .... isa
first year student at the School of Nursing,
Okanagan College, in Kelowna. British
Columbia. Her paper was written as a
requirement of a course on "Theory and
Application of Communication Skill. " A
graduate psychiatric nurse, the author writes
"When I read the qualifications of others
whose articles you have accepted, I felt
delighted that student nurses are recognizea
and encouraged to actively participate in the
direction nursing is taking today."
ANOREXIA
NERVOSA:
A nursing
approach
Anorexia nervosa is defined as the
condition of "self-inflicted starvation,
without recognizable organic disease and
in the midst of ample food. " The
seriousness of the illness is indicated by a
mortality rate of approximately fifteen
percent.
It is a complex problem and there is
some dispute regarding the etiology of the
illness. It occurs most frequently in single
females in their adolescent or young adult
years. Generally, the patients are of
average or above average intelligence;
often, they have a history of obesity.
Although the literature is not unanimous in
documenting this, those diagnosed as
suffering from anorexia nervosa are
descrit>ed as having been quiet, obedient
children, often from financially or socially
successful families.
Barbara Butler, Mary Jane Duke, Toni Stovel
Symptoms
Anorexia nervosa is characterized by
some or all of the following symptoms:
• amenorrhea
• disturbance in body image and body
concept of delusional proportions
• perverse eating habits, including:
1 . starvation diets with compulsive
overeating
2. gorging followed by self-induced
vomiting;
3. hoarding of food;
4. excessive use of laxatives and enemas.
• difficulty in interpreting body cues, such
as:
1. inability to recognize hunger;
2. hyperactivity and denial of fatigue;
3. failure of sexual functioning.
• a low basal metabolic rate
• constipation
• a sense of ineffectiveness, that is, a lack
of self-awareness. They see themselves as
always responding to others' demands rather
than to their own desires.
Along with the generally recognized
symptoms, we have noted several common
behavioral characteristics in patients having
anorexia nervosa. One of these is a child-like
quality and another is extreme anxiety related
to gaining weight. The patient attempts to deal
with this great fear of weight gain and to gain
control by any means possible, a behavior
described as "manipulation. "
Manipulation has been defined as a
"process by which one individual influences
another to function in accord with his needs
without regard forthe other's needs or goals. "^
It can be seen that manipulation is an
interpersonal phenomenon. Within the
nurse-patient relationship, the nurse
strives to limit manipulative behavior and at the
same time assists the patient to learn more
mature methods of relating to others in order to
satisfy his needs. The use of cooperation,
collaboration and compromise are seen as
more effective interpersonal methods for need
gratification.
Case Study: Margie
Margie, a twenty-one year old, was first
diagnosed as having anorexia nervosa in
England when she was sixteen years of age.
At that time, she discovered that her unmarriec
sister, two years older, was pregnant. Margie
was quite disgusted with the whole matter and
was extremely fearful that she, too, might
become pregnant. She associated pregnancy
with a feeling of fullness in her stomach. It was
at this time that she developed irregular
menstrual cycles, began dieting, and lost 7.7
kg (17 lbs).
Margie's parents were both successful ir
their chosen careers. Their marriage,
however, had dissolved when Margie was a
young girl. Margie had a history of three
previous hospital admissions and intermitter
psychiatric treatment on an outpatient basis,
addition she had been admitted twice to
medical wards for treatment of pneumonia
More recently, Margie had had one
previous admission to our hospital and
although she had gained 4.5 kg (10 lbs) hes
stay was described as unsuccessful. She
would sneak food from other patients' traysi
and hide it in her room under her pillow
between her clothes, and in drawers. This Wi
a constant problem and her room often reeki
of stale food. She would harrass the dietal
staff for extra food, beg candy from other
patients, then gorge herself and induce
vomiting several minutes later. Margie was
constant conflict with her need for hunger
satisfaction and having to deal with feelings
guilt and fullness. This led to many outburst
and tantrums which proceeded to increase h(
self-dislike. Eventually it became clear that ht
stay in hospital was no longer producinc
worthwhile change, and discharge was
recommended.
We readmitted Margie from a medi
ward in another hospital where she had bt
patient for two-and-one-half weeks for
treatment of malnutrition. Her physical s;
was considered to be precarious; her
resistance to infectious diseases was low. j
fact during that admission, she had lost '
another pound so that she now weighed 3
kg (73 1 /4 lbs) in spite of her height of 1 70
(5'8 "). She appeared gaunt and frail. Hi
sunken eyes and pallor gave her a ghost-l;lj
appearance. She was unsteady on her feel
and unable to speak more than a few wo
The Canadian Nurse June 1977
Nursing Kardex — Initial Care Plan
Short term goal
Long term goal
— Weekly weight gain of 0.91 kg (2 lbs)
— Physical stability and health through re-establishing better eating habits.
Problem
Plan
Physical Instability
— record intake and output
— take vital signs and temperature prior to giving medications
— bedrest, in pyjamas
— meals in room
Anxiety
— Chlorpromazine 50 mg QID and increased to 175 mg QID
— consistent staff visits q 15 minutes
— in pyjamas with clothes tocked up
Obsession with food and fear of weight gain
e hoarding
• gorging
e vomiting
• weight loss
• abuse of laxatives
— 0800-0845 breakfast
— 1000-1030 snack
— 1200-1245 lunch
— 1500-1530 snack
— 1700-1745 dinner
— 2100-2130 snack
— consistent staff members to sit with patient during meals and snacks and for one hour following
— not to leave room — use call bell if necessary
— no conversation during meals and snacks with social conversation following
^ no psychotherapy
— allow patient to eat at own pace but at end of allotted time remove tray from room and calculate numlx
of calories not eaten (keep caloric values in chart for easy calculation)
— equivalent oral Sustagen supplement given with HS snacks
a) for total daily calories missed when exceeding 400 calories
b) for emesis — supplement per volume
— direct conversation away from food
— increase roughage in diet
— Metamucil 30 cc BID
— weigh once a week
Manipulation and resistance to treatment — weekly contract meetings - f^/londay a.m.
— involve patient in own care plan
— be firm and consistent in manner
— follow care plan explicitly
— patient to have no direct contact with dietician
Dependency
• on mother
• on material possessions
- mother 1 /2 hour visit per day (no other visitors)
- one phone call per day
- personal articles limited — no further articles brought in unless exchanged for those in present
possession
■ Boredom
• provide limited occupational therapy supplies
■ provide consistent volunteer member for companionship other than nurses
■ increase privileges slowly so that we have something to offer patient at each contract meeting.
The Canadian Nurse June 1977
ANOREXIA Anursing
NERVOSA: approach
Barbara Butler fRSc. A/., McMaster
University), Mary Jane Duke (M.S.N.,
University of Britisii Columbia) and Toni
StovelfR/V., Winnipeg General Hospital) are
members of the nursing staff, Health Sciences
Centre Hospital, Department of Psychiatry,
The University of British Columbia.
a time because of her exhaustion. On closer
observation, she showed further signs of
malnutrition: anemia, poor skin turgor, little
muscle tone and lack of subcutaneous fat.
The nursing staff on the psychiatric unit
felt well-prepared for Margie's admission.
Articles on anorexia nervosa and manipulation
were made available. The dietician,
occupational therapist, social worker and
psychiatric resident were involved to help
establish staff agreement on nursing
management and thus consistency in her
care. We met to formulate the treatment plan
that covered all present and anticipated
problems. Explicit and detailed pre-planning
left little room for patient manipulation (See
Kardex outlining Margie's initial care plan).
Because of Margie's physical instability
and previous management difficulties, she
was initially put on bedrest in pyjamas; her
clothes and possessions were locked up; her
visitors and recreational activities were limited.
These activities and privileges were slowly
increased as her health status improved. It
was agreed that the goal of this admission was
to attain physical stability and health through
the establishment of better eating habits. No
attempts were made to explore with Margie the
underlying reasons for her behavior through
intensive psychotherapy. Those would be
achieved lateron an outpatientfollow-up basis
with her psychiatrist.
Weekly contract meetings were
established soon after her admission. Each
Monday morning, Margie, her primary nurse
and the psychiatric resident met to discuss and
agree on care plan revisions. Prior to the
meeting, the resident and the nurse together
reviewed any possible plan changes which
were then discussed at the meeting. These
meetings succeeded in decreasing staff
confusion about Margie's manipulative
behavior and also encouraged consistency of
care with an open and honest relationship
between staff and patient.
We encouraged Margie to become
involved in these meetings by allowing her a
choice within the boundaries we had set for
her. For example, Margie could suggest menu
changes or help us decide changes in activity
level. We found that when Margie took
responsibility for her care plan she was more
willing to follow it. This increased her
motivation, self-esteem and sense of trust
towards staff and, in turn, the staff's anxiety
lessened as progress was made. All care plan
changes were thoroughly noted in Margie's
chart and there were no further changes made
until the next meeting.
Margie's conversation centered around
food, diets, and her body image. She was
constantly worried that she was 'fat': "My
stomach is huge, I'm fat;" "Do I look fat?" This
misconception of body image was of
delusional proportions and was dealt with by
redirecting conversation to other areas of '
interest such as sewing, fashions and poetry.
As can be seen by the Kardex, there was
constant supervision during and following
meals. This was done to prevent hoarding of
food and to control vomiting.
We felt the amount of time given to Margie
was necessary, at first, due to her lack of
physical stability and her unpredictable
behavior, sometimes being a charming and
sweet girl but just as often a screaming and
demanding child. Her manipulative tactics
were evident in statements such as "I'm
hopeless, I'm ugly and horrible, nobody loves
me, " or "You're nicer than the other nurses." It
was often frustrating for the nursing staff to
deal with her constant manipulation and
demanding behavior. The amount of time
spent with Margie created a feeling of isolation
for those working closely with her and was a
general energy drain for all staff members. We
were fortunate to be able to work through
frustrations by sharing our feelings with one
another and, of course, a sense of humor
helped.
As her physical status stabilized, Margie's
activity was slowly increased. From bedrest,
she was allowed to sit up in her chair for 30
minutes twice a day, then go for supervised
walks in the hallway, then spend a half hour in
the patients' lounge and so on. At the same
time, she was gradually given back some of
her possessions — clothes, jewelry,
embroidery, sewing. All these privileges were
gained back slowly and only granted at the
weekly contract meetings.
Margie's obsession with food never really
decreased but she did gain confidence in
herself and her diet. As this trust built up, staff
slowly decreased time spent with her following
meals and finally she was able to eat on her
own. Margie was allowed more control over
her own care plan changes and although there
were occasional setbacks in the form of hiding
food from her tray, and vomiting once while on
a weekend pass, she managed to control this
behavior and it soon disappeared.
On discharge, Margie weighed 40.9 kg
(90 lbs) the goal she had set for herself on
admission. She was still very thin but she had
gained physical stability and was well
motivated to continue her diet. It was a fulfilling
experience for the staff to observe Margie
slowly improve, to gain some independence
and begin to establish some healthy
relationships. It has been two years since this
admission and there have been three
admissions since, but each time there is a
morehealthy response. Margie's weight today
is 46. 8 kg ( 1 03 lbs) she has a part-time job in a
daycare center and is beginning to develop a
close relationship with a young man.
Conclusion
Patients with anorexia nervosa pose
difficult and challenging problems for
members of the health care treatment team.
For nurses, the behavior patterns of these
patients are often a source of frustration,
bewilderment and anxiety. The establishment
of nurse-patient contracts as a mechanism for
limiting the patient's manipulative behavior
and at the same time, involving her in the
treatment program are seen as effective
nursing interventions.*
References
1 Bruch, Hilde. Anorexia nervosa and its
differential diagnosis. J. A/en/. Menf. Dis. 141:555.
Nov. 1965.
2 Kumler, Fern R. An interpersonal
interpretation of manipulation. In Burd, Shirley F.
Psychiatric nursing. New York, Macmillan, 1963. p.
116.
Bibliography
Bruch. Hilde. Anorexia nervosa and its differential
diagnosis. J. Nerv. I^ent Dis. 141:555-556, Nov.
1965.
Schmidt, Mary. Modifying eating behaviour in
anorexia nervosa, by ... and Beverley A. B. Duncan.
Arrter J. Nurs. 74:9:1646-1648, Sep. 1974.
The Canadian Nurse June 1977
Kanchan Desai, B.Sc.N.,
Peggy Hotchkiss, Reg. N..
Geraldine Fletcher, Reg. A/.,
Beverley McCann, M.Sc.N.
What do a county fair and physical fitness
have to do with the public's image of
nurses? Taken separately, nothing, but
when you put them together, the
combination may be just what is needed
to create a more enlightened view of the
nurses role as a health educator.
Like nurses everywhere in Canada
we had grown weary of our Florence
Nightingale image. As members of the
Oxford Chapter of the Registered Nurses
Association of Ontario, we decided the
time had come to do something about
changing the public's conception of what
we do.
We tcek
■Physical Pitness
tcthe
The best way to do this, we
concluded, was to find a way to show
people we can provide a service which is
closely linked with steps they can take to
lead healthier lives. With more and more
Canadians determined to catch up with
that 60-year-old Swede, we hit on the idea
of showing how physical fitness benefits
health.
A small town tradition — the county
fair — presented us with the opportunity to
take our message to a good chunk of the
population we serve. So. we rented
booths at three fairs held in the county
and, with some trepidation, prepared
ourselves for a brief stint in
showbusiness.
We used the allure of a "mini-fitness
test" to get people to our booths. We
employed such basic testing standards
as, weight and height measurement, lung
capacity, heart recovery rate and blood
pressure assessment, to evaluate the
physical fitness levels of participants.
(See next page for details)
To personalize our service to the
public each person who took the fitness
test was closely monitored by one of our
volunteers.
We tested more than 1 ,200 people at
the three fairs and answered hundreds of
questions on health -related topics.
Did we succeed in making the public
more aware of the nurses role in
promoting good health? Judging by the
number of requests we have received to
speak to service clubs and to set up other
fitness tests, we feel that at the very least,
a start has been made in that direction.
The Canadian Nurse June 1977
Planning Essential
We hope we have convinced other
nurses to be more visible in their
communities. And for those who are
interested in setting up booths at fairs,
shopping centers, or other places where
crowds gather, our experience may be of
some help.
Even though space rented for the
booth may be on the small side, every bit
of it should be used to promote health
themes.
Posters and pamphlets should be
imaginatively displayed, and if possible, a
"gimmick" should be featured. Ours was
a T-shirt which had the words, Tm a
health lover," emblazoned on an
oversized heart.
To ensure the display is
well-attended, advance publicity is a
must. Some of the methods we used
included placing posters in public
buildings and distributing material to local
newspapers and radio stations. All
publicity material should clearly identify
the local nursing association with the
project.
Staffing
In a recent article, VanDerSmissen'
reminds us there are legal implications in
instituting adultfitness programs. In order
to protect ourselves and safeguard the
public we asked each participant to
complete a questionnaire before taking
the test (See Fig.1). Thus, anyone known
to have heart disease, or who was 69
years of age or more, or had a resting
pulse of 1 00 or greater was advisednof to
attempt the Bicycle Stress Test.
Another way to safeguard the public
is to use only active registered nurses
who are trained in operating the
equipment and prepared to give health
instruction if requested.
We needed about 80 nurses to staff
the three booths. Each booth was staffed
1 2 hours a day, and the three fairs ran for
a total of 1 1 days. The volunteers who
staffed the booths were employed by the
three hospitals in the district, the public
health unit and the Victorian Order of
Nurses. In addition to general duty
nurses, we had nursing administrators,
nursing educators and a local industrial
nurse helping out. We also had a physical
fitness consultant at each fair to answer
requests for information on specific
exercise programs.
Our planning also included
consultation with a medical practitioner
responsible for devising fitness programs
for cardiac patients. Finally, we wrote
letters to the medical chiefs-of-staff at
each of the three general hospitals and
the chairman of the county medical
association, informing them of our project
and asking for their suggestions and
support.
Figure 1
Physical Activity Readiness Questionnaire (PAR Q)*
For most people, physical activity should not pose any problem or hazard. PAR
Q has been designed to identify the small number of adults for whom physical
activity might be inappropriate or those who should have medical advice
concerning the type of activity most suitable to them. If you answer YES to any of
the questions below, consult with your doctor BEFORE trying the Test.
1. Has your doctor ever said you have heart trouble?
2. Do you frequently have pains in your heart and chest?
3. Do you often feel faint or have spells of severe dizziness?
4. Has a doctor ever said your blood pressure was too high?
5. Has your doctor ever told you that you have a bone or joint problem such as
arthritis that has been aggravated by exercise, or might be made worse with
exercise?
6. Is there a good physical reasorrnot mentioned here why you should not follow
an activity program even if you wanted to?
7. Are you over 69 and not accustomed to vigorous exercise?
' From the Fit- Kit by the Federal fvlinlstry of Health and Welfare.
Response
The public's interest in health matters
was apparent from the outset. Four
newspapers carried stories on our project
and two radio stations interviewed nurses
staffing the booths. Our Member of
Parliament visited the booth and
commended us for promoting health.
Several physicians and other health
professionals were among the thousands
of people who stopped to view the display
and chat with us.
We were pleasantly surprised by the
many children who wanted to know more
about proper health care and were keen
to see how they rated on the fitness tests.
American visitors expressed surprise and
appreciation for the free service we
provided.
Perhaps the most gratifying
response came from nurses themselves.
Our early fears about getting volunteers to
staff the booths proved groundless as we
had no trouble at all in achieving our
quota. As a result of their opportunity to
work together, public health nurses, staff
nurses and nursing administrators
improved their rapport and now have a
better understanding of each other's role.
Following the fairs, questionnaires were
sent to each of the 80 nurse volunteers.
Nearly all responded and 85 percent felt
the project was "very successful" and
would volunteer to assist in future
endeavors,*
The four authors of "We Took Physical Fitness
to the County Fair" have caught the fitness
bug themselves. They believe if they watch
their weight and get a reasonable amount of
exercise, other people in the community will
realize they practice what they preach.
Kanchan Desai is the Administrator of
Home Care for Oxford County, Peggy
Hotcfikiss is the Staff Health Nurse,
Tillsonburg District Memorial Hospital,
Geraldlne Fletcher ;s an Area Co-ordinator
for Nursing in the Woodstock General
Hospital, and BevMcCann/s Co-ordinator for
the Diploma Nursing Program. St Thomas
Campus, Fanshawe College
They were members of a committee
established by their local R.N.A.O. to
investigate ways to make nursing more visible
to the public.
Bibliography
Van der Smissen. Betty. Legal aspects of adult
fitness programs. J. Health Phys. Educ. Rec.
45:2:54-56, Feb. 1974.
The Canadian Nurse
Equipment Used to Measure Fitness Levels
IVe used standard balanced scales to obtain height and weight measurements.
Individual measurements were compared with Metropolitan Life charts.
Posters showing desirable weights for adults and children helped visitors
gauge how they "shaped up."
A borrowed vital capacity machine was used to evaluate adult lung
function. Located in the center of Canada's tobacco-growing area. Oxford
County's percentage of cigarette smokers is probably higher than the national
average. Those visiting our booth should have a much better idea now of what
smoking does to the lungs. We employed the familiar method of having people
take two deep breaths, and on the third one, exhale all the air stored in the lungs
into the machine's mouthpiece.
Most authorities agree that the standard exercise bicycle is the best device
to determine the heart's recovery rate, the most important indicator of a person's
fitness level. We had no difficulty with it, using the following method:
a) Resting pulse was taken before the participant got on the bike;
b) It was taken again after completing a two-minute ride at 25 miles an hour, and
thereafter at two-minute Intervals.
Blood pressure readings were also taken, and those with high readings
were advised to see their doctors.
Clinical Wordsearch
Answers
Puzzle no. 6 (appears or)
1
Freud
2
Group Therapy
3
Glasser
4
Primal
5
Denial
6
Reaction formation
7
Day Care
8
Suicide
9
Valium
10
Alcohol
11
Compensation
12
Neurosis
13
Schizoid
14
Dementia
15
Undo
16
Hypochondriac
17
Jung
18
Pride
s
19
Projection
z
20
Self
3
21
Sublimation
O
22
Fear
=
23
Berne
s
24
Anxiety
o
25
Deviation
o
26
Anorexia
27
Ego
28
Emotions
29
Apathy
30
Psychodrama
31
Sociopath
32
Stress
33
Shock
34
Manic
35
Senile
36
Lithium
37
Modify
38
Retarded
39
Phenothiazines
40
Mind
41
Fantasy
Hidden Answer: Sound body, sound mind.
(1)
INDEPENDENT NURSING PRACTICE WITH CLIENTS
This extraordinary new book is destined to be one of the more
talked about contributions to nursing literature. It presents the
rationale for independant practice, for giving care, for putting
nursing in Its proper place in the health field as a practice discipline
that is the extension of the client, not an extension of the physician.
M. Lucille Kinlein, the first nurse in this country to hang out her
shingle, tells how her independent practice came to be; relates
her philosophy of Independent nursing practice with emphasis
on how it differs from the medical model and medical practice:
explains how she made aspects of her philosophy operational;
and, in an extensive section on client examples, spells out the
results of nursing judgement and shows nursing measures and
their implementation.
M. Lucille Kinlein, R.N., B.A., M.S.N.E., Independent Generalist
Nurse.
Lippincott 200 pages 1977 $8.25
(^ ADVANCED CONCEPTS IN CLINICAL NURSING,
2nd Edition
Written by professionals active in their resprective fields, this revised
second edition offers valuable guidance to students and practitioners
in developing expertise in the more complex and challenging aspects
of clinical nursing. It integrates current concepts of nursing assess-
ment and management throughout each chapter. Extensively revised
material includes the problems and needs of those undergoing an
abortion; genetic counseling and the health requirements of those
with hereditary health problems; the immune process and care of
proton
New books anc
the allergic patient; mechanisms of shock; intensive care nursing;
and management of the burn patient.
Other new topics include: delivery of health care: psychological
concepts of health-related behavior; the diagnostic assessment of
health status: and nursing as a primary service in the post-acute
phase of illness.
Kay Corman Kintzel, R.N., M.S.N., Editor; formerly Instructor in
Research in Nursing Graduate Division, University of Pennsylvania.
With 29 contributors.
Lippincott 784 pages 137 illustrations 1977 about$21.00
ILLUSTRATED GUIDE TO ORTHOPEDIC NURSING
With over 500 figures and photographs, this lavishly illustrated
manual covers the major problems encountered by nurses in the
orthopedic unit. Emphasis is on nursing care of patients in casts
or traction, those undergoing hip repair or replacement, knee
repair or reconstruction, spinal surgery, amputation, or common
shoulder, foot, or hand surgery. Basic anatomy is described, along
with surgical procedures.
Numerous figures and photos illustrate the various aspects of
anatomy, surgery, and nursing care. Each of the figures is carefully
correlated with the text material so that discussion and figures will
flow in meaningful sequence. An appendix at the end of the text
presents a summary view of classic fractures and their treatment.
Jane Farrell, R.N., Orthopedic Clinician, Assistant Nursing Instruc-
tor, School of Nursing, Bellin Memorial Hospital, Green Bay,
Wisconsin.
Lippincott 242 pages 550 illustrations 1977 paperbound $10.95
0
DISTRIBUTIVE NUSING PRACTICE: A Systems
Approach to Community Health
Based on a belief that most diseases stem from the ways people
live, this challenging book focuses on preventive health care based
on education and preventive treatment of populations "at risk"
because of environment, employment, heredity, and adverse health
practices. Specifically it assists practitioners to 1) utilize a systems
perspective for nursing intervention; 2) employ nursing practice
components independently and collaboratively to promote, main-
tain, and restore health, prevent illness and facilitate health-abetting
behavior; and 3) develop professional roles for delivery of optimal
health services.
Joanne E. Hall, R.N., M.S., Associate Professor School of Nursing,
Duke University, Durban, N.C.; and Barbara H. Weaver, R.N. , M.S.,
Associate Professor, School of Nursing, Capital University, Colum-
bus, Ohio.
Lippincott 530 pages 1977 $15.25
PAIN: A Sourcebook for Nurses and Other Professionals
A landmark study of a topic of immediate concern to all nurses.
The authors present the most up-to-date information available on
all aspects of pain, its assessment and alleviation, as well as specific
clinical applications based on the theories and research of the more
than 30 contributing authors. They also demonstrate how the great
promise of major research projects undertaken by nurses can be
fulfilled and translated directly into practical improvements in
nursing care.
Edited by Ada Jacox, R.N., Ph.D., University of Colorado.
Little, Brown about 500 pages illustrated 1977 about $16.00
.^mt
|)ORTHOPEDIC NURSING
A lavishly illustrated, comprehensive text on the most widely
approved techniques and procedures in orthopedic nursing. Written
by two top authorities in the field, this book covers such topics
as nursing assessment of orthopedic patients (following the Stan-
dards for Nursing Practice), pertinent laboratory studies, application
of the cast and cast revoval, and x-ray interpretation. Of special
interest are chapters on mechanism of injury and diagnosis of
trauma, common disease processes related to orthopedic problems,
and orthopedic complications.
Clara A. Donahoo, R.N., and Joseph H. Dimon, III, M.D.. both
at the Peachtree Orthopedic Clinic, Atlanta.
Little, Brown 260 pages illustrated 1977 S13.75
\NURSING CARE OF THE GROWING FAMILY:
A Child Health Text
A major new student text in pediatric nursing that comprehensively
covers family-centered child health care with extensive attention to
normal growth and development and emotional and social dimens-
ions of the family. This second of two volumes discusses thoroughly
the latest nursing techniques and procedures and emphasizes the
broader role for nurses in today's health care system. Topics covered
include the growth and development of the child at all ages,
newborn through adolescent, health assessment of children, and
nursing intervention with the ill child.
Adele Pillitteri, R.N.. B.S.N. . M.S.N. . P.N. A.. State University of
New York at Buffalo.
Little, Brown 834 pages illustrated 1977 S19.75
ditions for 1977
and the father's role in pregnancy and childbirth. Also included
are chapters on sexuality and the structure and function of re-
productive organs and on pediatric conditions encountered in
obstetrical nursing.
Mary Ann Miller, M.S.N., University of Pennsylvania School of
Nursing, and D. Brooten, M.S.N. , College of Allied Health Sciences,
Thomas Jefferson University.
Little, Brown 500 pages illustrated 1977 S16.50
/gvTHE PSYCHOLOGICAL AND SOCIAL IMPACT
^^OF PHYSICAL DISABILITY
This is a primary text for training rehabilitation counselors and
an up-to-date resource for practitioners. Readings in areas like
interpersonal relations, sexuality, and consumerism document
advances in this country in helping the disabled with respect to their
multifaceted needs. Included is a review of rehabilitative steps,
among them the new Structured Experiential Therapy.
Edited by Robert P. Marinelli.anc/ Arthur E. Dell Orto.
Springer 414 Pages 1977
$19.75
gsTHE CLINICAL PRACTICE OF MEDICAL-SURGICAL
-^NURSING
A major new classroom text that focuses on patient care exper-
iences, this highly readable book incorporates all the scientific
background necessary for a full understanding of nursing respon-
sibilities. The authors integrate the physical, psychological, social,
and technological components of nursing into the clinical nursing
procedures. Each chapter includes the full spect'um of nursing care,
assessment, primary care, acute care, chronic ca're, and rehabil-
itation. Extensively illustrated with line drawings, photographs,
diagrams, and color illustrations, this book provides students with
a comprehensive picture of this most essential nursing field
By Marjoria Beyers, R.N., M.S.N. , Evanston Hospital, and Susan
Dudas. R.N., M.S.N., Department of Health Education, and Welfare,
and the United States Public Health Service.
Little, Brown 1236 pages illustrated
paper, S19.75 cloth, $27.00
1977
|)THE CHILDBEARING FAMILY: A Nursing Perspective
The well-organized and easy-to-follow chapters of this important
new text focus on the biological changes in the expectant mother
as well as on the emotional needs of the mother and father. A
unique feature of this major book is its cogent discussion of such
current issues in maternity nursing as psychological adjustment
to pregnancy, the unwed mother, the unwed father, single parents.
J. B. Lippincott Company of Canada Ltd:
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The Canadian Nurse June 1977
NURSING
THE ALCOMOLiC
PATKHT
Alcoholism and drug abuse now rate as Canada's third most serious health problem but controversy and uncertainty
still surround treatment techniques for the individual who is addicted to alcohol. The author suggests that nurses
can help the alcoholic take positive steps towards responsibility for his total problems by restructuring existing
programs to take advantage of community resources.
Arlee McGee
Many, if not most, doctors and nurses are
poorly informed and lack understanding of the
various manifestations of the problems of the
alcoholic. Schools of medicine and nursing
virtually ignore it in their curriculum planning.'
Some nurses are further handicapped in their
dealings with these patients by feelings of
inadequacy, the notion that they are dealing
with a "hopeless case," that nothing
constructive can be done to help the alcoholic,
or an inherent disapproval of alcohol use. ^
Knowing all this, I decided while I was an RN
student in a bachelor's program in nursing that
this was the public health problem that
concerned me most. I began then to acquire
data on all facets of this addictive disturbance
and, when the time came, elected to do public
health field work in the area of alcoholism.
As a preliminary step, I became involved
in an independent treatment center
(government financed, but governed by a
board of directors). Because of my nursing
experience I was given a great deal of leeway
by both the nursing faculty and the board. I
reviewed a proliferation of books, pamphlets
and documents related to alcoholism; chose
courses to supplement my reading,
(e.g. Counselling, Deviance, Small Groups,
Reality Therapy, etc.); researched and
prepared a number of papers on various
aspects of alcoholism; visited Alcoholics
Anonymous and Al-Anon groups. (I was
previously fortified with a psychiatric nursing
and public health background). Even so, when
faced with first-hand experience, I was not
really prepared for the actuality and extent of
the problem.
Alcoholism is a problem area which
seems to have no universally accepted
definition. One author describes it as
"basically a means of avoiding the
responsibility of life situations. "^ Looked at in
this light, alcoholism becomes a symptom of a
problem, rather than simply a problem.
There are many theories about the'
causes of this phenomenon. Research into the
three dimensions — physiological,
psychological and sociological — has resulted
in some understanding. For example:
Physiological Factors — Neither chemicals
in specific beverages nor physiological,
nutritional, metabolic or genetic defects have
been found which can explain alcoholic
drinking.
Psychological Factors — If there is such a
thing as an alcoholic personality, its
specifications are poorly defined, often
contradictory and seem to apply to all mental
Illness.
Sociological Factors — Research shows that
alcoholism is widespread in some national,
religious and cultural groups. It is rare in other
groups, for example IVIormons and Jews. The
lowest incidence of alcoholism is associated
with certain habits and attitudes. '
Methods of treatment are as diverse as
the suggested causes of alcoholism. Basically
there are two distinct approaches, a
conventional method and one that utilizes
techniques based on the learning theory.
Conventional treatment involves
individual counselling, group therapy
(including AA), and the use of vitamins,
tranquilizers, antidepressants or Antabuse.
Learning theory techniques may involve
aversion conditioning which incorporates the
use of means of making alcohol a negative
rather than a positive stimulus. A newer
approach aims at teaching the patient through
behavior modification, to become a social
drinker.
Alcoholism is commonly thought of as a
chronic disease but E.J. Larkin, Psychologist
Operations Research, Addiction Foundation
of Ontario, points out that by accepting
alcoholism as a chronic disease, we also
accept the concept of uncontrollable drinking
We imply that an individual is not responsibi
for his behavior. He suggests, on the other
hand, that the alcoholic /s responsible for th(
behavior which occurs when he has been
drinking and must take responsibility.^
Acute treatment for alcoholics involves
detoxification period (five to seven days),
sometimes followed by short-term
rehabilitation (28 days). In many areas a
non-medical approach is stressed. Nurses wi
recognize the value of a non-medical
approach which de-emphasizes use of
tranquilizing drugs (alcoholics can become
cross addicted when tranquilizers are
substituted for alcohol). However, when this
non-medical approach also involves lack of
physical examination within the first 24 hour;
of detox, undetected secondary problems
(physical, mental, social), ignorance of
nutritional needs and a general lack of othe
guidelines to promote a change in total
lifestyle then there is cause for concern. If ai
alcoholic is simply taken in for care and shelte
until his body is physiologically "dried out, '
major health problems can be overlooked an
a revolving door syndrome encouraged.
Medical intervention is essential at this critica
stage of treatment.
Learning and unlearning
What I saw when I looked at the cente
where I wor1<ed was a non-medically oriente
program that did not encourage the alcoholi(
to attempt to find long-term solutions to his
total problem. I was convinced that what wa
needed was a "now and tomorrow"
community approach.
The first step was an assessment of th
needs in the existing treatment program. This
was accomplished through visits to the center
interviews with members of the board, staff,
patients and community resource persons.
The Canadian Nurse June 1977
/P<
Priority was given to the area of staff
education. (The staff consisted of eleven male
alcoholics and two female non-alcoholics
whose previous training was on-the-job, and
whose educational backgrounds were varied
but limited). The course that I designed was
intended to meet their specific needs and,
indirectly, the more basic immediate needs of
the patients. (The center accommodates two
females and eleven males for detoxification
and short-term rehabilitation; most patients
are of mid- to lower-socioeconomic status).
I was aware that, as a nurse, I was
susceptible to the biases against the alcoholic
client that are described in the literature. This
helped me determine how I should present
myself to the clients and staff and to
experience a kind of anticipatory
socialization.' Research also convinced me
that I should strive to be non-judgmental and to
react on a non-threatening level as an equal. A
teacher-helper role seemed most appropriate.-
A teacher sets goals. The specific
long-term goal for my program was to present
a number of instructional classes for health
workers of an alcoholic detox center. A
broader short-term goal was to identify needs
of workers and clients and to seek appropriate
solutions.
Many theorists suggest that alcoholic
behavior is learned and, in view of this fact, a
goal-oriented approach seemed more suitable
than a problem-solving one. The staff for
example, were notified that on completion of
the course, a certificate and possible salary
increment would be awarded. A course was
designed to entail 30 hours of classes. Plans
for the staff included new leaming, unlearning
and releaming — in essence it meant change.
"People are likely to accept a proposed
change when it makes demands whose
components they have already learned or feel
confident they can learn. ^ Classes were
designed and presented in the light of this
t
knowledge of the change process. Specific
lessons included:
1. A general outline of criteria for care
given in some other Canadian detox
centers, accompanied by a film on detox
programs.
2. Acute care of a patient in detox with
emphasis on delirium tremens and care
during convulsions.
3. Instruction and demonstrations on
cardiopulmonary resuscitation.
4. Continuation of recognition of vital
signs, TPR Measurement, secondary
problems.
5. General nutrition of the alcoholic
(including detox period).
6. Suicide, including drug abuse.
7. Safety, basic first aid, moving of
patients and demonstration of lifts.
8. General physical care, secondary
effects of alcohol (cirrhosis, etc.)
9. Listening skills, interviewing and
recording.
10. Rehabilitation and introduction to
reality therapy.
Many resource persons were utilized in
this teaching program, including a nutritionist,
physician, St. John Ambulance persons and
counsellors for role playing. A ' graduation'
was held and an evaluation of the program
indicated that the long-term goal was reached
satisfactorily.
On the completion of this instructional
program, the board requested that I return to
the center as Co-ordinator of Patient Care and
Service. In that role, I have designed a second
program with a specific treatment approach.
The opportunities to utilize nursing skills have
become more numerous and challenging.
The Canadian Nurse June 1977
Working in a treatment center for alcoholics provides a nurse with one of the most challenging experiences of her career. The
problems that she encounters are unique and demand all of her nursing skills. These problems are apt to fall into three categories:
• community support
• administration
• client characteristics
Trial and error suggests that the following approaches may be helpful to nurses working in these settings.
I Community support
Barrier: Community attitudes, unconcern and/or unawareness of
alcoholism in immediate area.
Useful Approach: Talked witti groups of women, professionals and
friends and invited them to the center. Involved the clergy in weekly visits.
Informed the Chief of Police and civic officials of the center's work.
Included a description of the program in all correspondence. Positive
publicity is important.
Barrier: Community resource persons not coming to the alcoholic center.
Useful Approach: Took the center's staff to the community resources,
i.e. the university, hospital emergency and psychiatric units etc.
Conducted meetings for staff at the university with a pharamacist,
physician and counsellor. Invited R.C.M.P. and mental health officials,
etc. to the center for presentations.
Barrier: A patchwork quilt of support systems operating independently in
the community.
Useful Approach: Shared patient information frequently with other
disciplines. Worked through public health nurses and phoned agencies
regularly to update client data. Being a member of an agency board is
useful for keeping one's self informed, (e.g. Mental Health Local Branch)
Barrier: Medical community superficially involved in care of the alcoholic
patient.
Useful Approach: Made frequent referrals to physicians for physical care
of patients. Designed a Medical Treatment Record card for patients to
take to the hospital and to the doctors office. The card includes patient
information for doctor's use and a record of his assessment and
recommendations. Involved the Medical Health Officer re chest x-rays of
staff and patients. Corresponded with Medical Society re drug control
(doctors prescribing too many tranquilizers for patients). Independent
meetings were held with physicians to request routine medical care for
alcoholics in the area.
II Administration
Barrier: Some non-medical people involved with government alcoholism
programs regard medical persons as a threat to their established
treatment methods.
Useful Approach: Nurses must keep well informed, practice patience,
tolerance and speak firmly on issues which are their concerns. Positive
program results will eventually help gain the support of "doubting
Thomases. "
Barrier: Working with clients allows limited time for in-service.
Useful Approach: The Faculty of Nursing of the University of New
Brunswick allowed three senior nursing students to do public health field
work at our center. They acted as resource persons for in-service. A
retired psychiatric nurse (former superintendent of a Canadian hospital)
also helped on a voluntary basis.
Barrier: Staff members at times not 'weller' than patients.
Useful Approach: Held discussions on lifestyle using material from
Health and Welfare Canada. Enforced a decrease in smoking during
group meetings. Changed coffee at the center to decaffeinated. Gave
staff Vitamins B and C (same as patients receive). Encouraged staff to
B relate problems in group sessions. Used bulletin board for educational
B material relating to lifestyle.
L
Barrier: Staff discouragement with repeaters and chronic inebriates.
Useful Approach: We try to look at old problems in a new way. One
patient from our center has been accepted into a Senior Citizens' home
and is maintaining sobriety. One chronic inebriate is awaiting plastic
surgery for a body image problem. We try to utilize patient skills in our
program, i.e. paperhanger, projectionist, cookee, etc. We work with
employers on short-term employment arrangements. We have access to
facilities at a Community Service Center co-ordinated by a psychiatric
nurse for day-to-day recreation.
Barrier: Kitchen staff not sufficiently informed about specific dietary
needs of alcoholics, resulting in nutritional deficits.
Useful Approach: A provincial nutritionist completed a food consultation
upon request. Two home economics students have consented to do
independent studies at our center and at the same time assist the cook
with menus, etc. A useful reference is "Guidelines for Nutrition Care of
Alcoholics."'"
Barrier: Nurses have been conditioned to believe what the patient offers
verbally.
Useful Approach: The term "con-artist" is synonomous with alcoholic.
Confrontations are a frequent part of communication. After a series of
confrontations, a working relationship can be established.
Ill Client characteristics
Barrier: Alcoholics have the attitude that only an alcoholic knows about
alcoholism.
Useful Approach: Designed and administered questionnaires on
various aspects of alcoholism (together we are becoming conscious of
our lack of knowledge).
Barrier: Difficult to determine a specific treatment approach when
planning a program for alcoholics.
Useful Approach: We chose a multi-moderate approach. Included AA,
individual counselling and group meetings. Vitamins are given and
tranquilizers de-emphasized. William Giasser's counselling theory is a
practical guide. He advocates the teaching of responsibility as the main
emphasis in psychotherapy.^ A guideline used by the Johnson Institute of
Minnesota is helpful for group work.'
Barrier: Short stays and transient nature of clients create problems in
attempts to rehabilitate and resocialize alcoholics.
Useful Approach: Alcoholism is a negative concept. At our center we
attempt a positive feedback system. We discourage toxic behavior and
encourage nourishing actions. We hold insight groups, not group therapy
sessions. We include talks on positive commitments of patients and
positive characteristics of self, etc. Meaningful relationships are still hard
to develop over the short run. We use appointment cards for follow-up
visits to help prolong treatment. We refer selected candidates to
long-term rehabilitation programs elsewhere.
Barrier: Difficulty getting female alcoholics to overcome stigma attached
to accepting treatment.
Useful Approach: Public Health Nurses can be good sources for
identification and referral of female alcoholics. We also get referrals
through a crisis center and local women's group. Obtaining female
patients remains a problematic area.
1
The Canadian Nurse June 1977
t-,
1.
"It
fe
Arlee McGee, author of "Nursing the
alcoholic patient," recently completed her
post basic nursing degree at the University of
New Brunswick School of Nursing in
Fredericton. She is a graduate of Victoria
Public Hospital School of Nursing in
Fredericton and received a diploma in
psychiatric nursing from the University of
Western Ontario in London.
Of her worl< with alcoholics she says,
"there are many other aspects I would like to
have described, such as sharing recipes with
the cook, shopping for wallpaper with clients
and handing out fried chicken at the
Christmas party." She comments also that
"We function with extreme flexibility;
counselling is done at the kitchen table, my
five-by-five office and in one of the bedrooms.
However, elegant surroundings are not
essential to giving good care In a detox
center. "
The nurse in the detox center
A nurse who works in a detox and
hort-term rehabilitation unit undertakes many
isks that are not usually considered her
xclusive function. One of the key reasons is
lat the opportunities for her to utilize various
ursing skills are endless. The following
escription of the clientele illustrates some of
16 reasons for this:
The physical health of the heavy alcohol user
i typically poorer than that of the general
opulation. Some illnesses result from the
irect effects of alcohol, or they may involve
ther factors such as general lifestyle,
utritional deficiencies, heavy use of other
rugs (i.e. tobacco, tranquilizers, aspirin),
odily injury due to accident and other violent
lishaps, inadequate hygiene and rest;
ver-exposure, over-crowding and other
orms of stress."'
Added to this, heavy alcohol consumption
ivolves a variety of psychiatric and
leurological disorders. Social problems,
insistent relationship to crime and family
;rises are overwhelming.
On a formal level therefore, my nursing
Die in the center includes performance as:
'Counsellor — to workers, clients and family
Tiembers.
Protector — prevention was necessary in
nany aspects, including drug control and
ittempts to alleviate secondary effects of
ilcohol. Follow-up was an important aspect.
'^Collaborator — this became a key issue as
legotiations with outside agencies and the
center's board were frequent. Collaboration
vas done with doctors on patient's behalf.
Advocate — continuous recommendations
\'ere made to the various bureaucracies for
mprovements in the alcoholic treatment
urogram.
Teacher — the main thrust was in the
n-sen/ice education program.
Comforter — comforting care was provided
to clients when situations presented
\hemselves.
A nurse functioning in detox must be well
informed on signs and symptoms of patients in
withdrawal, delirium tremens and dry-drunk
symptoms. She should have information on
Antabuse, Temposil and mood-altering drugs.
She requires knowledge of the functions of
Alcoholics Anonymous, other treatment
centers, govemment policies on alcoholism
and the peculiarities of the alcoholic
subculture.
A physically unwell, emotionally confused
and socially maladjusted alcoholic comes to a
treatment unit to dry out his body
physiologically. Under the present system, he
is then discharged from some detox and
short-term rehabilitation programs — a sober,
physically unwell, emotionally confused and
socially maladjusted alcoholic.
Stepping stones to the community should
be laid while he is undergoing treatment so he
can take positive steps toward responsibility
for his total problems. Alcoholism need not be
a dilemma when an alcoholic is viewed as a
total person with other problems besides
alcoholism. Present programs can be
improved at relatively little cost by
utilizing community resources. Nurses
possess the versatility to put such programs
into effect.
In summary, nursing in alcoholism is
probably the most stimulating area in the
profession. There seems to be nothing the
nurse in this field doesn't do — negotiate with
bureaucracies, administer physical care and
participate in psychiatric and public health
nursing. What more could any risk-taking
nurse ask for? ^
References
1 Maclver, Charles. Increasing self-worth:
is it an answer for alcoholism? Canad. J.
Psychiatr. Nurs. 16:4: 8-10, Jul. /Aug. 1975.
2 Leahy, Kathleen M. Community health
nursing, by ... etal. 2ed. Toronto, McGraw-Hill,
1972. p. 218.
3 Larkin, E.J. The treatment of alcoholism.
2ed. Toronto, Addiction Research Foundation,
1976.p. 75.
4 Chafetz, fvlorris. Alcohol and
alcoholism. Maryland, National Institute on
Mental Health, 1972. p. 13-15.
5 Ibid. p. 75.
6 Doob. Leonard W. Psychological
aspects of planned developmental change. In
Creating social change, edited by Gerald
Zoltman et al. New Yori<, HR-W, 1972. p. 70.
7 Canada. Dept. of National Health and
Welfare. Commission of Inquiry into the
Non-Medical Use of Drugs. Final report.
Ottawa, Information Canada, 1 973.
8 Glasser. W\\\\am. Reality therapy: a new
approach to psychiatry. New York, Harper &
Row, 1975. p. 21.
9 Johnson, Vernon E. I'll quit tomorrow: a
breakthrough treatment for alcoholism. New
Yori<, Harper & Row, 1973.
10 American Dietetic Association.
Guidelines for nutrition care of alcoholics
during rehabilitation. Chicago, 1972.
The Canadian Nurse June 1977
In the early 1820's, a Scottish doctor,
Thomas Lotta, administered the first
intravenous infusion to patients suffering
from cholera. Since then, we've gone a
long way in improving the technique.
Nevertheless, hazards still exist for all
patients on I.V. therapy. This "idea
exchange" discusses one such hazard —
foreign particles in I.V. fluids — and gives
some tips on how you can be alerted to
their presence in the intravenous fluids
you administer.
Idea Eeijcliange
A hazard of intravenous therapy — |
CORED PAm
Michel C. Bessette
The parenteral route is the most controlled and
expedient method of fluid administration, and
in many cases, is a life-saving measure. It is
also, however, the most dangerous method of
administering fluids and gives rise to potential
complications. Many of the hazards such as
thrombophlebitis, pyogenic reactions, air
emboli and circulatory overload are generally
known and are closely monitored. One hazard
that may not be as well known but which is
potentially harmful is the presence of foreign
particles in large volume containers of
parenteral fluids.'- The effect that these
particles have on the patient receiving
intravenous fluids is fortunately avoidable.
The removal of particles smaller than 50
millimicrons in diameter, which cannot be
detected by visual inspection at the time of
administration, can be achieved by the use of
intravenous sets equipped with a filter. Larger
particles can be prevented from entering the
patient by adherence to propertechnique, and
by visually inspecting the administration set
prior to starting the infusion.
Recently, at this hospital, a number of
intravenous sets have been found to contain
these larger particles. (Figures 1 and 2) These
particles, although readily visible, can easily
pass into the patient's vascular bed through a
large gauge cannula. (Figure 3) The particle in
these photographs is a piece of the "rubber"^
stopper which was cored, and introduced into
the fluid path at the time that the stopper was
pierced. A 16-gauge central venous catheter
was connected to the set at the time the
particle was discovered.
If it entered the patient, this particle would
have passed through the right atrium and
ventricle and lodged in a lobar or segmental
artery. The resulting interruption of circulation
may have caused a pulmonary infarction."
The use of a filter will prevent the
introduction of particles. The disadvantages of
filters are the increased cost and the inability to
utilize them with some fluids, for example
crystaloids.'-^
The Canadian Nurse June 1977
cmlHiiliili iill|ll
SPECIMEN
Figure 1 — Photograph showing the size of the particle described in this article.
Figure 2 — The particle inside the tubing of the Intravenous set.
em|iliiiniljllll|||||{iiii|iiii||||j{||,,|,, I, |, ,,,.,,
12 3 4 5
SPECIMEN , DATE_
Figure 3 — The ability of the particle to pass through the size 16 gauge catheter
Guidelines
When using intravenous sets which do
not have a filter, the following guidelines may
be of help in avoiding the introduction of visible
particles.
• Push the piercing pin straight through the
center of the stopper. Do not twist or angle.
• Visually check the contents of the
container for particles. Ideally the container
should be held against both a white and black
background to detect both black and white
particles, respectively.'^ Look at the interior
surface of the stopper for particles which may
become dislodged with movement.
• Purge the air from the I.V. tubing. Once
the air has been removed, inspect the entire
set, including the container.
• Never connect a cannula to the
intravenous set before ensuring that the fluid
path and container are free of particles. This is
of utmost importance since a particle will be
difficult, or impossible to see if it has passed
into the cannula or needle. *
References
1 Particles in veins. Br. Med. J. 1 :5849:307,
1973.
2 Klelnman. L.M. Particles in parenteral
solutions, by ... et al. Arch. Pathol. 96:144. Aug.
1973.
3 Charlebois, P. A. Coring: the unseen menace.
Canad. Anaesth. Soc. J. 13:585-597, Nov. 1966.
4 Personal communication.
5 Harrison, M.J. Intravenous administration
sets. The effect of flushing and filtration on
particulate contamination, by ... and T.E. Healy. Br
J. Anaesth. 46:59-65, Jan. 1974.
6 Duma. Richard J. Thomas Latta, what have
wedone? The hazards of intravenous therapy. New
Eng. J. I^ed. 294:21:1178. May 20. 1976.
Presently employed at thie Queen Mary
Veterans Hospital as tfie Department Head of
Inlialation Therapy Anesthesia Technology.
Michel Bessette graduated from the Toronto
Institute of Medical Technology In 1 972 with a
diploma in Respiratory Technology. He
received certification from the Canadian
Society of Respiratory Technologists in 1 973 .
He is presently the Vice-President of the
Quebec Corporation of Inhalation Therapy.
He was previously employed at Vanier
College as a clinical and classroom instructor
in Inhalation Therapy Anesthesia Technology.
Acknowledgments: The author wishes to
thank the nursing staff of the Surgical
Intensive Care Unit, and V. Frechette of the
photography department of the Queen Mary
Vpfpran'} HriKnital i
The Canadian Nurse Jura 1977
-... Care vs. Custodialism
Following publication of "Nursing the
Acutely Psychotic Patient" In February, CNJ
received a letter from Jose de Cangas, on
behalf of tfie Faculty of the school of nursing of
Brandon /Cental Health Centre in Brandon,
Manitoba. The letter raised these points:
..."the impression one gets is that whenever a
nurse is faced with an acutely psychotic
patient, she should call in the marines and
administerenough medication to accomplish a
state of complete submission. Although this
approach may be resorted to in extreme
cases, it should by no means constitute the
general rule. If such an approach were
condoned by health care givers, then I am
afraid that the head nurse in the now famous
"One Flew Over the Cuckoo's Nest" would
also be seen as someone to be idealized. As
most readers will recall, she also strived for
control as her number one priority.
1 . The author uses the word control ten times
explicitly, and alludes to mechanisms of
behavior control throughout the article.
Psychiatric nursing does not have as its prime
objective control but rather, care.
It is a mistake for nurses to think that the
most important thing is to show that they have
control. The emphasis is not on control with
such clients, rather the client being reassured
and assisted to regain control of his/her
environment and behavior.
2. Why so much concern about hostility? Most
psychotic patients are not hostile even in the
acute episodes.
3. One cannot make sweeping generalizations
about the nursing care of this type of client
because its application in toto, often leads to
anxiety responses in the client and thus,
hostility. What the author does not seem to
understand is that such an anxiety-hostility
paradigm is the direct result of unskilled
nursing intervention.
4. Even the most "psychotic" clients have lucid
intervals. Naturally the nurse can use them
only if she/he is able to recognize them.
5. The importance of benavioral analysis,
nursing and social histories are not even
mentioned in this arl;Cle. This data gathering is
essential in caring for these clients as, through
them, factors are identified, which not only
point out the behaviors leading to violent
outbursts, but also enable us to avoid them.
6. Mattresses on the floor! Maybe padded cells
next and chains following? This is seldom
necessary. As a matter of fact, it accounts foi
more anxiety building in both staff and clients.
7. Isolation — we cannot generalize as mos
commonly this leads to further depression and
withdrawal.
8. Medications — they are an adjunct to
therapy. They give symptomatic relief, but are
not the only means of helping the client.
Certainly not an end in itself, as seems to be
implied.
I ns i;anaai8n Nurse
>••«
Author Janet Berezowsky responds to
these concerns:
I appreciate your extreme discomfort with my
use of the word "control. " I also acknowledge
your concern about the whole issue of control
in nurse-patient situations. It has been my
experience that nurses are often not
comfortable with such an open and direct
description of nursing intervention. It has also
been my experience that such anxieties are
expressed primarily in reference to psychiatric
patients. However, I do not discriminate
between the appropriateness of the nurse
taking control in any of the following situations:
— limiting the privileges of the suicidal patient,
— providing skin care for the immobilized
patient,
— forcing fluids on the dehydrated patient,
— administering CPR to the patient in cardiac
arrest, or
— medicating the acutely psychotic patient.
In each case the nurse acts on the basis of
her assessment of the patient's needs as
expressed through his behavior. To fail to take
control in these or numerous other situations
constitutes negligence.
Nurses frequently fail to realize that
nursing intervention is the assumption of
control on behalf of the patient to the extent to
which it is unsafe for the patient to be in control .
We cannot escape this responsibility. The
whole essence of professionalism is
recognizing ournursing responsibilities, acting
on our nursing judgments, and being
accountable for our nursing behaviors.
Your comments seem to be addressing a
philosophical issue rather than a professional
issue. In the words of Lisa Robinson, ■ ... a
dead person is not one whose psychological
condition can be modified. " The nurse puts the
patient as well as all other patients and staff at
significant risk if she does not assume control
of the situation.
Your definition of control as other than
caring, suggests that control can only be
punitive or in the interest of meeting the
nurse's needs. This is not the context in which
the article deals with control. No mention of
hostility is made in the article. Assaultive
behavior and "fight or flight " responses are
motivated by fear. If, however, the nurse
assumes a punitive attitude, she is likely to
provoke hostility.
Maslow's hierarchy of needs provides the
rationale for meeting psychological and safety
needs as a necessary prerequisite to the
development of a therapeutic relationship.
This includes controlling his environment so as
to provide both physical and psychological
protection. As indicated, these nursing
measures are the means through which the
relationship is established. Again referring to
Lisa Robinson, "The nurse, through her
ministrations, demonstrates to the patient that
she not only is concerned but that she actually
will take care of the patient. " As the patient
becomes more lucid, psychosocial needs can
begin to be dealt with more directly. The
nursing measures described should be
required for a relatively short period of time,
until the acute psychotic episode subsides,
frequently less than a week.
The nursing interventions presented in
this article can provide, and in fact do provide
the basis for standardized nursing care plans
in a numberof Canadian hospitals on medical,
surgical, obstetrical, and psychiatric units. As
such, this standardized regime provides the
basis for teamwork which is essential in
caring for acutely psychotic patients. Skilled
nursing judgments are basic to the
implementation of such a nursing care plan.
Your comments emphasize the
importance of nurses dealing with their own
anxieties prior to and in such a way that
patients are not the recipients of misdirect
frustrations. Priorities in crisis situations mi
be determined on the basis of safety for tf
patient, other patients in the setting, and stc
If nurses are not comfortable with their ow
feelings about taking control, the outcome m
be disastrous.
If, for example, nurses put a mattress <
the floor even though they are very
uncomfortable doing so, their own anxietie
will be communicated to the patient, and s
create a more unmanageable situation. If
theyare not comfortable medicating patien
who are acutely psychotic, then they will ha
more difficulty doing so. The patient who 1;
already terrified will quickly perceive their
insecurity, and this in turn will have an
escalating effect on his fear. As pointed out
the article, staff need opportunities to practii
these measures under careful supervision
order to develop their skills and to deal wii
their own anxieties.
The context of the article is the safe,
efficient, humane management of the acut(
psychotic patient by the nurse in any hospH
setting. As Lisa Robinson expresses it,
"Patients who cannot care for themselves a
afraid, but when they see that others are
strong and firm and able to care for them, th
tend to be less frightened." *
Robinson, Lisa. Psychiatric Nursing as a
Human Experience. Toronto. W.B. Saunde
Co. 1972.
The Canadian Nurse June 1977
Clinical Wordsearch no. 6
This is another in a continuing series of clinical
wordsearch puzzles relating to different areas of
nursing, by Mary Elizabeth Bawden (R.N..
B.Sc.N.) who presently works as Team Leader
in the Rheumatic Diseases Unit, University
Hospital, London, Ontario.
Solve the clues. The bracketed number
indicates the number of letters in the word or
words in the answer. Then find the words in the
accompanying puzzle. The words are in all
directions — vertically, horizontally, diagonally,
and backwards. Circle the letters of each word
found. The letters are often used more than once
so do not obliterate them. Look for the longest
words first. When you find all the words, the
letters remaining unscramble to form a hidden
answer. This month's hidden answer has four
words. (Answers page 27). *
R
E S
SALGHYTE 1 X
NASD
N
E V
UNDOYPSEN 1
L E M E
0
M A
ILSSPRIDEC
P 0 Y M
1
0 L
CICEOIKDOS
D S F E
T
T 1
DTHLCMCHY 1
A A E N
A
1 U
EH 1 FHAOCFT
1 S A T
M
0 M
U 1 ZOOLHYNX
D 1 R 1
1
N S
CUOONOSAEN
L S P A
L
S T
1 M 1 0 D F F R 1 1
A 0 R D
B
E R
NEDRREOMUY
1 R 0 E
U
G E
ANAE 1 NVRDG
N U J D
S
0 S
MMUBANO 1 MD
E E E R
D
N J
ADAYCAREAA
D N C A
G
R 0
UPTHERAPYT
T S T T
N
0 1
TASNEPMOCM
1 1 i E
S
E N
IZAIHTONEH
POOR
S
0 C
1 OPATHYHTA
P A N N
1 Sigmund or Anna. (5)
2 Treatment modality involving 8-10 persons
at one time. (5. 7)
Developed Reality Therapy. (7)
A type of scream. (6)
No it's not. (6)
A defence mechanism by which one adopts
an attitude opposite to the repressed,
unacceptable one. (8, 9)
7 Partial hospitalization. (3, 4}
8 A final answer to a stressful situation. (7)
9 The most over-prescribed minor
tranquilizer. (6)
10 An addicting chemical used by some to
escape from distressing situations. (7)
1 1 A coping mechanism by which one attempts
to make up for real or imagined deficits. C72;
12 Snoruise (anagram)
13 A personality disorder resembling
schizophrenia. (8)
14 Predominant feature of Altzeimer's
disease. (8)
15 Doun (anagram)
16 The imaginary invalid was one. (13)
17 He doesn't sound old. (4)
18 Too much of this prevents some people from
seeking help. (5)
1 9 A mental mechanism by which one attributes
one's own unacceptable feelings or traits to
another person. (10)
20 Pels (anagram)
21 The process of diverting socially
unacceptable instinctive drives into socially
acceptable behaviour. (1 1)
22 Emotion caused by specific impending
danger. (4)
23 Erics the name, transactional analysis the
game. (5)
24 Generalized feeling of discomfort or
apprehension. (7)
25 Any behaviour that varies from that
considered socially acceptable. (9)
26 Loss of appetite, often psychogenic, may
result in cachexia. (8)
27 Sigmund, his self. (3)
28 Feelings. (8)
29 Absence of feeling. (6)
30 A treatment modality involving a protagonist,
an alter ego, and a director. (11)
31 McMurphy in "One Flew Over the
Cuckoo's Nest " might have
been one. (9)
32 Hans Selye's claim to fame. (8)
33 Electroconvulsive therapy. (5)
34 Hyperactive stage of a bi-phase
psychosis. (5)
35 Pertaining to changes resulting from the
aging process. (6)
36 Drug, useful in 34. (7)
37 What behaviourists attempt to do for their
clients' problems. (6)
38 Depression mar1<ed by slowness of thought
and action. (8)
39 Family of major tranquilizers. (14)
40 Usually found over matter. (4)
41 A daydream. (7)
I ne ^anauitiii nura
vfune 19/ /
raleiidar
lune
econd National Nurse Practitioner
ymposium to be held in Denver,
: orado on June 23-25, 1977.
ontact; Primary Care Nurse
ractitioner Symposium, University of
olorado School of Nursing,
ontinuing Education Services,
-287, 4200 E. Ninth Ave.. Denver,
olorado, 80262.
8th Annual Conference of the
anadian Public Health
ssociation to be held in Vancouver,
C on June 28-30, 1977. Contact:
--lA, 1335 Carting Ave., Suite 306,
■va, Ontario, K1Z 8N8.
■July
"•u ration ' 77. The 12th Annual
erence of the Canadian
validation on Alcohol and Drug
)ependencies, Winnipeg, Manitoba
" 'jly 10-15. 1977. Information:
erence Manager, Futuraction
'he Alcoholism Foundation of
:oba, 1580 Dublin Ave.,
t^nnipeg. Man.. R3E 0L4.
lilemmas in Treatment a
lonference on dilemmas in
)sychotherapies and medical
jractice. To be held on July 24-29,
1977 in Venice, Italy. Fee: S85
Contact: Clara Shapiro. Center for
^olicy Research. 475 Riverside Drive.
•Jew York, 10027, U.S.A.
August
iealth Care Evaluation Seminar. A
)ne-week seminar for those
nterested in health care evaluation to
)e held at Memorial University of
^lewfoundland, from August 29-Sept.
, 1977. Applications due June 1.
ontact: Patricia Bruce-Lockhart,
'>ivision of Community Medicine,
acuity of Medicine, Memorial
Jniversity of Newfoundland, St
lohn's, Newfoundland, A1B 3V6.
Strategies for Curriculum Change.
To be held in Winnipeg, Man. on
\ugust 18-20, 1 977. Contact: /nsf/fufe
)/ Nursing Consultants, Fay Bower,
1820 Portola Road, Woodside,
'■alifomia, 94062.
Symposium on Canada and
World Food to be held at Carleton
University, Ottawa on August 22-24.
1977. Multidisciplinary topics
discussed. Contact: The Royal
Society of Canada, 344 Wellington
St. Ottawa. Ont, KIA 0N4.
World Federation for Mental
Health - 1977 Congress, "Today's
Priorities in Mental Health," to be
held in Vancouver, B.C. from August
21-26, 1977. The focus of the
meeting will be on finding ways to
mal<e health systems work for all the
people, including the mentally ill.
Techniques of Health By The People
will be emphasized. For further
information contact: Secretariat.
World Federation for Mental Health,
Health Sciences Centre Hospital,
2075 Wesbrook Place, The University
ol British Columbia, Vancouver, B.C.
WT 1W5.
September
Emergency Nurses Association of
Ontario Annual Conference to be
held September 12-14, 1977 at the
Skyline Hotel, Ottawa, Ontario.
Contact: Helen McPhee, Supervisor,
Emergency Department., Ottawa
Civic Hospital, 1053 Carling Ave.,
Ottawa, Ontario.
Fourth Annual Meeting of the
Ontario Psychogeriatric
Association to be held on Sept.
19-21. 1977. Theme: Bringing
Continuity to Care. Contact: Dr. M.
Farquhar, P.O. Box 14, Postal Station
"C", Toronto, Ontario, M6J 3M7.
Initial Assessment and
Management of Patients with Acute
Illness and Injury. Atwo-dayseminar
sponsored by the Emergency Nurses
Group, a special interest group of the
RNABC. To be held on Sept. 30 - Oct.
1, 1977 at the Four Seasons Hotel,
Vancouver, B.C. Contact: Linda J.
Clark, do Emergency Nurses Group,
Box 86824, North Vancouver, B.C.
October
Sixth Annual General and Scientific
Meeting of The Canadian
Association on Gerontology to be
held October 13-16, 1977 in Montreal
at Loews "La Cite' Hotel. Contact:
Blossom T. Wigdor, Ph.D., Director,
Psychology Services. Queen Mary
Veterans Hospital. 4565 Queen Mary
Road. Montreal. Quebec. H3W 1W5.
28th Annual Meeting of the Ontario
Public Health Association to be held
on Oct. 18-21, 1977 at the Skyline
Hotel in Rexdale, Ont. Contact: Kae
Sutherland, OPHA, 7 Carlis Place,
Port Credit, Ontario, L5G 1A8.
12th Operating Room Nurses
Conference to be held by the O.R.
Nurses of Nova Scotia on Oct. 18-20,
1977 in Halifax. Contact: Miss L
Hirtle, R.N., Halifax Infirmary (OR),
1335 Queen St, Halifax, Nova Scotia.
November
First Annual Nurse Educator
Conference to be held at the
Hyatt-Regency Hotel in Chicago, III.
on Novemt)er 7, 8 and 9, 1977.
Theme: Transition from student nurse
to effective professional. Contact: S.
Swartz, 12 Lakeside Park, 607 North
Ave., Wakefield, Mass., 01880.
Canadian Nurses Foundation
Have you forgotten to renew your 1977 CNF
membership?
Are you thinking of becoming a memtier?
Money donated by nurses to the Foundation is used to support
nursing scholars and nursing research.
Since 1962 144 nurses have been awarded 174 CNF
Fellowships. Thirty nurses have been funded twice.
Please complete the form below and send to:
Canadian Nurses Foundation
50 The Driveway,
Ottawa, Canada, K2P 1 E2.
Regular member (Si 0.00)
Sustaining member (550.00)
Patron ($500.00)
Donation (membership not Included) to
Scholarship Research
Capital Trust Administration-
Name
Address
Amount of cheque for the year 1977
ConinbutKjns lo the Canadian Nurses Foundation are deductible for rncome tax purposes.
The Canadian Nurse June 1977
Information is supplied by the
manufacturer; publication of ttiis
information does not constitute
endorsement.
Wlial's New
total function
recreation eciuipment
for the disabled
Recreation Equipment
for the Disabled
"Total Function Recreation
Equipment for tfie Disabled," is
the title of an all new, eight-page
catalog supplement issued by
Maddak Inc., subsidiary of Bel-Art
Products.
Featured are such equipment as
table tennis, pool tables, bumperpool,
miniature txiwling alleys, txjwiing
ramps and a host of table top games.
"Total Function" is achieved through
the adjustable table height design
which permits use in regular and
adapted programs and
accommodates individual
requirements of height, age and
ability.
This brochure is available free,
by writing to Maddak Inc.,
Pequannock, N.J. 07440.
Visual Scheduling System
A visual staff scheduling system,
the Beanstalk, consists of
wall-mounted modular grid boards
and inch square colored cardboard
tabs clipped into plastic holders. The
tabs can be written on and dropped
firmly into place anywhere in the grid
pattern.
The system provides a complete
overview of the nursing staff complex
at a glance, yet the system itself is
simple and easy to maintain.
Details of this system and many
similar applications are available
from: Kentron Services, 50 Firvtfood
Crescent, Islington, Ontario
M9B 2W2.
Computer Health Testing
System
International Health Systems,
Inc., of Illinois has introduced a new
vertical configuration of the
Computa-Lab DSN, hospital
information and health testing system.
The Computa-Lab System is portable
so that it can be wheeled info plants,
offices or otherlocations. It requires as
little as 1 50 square feet of work space
but meets the same performance
capabilities as the standard
Computa-Lab system.
Up to 50 patients a day can be
tested using this system. Complete
procedures including history taking,
physiological testing, and collection of
specimens for laboratory testing can
be performed by one to three
technicians in less than an hour. IVIost
of the testing is performed as the
patients relax comfortably in chaise
lounges.
Patient health histories are taken
automatically by the Computa-Lab
Audio-Response Unit. The patient
listens to a recorded program of
history questions, pressing buttons to
give the computer his answers.
Foreign language and custom
history programs are readily available.
All test information and data are
printed out by the systems computer
as soon as testing is completed.
The Computa-Lab system
includes instrumentation for a 12-lead
E.C.G., pulmonary function testing,
tonometry, blood pressure,
audiometry, vision testing,
anthropometry and temperature.
The system is equipped for
computer interpretation of ECG's.
ECG interpretation and biochemical
profiles are offered as optional
services. The manufacturer provides
training for operating personnel and
equipment maintenance.
For further information, write:
International Health Systems, Inc.,
3603 Edison Place, Rolling
Meadows, Illinois 60008.
Multi-Position Foot Board
The Multi-Position Foot Board is
designed by Lumex Inc. to help
prevent and/or correct foot drop and
foot rotation, and provide comfortable
immobilization at prescribed position.
The board acts as a bed cradle,
keeping bedding off patient's feet; it
fits any standard hospital bed, can be
installed/removed without tools, and
can be positioned anywhere on the
bed to accommodate short or tall
patients, without interfering with
gatch. The board can be used with
side rails up or down and mounting
arrangement eliminates heel
pressure. The foot board can also be
tilted and the triangular positioning
blocks can be rotated to any desired
position. Removable blocks are
adjustable to any width.
The board is of molded, structural
foam construction, and is easy to keep
clean. It measures 15'x36"x4 1/2".
For further information contact:
Lumex, Inc., 100 Spence Street, Bay
Shore, N.Y. 11706.
Electronic Thermometer
The new LaBarge Model 12
Electronic Thermometer saves both
time and money by providing an
accurate temperature reading in less
than 30 seconds. It features a unique
LED (light emitting diode) display that
permits simultaneous readings in both
fahrenheit and centigrade.
A tough Lexan case and all
solid-state circuitry make the Model 1 2
durable enough to withstand constant
hospital service. Replaceable
batteries provide portability and give
six months' normal use before
replacement is necessary.
The LaBarge Model 1 2 Electronic
Thermometer includes separate oral,
rectal and continuous monitoring
probes. In addition, a special plug-in
module provides an easy method of
verifying calibration of the unit in the
hospital. The new Model 12
Thermometer uses LaBarge's
patented disposable SteriTherm
covers, which are available in both
oral and prelubricated rectal form.
For further information, write:
Mark J. LaBarge, LaBarge Inc., 500
Broadway Building, St Louis,
Missouri 63102.
Kolaps-A-Tank for
Hyperpyrexia
The Kolaps-A-Tank, a new,
lightweight, collapsible
immersion tank designed to meet
critical need for immediate treatm
in cases of malignant hyperpyrexi;
now available from Burch
Manufacturing Co.
The Kolaps-A-Tank weighs c
10 lbs., can be set up in only eigl
seconds by one person, fits any
standard size O.R. stretcher cart, ;
perm its patient treatment to be can
out at a normal working level.
The Kolaps-A-Tank features;
sturdy, aluminum frame;
bacterial-resistant tank material; I
drain outlets; detachable cover wl
permits easy cleaning: storage po
with grommets for convenient,
accessible wall mounting.
The 72"x26 "x14" vessel can
folded up for compact storage.
For more information contact:
Burch Manufacturing Co., Inc., F
Dodge, Iowa 50501.
Built-in Hyper/Hypothermii
Systems
Gaymar Industries Inc., now
offers built-in hyper/hypothermia
systems for areas such as ICU, 01
Critical Care areas, and recovery
rooms. Two styles of units are
available with these custom desigi
systems. One is a movable wall \.
andtheotherisan in-wall, flush mo
control unit.
The system offers a number
features: savings on floor space 1
critical hospital areas; easier aco
to the patient; convenient locatioi
equipment for nursing care; reduc
of noise and heat; aid in eliminat
cross-contamination potential;
reduction of leakage current level
the electrical load on isolation
transformers; instant hypothermic
with 40° blanket water always
available.
Systems are compatible witt
patient head walls. Built-in syster
are designed to meet customer
requirements.
For information contact: Gayn
One Bank St., Dept. 501, Orchai
Park, A/ew York, 14127.
Canesten
mtifungal and
richomonacidal agent
clotrimazole
RESCRIBING INFORMATION
NJDICATIONS Canesten Cream and Solution Topical
eatment of the following dermal infections tinea pedis.
nea cruris and tmea corporis due to T rubrunn T menta-
ophvtes and Epidermophyton floccosum. candidiasis due
) C albicans, tinea versicolor due to Malassezia furfur
anesten Vaginal Tablets Treatment of vaginal candidiasis
r>d trichomoniasis Canesten Vaginal Tablets may be used
both pregnant and non-pregnant women, as well as in
omen taking oral contraceptives (See Precautions)
)OSAGE AND ADMINISTRATION Cream and Solution
hiniy apply and gently massage sufficient cream or solu-
nto the affected and surrounding skm areas twtce
aily m the morning and evening
tor vulvitis. Canesten Cream should be applied to the vulva
id as far as the anal region For balanitis and prevention of
sgmal infection or reinfection 6y the partner Canesten
ream should be applied to the glans penis
'agmal Tablets One tablet a day for six consecutive days
Ising the applicator insert one tablet deep mtravagmally.
eferably at bedtime In order to avoid treatment during
lensiroation it ts suggested that treatment be started at
?ast 6 days prior to the anticipated menstrual period
JURATION OF TREATMENT Cream and Solution The
uration of therapy vanes and depends on the extent and
«< )calization of the disease Generally clinical irnprovement
%nXh relief of pruritus usuallv occurs withtn the first week of
reatment Tmea infections require approximately 3-4. weeks
f therapy while m candidiasis. 1 -2 weeks treatment is often
* dequate If no clinical improvement is observed after 4
rfeeks. the diagnosis should be reviewed
f a cure ts not mycologtcally confirmed or in order that
elapses may be prevented (particularly in mycoses of the
g oot). treatment should as a rule be continued for 2 weeks
fter all clinical symptoms have disappeared
T 'agmal Tablets The six-day therapy may be repeated if
ecessary
SPECIAL REMARKS Cream and Solution Added hygien-
measures are of special importance m the management
ni>f the often refractory fungal diseases of the foot To avoid
rapped moisture the feet — particularly between the toes
should be dned thoroughly after washing
)nychomycoses owing to their location and physiological
actors generally respond poorly to topical antimycotic
herapy alone due to poor penetration into horny substance
reatment with Canesten may be considered in cases of
laronychia and as ad)unctive therapy m onychomycoses
ollowmg extraction or ablation of the nail
Q /agmal Tablets Added hygienic measures such as twice
Jaily tub baths and avoidance of tight underclothing is
iighly recommended
n the case of clinically significant tnchomonal infection,
additional therapy with a systemic tnchomonacidal agent
' ihould be considered Such therapy is essential for the
reatment of vaginal infections which may also involve
Jartholin s glands and the urethra
:ONTRAINDICATIONS Except for possible hyper-
fi lensitivity. Canesten Solution Cream and Vagmat Tablets
lave no known contraindications
PRECAUTIONS As with all topical agents skin sensitiza-
lon may result Useof Canesten topical preparations should
>e discontinued should such reactions occur, and approp-
ale therapy instituted
anesten Solution and Cream are not for ophthalmic use.
"anesten Vaginal Tablets are not for oral use
Jse in Pregnancy Although mtravagmal application of
'otnmazole has shown negligible absorption from both
"■■^1 and inflamed human vaginal mucosa Canesten
ai Tablets should not be used m the first trimester of
ancy unless the physician considers it essential to the
v. r rare of the patient
The use of the supplied applicator may be undesirable in
P 5ome pregnant patients and digital insertion of the tablets
IS an alternative which should be considered
POSEY FOR PATIENT COMFORT
^
The new Posey products shown
here are but a tew included in 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
insure the original quality product,
always specify the Posey brand
name when ordering.
The Posey "Swiss Cheese" Heel
Protector has new hook and eye
fasteners for easy application and
sure fit. Available in convoluted
porous foam or synthetic fur lin-
ing. #6727 (fur lining), #6722
(foam),
The Posey Foot Elevator protects
pressure sensitive feet by keeping
them completely off sheets. A
washable flannel liner protects the
ankle. Soft polyurethane foam ring
with slick plastic shell allows pa-
tient to move his foot freely.
#6530 (4 inch width),
The Posey Foot-Guard with new
"T" bar stabilizer simultaneously
keeps weight of bedding off foot,
helps prevent foot drop and foot
rotation. #6412,
The Posey Elbow Protector helps
eliminate pressure sores and fric-
tion burns. Three models are avail-
able. #6220 (synthetic fur wlout
plastic lining).
The Posey Ventilated Heel Pro-
tector helps prevent friction and
skin breakdown while allowing
free movement. The newly devel-
oped dosure holds heel protector
on the most restless patient. #6170
(w/plastic shell),
Send for the free new POSEY catalog — supersedes all previous editions.
Please insist on Posey Quality — specify the Posey Brand name.
Send your order tod^!
HEALTH DIMENSIONS LTD.
Commerce City
2222 So. Sheridan Way
Mississauga, Ontario
Canada L5J 2M4
Phone: (416) 823-9290
J
The Canadian Nurse
Audiovisual
■ Maternity
Breathing Exercises for the
Expectant Mother
A 15-minute 16mm color sound
film directed by Marie-Elizabeth
Taggart, Assistant Professor, Faculty
of Nursing, University of Montreal,
Montreal, Quebec. This film is about
preparation for childbirth through the
instruction of various breathing
techniques designed to help the
mother attain successful, conscious
childbirth. It explains the process of
normal respiration and the changes in
normal respiration during pregnancy.
Through silhouette animation, the film
reviews and explains different types of
breathing to be used during each
stage of labor and childbirth. It may be
used for teaching expectant mothers
in prenatal classes, student nurses or
health education trainees. An
independent Canadian production
available in the French language as
"Exercices de respiration pour la
femme enceinte." Approximate price
$200; available for preview when
there is intent to purchase for $1 5.00,
applicable to purchase price. For
'.nformation, contact: Cin6dessins,
Reg'd., P.O. Box 430, Mount Royal
Station, Montreal, P.O. Canada,
H3P 3C6.
The Neurological Evaluation of
the Maturity of New Newborn
Infants
This 32-min. color film uses stick
figures and live infants to demonstrate
neurological gestational age
assessment. Infants at 30 wl<s., 34
wks., 36 wks.. and 38 wks., are
examined, and stick figure diagrams
are used to show where the infant is in
neurological development. A general
summary of neurological assessment
is given at the end of the film. The film
assumes some familiarity with the
newborn, terminology associated with
neurological examination and
pediatrics. Available in 16 mm and in
3/4 inch video-cassette, for rent or
purchase from the Health Sciences
Communication Center, Case
Western Reserve University School of
Medicine, 2119 Abington Road,
Cleveland, Ohio 44106.
■ Health Promotion
Canada Safety Council
Brochures
The Canada Safety Council
publishes brochures and educational
materials that are helpful in teaching
and promoting accident prevention.
They are available from the Canada
Safety Council, 1765 St. Laurent
Blvd., Ottawa, Ontario, KIG 3V4.
Some examples are;
mSelecting the right toy for the right
child — a two-color pamphlet, gives
suggestions for toys suited to the
child's age and ability. Hazards to
avoid are listed. Costs up to 7 cents
each depending on number ordered.
Minimum order 10.
• Home workshop, electrical
power tool safety — six-page,
two-color booklet deals with common
unsafe acts and conditions in home
workshops. Up to 10 cents each,
minimum 10.
• Guide for home safety —
eight-page, two-color booklet on
prevention of accidents in the home.
Includes a home safety check list Up
to 10 cents each, minimum 10.
• Babysitters' course — designed
and packaged to facilitate the training
of part-time babysitters. One kit (at
$10 each) contains materials and
information to conduct a course for 20
students.
• Guide for child safety — two-color
pamphlet about preventing child
accidents in the home from birth to
school age. Up to 7 cents each,
minimum 10.
• Prevent falls — two-color
pamphlet with facts on accidental falls,
their causes and how to prevent them.
Up to 7 cents each, minimum 10
Your Move
This 22-min. color film is a
persuasive appeal to Canadian
women to get fit. A recent study
concluded that 47 percent of
Canadian women rate low to fair in
physical fitness. This film challenges
women to change that image and
shows the many sports that modern
women are becoming involved in.
Available from theXanadian Film
Institute, 303 Richmond Rd., Ottawa,
Ontario KIZ 6X3.
What's Good to Eat?
An 18-min. color film discusses
the importance of skillful choice when
planning a varied diet. A 12-year-old
boy learns to use the four food groups
as a way to get the nutrients he needs.
Available from the Canadian Film
Institute, 303 Richmond Rd., Ottawa,
Ontario KIZ 6X3.
■ Mental Health
No Tears for Rachel
This is a 27-minute, color film
dealing with how the rape victim copes
with a cold legal process and the
unpredictable reactions of her friends
and family. In order to prosecute, the
victim must undergo a physical
examination, detailed questioning and
a face-to-face confrontation with her
attacker in court. One woman
discusses the difficulties she
experienced when she told her friends
that she had been raped. Her
psychiatrist explains the importance of
their reactions and the stigma
associated with being raped. To
request this film contact the Canadian
Film Institute, 303 Richmond Rd.,
Ottawa, Ontario.
One Step Ahead
A 28-min. film dealing with crisis
control. It shows how to deal with a
disturbed person humanely, without
causing emotional trauma, injury or
physical pain by being 'one step
ahead" of any situation. Accompanied
by a 23-page training manual (with 70
illustrations), the program explores
the various types of emotional crisis
situations and presents viable
solutions based on the degree of
violence involved. The film is available
for purchase or for rent from Motorola
Teleprograms, Inc., 4825 N. Scott St.
Suite 23, Schiller Park, III. 60176.
Emergency Treatment of Acute
Psychotic Reactions due to
Psychoactive Drugs
Produced by the Addiction
Research Foundation, this 17-min.
black-and-white film shows the
program at Hotel Dieu Hospital in St.
Catharines for treatment of
drug-related emergencies. Available
in 1 6 mm from the Librarian, Canadian
Hospital Association, 25 Imperial St.
Toronto, Ontario M5P 1C1.
■ Audio Cassettes
How to Communicate
This is an audio cassette prograrr
that presents successful techniques
for effective communication, designee
for health administrators.
The 4 cassettes cover such topics
as: how to handle face-to-face
communication, how to be a "creative
listener," how to communicate
effectively in writing, how to
distinguish between fact and opinion,
how to improve relations with the
public and with patients, and how to
tell the press what they want to know.
For more information about How
to Communicate Effectively and other
programs for health workers, write:
Tech'em Inc., 625 N. Michigan Ave.,
Chicago, IL 60611, U.S.A.
Patient Teaching
Hospital-tested educatkDnal
cassettes for patients and their
families describe what doctors want
their patients to know about 4 commor
illnesses: diabetes, emphysema,
gout, and hypertension.
Developed by faculty members at
Chicago's Northwestern University
Medical School, the series uses
language that patients can
understand, to provide a basis for
them to use time with the attending
physician more effectively.
Information about the 4-cassette
package is available from: Teach'em
Inc., 625 N. Michigan Ave., Chicago,
IL, 60611, U.S.A.
. mes are based on studies placed
,e authors in the CNA Library
epository Collection of Nursing
tudies.
e search
Suicide
A Comparative Study of the
Self-acceptance of Suicidal
and Non-suicidal Youths.
Vancouver, B.C., 1976. Thesis
(M.Sc.N.) U.B.C. by Catherine
Ann Westwood
Youths who attempt suicide may
ave many negative feelings about
lomselves which are manifested in a
m level of self-acceptance. This
actor is often overlooked in specific
assessment and intervention
.Tieasures. Nurses, because of their
'ocation in schools, are in a unique
Dosition to recognize and intervene
with the potentially suicidal youth.
I Nurses however may have difficulty in
I ecognizing the youth with poor
self-acceptance.
This exploratory study was
undertaken in order to answer the
question: "is a low level of
self-acceptance in youths age sixteen
to twenty-five correlated with suicide
attempts?" The answer was sought
f'om information obtained from
youths' self-reports on the Berger
Scale of Self-Acceptance and the
'California Psychological Inventory.
These tests were administered to
thirty youths divided into three groups.
G roup A were suicide attempters seen
in the emergency ward of a large
'general hospital, group B were
non-suicide attempters seen in the
rgency ward and group C were
. ;3en from the community.
An analysis of variance was
carried out to discover if there
jwas a significant difference in
self-acceptance among the three
groups.
The findings supported the
overall conclusion: youths between
ages sixteen and twenty-five who
attempted suicide had a significantly
lower self-acceptance than control
group youths. The variable of
hospitalization did not affect
self-acceptance.
• Maternity
Selected Aspects of the
Childbearing Experience as
Described by Sixty Couples.
Nursing research conducted at
the School of Nursing, University
of British Columbia, Vancouver,
B.C. , 1 976 by Helen Elf en and
Linda Leonard.
This study describes aspects of
the experience of sixty couples
during pregnancy, childbirth and the
immediate postpartum period. The
couples were selected in a
semi-random fashion from patients in
two maternity units in Vancouver, B.C.
The two maternity units were similarin
some respects, e.g. husband
participation in labor and delivery, and
differed in other areas, e.g. visiting
regulations and participation of
parents in infant care.
The data showed a high level of
involvement of the couple in planning
for labor and delivery, with two-thirds
attending prenatal classes. Nearty all
husbands expected to be present
duting labor and 75 % expected to see
the delivery. In addition 78% of women
chose to breast-feed their infants.
There was less apparent
decision-making related to where the
baby would be born: fewer than half
had made a deliberate decision about
what hospital they would go to, and
some knew nothing about the unit
prior to admission.
Overall, couples in both settings
expressed satisfaction with their
hospital care and experience: specific
areas of concern were identified.
There was somewhat higher
satisfaction and feeling of control in
the unit in which there is greater
parental participation in infant care.
Recommendations are made for
further study , and possible changes in
maternity care are suggested.
• Emergency
A Study of Continuity of
Nursing Care from the Hospital
Emergency Room into the
Home. Toronto, Ont., 1976.
Thesis (M.Sc.N.), University of
Toronto by Catherine Ann Perkin.
The specific purpose of this study
was to describe the observed and
expressed nursing needs of patients
following discharge from the hospital
emergency room. The ultimate
purpose was to contribute to an
improvement in the quality of nursing
care received by patients using the
emergency room where contact is
brief and focuses on a presenting
complaint.
In this descriptive study, 30
patients between 20 and 75 years of
age were identified during their
contact with the emergency room and
then interviewed on one occasion at
home. Data were collected using a
highly stoictured interview schedule
prepared and administered by the
investigator. Patients' responses to
questions were analyzed under the
following headings: selected patient
characteristics; utilization of medical
care: patient perceptions of the kind,
source and amount of information
received: patient-perceived gaps in
care and the observed and expressed
nursing needs of these patients
including direct nursing care,
rehabilitation, health supervision, and
emotional support needs.
The findings showed that the
doctor was perceived by patients to be
the source of most useful information
regarding the diagnosis and plans for
treatment. An analysis of the observed
and expressed nursing needs and
patient comments regarding gaps in
care described in this study reveals
that patients want and need more
specific information both about their
health condition and instructions for
Continuing care related to drugs,
treatments, exercise and/or rest and
diet. The concerns expressed by
some patients about the kind and
amount of information they received
were associated with the non-specific
nature of information, not having
questions answered or instructions
repeated so that they might be
understood more readily.
The need for further health
supervision was related to some of
the following areas: lack of knowledge
regarding medication including the
expected results or possible side
effects: possible complications of
immobility and appropriate preventive
measures: specific descriptions of
types and amounts of food or fluids. It
appeared that receiving written
instnjctions was useful for patients in
helping them to follow the plan of care.
Although the data revealed that there
was provision for continuing medical
supervision, similar provision for
continuing nursing care or supervision
was not evident.
It is important that while in the
emergency room, the patients home
responsibilities and sources of help be
assessed by nurses so that alternate
resources can be utilized.
Findings related to the need for
emotional support indicated common
areas of concern expressed by
patients about the outcome of their
condition, lack of necessary
knowledge about the diagnosis or
treatment, anxiety in other family
members and changes in life style.
Implications are stated for
nursing practice, education and
researcfi. Generalizations are limited
because of the size and nature of the
sample. However, the findings in this
study do suggest areas of nursing
need and patient-perceived gaps in
care which impede the flow of
continuous and comprehensive care.
It is apparent that patients want and
need more specific information about
their health problem and instnjctions
for continuing care. It is important that
nurses take an active role in patient
teaching, interpreting and clarifying
instnjctions and anticipating common
patient questions and concerns.
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Copyriqtil 1977 Hollistor Incorpotated All Rh
Husband-Father's Perceptions
of Labour and Delivery.
Vancouver, B.C. 1975. Thesis
(M.SXC.N.), U.B.C. by Linda
Gaye Leonard.
This study was concerned with
the husband-fathers perceptions of
labour and delivery; how he perceived
his role during this period; and his
perceptions of the nursing care
provided to his wife and himself.
Sample selection was by random
sampling and included twenty
hustsands. All were Caucasian,
Canadian or British born, between the
ages of twenty-two and forty years of
age, and all had attended prenatal
classes. Eighteen fathers attended
the delivery. Seventeen were fathers
for the first time and three were fathers
for the second time.
Data were obtained via one
hour-long interview with the husband
during the first three days postpartum.
An interview schedule was used and
contained rating scales,
fixed-alternative and open-end
questions. Findings showed:
— that labour and delivery were seen
by the husband as being positive
experiences, with delivery being the
most positive,
— that the husband focused his
attention during labour on his wife until
late second stage when it shifted to the
baby and to his own feelings,
— that the labour was stressful for
many of the husbands who were
uneasy seeing their wives in pain,
— that the major function of the
husband in labour was to provide
moral support, encouragement, and
bodily care to his wife. Most felt that
they were effective in their role but
needed to confirm this with their wives.
— that prenatal classes were viewed
as having a positive influence on
husbands' attitudes toward labour and
delivery.
— that the attitudes and responses of
the nurses during labour and delivery
had a significant effect on the
husband's confidence and relaxation.
The major weaknesses of the nursing
care were the inadequate
assessment, explanation, and nurse
contact time during the active phase
and second stage of iabor.
The study results have
implications for the prenatal
preparation of couples, for care ofth
parents during labour, delivery, an
the early postpartum period.
Recommendations for future study, |
centered on the need for more
information about husband-father
response during labour and deliver
early responses to the newborn; an
information about the effects of
husband-father participation in
childbirth on the husband-wife-chil
relationship.
• Patient Teaching
Postoperative Cardiac
Surgical Patients' Opinions
about Structured Preoperativj'
Teaching by the Nurse.
Birmingham, Alabama, 1974.
Thesis (M.Sc.N.), University of
Alabama in Birmingham by
Louise Dumas.
In this study, the author tries tc, ^
analyze the responses of j ^
postoperative cardiac surgical
patients to a questionnaire on their
opinions regarding preoperative
teaching by the nurse. She attemptst
find out if these patients express a
desire to receive information about
their preoperative, operative, and i
postoperative periods through such 1
teaching. She then attempted to fin|
out if patients, following the same <
research criteria but in a different |
milieu, would have lil<ed to be
informed preoperatively by identica
teaching.
Thirty-six patients answered th
questionnaire, developed by the |
investigator from the teaching plan |
used in her previous research. The
results clearly show the desire of tf
patients to have received preoperati\
structured teaching and given,
preferably, by the nurse. All the j
questions (43), on the possible |
content of such a teaching prograrr
indicate 75% to 100% positive
answers, showing the preoperative
needs and the postoperative worrie
of these patients. I
This investigation is followed by )'
discussion of the results, some
recommendations for nurses and
future researchers, and some tools fc
patient education.
Books
Plus ga change ... Abortion then and now
The findings of the Committee on the Operation of the Abortion Law only
;onfirm what most of us have l<nown since the end of the first year of the
iberalized abortion law. namely: that the abortion law is not being interpreted
and enforced equitably across Canada and the consequences of this fact
;end to victimize the already disadvantaged, the young, less educated and
newcomers to the country. The Committee was asked only to provide
findings on the operation of the 1 970 litseralization of the Abortion Law which
Dermits women to be certified by a hospitaJ committee of three qualified
•dical practitioners for abortion if their life or health is endangered. The
n mittee was not asked to consider the merits of the abortion law itself or to
-TiaKe recommendations. .
The report contains a good deal
of provocative material on this still
enotive subject. One surprise was the
high failure rate of contraceptives — if
e can believe this finding. The usual
contraceptive pill failure is in tfie
-ange of 0.08%. The patient survey
rate cited in the Report emerges at
18% which brings up the question of
Chapter 14, Sexual Behavior and
Contraception.
This subject is wetl supplied with
tables of statistics but the psychology
of contraception and sexual
intercourse might profitably have been
mentioned as a possible explanation
of the unacceptable "rates of failure."
Everyone who works with teenagers
has heard of the young girl who
confidently explains that she takes a
pill just before going out with her
fnend.
Other more traditional young g iris
cannot morally anticipate (and
therefore prepare for) sexual
intercourse, so their "sin" can be
justified by "being swept away with
passion." One modem type naively
wants everything to be spontaneous
and "natural" so contraception is out.
The feminist radical wants her rights
respected to govern her own body.
These and other obstacles negatively
influence contraceptive use and lead
to conclusions like the committee's
allegation that education on
contraception seems to make little
difference to unwanted conception
because abortion seekers who had
not received school instnjction on
contraception used the same
contraceptives as those who had.
The committee conversely states
that appropriate contraceptive use
reduces the chance of conception and
it believes abortion rates will not be
Report of the Committee on the
Operation of the Abortion Law
to the Minister of Justice by Robin
F. Badgley, Chairman. 474
pages. Ottawa, Supply and
Services, January, 1977.
Price $6.75
Reviewed by Nancy Garrett
formerly pediatric associate.
Harvard MCH program,
University l-lealth Sciertces
Centre, Cameroon.
contained without coordinated public
education programs and health
promotion and research to find
improved contraceptives. The report
indicates that public health and
community agencies have not had
significant impact on public
knowledge. Most people rely on their
physician for inforftiation. But
sexuality education was only added to
medical education curricula in 1970
which may in part account for the
numtjer of uninformed and partially
informed respondents. The report
points out that young people do not
request contraceptive information
when visiting physicians for other
reasons. Media information was
conspicuously lacking in survey
responses to the question on
contraceptive information sources.
The type and consistency of
contraceptive use in the instnjcted
and non-instmcted groups was not
evaluated. Neither was the use of
Menses Induction, withdrawal of a
little of the uterine lining with a syringe,
performed in the doctor's office like an
lUD insertion, up to 40 days after
unprotected intercourse (a method
believed by some to be the answer to
preventing abortion).
The fact that repeat "offenders "
are twice as likely to have a college
education tends only to add weight to
the psychology or philosophy problem
discussed above.
The committee admits that, "iittle
is known, because there is much
stigma involved, little has wanted to
be known, about the socially rejected
outcomes of sexual intercourse. "
(p. 325-26).
Throughout the report, an
overtone of the illicitness of the subject
prevails. An unwanted pregnancy
seems somewhat akin to having a
social disease and the abortion seeker
to having a defective character. Health
care providers also seem punitive in
their references to "repeat offenders. "
The committee notes that "many
physicians and nurses have voiced
their deep concern about abortion
patients who obtain this operation
when their pregnancy is more
advanced and they attribute this delay
to the socially irresponsible behavior
of women seeking induced abortions'
(p. 151). In fact the delays are
unquestionably due to delays in
securing medical decisions,
sometimes requiring visits to several
doctors, and processing by abortion
review committees.
We cannot hope for a rapid switch
to prevention by young people until
they understand their sexuality better.
Sexual activity does not start
functioning at the arbitrary age
decided by a physician who decides to
withhold counselling until the girl is 17
or 18 years old. Neithercan we expect
health care wori<ers to be happy about
offering a socially rejected service
which is most needed by young,
uneducated, poor women who may
also be handicapped by their newness
to the country.
Delays, threats of sterilization
requirements with abortion , extra
billing especially of the young, less
well-educated (poor), and
pre-operative cash payments are
reported to be victimizing the already
distressed atxartion patient.
Twenty-five of the 474 pages are
tables including opinions of men and
women on reasons for abortion and on
their opinions of the abortion law. The
statistical method and the abortbn law
are provided in the appendices. The
terms of reference and summary of
findings are easy to find In Chapter 3.
The report may provide
enlightenment to those whose tseliefs,
(as evidenced by the hospital staff
survey) are contradicted by facts, e.g.
"I feel that allowing therapeutic
abortion has not decreased back alley
criminal abortions. " (p. 298). It will be
useful to authors of future papers
oecause it brings together current,
nearly comprehensive data, othenwise
Impossible or time-consuming to
gather on attitudes and practice of
Canadians receiving and providing
health care services for contraception
and abortion. Committee sources
were surveys of physicians, hospital
staff, patients and hospital agencies,
the 1 976 national population survey
as well as visits and reports including
use of abortion facilities outside
Canada.
It should be read by both service
providers and health manpower
educators with a view to improving
coordination and impact of programs
offering contraceptive and sexuality
education and services.
Health happenings
A fourth year student in applied human
nutrition at the University of Guelph In
Guelph, Ontario, has concluded that
pharmacists are no more
knowledgeable atxiut vitamins than
health food retailers and no more
qualified to sell them. The most
striking difference between the two,
she found, was in their relationship
with the consumer.
"The most impressive
characteristic of the health food
retailers was their sincerity. Most
appeared to be extremely earnest in
their goal of obtaining superior health
through nutrition. They were all
unusually amiable and comfortable to
chat with.
"On the other hand, the
pharmacists projected a colder image.
Because of this, they were more
difficult to approach and less willing to
talk. Eye contact was hard to establish
with the pharmacists since they were
all stationed behind high counters. " -
Researcher Jane MacDonald
who worked under the supervision of
Dr. Zak Satxy. coordinator of the
Nutrition Canada Survey, says she
doesn't ordinarily take vitamin pills
herself "except maybe during exams
when I'm too nervous to eat. "
The Canadian Nurse
Kocili.s
Toohey's Medicine for Nurses (1 1th Edition)
by Arnold Bloom. 61 2 pages. London, Churchill
Livingston, 1975.
Approximate price $12.50 Reviewed by Mary
Rakoczy, Assistant Professor, Queen's
University, Sctiool of Nursing, Kingston,
Ontario.
The appearance of the eleventh edition of this
book reinstates its value as a text for nurses. It is a
useful reference for both the graduate nurse, and the
nursing student.
Toofiey's tJledicine for Nurses is a referral for
causes, signs, symptoms, and treatment. If is
News (continued from page 10)
abundantly and clearly illustrated with diagrams,
photographs and tables.
The table of contents is complete but not as
detailed as it is in the tenth edition. The introductory
chapter discusses the general pathology of the
disease process, vifith an explanation of the terms.
The succeeding chapters are grouped according to
the systems of the body and the more common
diseases are outlined within.
The concepts that one might consider as part of
the whole are awarded their own chapters' i.e.,
Ctiapter 18, On Pain and Vomiting; Ctiapter 20,
Psyctiological t^edicine. In Chapter 20, it is
interesting to note that although the significant
emotional components are included in the various
medical conditions, the socioeconomic factors i
not emphasized.
The author, a medical doctor, stresses thei
physiological principles underlying the medical
disorders and their treatment. One detects no
chauvinism but rather insight into the nursing
process and support for it.
This edition has excluded the Trade Names
Drugs' and the reference table of Chemical Narr
and Drugs.' More serious omissions occur in th
absence of selected references and specific nurs
implications.
No doubt, there will be a twelfth edition of tl
text including the same high standard and ratio
explanation of diseases and their management
Summary of Information on Malpractice Insurance
Offered by Provincial/Territorial Associations
as of 1 April 1977
Association
Malpractice
Insurance
Offered
Included
In
Membership Fee
Coverage Per Year
Registered Nurses Association
of British Columbia
Yes
Yes
Up to $100,000 for three times in one year.
Alberta Association of
Registered Nurses
Yes
Yes
Approximately $100,000 to $300,000 per year.
Sasl<atchewan Registered
Nurses Association
Yes
Yes
Approximately $150,000 to a limit of $250,000
(In process of changing insurance companies).
Manitoba Association of
Registered Nurses
Yes
Yes
$100,000 for single incident. $300,000 for
more than one.
Registered Nurses Association
of Ontario
Yes
No-
(Voluntary
$3.50 per yr.)
$200,000 per incident to a total of $500,000 in one
calendar year. J
Order of Nurses of Quebec
Yes
No
($15.00 per yr.)
$500,000 per year (includes previous years and for nex
thirty years — Quebec law.)
New Brunswicl< Association of
Registered Nurses
Yes
No
($8.00 per yr.)
$200,000 per person. $600,000 in any one policy year.
Registered Nurses Association
of Nova Scotia
No
No
Association of Nurses of
Prince Edward Island
No
No
Association of Registered
Nurses of Newfoundland
Yes
Yes
$1 00,000 per incident with $200,000 aggregate.
Northwest Territories
Registered Nurses Association
Yes
Yes
$500,000 in any one policy year.
Source. Directors, provindal/lerritorial CNA member associations.
ine uanaoian Nurse June 1977
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The Canadian Nurse
Llbrarij Update
Books and documents
1. Alderson, Henrietta Jane. Twenty-five years
a-growing: the history of the Schooi of Nursing,
McMaster University. Hamilton, Ont. McMaster.
University, 1976. 333p. R
2. American Hospital Association. Dept. of Human
Resources Management, l-lealth manpower, an
annotated bibliography. Chicago, II., 1976. SSpj,
3. Auld, Margaret G. How many nurses? A method
of estimating the requisite nursing establishment for
a hospital. London, Royal College of Nursing of ttie
United Kingdom, 1976. 96p.
4. Belknap, Mary Morgan. Case studies and
methods in humanistic medical care; some
preliminary findings, by... Robert Arttiur Blau and
Rosalind Islagin Grossman. San Francisco, Institute
forttie Study of Humanistic Medicine, c1975. 1 lip.
5. Brockington, Colin Fraser. World health. 3ed.
London, Churchill Livingstone, 1975. 345p.
6. Canarecci, Thelma. Odds and ends of ward wit
Oradell, N.J., Medical Economics Co., c1976. 1v.
(unpaged)
7. Chretien, J. Abrege de pneumologie. Paris,
Masson, 1976. 331 p.
8. Conference Internationale du Travail, 63e
session, Geneve, 1977. L'emploi et ies conditions
de travail et de vie du personnel infirmier. Sixifeme
question ci I'ordre du jour. Geneve, Bureau
International du Travail. 1977. 188p. (Son Rapport
Vl(2))
9. Douglass, Laura Mae. Review of leadership in
nursing. 2ed. St. Louis, Mosby, 1977. 173p.
(Mosby's comprehensive review series)
10. Dubuc, Robert. Vocabulaire de gestion. Ottawa,
Lem6ac, c1974. 135p.
1 1 . Dynamics of problem-oriented approaches;
patient care and documentation edited by Judith
Bloom Walter, Geraldine P. Pardee and Doris M.
Molbo. Philadelphia, Lippincott, c1976. 206p.
1 2. Gibson, John. The nurse's materia medica. 4ed.
Oxford, Blackwell, c1976. 295p.
13. Giraudet, G. Biomecanique humaine appliquee
d la reeducation. Paris, Masson, 1976. 90p.
14. Handbook of critical care edited by James L.
Beri< et al. 1 ed. Boston, Little, Brown and Co., c1 976.
574p.
1 5. Helvie, Carl O. Self-assessment of current
knowledge in community health nursing: 1093
multiple choice questions and referenced answers.
Flushing, N.Y., Medical Examination Pub. Co.,
01976. 149p.
16. Hirschberg, Gerald G. Rehabilitation; a manual
for the care of the disabled and elderly. 2ed. by...
Leon Lewis and Patricia Vaughan. Philadelphia.
Lippincott, C1976. 474p.
17. A history of Red Cross outposts in New
Brunswick, 1922-1975. Saint John, Canadian Red
Cross Society, New Brunswick Division, 1977. 54p.
R
18. An instructional aid for the adult diabetic.
Hamilton, Ont., St. Joseph's Hospital, 1976. 62p.
19. International Labour Office, 63rd session,
Geneva, 1 977. Employment and conditions of work
and life of nursing personnel. Sixth item on the
agenda. Geneva, International Labour Office, 1977.
126p. (It's Report Vl(2))
20. King, Donald W.>*sun'ey of paf/JO/ogy, by...etal.
New York, Oxford University Pr., 1976. 21 6p.
21. King, Eunice M. Illustrated manual of nursing
techniques, by... Lynn Wieck and Marilyn Dyer.
Philadelphia, Lippincott, c1977. 432p.
22. Leboyer, Frederick. Birth without violence. New
York, Knopf, 1976 114p.
23. Mahoney, Joanne M. Guide to ostomy nursing
care. Boston, Little, Brown and Co., c1976. 246p.
24. Marks, John. Aguide to the vitamins; their role in
health and disease. Baltimore, Md., University Park
Pr., C1975. 207p.
25. f^otivating personnel & managing conflict; a
reader consisting of twelve articles especially
selected by The Journal of Nursing Administration
Editorial Staff. 2ed. Wakefield, Ma., Contemporary
Pub., C1976. 64p.
26. Ontario Cancer Treatment and Research
Foundation Toronto, 1977. Cancer in Ontario 1976.
Toronto, 1977. 278p.
27. Organizational research in hospitals. Invitational
Fonjm, Northwestern University, May 1-2, 1975.
Chicago, Blue Cross Association, 1976. 112p.
28. Paterson, Josephine G. Humanistic nursing,
by. .. and LorettaT.Zderad. New York, Wiley, c 1976.
141p.
29. Philbrook Marilyn McLean. Medical books for
the layperson; an annotated biography. Boston,
Boston Public Library, 1976. 113p.
30. Poisvert, Michel. Economie des urgences et
des detresses. Role des S.A.M.U. Paris, Masson,
C1976. 147p.
31 . The primary nurse practitioner: a multiple track
curriculum edited by Glen E. Hastings and Louisa
Murray. Miami, Banyan Books, c1976. 225p.
32. Riffel, J. A. Qualite de la vie dans Ies villes
industrielles. Ottawa, Ministere d'Etat, Affaires
urbaines Canada, 1975. 107p.
33. Rozovsky, Lome Elkin. Canadian manual of
hospital by-laws, by. ..and William McKay Dunlop.
Toronto, Canadian Hospital Association, 1 976. 54p.
34. Runnalls, John Lawrence. A century with St.
An essential film for any health
service, hospital, school or
university . . .
BREATHING EXERCISES FOR
THE EXPECTANT MOTHER
16 mm • 15 minutes • colour •
sound • $200 per copy
• Reviews and explains the
different types of breathing to
be used during each of the
stages of labour and childbirth
• Produced under the direction
of Marie-Elizabeth Taggart
Preview: $15 (applicable to
purchase price)
CInMessins Reg'd.
P.O. Box 430
Mount Royal Station
Montreal, P.O. H3P 306
Catharines General Hospital. St. Catharines, Ont.
St. Catharines General Hospital, 1974. 150p.
35. Schwarsrock, Shirley Pratt. Effective medical
assisting, by.. .and Donovan F. Ward. Dubuque,
Iowa, Wm. C. Brown, c1969, 1976. 642p.
36. Self-assessment of current knowledge in
maternity nursing: 1,227 multiple choice questions
and referenced answers, by Carol L. Miller... et al
Flushing, N.Y. Medical Examination Pub. Co.,
C1975. 272p.
37. So you have diabetes. Hamilton, Ont., St.
Joseph's Hospital. 1976. 54p.
38. Village health workers. Proceedings of a
workshop held at Shiraz, Iran, 6-13 h/larch 1976.
Editors: HA. Ronaghy, Y. Mousseau-Gershman
and Alexandre Dorozynski. Ottawa, International
Development Research Centre, CI 976. 48p.
39. Villedieu, Yanick. Demain la sante. Sillery, P.Q
Quebec Science, 1976. 291 p. (Les dossiers de
Quebec Science)
Pamphlets
40. Ambulance Saint-Jean. Secourisme oriente
vers la securite, methode multi-media pour les
ecoles canadiennes, les colleges et les universites
programme du cours et guide de I'instructeur.
Ottawa, St. John Priory of Canada Properties, 1976
1v. (various pagings)
41. Association des infirmi6res enregistr6es du
Nouveau-Brunswick. Declaration de I'AIENB sur
r usage du tabac. Fredericton, 1976. 1p.
42. — . Definition de la pratique du nursing.
Fredericton, 1976. 2p.
43. Basic guidelines on press relations for
management. Published jointly by The Winnipeg
Builders Exchange and The Manitoba Chapter,
Institute of Association Executives. Toronto, Publi
and Industrial Relations Ltd. n.d. 13p.
44. Canadian Hospital Council. Committee on
Nursing and Nurse Education. Report of
the. . .presented at the Ninth Biennial meeting of thi
Canadian Hospital Council 1947. Bulletin no. 50
Toronto, 1947. 20p. R
45. Conference on Lifestyle and Health of
Canadians, September 30th. 1975, Royal Yori<
Hotel, Toronto. Report of Conference... sponsoret
by the Health Citizens Committee of the World
Health Organization. Toronto, 1976. 1v. (various
pagings)
46. National League for Nursing. The open
curriculum in nursing education. New York, 1976
1p. "A statement approved by the Board of
Directors, National League for Nursing, February
1976"
47. — . Council of Hospital and Related Institutiona
Services. The role of the director of nursing service
Papers presented during workshop series.
Creating a Climate for Care... heldin February 197t
at Phoenix, Arizona and in April in St Louis,
IVIissouh. New York, c1977. 35p. (NLN Publicatior
number 20-1646)
48. New Brunswick Association of Registered
Nurses. Definition of nursing practice. Frederictot
1976. 2p.
49. — . Guidelines for the approval of short term
post-basic clinical courses. Fredericton, 1976. 2f|
50. Ordre des Infirmi^res et Infirmiers du Qu6be(
M^moire k la Commission parlementaire des
Affaires sociales sur le Reglement modifiant le
r^glement en vertu de la Loi sur les services de
sante et les services sociaux. Montreal, 1976. 29p
51. Ozimek, Dorothy. Considerations for the
effective utilization of nursing faculty in
baccalaureate and higher degree programs,
by. ..and Helen Yura, New York, National League fc
Nursing. Dept. of Baccalaureate and Higher Degre^
Programs, c1977. 9p. (NLN Publication no.
15-1655)
52. Reference resources for research and
fe
continuing education in nursing. Kansas City, Mo.
American Nurses' Association, c1977, 30p.
53 Registered Nurses' Association of British
Columbia. Continuing nursing education approval
program, by. ..and Registered Psychiatric Nurses
Association of British Columbia. Vancouver, 1977.
16p.
54. — . What is the RNABC position on drug
conviction as related to the practice of nursing?
Vancouver, 1976. 3p.
55. Registered Nurses Association of Nova Scotia.
Position paper concerning personnel required to
meet the needs of the aged. Halifax, 1 976. 2p.
56. — . Skill check list for newly employed nurses.
Halifax, 1976. 5p.
57. Toronto. Home Care Program for Metropolitan
Toronto. Report 1975/76. Toronto 1976. 12p.
Government documents
Canada
58. Anti-Inflation Board. First year report. Ottawa,
Supply and Sen/Ices Canada, c1976. 24p.
59. Comlt6 sur lapplication des dispositions
legislatives sur I'avortement. Rapport. Ottawa,
MInlstre des Approvlsionnements et Services
Canada, 1 977 524p. President du Comlt6: Robin F.
Badgley.
60. Commission de lutte centre I'inflation. Rapport
sur la premiere annee. Ottawa,
Approvlsionnements et Services Canada, c1976.
25p.
61. Commission du syst6me m6trique. Troisi^me
rapport. Ottawa, 1976. 56p.
62. Health and Welfare Canada. Canada health
■nanpower inventory 1975. Ottawa, 1976. 257p.
63. Institut canadien de I'informatlon scientlfique et
technique. Societes scientifigues et techniques du
Canada 1976. Ottawa, Consell national de
recherches Canada, 1976. 77p. R
64. Institute for Scientific and Technical Information.
Scientific and technical societies of Canada 1976.
Ottawa, National Research Council of Canada,
1976. 77p. R
65. fvlain-d'oeuvre et Immigration. Rapport
1975/76. Ottawa, 1977. 61p.
66. — . Direction de la Formation et du
Perfectionnement du personnel. Redigez les
particularites d'un poste de commis; un manuel
d'enseignement s6quentiel. Redlg6 par Louise
Newton et Michael Frayllng. Ottawa, MInlstre des
Approvlsionnements et Services Canada, 1976. 1v.
67. Manpower and Immigration. Report 1975/76.
Ottawa, 1977. 57p.
68. — . Staff Training Development Branch. Writing
job specifications (clerical): a self-instruction
manual. Prepared by Michael Frayling and Louise
Newton. Ottawa, Minister of Supply and Services
Canada, 1976. 1v. (various paglngs)
69. Metric Commission, r/7/rd report. Ottawa, 1976.
56p.
70. Statistics Canada. Census of Canada, 1971.
Special bulletin: population: current fertility
(own-children ratios) for married women. Ottawa,
1972. 1v.
71. Statistique Canada. Recensement du Canada,
1971. Bulletin special: population: f6condite
actuelle des femmes non c^iibataires (taux des
propres enfants). Ottawa, 1972. 1v.
Ontario
72. Ministry of Health. Proceedings of Health
Research Ontario, Toronto, 4-5 March, 1977.
Toronto. Ontario Science Centre, 1977. 158p.
Chairman: G. Fraser Mustard.
73. Status of Women Council. Annual report,
1974-1976. Toronto, 1975-1977. 28p.
Studies deposited In CNA Repository Collection
74. Brassard. Louise. Analyse des caracteristiques
socioprofessionnelles des educateurs d'adultes
dans les entreprises de Montreal. Montreal, 1976.
174p. R
75. DIonne, Denise. Comportements relies ^
I'expression verbale de malades aphasiques de
Broca ^ I'occasion d'activites nursing. Montreal,
1975. 222p. Th6se (M. Nurs.) — Montreal. R
76. Fen wick, Ann M. Towards continuity of patient
care: discharge planning. Vancouver, 1 977. 33p. R
77. Gascon, Louis. Evaluation des services aux
malades mentaux chroniques dans un centre de
sante mentale communautaire: rapport final.
par.. .Marie F. Thibaudeau, Richard St-Jean et
Francine Gratton-Jacob. Montreal, Centre de Sant6
Mentale Communautaire et Faculty de Nursing.
Unlverslte de Montreal. 1977. 209p. R
78. Gratton-Jacob, Francine. Relation entre
I'adaptation psycho-sociale et le foyer de contrdle
Chez les malades mentaux chroniques. Montreal,
1975. 119p. Th6se (M.N.) — Montreal. R
79. Saskatchewan University. Hospital Systems
Study Group. Nursing staff utilization study: Main
East Ward, Wascana Division, South
Saskatchewan Hospital Centre, Regina, Sask., by
James F. Hill and Merten Hokanson. Saskatoon,
Sask., 1971. 72p. R
80. Turner, Lettle. A project on self and peer
teaching-learning evaluation in the Faculty of
Nursing, University of Toronto. Toronto, University
of Toronto, Faculty of Nursing, 1 977. 56p. R
INTERNATIONAL NURSING
OPPORTUNITIES
If you have an adventurous spirit and have
ever thought of living and working in an-
other country, you may want to contact us.
A WORLD OF OPPORTUNITY MAY BE
AWAITING YOU!
At present there are two areas you may
want to consider — locations where Cana-
dian RN's are known and highly respected
for their contributions in Nursing.
SAUDI ARABIA: The King Faisal Specialist
Hospital and Research Centre in Riyadh,
Saudi Arabia — a modern 250 bed specialty
health center. Positions available (on 25
month contracts) for general and specialty
acute-care staff nurses.
UNITED STATES: Various locations in sev-
eral states are available — or will be in the
near future. Facilities may vary from small
community hospitals to major metropolitan
medical centers.
• Qualifications and requirements vary
with each location:
— Minimum for Saudi Arabia: R.N.
License, 3 years current acute-care
hospital experience
— Minimum for U.S. locations: R.N.
License and eligibility for U.S. state
licensure, 1 year experience pre-
ferred.
• Salary and benefits are competitive
and dependent upon location, hospital,
position, and qualifications.
If you meet minimum requirements and
think you may be interested, why not write
us for more details?
Please forward professional resume (indi-
cate location preference — i.e., Saudi Arabia
or U.S.A.) to:
Miss Marion L. Mullin, R.N.
International Representative
HOSPITAL CORPORATION
INTERNATIONAL *
One Park Plaza
Nashville, Tennessee 37203
* An International Subsidiary of
Hospital Corporation of America
Th« Canadian Nurw June 1977
(lassiriiul
Advert isiMiiiMit.s
Alberta
Ontario
Manitoba
Faculty Positions — Position open to do research and to teach at the
post-baste level in nursing for baccalaureate and master s programs
Preparation a( the doctoral level preferred- Other opportunities exist at
the Assistant or Associate Professor level to teach in both clinical-
specially areas and on campus. For more Information contact Dean.
Facutty of Nursing. The University of Calgary. Calgary. Alberta. T2N
RN or RNA, 5 7 or over and strong, without dependents, to care for
160 pound handicapped executive with stroke Live-in. ''j yr in To-
ronto and '? yr, in Miami Preferably a non-smoker Wage $200.00to
S220 00 weekly NET, depending on expenence plus Miami bonus-
Send resume to: M.D.C.. 3532 Eglinton Avenue West. Toronto. On-
tano. M6M 1V6
British Columbia
Psychiatric Head Nurse required for a l6-bed Psychiatric Unit
located in the Northwest of B.C. R N ABC contract is in effect.
Qualifications: Must be eligible for registration in B.C Previous Head
Nursing expenence essential. Baccalaureate degree preferable Ap-
ply in wniingto Mrs. F. Ouackenbush, R N., Director or Nursing. Mills
Memonal Hospital. Terrace. Bntish Columbia, V8G 2W7,
Head Nurse required for a 41 -bed unit m our Health Centre for
Children Patients ages range from newborn to early adolescence and
mainly have a neurosurgical or neurological diagnosis Head Nurse
also assists others in planning care of pediainc neurology patients
who ate (due lo age) admitted to other units Applicants should have
competence in the field of pediatric neurology and neurosurgery.
Position available mid June, Apply to: Vancouver General Hospital.
Employee Relations Department. 855 West 12th Avenue, Vancouver.
British Columbia. V52 1M9.
Operating Room Nurse required for an 87-bed acute-care hospital
located m Northern B C. R NAB C contract is tn effect Residence
accommodations available Apply in wnting to: Mrs. F Ouackenbush,
R.N , Director of Nursing, Mills Memonal Hospilal, Terrace. British
Columbia. V8G 2W7,
Help Wanted — Registered Nurses — The Bntish Columbia Public
Service has vacancies for Registered Nurses in the Greater Vancou-
ver and Other Areas. Positions are in mental health, mental retarda-
tion and psycho-genainc institutions Salaries and fnnge benefits are
competitive (1976 rates Si, 086 to Si, 267 for Nurse 1) Canadian
citizens are given preference. Interested applicants may contact the
Public Service Commission. Valleyview Lodge, Essorxlale, Bntish
Columbia, VOM 1J0 Quote Competition No. 77:449.
Registered Nurses — Licensed Practical Nurses — 37-bed Com-
munity Hospital Union agreements in effect Must qualify for B.C.
registration. Residence accommodation available. Wnte: Director of
Nursing, Ultooet Distnct Hospital. Box 249. Lillooet. Bntish ColumtHt.
VOK 1V0
Registered Nurses — required immediately for a 340-bed accredited
hospital m the Central Intenorof B C Registered Nurses interested in
nursing positions at the Pnnce George Regional Hospital are invited to
make mqumes to Director of Personnel Services, Pnnce George
Regional Hospital, 2000 - 15th Avenue. Pnnce George, Bntish Col-
umbia, V2M 1S2
Nurses registered or ellgjt)le for Registration In B.C. are invited to
submit applications for employment for General Duty positions on the
staff of the Royal Jubilee Hospital, 1900 Fori Street, Victona, B C.
V8R 1J8 Vacanaes are anticipated m all areas of this 975-bed
hospital which includes Psychiatnc and Extended Care Applications
for part-time, ful-time, or c^ual employment will be considered.
Liberal benefits exist under the RNABC contract, Apply to the : Direc-
tor of Nu'Sing
Experienced General Duty Nurses required for i34-bed hospital.
Basic Salary Si. 122 -$1,326 per month Policies in accordance with
RNA 8 C Contract, Residence accommodation available Apply in
wnting to Director of Nursing. Powetl River General Hospital. 5871
Arbutus Avenue, Powell River, Bntish Columbia. V8A4S3.
Ontario
Supervisor of Public Health Nursing for progressive generalized
public health program Salary commensurate with expenence Ad-
minisliative experience essential Send resume to M F Webster.
M D , D P H , Director Elgin-St. Thomas Health Unit, 2 Wood Street,
St, Thomas. Ontario. N5R 4K9.
Faculty — School of Nursing — For a Two Year Basic Diploma
Nursing Program in Brandon, Manitoba. Generalist in Focus, clinical
emphasis in acute and extended care institutions; M A, RN approved j
school; innovative, individualized teaching-learning process used
Baccalaureate Degree m Nursing and clinical nursing expenence I
required; teaching expenence an asset Must be eligible tor registra-
tion in Manitoba, Wnte, giving resume of preparation and expenence
to: Mrs. S.J. Paine. Director of Nursing Education, School of Nursing
Brandon General Hospital. 150 McTavtsh Avenue East. Brandon
Manitoba. R7A 2B3.
The
Rhodesian Nursing Service
Needs You
We offer you excellent conditions — 45 days Vacation Leave plus 1 2 days
Annual Leave yearly, free Medical Benefits, Pension Scheme, Annual
Bonus, Uniform Allowance.
Vacant posts are available for Qualified Tutors, Psychiatric Nurses and
Public Health Nurses, also General Nurses, Theatre Staff and Midwives in
the larger centres and in outstations where valuable experience can be
gained.
Salary Scales (Per annum) (Salaries are commensurate with the cost ot
living In Rhodesia).
Registered Nurse — $5,363 x $312 — $7,549:
Enrolled Nurse — $3,630 x $181 — $4,353 x $190 — $4,923:
Psychiatric — from $5,675 x $312 — $7,861 to
$6,299 X $312 — $8,798:
Enrolled Nurse Psychiatric — from $3,991 x $181
— $4,353 X $190 — $4,923 x $234 — $5,294
to $4,992 X $234 — $5,226 x $278 — $6,060
X $293 — $6,646:
Tutor— $9,110 X $390 — $11,062:
Public Health Nurse — $5,363 x $312 — $7,549:
Interested applicants please apply to:
The Ministry of Health
P.O. Box 8204
Causeway
Salisbury
RHODESIA
^ustralia
^e^avemany vacancies for Registered Nursing Sisters and other
ara-medlcai staH For details piease wnte to Hospital Staff
kgency, 388 Bourke Street, Meitwume, Viciona 3000, Australia.
■^ Jnited States
lagistered Nurses — Dunhill. with 200 offices «i the USA , tias
"ing career opportunitres for botti new grads and expenenced
N/s. Send your resume lo. Dunhill Personnel Consultants. No. 805
impire Building. Edmonton, Alberta. T5J 1V9 Fees are paid by
■ yef.
Isgistered Nurses — Florida and Texas — Immediate hospital ope-
nings m Miami, Fort Lauderdale, Palm Beach and Stuart, Bonda and
Houston, Texas Nurses needed for Medical-Surgical, Critical Care.
Pediatrics. Operating Room and Orthopedics Ws will provide the
lecessary won< visa. No fee to applicant Medical Recruiters of Ame-
ica. Inc.. 800 N W 62nd St , Fort Lauderdale, Florida 33309. USA.
IMS) 772-3680
Come South! Warmth & Beaches — Mild Winters. We represent
lurxJreds of clients that are seeking Canadian nurses toiom their staff
rhese sriuations are vaned, and income levels are excellent up to
H4.000 (US ) for ICU/CCU supervisors, S13.500 for shift super-
Msors. and up to St 2.000 for general duty staff nurses Situations may
-equire state licensure exam: however, temporary permits are availa-
ble without examination. Our fee is paid and H-i Visa assistance
provided For complete details send your resume and fuH particulars
to: Medical Search, 3274 Buckeye Road. Atlanta. Georgia, 3034t
(404) 458-7831
MCH Nurse Specialists — Overseas — Proiect HOPE seeks MCH
Nurse Specialists to work with host country counterparts m educa-
Hona) programs. Current and projected openings with Tunisia,
SuatemaJa. Brazil and Egypt programs. 2 year assignments frenewa-
Ue). Full benefits, paid relocation expenses and salary commensu-
rate with training and expenence Send resume to Personnel De-
partment. Prqiect HiDPE, 2233 Wisconsin Ave , N W,, Washington.
DTC. 20007 E O E
Associate
Executive Director
Applications are invited tor ttie position of
Associate Executive Director, Canadian
Nurses Association, Ottawa.
Candidates must be members of the
Canadian Nurses Association, have a
master's degree or equivalent and have at
least five years' administrative
experience. Bilingualism an asset.
Interested applicants are asked to submit
their curriculum vitae, in confidence, to:
Executive Director
Canadian Nurses Association
50 The Driveway
Ottawa, Ontario
K2P 1E2
Hospital Affiliates
International Inc.
NURSING
CAREERS
United States
Hospital Affiliates International, the leader
in the field of hospital management, has
over 70 hospitals in operation or under
construction in 23 States, with major
requirements in:
ILLINOIS - LOUISIANA
TENNESSEE-ARKANSAS
TEXAS
Please contact our Canadian
representative who will be pleased to
discuss your specific needs. All enquiries
will be treated in confidence and should
be directed to:
DOW-CHEVALIER
SEARCH CONSULTANTS
365 Evans Ave., Toronto M8Z 1K2
416-259-6052
Director
Extension Course
in
Nursing Unit Administration
Applications are invited for the position of Director,
extension course in Nursing Unit Administration. The
incumbent will be responsible for the conduct of the
program on a national basis and for several
international projects. The director is accountable to a
Joint Committee composed of representatives of the
Canadian Nurses Association and the Canadian
Hospital Association.
Applicants should have advanced academic
preparation, a Master's degree or equivalent, and a
relevant background of experience in nursing
administration and/or nursing education, Bilingualism
would be an asset.
The position should be filled in September, 1977 by a
candidate who is willing to locate in Ottawa in 1978.
Interested applicants are asked to submit their
curriculum vitae, in confidence, to:
The Selection Committee
Nursing Unit Administration Course
25 Imperial Street
Toronto, Ontario MSP 1C1
The Canadian Nurse June 1977
United States
United States
Nurses — RNs — Immediate Openings in Florida — California —
Arkansas — If you are experienced or a recent Graduate Nurse we
can offer you positions with excellent salaries of up to S13CX) per
month plus all benefits Not only are there no lees to you whatsoever
for placing you. but we also provide complete Visa and Licensure
assistance at also no cost to you Wnte ;mmediately for our application
even if there are other areas of the US that you are interested in We
will call you upon receipt of your application in order to arrange for
hosprtal interviews Windsor Nurse Placement Sen/ice. P O- Box
1133. Great Neck, New York 11023. (516-487-2818)
Registered Nurses — Hurley Medical Center is a well equipped,
modern, 600- bed teaching hospital offering complete and specialized
services for the restoration and preservation of the community s
health. It also offers orientation, in-service and continuing education
tor employees. It is involved in a buildmg program to provide better
surroundings for patients and employees. We have immediate ope-
nings for registered nurses in such specialty units as Cardio- Vascular,
Operating Rooms. Nursenes, and General Medical-Surgical areas.
Hurley Medical Center has excellent salary and fringe benefits. Be-
come a part of our progressive and well qualified work force Today.
Apply: Nursing Department. Mr. Garry Viele. Associate Director of
Nursing, Hurley Medical Center, Flint, Michigan 48502. Telephone
(313) 766-0386
Challenge Awaits You at our dynamic community medical center
Huntingdon Memorial Hospital is a 565-bed general care hospital
located in a beautiful suburban area of Los Angeles. The emphasis is
on excellence, m patient care and in maintaining the t)est possible
nursing staff through exceptional orientation and in-service training
programs, continuing education, and professional involvement with
innovators in many fields of medicine. We're presently seeking ex-
perienced RN's as well as new grads for many of our outstanding
untils. If you d like to enjoy the rewards of more challenge from your
career, plus the many benefits our hospital and Southern California
offer, please contact Linda Chavez, RN. (collect) at (213) 440-5400.
Huntingdon Memorial Hospital. 747 S. Fairmount, Pasadena, Califor-
nia. 91105,
Practice Total Nursing in a vanety of supportive environment. Op-
portunities include, expanded use of Pnmary Nursing; ICU/CCU; all
other subspecialties. You can realize your nursing potential in one of
our 18 hospitals (ranging from 15 to 570 beds) Continuing education
programs keep your skills up-to-date and can prepare you for a
management role Work where you re appreciated and make the most
of your free time at famous US. National Parks and numerous other
recreational areas. Contact: Gail C. Kuip. Intermountain Health Care.
Inc.. 36 South State, Suite 2200-F, Salt Lake City, Utah 841 1 1 , (801)
533-8282.
Registered Nurse
RN required for a 60-bed modern Home
for the Aged, in Little Current, Ontario.
Competitive salary and benefits.
Low cost of living.
Beautiful scenery
Friendly surroundings.
Apply:
The Administrator
Manitoulln Centennial Manor
Little Current, Ontario
POP 1K0
Telephone: 368-2710
@
Open to both
men and women
Canadian Penitentiary Service
Regional Psychiatric Centre, Prairie Region
Saskatoon, Saskatchewan
DIRECTOR NURSING SERVICE
]
Salary: $15,624 to $18,396 (under review)
Ref, No: 77-PSTP-22-102 ( N )
Duties
The candidate directs, administrates and evaluates the
nursing service and nursing education program in the
Regional Psychiatric Centre: develops the aims, objectives,
orientation and in-service programs for the nursing service;
and prepares the budget, establishes nursing procedures and
work performance requirements for the Centre.
Qualifications
The successful candidate must possess a Bachelor's Degree
in Nursing and registration as a registered nurse in a prov-
ince or territory of Canada. Experience and demonstrated
competence in nursing service management are required.
Knowledge of English is essential.
COORDINATOR, IN-SERVICE
EDUCATIONANDCUNICALNURSING
Salary: $14,424 to $16,596 (under review)
Ref. No: 77 PSTP 22-103 ( )
Duties
The candidate plans, orients, assesses and conducts the In-
Service Education Program; promotes a program directed
to the establishment and maintenance of acceptable stan-
dards of clinical nursing care; and participates in research
studies, inter-departmental committees and management
decisions.
Qualifications
The successful candidate must possess a diploma or Bache-
lor's Degree in Nursing and registration as a registered nurse
in a province or territory of Canada. Certificates, diploma
or experience in Psychiatric Nursing are required. Experi-
ence in the clinical teaching of nursing and the develop
ment of educational programs is necessary. Knowledge of
English is essential.
Further information may be obtained from M. Caroll,
Director, Nursing Operations, Canadian Penitentiary Ser-
vice, 340 Laurier Avenue West, Ottawa, Ontario K1 A 0P9
How to Apply
Forward completed" Application for Employment" {Form
PSC 367-41 W) available at Post Offices, Canada Manpower
Centres or offices of ttie Public Service Commission of
Canada, to :
Professional, Scientific and Technical Program
Public Service Commission of Canada
300 Laurier Avenue West
Ottawa, Ontario K1A OM7
Closing Date: June 30, 1977
Please quote tfie applicable reference number at all times.
Assistant Director
Nursing Services
McMaster University Medical Centre is seeking an Assistant
Director of Nursing Services.
THE POSITION:
An excellent career opportunity exists for a qualified innovative
individual to fill a demanding position involving responsibility for
specific in-patient/out-patient areas. Tfie incumt)ent will have the
opportunity to plan, establish, implement, and direct nursing care.
Interested candidates are required to have the managerial ability to
vmik with all levels of nursing, administration and medical staff.
MINIMUM QUALIFICATIONS:
Must be currently registered in the Province of Ontario. Preference will
be given to candidates with additional educational preparation and
experience in nursing management.
Resumes should be sent to:
Mr. R. E. Capstick
Manager, Employment & Staff Relations
McMaster University Medical Centre
1200 Main Street West
HAMILTON, Ontario
L8S 4J9
@
Open 10 both
men and women
Canadian Penitentiary Service
B.C. Penitentiary
New Westminster, B.C.
HEALTH CARE OFFICER
Salary: $13,567. - $15,838. (Under Negotiation)
An additional Penological Factor Allowance is applicable
to these positions.
Comp. No.: 77-V CPS-88
DUTIES:
On a shift rotating basis, gives medical treatment and health
counselling and performs basic clinical tests; provides
direct nursing care to inmates to implement preventive,
diagnostic therapeutic and rehabilitative measures and
ensures that measures directed to the security of medical
and nursing areas prevail at all limes.
Combine vacation and continuing education this summer
CHAUTAUQUA 77:
HAWAII EAST in VAIL, COLORADO
Enjoy the beauty of the cool Rocky Mountains
this summer and fulfill mandatory continuing
education requirements at Chautauqua '771 The
eight day symposium will be held in Vail, Colorado
August 6-13, 1977. In the tradition of summer
adult education, Ctiautauqua '77 offers 136 semi-
nars in the general content areas of administration,
education, primary care and clinical nursing. This
is a unique conference with RNs planning, con-
ducting and participating in the various three hour
seminars. Seminars, lodging, social events have all
been planned to accomodate your needs ■ and bank
account. Vail is a great place to recreate and
educate. Plan now to attend CHAUTAUQUA '77:
HAWAII EAST! Sponsored by the Colorado Nur-
ses Assn. Mail-in registration closes July 15, 1977.
Yes! I'm interested in Chautauqua '77: Hawaii
East. Please send me your program catalog and
registration information.
Name ,
Address .
City
.State
^ip.
Mail to: Chautauqua '77: Colorado Nurses' Association,
5453 E. Evans Place, Denver, CO 80222. 303-757-7483.
QUALIFICATIONS:
Eligibility for registration as a registered nurse in a province
or territory of Canada. Candidates will be required to pass
a pre-employment medical examination. Knowledge of the
English language is essential.
How to Apply
forward completed" Application for Employment" (Form
PSC 367-41 10) available at Post Offices. Canada Manpower
Centres or offices ofttie Pulilic Service Commission of
Canada, to :
hjegional Statting I
Jtticer
Public Service Commission
P.O. Box 11120, Royal Centre
500 - 1055 West Georgia Street
Vancnuver, B.C.
V6E 3L4
Please quote the applicable reference number at all times.
54
The Canadian Nurse June 1977
UNITED STATES
OPPORTUNITIES
FOR REGISTERED NURSES
AVAILABLE NOW
IN CALIFORNIA
FLORIDA
MISSISSIPPI
NEW ORLEANS
TEXAS
WE PLACE AND HELP YOU WITH:
STATE BOARD REGISTRATION
YOUR WORK VISA
TEMPORARY HOUSING - ETC.
A CANADIAN COUNSELLING SERVICE
Phone: (416) 449-5883 OR WRITE TO:
RECRUITING REGISTERED NURSES INC.
1 200 LAWRENCE AVENUE EAST, SUITE 301 ,
DON MILLS, ONTARIO M3A 1C1
JURIST
NO FEE IS CHARGED
TO APPLICANTS,
OPEN 7 DAYS A WEEK,
Director of Nursing
Services
Tlsdale Union Hospital is an accredited
68-bed Institution located in a
progressive community of 3,000.
Applicant must be eligible for registration
in the Province of Saskatctiewan, with
some administrative experience or
education. The applicant is responsible
for staffing, organization and planning of
all the nursing functions in the Hospital,
Please apply stating education,
experience and salary to:
Mr. G. Schurman
Administrator
Tisdale Union Hospital
P.O. Drawer 1630
Tisdale, Saskatchewan
SOE 1X0
Telephone: 306-873-2621
LAURENTIAN UNIVERSITY
SCHOOL OF NURSING
Offers a
B.Sc.N. PROGRAMME
for
REGISTERED NURSES
Full-Time
or
Part-Time
For Further Information:
Write: School of Nursing
Laurentian University
Sudbury, Ontario
P3E 2C6
Phone (705) 675-1151, Local 239
Applications for the
position of
Supervisor
Operating Room and
Recovery Room
are now being accepted by this
300 bed fully accredited hospital.
We offer an active staff
development programme.
Salaries and fringe benefits are
competitive, based on
educational background and
experience. Temporary
accommodation available.
Apply sending complete
resume to:
The Director of Personnel
Stratford General Hospital
Stratford, Ontario
N5A 2Y6
Needed Immediately
Registered Nurses are requested for
nursing stations on the Lower North
Shore.
Experience:
Two (2) years or more.
Salary:
According to the convention plus isolation
and availability premimum.
Please send your curriculum vitae to:
Director of Nursing
Notre-Dame Hospital
Lourdes of Blanc-Sablon
Co. Duplessis, Quebec
GOG 1W0
Sudbury and District Health
Unit requires a Public Health
Nurse for service in Chapleau
and surrounding area,
preferably bilingual.
Qualifications:
Baccalaureate degree in nursing
with Public Health content or
equivalent post basic nursing
preparation.
Reply to:
Miss F. Tomlinson
Director of Nursing
Sudbury & District Health Unit
1300 Paris Crescent
Sudbury, Ontario
P3E 3A3
Registered Nurse
required for 150-bed hospital at St.
Anthony, Newfoundland.
Subsidized accommodation, fringe
benefits, group life insurance, salary in
accordance with collective agreement.
Travel paid for minimum of one year
service.
Apply to:
Mr. D. Heath
International Grenfell Assoc.
Rm 701, 88 Metcalfe Street
Ottawa, Ontario
KIP 5L7
Head Nurse
with preparation and/or
demonstrative competence in
Psychiatric Nursing and
Management functions, required for
Head Nurse appointment. To be
responsible for participation in the
organization, initiation, and the
management of a New Psychiatric
In-patient Unit.
Please apply, forwarding
complete resume to:
Director of Personnel
Stratford General Hospital
Stratford, Ontario
N5A 2Y6
HEAD NURSE
INTENSIVE CARE
UNIT
Applications for the above position are
now being accepted by this 300 bed fully
accredited General Hospital. We offer an
active Staff Development Programme,
Competitive Salaries and Fringe Benefits
based on Educational background and
experience.
Apply sending complete resume to:
Director of Personnel
Stratford General Hospital
Stratford, Ontario
N5A 2Y6
I ne L^anaaian nurse June i»//
Wish
you were
here
...in Canada's
Health Service
Medical Services Branch
of the Department of
National Health and Welfare employs some 900
nurses and the demand grows ever> day.
Take the North for example. Community Health
Nursing is the major role of the nurse in bringing health
services to Canada's Indian and Eskimo peoples. If you
have the qualifications and can carry more than the
normal load of responsibility. . . why not find out more!"
Hospital Nurses are needed ttxi in some areas and
again the North has a continuing demand.
Then there is Occupational Health Nursing which in-
cludes counselling and some treatment to federal public
servants.
You could work in one or all of these areas in the
course of your career, and it is possible to advance to
senior positions. In addition, there are educational
opportunities such as in-service training and some
financial supptirt for educational leave.
For further information on any. or all. of these career
opportunities, please contact the Medical Services
office nearest vou or write to:
Medical Services Branch
Department of National Health and Welfare
Ottawa. Ontario K1A 0L3
Name
Address
City
1^ Health and Wellare
^^ Canada
Prov
Sante el Blen-eire social
Canada
Open to both
men and women
Ministry of the Solicitor General
Canadian Penitentiary Service, Prairie Region
iitoba • Saskatchewan . Alberta
BACCALAUREATE & DIPLOMA
REGISTERED NURSES
Reference No. Quote: Health Care Nurses
Salary: $12,624 to S16,825 (under negotiation)
Penological Allowance: S425.00 per yr - medium security
institutions
S850.00 per yr - maximum security institutions
Shift differential paid.
Medical and Health Care Services Division have a one-year
term position available in the Prince Albert Penitentiary.
Future permanent position will be available in the Saska-
toon Psychiatric Hospital and the Edmonton Maximum
Security institution. Applicants should be qualified and
experienced Baccalaureate and Diploma Registered Nurses.
Knowledge of English is essential.
Basic duties will be to provide primary health care to in-
mates in both general and psychiatric nursing situations.
The supervising positions will require knowledge and expe-
rience in nursing administration.
For additional information please contact:
Phyllis Peters, Regional Nursing Officer
Canadian Penitentiary Service
Regional Headquarters, Prairies
P.O. Box 9223
Saskatoon, Saskatchewan S7K 3X5
Telephone: (306) 665-4871
How to Apply
Forward completed Application for Employment" (Form
PSC 367-41 JO) available at Post Offices, Canada Manpower
Centres or offices of ttie Public Service Commission of
Canada, to :
Public Service Commission of Canada
500 Credit Foncier Building
286 Smith Street
Winnipeg. Manitoba R3C OK6
Please quote the applicable reference number at all times.
The Canadian Nurse June 1977
ASSOCIATE
DIRECTOR
OF NURSING
Applications are invited for the position of Associate Director of
Nursing in a 500 bed accredited general hospital.
THE POSITION:
As a member of the Nursing Administration team, this position
requires a nurse with innovative qualities and ability to organize,
delegate, and direct the work of others.
The applicant must have an enthusiasm for initiating and following up
new ideas, projects and programmes.
MINIMUM QUALIFICATIONS:
Must be currently registered in the Province of Ontario. Preference will
be given to candidates with a B.Sc.N. and experience in Hospital
Administration.
Apply In writing to:
Director of Personnel
Belleville General Hospital
Belleville, Ontario
K8N 5A9
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.
Closing date for copy and cancellation is 6 weeks prior
to 1st day of publication monthi.
The Canadian Nurses Association does not review the
personnel policies of the hospitals and agencies
advertising in the Journal. For authentic information,
prospective applicants should apply to the Registered
Nurses' Association of the Province in which they are
interested in working.
Address correspondence to:
The Canadian Nurse
50 The Driveway
Ottawa, Ontario
K2P 1E2
4f
Index to
Advertisers
June 1977
Boehringer Ingelheim (Canada) Limited
9,41
Cin6dessins Reg'd.
48
The Clinic Shoemakers
2
Equity Me6\ca\ Supply Company
47
Hollister Limited
44
Kendall Canada
47
J.B. Lippincott Company of Canada Limited
28,29
Posey Company
41
Procter & Gamble
Cover 3
Reeves Company
11
W.B. Saunders Company Canada Limited
5
Stiefel Laboratories (Canada) Limited
Cover 4
White Sister Uniform Inc.
Cover 2
Advertising
Gerry Kavanaugh
The Canadian Nurse
50 The Driveway
Ottawa, Ontario K2P 1 E2
Advertising Representatives
Richard P. Wilson
219 East Lancaster Avenue
Ardmore, Penna. 19003
Telephone: (215) 649-1497
Gordon Tiffin
2 Tremont Crescent
Don Mills, Ontario M3B 2S1
Telephone; (416) 444-4731
Member of Canadian
Circulations Audit Board Inc.
G£13
Pampas
ives
you both
ahieak
lini drier ^^^^K ^^^^ you time
Instead of holding ^^^^^^^^^Bm^K^ Pampers
moisture, Pampers H^^^^^P ^^^^EW ; helps prevent moisture
hydrophobic top sheet ^^^^■[^ f ^ from soaking through
allows it to pass ^^^^^^^ ^^^^T^V I^E and soiling linens. As a
through and get ^^I^^S" H^fc'^K. J^i result of this superior
"trapped" in the "ir^Takjt. ^^^ ^^rf^ '' containment, shirts,
absorbent wadding v^^'^P^^^ ^IL ^ ^^^^*^' ^^^^^^^*^ ^^^
underneath. The inner j^^Pers M" |\ ^R & ^^^^ P^^^ ^^^'* ^^^'^ *°
sheet stavs drier, and ^•■'^ -^ HlJI ^^ changed as often
babv's bottom stays ^0"^ Iv ^^K as they would with
drier than it would in JR^ "^ f ^ W' ^^^ conventional cloth
cloth diapers. ^^' ^5% t "J ^ diapers. And when less
time is spent changing
linens, those who take
care of babies have
more time to spend on
other tasks.
r&OCTER « GAHSLE CAR-32Z
Benaxyl Lotion 20%
proven effective
in treatment of cutaneous ulcers
BEFORE AFTER
Left: ulcer of right greater trochanter, 14 cm in diameter, with
undercutting of superior border to 3 cm. Right: full healing after
8 months therapy with benzoyl peroxide.
Benzoyl peroxide, a powerful organic
oxidizing agent, was applied topically
according to a carefully developed
technique to cutaneous ulcers of
different types. The healing time was
shortened greatly by the rapid
development of healthy granulation
tissue and the quick ingrowth of
epithelium.
Exceptionally large pressure ulcers
with deep cavities, undercut edges
and sinus tracts were successfully
treated, as were stasis ulcers of long
duration resistant to all other therapy.
There were only 13
treatment failures
among the 133
cases. 1
Available only from Stiefel
STIEFEL
FOUNDED 1847
TM trademark
STIEFEL LABORATORIES (CANADA) LTD., user
Montreal, Canada H4R 1E1
Reference: ' Pace. WE: Treatment of cutaneous ulcers with l>enzoyl peroxide. Can Med
Assoc J 115:1101. 1976
tHo eammdimwB
July 1977
ES7607615935
WP*^ ED fKTMF
58 HARMER AVE N APT 3
OTTAWA ONT
977
lUY 0T6
Metamucil
for bowel management
and anorectal
surgery patients
®
"Gentle persuasion sums it up!" Metamucil
is a natural source preparation that pro-
duces a gentle action.
Metamucil, refined and purified from natu-
ral psyllium seed, works gently but firmly.
It does not depend on chemical irritants,
methylcellulose or other synthetic laxative
agents for its effect.
Mixed with a cool liquid, Metamucil passes
through the digestive system to promote
soft, fully-formed stools and gentle, yet
definite urging of peristalsis followed by
easy passage and elimination. Regular
bowel function usually takes place without
stress, strain, irritation, or cramping.
Importantly, Metamucil is non-habit-form-
ing and may be prescribed for short or
long term therapy. The dosage can be
individually regulated.
SEARLE
Available as Metamucil Powder and
flavoured, effervescent Instant Mix.
tHc eawBadlian
nummo
July, 1977
The official journal of the Canadian
Nurses Association published
monthly In French and English
editions.
Volume 73, Number 7
^^^^^^^^^^^^^^H
Input
4
News
7
Names
40
Calendar
41
What's New
42
Congenital Dislocated Hip
Celia Nichol
14
Audiovisual
44
A Gift of Tomorrow
Patricia Harcourt French
20
Research
45
The Canadian Institute of
Child Health: A Personal Responsit)ility
Sharon Andrews
21
Books
46
Behavioral Therapy
Larry MacDonald
26
Library Update
48
Helping Young Ostomy Patients
Hildegard Tisdale
30
Privacy: The Forgotten Need
Ellen D. Schultz
33
Expanded Roles in Respiratory Nursing—
The Respiratory Nurse Clinician
for Quality Care Ella MacLeod
36
The Clinical Nurse Specialist:
An Individual Perspective
Lee Robinson
36
Clinical Wordsearch #7
Mary Bawd en
39
It was 1892 when Canadian poet
Archibald Lampman called summer a
time "for loafing and dreaming and
getting close to nature. " Things
haven't really changed — every
summer, Canadians are "getting
away from it all," enjoying camping,
relaxing at cottages, swimming, and
long lazy walks along the seashore.
This month s cover photo, courtesy of
Health and Welfare Canada captures
a little of the spirit of summer.
The views expressed in the articles
are those of the authors and do not
necessarily represent the policies of
the Canadian Nurses Association.
ISSN 0008-4581
Indexed in International Nursing
Index, Cumulative Index to Nursing
Literature. Abstracts of Hospital
Management Studies, Hospital
Literature Index. Hospital Abstracts,
Index Medicus. The Canadian Nurse
is available in microform from Xerox
University Microfilms. Ann Arbor.
Michigan. 48106.
The Canadian Nurse welcomes
suggestions for articles or unsolicited
manuscripts. Authors may submit
finished articles or a summary of the
proposed content. Manuscripts should
be typed double-space. Send original
and carbon. All articles must be
submitted for the exclusive use of The
Canadian Nurse. A biographical
statement and return address should
accompany all manuscripts.
Subscription Rates: Canada: one
year, $8.00: two years. 515.00.
Foreign: one year, S9.00: two years,
S17.00. Single copies: SI .00 each.
Make cheques or money orders
payable to the Canadian Nurses
Association.
Change of Address: Notice should be
given in advance. Include previous
address as well as new. along with
registration number, in a provincial/
territorial nurses association where
applicable. Not responsible for
journals lost in mail due to errors in
address.
Postage paid in cash at third class rate
Montreal, P.Q. Permit No. 10,001
'' Canadian Nurses Association
1977.
Canadian Nurses Association,
50 The Driveway, Ottawa, Canada,
K2P 1E2.
The Canadian Nurse July 1977
IVrspoetlvc
A fortunate few Canadian nurses
spent ttie first week of June in Tokyo,
Japan, rubbing stiouiders and
excfianging Ideas witti ttieir
professional counterparts from close
to 1 00 countries around ttie world. The
occasion was ttie 16tti quadrennial
congress of ttie International Council
of Nurses, an event tfiat attracted
more ttian 12,000- nurses, including
approximately 530 Canadians.
For ootti participants ana
observers, the congress provided a
unique learning situation — a
never-to-be-forgotten oppxjrtunity to
acquire firsthand information about
nursing practice, education and
professional responsibility on a
world-wide scale.
International nursing became a
living realityforthese nurses. But what
about those of you who stayed at
home to cope with the day-to-day
responsibilities of looking after the
health of this country's population?
Did you know that you also
support nursing at the international
level through membership in your
provincial association?
Did you know that your fellow ICN
members number close to a million
nurses around the world and that the
Council exists to serve all nurses,
regardless of nationality, race, creed,
color, politics, sex or social status?
Did you know that the ICN which
was founded in 1 899 is recognized as
the oldest international professional
organization in the health field?
Did you know that the ICN exists
to provide a vehicle for nursing
associations throughout the world to
share common interests and work
together to develop the contribution of
nursing to the promotion of health and
care of the sick around the world?
Did you know the ICN has
adopted official policy statements on
issues such as human rights, family
planning, equal pay for equal work and
continuing education? And that the
IC N has formulated a Code for Nurses
recognized by nurses internationally?
So, whether you were in Tokyo or
not, the ICN is YOUR association. It
exists to help you and to helpyou help
other nurses throughout the world.
llt»roiii
There are approximately 8,000,000
children in Canada today. Recently
the Canadian Institute of Child Health
began operation in Ottawa. The
purpose of the I nstitute is to take a look
at the special problemsfacing children
in our modern society — problems like
immunizations, nutrition, poverty,
venereal disease and physical fitness.
The Institute hopes to act as a
catalyst to encourage people all
across the country to think about, anck
work towards, improving the mental
and physical health of our children.
How can we as nurses help?
This month CNJ talked to Shirley
Post, a nurse who believes the
question of child health has to be
taken on as a personal responsibility!
How long has it been since you
updated your knowledge about the
care of the burn patient? Too long? '
Next month, in a series of three
articles, CNJ takes a look at the basic
of burn care — the principles of first!
aid, the priorities in treatment, drugs
and nursing care. Dietician-nutritionisi
Rosemarie Repa Fortier reviews thei
nutritional needs of the burn patient I
and author Marilyn Savedra
investigates strategies of helping the
severely burned child cope with paint
Editor
M. Anne Hanna
Assistant Editors
Lynda Ford
Sandra LeFort
Editorial Assistant
Sharon Andrews
Production Assistant
Maty Lou Downes
Circulation Manager
Beryl Darling
Advertising
Gerry Kavanaugh
— M.A.H. CNA Executive Director
Helen K. Mussallem
I ne Canadian Nurse July 1977
Du Gas: New Third Edition
Introduction to Patient Care
A Comprehensive Approach to Nursing
"Comprehensive" is the word for this outstanding volume on the vital
topic of patient care. In this new edition, you'll find completely up-to-
date information on every facet of the fundamentals of nursing, includ-
ing all-new chapters on Nursing Practice, Communication Sl<ills, and
Sensory Disturbances. Material on The Nursing Process has been
expanded to form an entire unit. In addition, Du Gas features updated
coverage of: the health care system; major health care problems; the
expanded role of the nurse; problem-oriented medical records (POMR);
and movement and exercise, rest and sleep, and comfort.
By Beverly Witter Du Gas, RN, BA, MN, EdD, LLD, Health Science Educator,
Pan American Health Organization, Barbados. Regional Allied Health Project:
with special assistance from Barbara Marie Du Gas, BA. About 690 pp.. 240 ill.
(78 in color). Just Ready. About $13.40. Order #3226-2
Marlow:
New Fifth Edition
k
Textbook of Pediatric Nursing
MARLOW — a book nursing professionals everywhere know and trust!
Now in its fifth edition, this outstanding text maintains its tradition of
detailed, up-to-the-minute coverage of children's nursing care needs
from birth through adolescence. It's an exceptionally quick and easy-
to-use reference. Information is organized by age groups — each section
then describes: a normal child of that age group; medical conditions
requiring immediate or short-term care: and medical conditions requir- ^
ing long-term care. You'll also find: a new chapter entitled The Nursing
Process; expanded coverage of sex education; and many other new
topics including: Fetal Alcohol Syndrome; Parenting, Preparation for
Parenthood, and the Role of the Father; Genetic Counseling and the ^
Nurse; Immunity in the Newborn, Infant, and Child; Reyes Syndrome;
Hypertension; Rape; and much more.
By Dorothy R. Marlow, RN, EdD, formerly Dean and Professor of Pediatric
Nursing, College of Nursing, Villanova University. About 975 pp., 400 ill. (3 color ^-
plates). Ready August 1977. About $16.50. Order #6099-1
V
••l
Vi. k
/
■ Please send me on 30-clay approval:
ID 3226-2 Dugas
D 6099-1 Marlow
ON 7/77
Please Print;
I
I
^ check enclosed — Saunders pays postage G send C.O.D.
Z Bill me—
ZI I have an open account wtth Saunders
Z: My credit card or bank account refererKe is:
FIJI 1 NAMF
POSITION AND AFFILIATION (IF APPLICABLE)
HOME PHONE NUMBER
HOME ADDRESS
CITY PROVINCE
ZONE
W.B. Saunders Company Canada LTD. lo^roSrontaSsz 5T9
I
I
I
J
The Canadian Nurse July 1977
The Canadian Nurse invites your
letters. All correspondence is subject
to editing and must be signed,
although the author's name may be
withheld on request.
Input
Planning and health care
Ever since my copies of The
Canadian Nurse began arriving in
Barbados a few months ago, I have
noted with concern the repeated
reports of a depressed market
situation for nurses in Canada, and the
numerous pleas for improved
methods of long-term nursing
manpower planning.
As a former director of the now
non-existent Health Manpower
Directorate of Health and Welfare
Canada, I would like to point out that
early warning signs of the present
over-supply of nurses were evident as
far back as six years ago. National
projections of anticipated supply and
demand for nurses, made in 1971 for
the forthcoming 10-year period,
clearly indicated that we were tending
towards an over-production of
graduates from our diploma schools of
nursing.
A report prepared by our division
in December 1971 warned that,
unless the situation changed
drastically in the next few years, "we
must be prepared for an
unemployment problem with nurses."
Immediately after the report was
prepared, it was taken to a meeting of
the CNA board of directors to alert
them to the results of our projections.
The report was also circulated to all
provincial nursing associations and to
all provincial governments with the
recommendation that, because the
situation might well vary in different
provinces, nursing manpower studies
should be undertaken at the provincial
level without delay. Outcomes of the
report included the establishment
within a few months of a National
Committee on Nursing Manpower and
the provision of assistance by the
division to two provinces (on their
request) with studies of their nursing
needs and resources.
Ontario and a number of other
provinces undertook their own studies
and, as I recall, the Ontario short-term
projections of nursing supply and
demand were remart<ably accurate.
As has t)een noted elsewhere, it was
unfortunate that they did not appear to
believe their own long-range
forecasts.
The problem of improving nursing
manpower planning would appear to
lie, then, not so much with better
methods of forecasting — we were
warned by our earlier projections —
but, rather, with the rational
coordination of health services
planning and that of educational
authorities to prepare the required
number of nurses and level of
practitioner and to ensure their most
effective utilization in our health
services.
Nursing is the largest component
of Canadian health services. It is
essential, therefore, that nurses be
involved in all aspects of planning for
health care if the profession is to react
appropriately and in time to achieve a
more stable balance between the
supply of nurses on the one hand and
demand for their services on the other.
— Beverly Witter Du Gas, R.N., Ed. D.,
PAHO/WHO Health Sciences,
Barbados.
P.S. I like the new format of the
journal, and look forward to receiving
my copy each month.
Sharing budget restraints
I would like to commend Thelma
Milleron her excel lentletterto the B.C.
Minister of Health, a letter that also
appeared in The Canadian Nurse,
April 1977.
I wori< in a hospital in Montreal. As
a head nurse I feel just as frustrated
trying to run a good floor with a high
standard of nursing care. Due to
reasons similar to those Mrs. Miller
states, quality care is becoming
almost a myth. We are constantly
reminded to "budget," to cut down on
supplies, cut down on nurses, cut
down on overtime; but a good nurse is
a good nurse, and she or he will strive
for the impossible, regardless of
restraints imposed.
Our hospital is a teaching hospital
and there seems to be no restraint or
budget on what the medical staff,
interns, and students can order in the
name of medicine. Blood tests, x-rays,
procedures, etc. are ordered
regardless of cost, and in many cases,
regardless of the fact that the patient
has had these procedures done
before, or that they are old people who
would like to be treated as people —
with a little T.L.C. These procedures
increase the wori<load of the nurses
who are overloaded with extra work —
all in the name of medicine.
A letter should be sent out to all
concerned, including the public to let
them know 'why motherfell out of bed,'
or 'why grandpa's lunch was late,' or
'why great-grandpa was resuscitated
for the third time.' I'm sure every nurse
in every department has the same
problems. I'm not-knocking the
medical teaching program, but if we
have to budget and cut short on our
care, the others should be asked to
share in cutting costs.
— Ira Sen, R.N., Montreal, Quebec.
Surnames again ...
Just a quick note to express an
opinion. I feel strongly that the use of
Miss and Mrs. must be avoided to
effect an end to discrimination on the
basis of marital status. Titles
indicating position or academic
degree are fine.
I really do not care much whether
people call me by my first or last name.
However, in communication between
strangers, which is what a journal
involves, a little formality does not
seem inappropriate. It is very common
when speaking or writing about
authors to use their last names. I do
not find the practice "harsh, "
"abrasive" or "pretentious." What is
pretentious about being
business-like? Are we adults and
professionals or school children?
— Nora J. Br lent, R.N., Fredericton,
New Brunswick.
Entitled to my title
Dear Madam,
I'm an Adam. Apply my appellationi
I'm entitled to my title!
I have the inclination
To fight now for my right. I'll
Insist on being Mr.
(I'm quite different from my sister)
Distinguish me from she
For it's plain that I'm a he
Don't ask me what's amiss
Or a Mrs. or a Ms.
Give to her what's plainly hers
Give to him what's plainly his
If you don't, I'll put a curse on
Every ignorant nurseperson
And on all will fall a hex
Who try to rob me of my sex.
—Mr. David J. Davis, R.N., R.P.N. ,
Burnaby, B.C.
A note of appreciation
Kudos for the April issue of The
Canadian Nurse. I wori< as a
permanent night charge nurse in a
nursing home, and I found the article;
in the April issue interesting and ver^
informative.
I believe that some of my
colleagues feel that it is boring and
uninspiring to work in a nursing home
... but I firmly believe that the articles ir
the journal may help nurses to realize
that there's a lot to being a "nursing
home nurse.' Working with and carin(
for older people has helped me to
have a better perspective on aging.
I hope to read more articles abou)
geriatric nursing in future issues of Tht
Canadian Nurse. I also wish to
express sincere appreciation to all thf
contributing authors to the April issu
— Myndah Derro, R.N., B.S.N. , The
Pas, Manitoba.
Avoid inhaling
Recently, I learned of a small
hospital which had got rid of its
cigarette vending machines. When
the hospital administrators realized
that they were losing the profits frorr
these sales, they re-installed them!
This is typical of our confused
thinking. Hospitals have notices
banning smoking in corridors and
elevators but the public may smoke in
lounges, and most of the nursing
personnel smoke in the dining room.
To a layman such as myself it is
paradoxical that nurses — and
doctors — should themselves persist
in a habit that is ""harmful."
One nurse who deals exclusively I
with patients suffering from respiratory
diseases, and who herself smokes
two packages of cigarettes a day,
says, "'I wish the hospital rules would
prohibit all smoking here."
A volunteer group in a Toronto
hospital has been trying to have
cigarette sales banned in the gift shop,
but without success: they cannot
defeat the argument ""We would lose
revenue if we ban cigarettes."
Pertiaps one day the Medical
Council will ask the government to add
to the existing warning on cigarette
packets the following seven words:
"KEEP IN TOUCH WITH YOUR
LUNG SPECIALIST."
— Eric Curwain, Etobicoke, Ontario.
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For engraved last name or initials add 60«
KELLY FORCEPS
' So handy for every nurse! Ideal for clamping
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Includes FREE last name or initials on sphyg and steth.
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METAL CAP TACS Pair of dainty jew-
elry-quality Tacs with grippers, holds cap
bands securely. Sculptured metal, gold finish,
approx. %" wide. Choose RN, LPN, LVN, RN
Caduceus or Plain Caduceus. Gift boxed.
No. CT-1 (Specify Init.) ... No. CT-3
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The Canadian Nurse July 1977
Input
Help or hindrance?
I must disagree with Hodnett's
conclusion (Fetal Monitoring, Wtiy
Bother? March, 1977) that fetal
monitoring should be routine for all
women giving birth. A recent study
seriously questions whether fetal
monitors do lower perinatal mortality
and morbidity any more than
conscientious nursing care
does ("The Evaluation of Continuous
Fetal Heart Rate Monitoring in High
Risk Pregnancy," Haverkamp, A., et
a\.,Am. J. Obstet Gynecol., June 1,
1976).
The authors became involved in
this research because, although
numerous statements have been
made by leading obstetric authorities
that all labors should have electronic
fetal monitoring, no controlled study
has been done to evaluate the actual
influence it has on perinatal death and
morbidity.
A total of 483 high risk patients
were fitted with scalp electrodes and
uterine catheters so both fetal heart
tones and uterine contractions could
be evaluated. The monitor was used
with half of the sample and with the
other half the bedside monitor was
shut off and the monitor in the hall
covered. These women had their fetal
heart tones auscultated by a nurse
every 1 5 minutes In first stage of labor,
and every five minutes in the second
stage.
In the monitored group, fetal
distress was defined by the criteria of
Hon and Kubli. In the auscultated
group fetal distress was diagnosed
when fetal heart tones dropped below
100 beats per minute after three or
more consecutive contractions
despite any corrective measures.
There were essentially no differences
in the perinatal mortality and
morbidity of the two groups. The
difference between the number of
infants requiring intermittent positive
pressure ventilation at two minutes
(2. 1 % for the monitored group and 0%
for the auscultated group) was of
borderline significance with a P value
of < 0.07.
In the machine monitored group
40 women (16.5%) gave birth by
cesarian section, while only 16
(6.6%) of the nurse monitored group
had cesarian section deliveries. The
rate of postpartum infection was also
significantly higher in the monitored
group, 1 3.2% compared to 3.4% in the
nurse monitored group. Even with
correction for cesarian section the
rate was statistically significant. This
difference was unexplained.
Haverkamp et al theorized that
the nurse, with her physical and
emotional support throughout labor,
had a beneficial impact on mother and
baby. They also hypothesized that the
machine was an irritating factor with its
flashing lights, audible sound for the
fetal heartbeat and visible patterns on
the screen.
I note that in the photographs in
Hodnett's article the women are lying
on their back, unfortunately a
requirement of most women being
monitored indirectly. However, it is
well documented that prolonged back
lying during latxsr and delivery can
result in fetal hypoxia.
In view of the points raised I think
we must seriously question the routine
use of fetal monitors. In selected
cases, electronic fetal monitoring is a
very valuable adjunct in our
assessment of mother and baby, but I
feel we must deal with the very real
possibility that the presence of the
fetal monitor itself may be a
disturbance to the normal process of
labor and birth resulting in a higher
incidence of fetal distress, and
consequently more cesarian births.
— Baine Carty, Assistant Professor,
School of Nursing, University of
British Columbia, Vancouver, B.C.
Abortion counselling
no solution
The Badgely Report states that
"a large proportion (84.8%) of the
women who were seeking an induced
abortion were contraceptively
experienced, and it was factors other
than their lack of knowledge or
exposure to contraceptives that were
involved in accounting for their
unwanted pregnancies " (p. 381).
In light of this evidence it is clear
that Mr. Lalonde's program of actively
promoting family planning will not
effectively curtail the escalating
number of abortions. Lack of
motivation to prevent unwanted
pregnancies would appear to be the
cause of ineffectiveness of family
planning programs.
As long as abbrtksn counselling
services are readily available, no
amount of family planning promotion
will make the program effective.
— M. Case, Prince Albert, Sask.
Editor's Note: See CNJ May, 1977,
p. 16, "News".
Call for change
The February edition oi Pediatric
Clinics of North America 1977
provides a shocking eye opener for
nurses. Ignorance has led us to defeat
our objective of health promotion. We
have in fact been fostering the
occurrence of disease by playing a
major role in the promotion of formula
feeding. It is our professional
responsibility to update our
knowledge.
Prominent authorities in the field
of infant nutrition assert that promotion
of breast-feeding should be looked
upon as a major public health
measure. Not only would its
reintroduction as the dominant
method of feeding eliminate formula
induced hazards, but new knowledge
shows that breast milk will provide
protection against disease later in life
as well as during infancy.
The impact of this issue does not
remain at the individual level. Its
ramifications extend into the health
and economics of society and the
world at large. We are paying dearly
by artificially feeding our young and
the only profit to be found is in the
purses of the food industry.
Health professionals must take
stock of their attitudes and review their
current perinatal practices. Nurses
have much to evaluate, much to
change. The position as leader in this
field of preventive practice is up for
grabs and our responsibilities are
clear. We must take immediate steps
to correct this almightly blunder that
has been committed by our
technological age.
— Pat PhilHps, R.N., Fairview, P.E.I.
On cardiac depressants
I have just finished reading the
May issue of The Canadian Nurse,
and wanted to express my
appreciation for Eleanore Warkentin'si
article "Programmed Learning —
Cardiac Depressants." This article
proved to be a most valuable review. I
hope that in the future you will publish
more articles of this nature.
— LuciGolab, R.N., Thornhill, Ontario.
Did you know ...
The Vancouver Perinatal Health
Project or "Parent's Choice " is one
attempt to integrate services for
expectant families. It is conducted
cooperatively by the Vancouver
Health Department and St. Paul's
Hospital — Departments of
Obstetrics, Gynecology, and Family
Practice — without disrupting the
traditional doctor-patient relationship.
At the beginning of her pregnancy, a i
woman is referred to the program by i
her doctor. The program staff follow
the family for up to six months
post-partum, providing nutritional
assessments, prenatal classes, food
supplementation, and individual
counselling as necessary.
A second project, known
as "Healthiest Babies Possible" runs i
concurrently. It focuses on nutritional*
assessments and education for
pregnant women who choose not to
attend prenatal classes due to attitude i
differences or language barriers.
Trained lay health workers and project i
staff provide these services in the
woman's home in several languages,
including Chinese, Italian and Greek.
Both projects have been funded
by the City of Vancouver and the
Government of British Columbia for a i
two-year period.
ine uanaaian Nurse juiy 1977
Xews
Future for VON
"despite budget cuts
The transfer of home care services to
govemment-administered programs
and increased budget restraints
emerged as the two key problems
facing the VON for Canada at their
79th Annual Meeting in Ottawa early in
May. Yet in spite of these problems,
National Director Ada McEwen was
optimistic about the future of visiting
nursing services, citing the 13%
increase in government support of
VON home visits in the last six years
as indicative of the importance of this
aspect of health services. In her
Annual Report to the meeting she
:dded, "in spite of restraints on
' spending, the trend to more
government financing of this t)asic
service in all provinces is essential if
care in the home is to be a viable
alternative to other more expensive
'evels of care."
This increased interest in home
nursing has resulted in various
changes in administration, however,
as some govemments move towards
a provincial approach to provision of
home care programs. During 1976 the
staff of the VON in B.C. wor1<ed closely
with provincial health personnel to
prepare for a transfer of service to
municipal authorities in the Vancouver
area. Some VON branches in Quebec
were also affected in a move to
provide home care services through
community health departments of
hospitals and community health
clinics. In Calgary and Edmonton, the
administration of home care programs
has been transfen-ed to health
departments, although VON branches
continue to provide nursing care in
their areas.
These changes have had an
effect on the statistics of the
organization. McEwen indicated that
half of the 10% decrease in the
number of patients visited by the VON
and the 6% decrease in the numlserof
home visits from 1975 to 1976, could
be attributed to this transfer of
services. The remainder was a result
of budget restraints.
To the degree that budget
restraints forced a re-evaluation of the
efficiency of services, they had a
positive effect, she said. In some
areas more attention was given to
One hundred and fifty
member-states, including almost
every country of the world, took part in
the recent Thirtieth World Health
Assembly in Geneva, Switzerland.
Discussion during the 21 -day
meeting, centered on the Assembly's
target of health for all the citizens of
the world by the year 2000.
Above, some members of the
Canadian delegation are
photographed during the meeting.
Left to right in the front row are: Aubert
Ouellet, deputy minister of social
affairs, Quebec; Helen K. Mussallem,
CNA executive director Dr. A.J. De
Villiers, director general, International
Health Services, Health and Welfare
Canada: R. Harry Jay, ambassador
and permanent representative.
Permanent Mission of Canada to the
United Nations Office and
International Organizations at
Geneva.
teaching family and friends to care for
the ill, and in others the use of
volunteers as support was explored.
But she added that, as well as
reviewing the efficiency of their
programs, "we must be prepared to
object strongly, as some branches did,
to arbitrary budget restraints that
deprive individuals of essential
services at home and, not
infrequently, result in admissions to
more expensive care facilities."
She cited another negative effect
of budget restraints as the decrease in
the number of branches involved in
occupational health counselling, from
24 in 1972 to 18 in 1976. Most
companies that discontinued this
service apparently gave budget
restraints as the reason. Yet statistics
indicate a steady increase in the
number of patients with circulatory
and heart conditions, and
occupational health is receiving high
priority in federal and provincial
govemments. McEwen concluded
that "Health counselling services in
industry allow contact with individuals
between 25 and 65 years of age and
could contribute to healthier life-styles
with a potential reduction in chronic
illnesses in later life."
On the brighter side, McEwen
noted that the VON continues to
concentrate services on meeting the
needs of medical and surgical
patients, and that care of the elderly is
receiving high priority in all branches.
With the increasing numtier of
elderly in our society, more attention is
Ijeing given to improved ways of
helping them cope with their unique
problems. She pointed out that, while
75% of the elderiy have some form of
chronic illness, most are not severely
limited by their conditions and over
90% are at home. She noted that an
effort is being made by government to
reverse the trend of building
institutions for the aged by
re-allocating resources.
McEwen added that, "the
growing list of VON branches, 25 in
1976 compared to 12 in 1974,
providing counselling services in
senior citizen residences, both large
and small, is indicative of the interest
and effort in helping these individuals
to remain healthy and independent as
long as they can."
Ot tier VON sendees that allow the
elderly to retain their independence
include Meals on Wheels. But, she
added, "Appropriate housing and
transportation services, improved and
expanded support services including
homemaker and home help services,
meals on wheels, friendly visitors will
be necessary to allow individuals to
make the choice of remaining at
home."
The Canadian Nurse July 1977
]Vc»ws
SRNA Diamond Jubilee celebrates
sixty years of growth and progress
This year's May Annual Meeting of the
Sasl<atchewan Registered Nurses
Association gave delegates an
opportunity to pause and take a close
look at the past, present and future of
the nursing profession in
Saskatchewan and in Canada. CNA
president Joan Gilchrist, director of
the School of Nursing at McGill
University, Montreal, brought
greetings from CNA to the association
membership.
In her opening remarks to over
400 nurses present, SRNA president
Sheila Belton referred to the dramatic
changes in nursing over the
Association's 60 years, changes that
vi^ill continue in the future. "Each
individual," she said, "has a
responsibility to determine what
changes should be made and the
directions that nursing must take. We
must be involved in decision-making
concerning the delivery of health care
services ... specifically those
decisions being made related to the
future of the nursing profession and
the provision of nursing care."
The lively response of delegates
to the Council's proposed revision of
the Saskatchewan Registered Nurses
Act and Bylaws and to the resolutions
presented was perhaps an indication
that both new and long-standing
members of the Association are
committed to involvement and
planning for change. Many of the 24
resolutions passed by the assembly
were concerned with strengthening
the voice of the provincial Association
on a variety of broad health care
issues. Collective approval was given
to:
• requesting the appointment of
an SRNA member to provincial
government interdisciplinary health
care committees
• the continual promotion of the
acceptance by the provincial
government of the principle of funding
health care agencies for orientation
and staff development programs until
such funding is an accomplished fact
• requesting the Departments of
Health and Social Services to
cooperate in an effort to eliminate
duplication, fragmentation, lack of
continuity and increased cost of
services in the delivery of health care
• bringing the need for increased
supervision of prescribed drug
therapy in the home and the necessity
for this service to the attention of the
Minister of Health
• requesting the Government to
review the entire system for extended
care in Saskatchewan to bring atxsut
an orderly, coordinated, well-defined
and more equitable system
• seeking direct SRNA
representation on planning and action
committees being established as a
result of the Government report
"Adding Life to Years" by Dr. S.L.
Skoll
• recommending to the Minister of
Health a comprehensive parent-child
education television series developed
with emphasis on basic child health
care and prevention of unnecessary
hospitalization
• making a collective and
concerted effort towards further
membership involvement in
Association business through support
of Association activities
• responding promptly and publicly
as an Association to issues directly
influencing nurses in their functions of
providing quality health services to
Saskatchewan consumers
• strongly recommending to the
government of Saskatchewan that
home care programs remain under the
jurisdiction of the Regional Health
Services Branch of the Department of
Health
• lobbying for a public education
program to be sponsored by the
government on the use and misuse of
prescription drugs.
In addition, delegates agreed that
the SRNA Council:
• support research into the effects
of ratio of staff to patient workload,
staffing and rotation patterns on the
quality of nursing care
• publicly affirm the belief that one
of the accepted rights of the individual
is to choose to die with dignity, in
comfort, without extraordinary means
of life support
• pursue mechanisms through the
provincial institutes of applied arts and
sciences and the University of
Saskatchewan to establish
educational programs in
gerontological nursing in
Saskatchewan
• request financial assistance from
the Department of Health for
Continuing Nursing Education
through the College of Nursing,
University of Saskatchewan and
support the request of Continuing
Nursing Education for additional
funding from voluntary agencies.
The final draft of the proposed
changes to the SRNA Act and Bylaws
was presented by the Committee on
Legislation and Bylaws to
membership: the draft was
discussed and approved in principle
for review by the Saskatchewan
legislature. Membership also
approved an increase in SRNA
registration fees to $75 per year.
Delegates learned that the
Saskatchewan Hospital Services Plan
will be providing funds this year for a
one month orientation program for
new graduates in hospitals of 50 beds
or less, a move pushed by SRNA in
meetings with government
representatives, and most recently
through the survey "Performance
Expectations of Beginning
Graduates " (see page 12) which was
made available to the government in
January 1977. President Sheila
Belton assured the membership that
they would continue to press for
orientation programs for all new nurse
employees in all hospitals.
Norma J. Fulton, director of
Continuing Nursing Education, a
program of the College of Nursing,
University of Saskatchewan,
Saskatoon, reported on the i ncreasi ng
number and support of workshops
provided throughout the province
during the past year. The program is
partly funded by SRNA.
Newly elected members to SRNA
Council were: First Vice-President —
Delia Howe, program supervisor,
diploma nursing, Wascana Institute of
Applied Arts and Sciences; Chairman
of the Committee on Chapters and
Public Relations — Phyllis Goertz,
head nurse on a medical unit at the
University Hospital, Saskatoon;
Chairman of the Committee on Social
and Economic Welfare — Pearl
Folkerson, head nurse on a medical
ward, Battlefords Union Hospital,
North Battleford.
Two panel presentations
provided delegates to the three-day
meeting with the opportunity to take a
look at where nursing is going. The
first, entitled "Nursing —
Past-Present-Future", was
moderated by Madge McKillop, a
former president of SRNA and
assistant executive director of
University Hospital in Saskatoon.
Louise Miner, director of Public
Health Nursing for the Saskatchewan
Department of Health and a former
president of SRNA and the Canadian
Nurses Association, talked atx)ut the
growth of public health nursing in
Saskatchewan and urged the
expansion of preventive health
programs for children, emphasizing
the need for interpretation of
preventive medicine to the public.
Pearl Folkerson, president of the
Battlefords Chapter SRNA and
vice-president of Saskatchewan
Union of Nurses local, spoke atxDut the
trend towards specialized nursing,
stressing the importance of geriatrics
as the specialty of the future. Marilyn
Reddy, a regional representative of
S.U.N, and member of the Regina
General Hospital's Committee on
Alcoholism reviewed the change in
nursing education from obedient
apprenticeship to an
education-centered program. Hester
Kernen, dean of nursing of the
University of Saskatchewan
emphasized the importance of taking
responsibility for change in nursing,
reevaluating priorities, and teaching
effectively through example. Pat
McGrath, a former president of SRNA
and the Canadian Catholic Hospital
Association and presently Hospital
Standards Consultant in Nursing for
Saskatchewan Hospital Services Plan
stressed the importance of health
teaching and primary care in nursing.
A second panel presentation
■Health Care — Quality at What Cost?'
took a comprehensive look at a
provocative and timely issue. Panel
members taking part in the fast flowing
and controversial discussion included:
The Canadian Nurse July 1977
Mel Derrick, deputy minister of
Health in Saskatchewan, Dr. E.F.
" Busse, president of the
Saskatchewan Medical Association,
Richard Fontanie, assistant deputy
minister — Community Affairs,
Saskatchewan Department of Social
Services, Maria Reardon, director of
education for Saskatchewan Health
Care Association, and Jean Conroy,
assistant professor of Nursing,
University of Saskatchewan and
former SRNA president.
Saskatchewan journalist and radio
announcer, S. Shragge, moderator
for the panel, summed up the
contributions of panel members in the
following suggestions for maintaining
^ality care at less cost: by changing
-styles, ending defensive practice
•.nat brings about costly duplication of
services, setting a high priority on
patient teaching, and using an
interdisciplinary approach in which
nurses, doctors and the government
participate responsively and
cooperatively.
Huguette Labelle, director
general. Policy, Research and
Evaluation Branch of the Indian and
Eskimo Affairs Program, past CNA
president and former Principal
Nursing Off icer for Health and Welfare
Canada, was guest speaker for the
Diamond Jubilee N^eeting. She left
delegates with a look towards the
future, and changes that they as
individuals and as an Association
have the responsibility to shape.
Labelle stressed the importance of
looking at where we are now in the
world around us, taking the
responsibility for keeping in tune,
- getting into planning and making sure
2t changes are for the best. She
essed the importance of
recognizing certain indicators for the
future: at the evolving acute care
system, the rising importance of
occupational health, decreasing size
of families, limitations in the health
care budget, the increased trend
towards deinstitutionalization,
conservation values and the
demystification of medicine.
Recognizing these trends, she
suggested weighing the nurse's
influence in schools and communities,
in planning committees.
Labelle said that given
knowledge alx)ut trends, nurses must
aim at a community support system, a
"community for coping . ... where we
are not doing for ... but facilitating
ways in which people can do for
themselves." She underlined the need
for careful planning, so that nurses
can use creative, imaginative minds to
make hard decisions' towards the
health of people.
Retired nurses aid
elderly in Alberta
New horizons in health care are being
met by a group of retired nurses in
Edmonton, Alberta. The Strathcona
Retired Nurse Services began when
volunteer retired nurses recognized
the need for supportive care for many
senior citizens.
The aim of the volunteers has
t>een to reach people who are living in
isolated or uninvolved retirement.
These people may be physically
unable to participate in other planned
programs, and the volunteers have
found them to be lonely — craving
soaal contacts.
Together the nurses have many
years of experience in various health
care fields. They are not employable
— but they are well qualified to
cooperate with and guide a group of
men and women volunteers who, like
them, feel the need to be of service to
others in their community.
By noting the physical abilities,
social needs and special interests of
the person, the volunteers have
helped to make changes in life-style
after illness or injury, less traumatic.
The volunteers try to provide the
elderly with helpful aids to dally living,
tempered with a good measure of
reassuring support.
One of the volunteers says, "We
have found many timid folk who have
difficufty in communicating with
relatives and friends, they need
support. They are often unable to
interpret directions from their
physician. They are unaware of the
agendes in the community which offer
special services for senior citizens.
Their problems can often t>e identified
during a friendly visit and referred to
the appropriate agenaes."
"Coping with Loss," a one-day
seminar sponsored by the Faculty of
Nursing, University of Toronto in
cooperation with the Registered
Nurses Association of Ontario
attracted approximately 70 nurses
from in and around the Toronto area in
early fJlay. Shown above are some
members of the Course Advisory
Committee who planned the
successful education day. From left to
right are: Eleanor Trutwin, Nursing
Division. RNAO; Mary K. Harrison,
Assistant Professor, Faculty of
Nursing, U. of T.; Hilda Mertz,
Associate Professor, Faculty of
Nursing, U.of T; Nancy Chadwick,
Nursing Division, RNAO; Dorothy
Brooks, Chairman, Continuing
Education Program, Faculty of
Nursing, U. of T.
On the other hand people have
been referred to tfie Nurse Services
group by the V.O.N. , the Public Health
Department, the Department of Social
Services and Community Health,
Mental Health Services, physicians,
hospital social worf<ers, the Edmonton
Home Care program and many
concerned individuals.
Helen Sabin named
AARN honorary member
The Alberta Association of Registered
Nurses has honored its retiring
executive director, Helen Satiin, with
an honorary memtiership in the
association and establishment of an
educational scholarship in her name.
AARN president Audrey
Thompson presented the honorary
membership to Sabin during the
associations annual meeting in May.
The scholarship, in the amount of
52,000, will be awarded to memtjers
wishing to pursue graduate studies of
not less than one academic year in the
final year of a baccalaureate program
or in a master's or doctoral program.
Sabins abilities were recognized
by the national association when she
was chosen to represent the
Canadian Nurses Association at the
1970 International Council of Nurses'
Seminar on Legislation in Warsaw,
Poland. Her expertise was also sought
by the nurses of the Northwest
Territories in their successful
endeavors to found the Northwest
Territories Registered Nurses'
Association in 1974.
In 1976, Sabin was the recipient
of the Altserta Achievement Award in
the Service Award Category for
outstanding service to her profession.
Sabin was executive director of
the AARN from 1960 to March,
1 977. Her professional career as a
registered nurse in the province of
Alberta spans the period from 1 938 to
1977. During her term as executive
director, she was responsible for the
implementation of policy as directed
by the Provincial Council and for
co-ordinating activities that included
speaking for nursing, interpreting
association policy and seeking
solutions to mutual concerns with
memt)ers, governments and
associations.
The Canadian Nurse July 1977
Xews
Manitoba nurses study implications
of development of nursing standards
What part does the development of
standards for nursing practice play in
assuring competence, accountability,
responsibility and excellence in
nursing? This year's May Annual
Meeting of the Manitoba Association
of Registered Nurses gave over 250
MARN delegates the opportunity to
take a close look at the implications
written standards have in providing
nurses with the direction necessary to
allow them to use their own judgement
and creativity in many clinical settings
and ensure quality care to the
consumer.
The past year has seen MARN
deeply involved in the development of
nursing standards; workshops in the
nursing process have been held
throughout the province to promote
the framewori< within which nursing
practice standards have been
developed. The Standards of Care
Subcommittee of MARN's Nursing
Committee has used questionnaires
to involve membership and
consumers in the development of draft
standards.
The establishment of these
standards has grown out of a
resolution passed at last year's
Annual Meeting. This year, delegates
gave further support to standards by
resolving:
• the acceptance of the broad
Standards of Nursing Practice so that
they may be implemented and
evaluated
• that each nurse take personal
responsibility to prepare
herself/himself to consider the
application of MARN's broad
standards for daily nursing activities
• that MARN's Board of Directors
continue to encourage employers to
support the u se of the nursing process
by individual nurses.
What part do nursing standards
play in quality assurance? Keynote
speaker Joan Ganong,
vice-president and nurse consultant
with the W.L Ganong Company,
Consultants to Management,
Pittsburgh, Pa., pointed out that
nursing with its focus on results, needs
standards to enable effective
evaluation, for measurement of quality
against "something solid, not
ephemeral." Ganong, who has many
nursing publications to her credit as
well as experience in both nursing
education and service, differentiated
between the workload concept of
nursing, based on tasks, procedures
and routines that are "going nowhere
... and killing professional nursing ..."
and the new patient care management
concept. The latter involves asking
ourselves: "Are the patient's needs
being identified, are they being met
based on nursing process rather than
routines?" Ganong stated that most
nurses are "in the middle ... trying to
learn new ways."
The speaker also said that in
order to judge quality, nurses need to
create a plan, take action by
implementing the plan, and evaluate
the results of their plan and action. In
this way, nurses can ensure that they
are accountable fortheir nursing care.
Ganong stressed the importance of
"academic excellence with the patient
in mind, ... of progress for us meaning
progress for the consumer." She also
underlined the fact that quality of care
stems from quality of the nurse
herself, that standards derive greatly
from personal experience. 'Quality
begins with the individual in any
institution ... with self-knowledge,
increased knowledge and skills,
tempered with caring for others."
Within the framework of standards
developed by the profession. Ganong
said "we can use our judgment and
feel good about it" by seeing results,
by being able to evaluate our efforts in
a measurable way.
A panel presentation moderated
by Margaret McCrady, director of
educational services, nursing, at
Health Sciences Centre, Winnipeg
and 2nd vice-president of MARN for
the past two years, saw MARN
members from various areas of
nursing discuss the implications of
standards to their particular settings.
Included in the panel were: Dr.
Gaetane Laroque vice-president,
patient care. Health Sciences Centre
— representing nursing
administration; Lesley Degner,
associate professor and research
associate, School of Nursing, the
University of Manitoba —
representing nursing research;
Joanne Oldham, home care nurse for
the public health department —
representing nurse practitioners in
public health; Belle Gowrlluk, nurse
clinician, medicine, Misericordia
Hospital — representing nurse
practitioners in the institutional setting;
Shirley Jo Paine, director of nursing
education, Brandon General Hospital
School of Nursing — representing
nursing education.
It was brought out by the panel
that written standards would imply
consistent nursing decisions in favor
of the client and would enable
nurses to defend a systematic and
rational approach to care. It was said
that nursing research has a role in
quality assurance through finding,
demonstrating and evaluating models
of practice. Standards as guidelines
were seen as a way of facilitating staff
rapport and the growth of nurses, as a
way to meet the goals of consumer
protection and care. They were also
seen as an impetus to encourage
responsibility, accountability and
creativity. It was suggested that
teaching would be made easier by
using written standards, and that
standards would allow the young
graduate to know what is expected of
her.
Roundtable discussions following
the panel presentation gave everyone
present the opportunity to voice
questions and concerns about
standards in small group settings led
by panel members and members of
the subcommittee on standards.
Following these lively discussions,
C.N. A. president Joan Gilchrist
summarized some of the feelings and
concerns expressed by participants.
She remari<ed that generally, the tone
of discussions was positive in nature
— that standards were seen as
valuable in assuring accountability,
responsibility, quality care, and the
rights of the consumer. Gilchrist also
outlined the concerns voiced by
nurses around the di scussion tables ; a
concern that the meaning of nursing
process, assessment and nursing
diagnosis must be made clear; the
concern that nursing care plans could '
become just another ritual; the
concern that the u se of new words and i
a different vocabulary could cause an
interference in communication among]
nurses; would standards, in fact,
improve the quality of our care?
Joan Gilchrist also said that it was i
necessary for those who developed
nursing standards in Canada to share i
with other areas and prevent
duplication, suggesting an intensitiedi
directing and liaison role for C.N.A.
She stated that determining
responsible self-direction required thei
commitment, courage and unity of
nurses for success.
In addition to supporting
standards and their implementation
membership voted in favor of a
numt)er of resolutions concerning
continuing education for nurses.
Collective approval was given to:
• the cooperation between the
MARN board of directors and the
provincial health authorities and
Manitoba Health Organizations to
pursue avenues by which financial
support for continuing education can
be promoted in individual agencies
• approaching community collegesi
to develop courses for adult educators!
in the health field that can be
conducted in various areas in the
province
• requesting the Department of
Continuing Education and Manpower
to include health agency educators asi
well as individuals employed in the
community college system
• requesting Manitoba Health
Organizations Inc., to encourage its
members to include provisbn in their
agency budgets to allow staff
members to attend relevant courses in
adult education
• promoting the development of
certificate courses and
recommending that employment
agencies provide financial recognition;
to nurses who have successfully
completed approved courses
• investigating the feasibility of the ;
continuance of a post-diploma
certificate course in Community
Health nursing to meet immediate and i
short term needs for nurses prepared
to wori< in the community and
exploring the establishment of a
The Canadian Nurse July 1977
[Public Health Nursing Course to meet
ion-going needs for post-basic
I education
promoting the development of a
I Baccalaureate Nursing program at
Brandon University.
The Association's interest in
continuing education was not limited
to the local level. Encouraged by
MARN's executive director, Louise
Tod, and president Marvelle
McPtierson, IVIARN members
lidpated in a project to raise money
the Canadian Nurses Foundation,
a fund for the post-baccalaureate
education of nurses throughout
Canada. Members raised a total of
Si .632 for C.N.F. and added a
nsiderable number of new
mbers to the Foundation. The
ney was raised by members who
e sponsored by their colleagues
r a ten-lap run around the University
of Brandon track.
Other resolutions passed by
egates included:
that the Board of Directors
ablish a means of formal
ognition of specialized
^Tpetencies of members
• recommending to all hospitals
operating emergency departments
ervice education on all aspects of
T care of victims of sexual offences,
ng on all hospitals to treat rape
.tims alike regardless of whether
; -arges are to be laid, and
recommending to all schools of
nursing that curricula include all
aspects of care of the rape victim
• urging the Minister of Health and
Social Development to expand the
province's Child Day Care Program
and develop provincial licensing
standards to child care facilities
• supporting research into
identifying specific health needs of
native peoples in Manitoba,
supporting groups such as the
Registered Nurses of Canadian Indian
Ancestry ... and supporting groups
within native communities who are
Interested in promoting health care
• continuing the Special
Committee for the Position Paper on
Occupational Health Nursing and
delegating to them the responsibility of
preparing a handbook on the "Role,
Function, and Responsibilities of the
Occupational Health Nurse. "
Newly elected members to
MARN's Board of Directors include:
Shirley Jo Paine — second
vice-president by acclamation;
Sister Bernita Ozubko —
member-at-large, Nursing Sisterhood,
by acclamation; Darlene Hamm,
inservice instmctor at Portage District
General Hospital — member-at-large;
Sue Hicks, educational director,
Brandon Mental Health Centre —
member-at-large: and Anne Friesan,
inservice coordinator, Bethesda
Hospital. Steinbach, Manitoba —
member-at-large. Two members were
elected to MARN's Nominating
Committee: Jean Burrows,
instaictor. Red River Community
College, Winnipeg, and Anne
DeFehr, V.O.N, and Home Care
Coordinator, Winnipeg Municipal
Hospital.
CNA Health Promotion
Program: Phase Two
Thanks to a $23,124 contribution,
recently granted by Recreation
Canada, the Health Promotion
Program of the Canadian Nurses
Association will soon enter its second
phase. These funds will be allocated
to the first of three proposed
workshops. These workshops will
make up Phase Two of the Program.
The aim of the fi rst workshop is to
involve "nurse teachers" in the
Program, to sensitize them to healthy
life-styles and to increase their skills
in multi-risk counselling.
Twenty-two nurse teachers
chosen by CNA's member
associations will be invited to the
wort<shop. It is scheduled to be held
September 6th to 11th at the YMCA
Conference Centre, Geneva Park,
near Orillia, Ontario. The five-day
conference will feature formal and
informal presentations as well as
theoretical and practical sessions on
life-style topics.
An important facet of the
workshop will be the material sent to
the participants for their
pre-conference preparation. It will
consist of background documentation,
suggested readings and annotated
bibliographies intended to set the
stage for discussion on the
relationship between health, fitness
and life-style.
Criticisms and suggestions will be
sought from participants through the
use of open-ended questionnaires
distributed at the time of the wori<shop
and after six months have passed.
When the partiapants have
returned to their own regions, it is
anticipated they will act as role models
in sensitizing other nurses and their
clients to tfie concepts of
health/fitness/life-style.
Funding for the second and third
wori<shops will be requested by CNA
at a later date. This first workshop will
be produced with the assistance of the
Fitness and Amateur Sport Branch,
Health and Welfare, Canada.
Did you know ...
The Canadian Nurses Foundation is
looking for a logo, an identifying
design, and they're holding a contest
to find it. They will pay $200 to the
winner of their design competition and
the contest is of>en to all interested
persons.
To enter, submit your name,
address and telephone number along
with your logo design to: Canadian
Nurses Foundation, 50 The Driveway,
Ottawa, Canada, K2P IE3. The
contest deadline is set for March 31,
1978 and the winner is to be
announced in June of 1 978. All entries
become the property of the CNF and
all decisions will be final.
Moving, being married?
Be sure to notify us in advance.
4f
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Mail to: The Canadian Nurse, 50 The Driveway. Ottawa K2P 1E2
The Canadian Nurse July 1977
A'ews
Performance
expectations
of new grads
The study Performance
Expectations of Diploma Nursing
Graduates in Saskatchewan,
released by the Saskatchewan
Registered Nurses Assocatlon In
January of this year, has already had
positive effects. At this year's May
Annual Meeting In Reglna, SRNA
president Sheila Belton reported to
membership that the Saskatchewan
Hospital Sen/ices Plan would be
providing funds this year for a
one-month orientation program for all
new graduates beginning work in
hospitals of 50 beds or less. And this
step is only the beginning.
The survey grew out of a
resolution passed by SRNA
membership at their 1975 Annual
Meeting because nursing personnel in
Saskatchewan hospitals and nursing
homes had stated concerns about the
nursing capabilities of beginning
diploma grads, and because the new
graduates themselves expressed
concern about their ability to meet
expectations of employers.
Performance expectations were
defined by the Core Committee of
SRNA's Committee on Registration
and Admission to Membership as the
attitudinal characteristics and nursing
skills that the beginning diploma
graduate is expected to demonstrate
in the work situation. It was projected
that survey results would benefit:
• funding agencies — for
budgetary puposes
• employing agencies — for
planning orientation and inservice
programs
• nursing administrators — for
staffing purposes
• educational institutions — for
curriculum planning.
The survey involved the opinions
of directors of nursing, directors of
educational programs, and 1975
diploma graduates regarding the
performance expectations of
beginning graduates in their first
employment experience in general
hospitals or nursing homes. It dealt
only with expectations on the fl rst day
of employment prior to an orientation
period. The study did not concern Itself
with expectations for degree
graduates or for those working in
specialty care units.
The results of the survey
indicated that:
• 1975 diploma graduates rate
observation and communication s/c///s
higher as performance expectations
than the other respondent groups.
• personal care skills were rated
high as a performance expectation by
all groups.
• sl<ills in assisting with nutrition
and mobility as well as nursing
techniques, diagnostic tests and
preparation for treatment and patient
teaching were rated higher by
educational programs than by the
other respondent groups.
• attitude and employment
characteristics were rated higher by
directors of nursing in hospitals and
nursing homes, and by 1975 diploma
nursing graduates than they were
rated by educational programs.
The question raised by higher
scale ratings of performance
expectations by beginning graduates
compared to the rating of other groups
was that: either the 1975 diploma
graduates overrated performance
expectations, or, directors of nursing
in hospitals, nursing homes, and
educational programs underrated
them.
The survey results indicated the
need to Investigate the reasons for the
differences in ratings by educational
programs and by employing agencies.
A need was also seen for identification
of the general performance
expectations which could best be
acquired through the educational
program and the specific
performance expectations best
acquired through orientation and
on-the-job training.
The assignment of "charge
nurse" responsibilities on evenings
and nights within the first six weeks of
employment by the majority of
employing agencies raised questions
regarding patient safety and
reasonable employment practices.
The survey results reflected a strong
need for provision of an orientation
program and opportunities for
beginning graduates to wori< with
experienced staff in order to develop
confidence before assuming charge
nurse responsibilities. A need was
also seen for staff overlap during
orientation periods.
The recommendations made by
the report are all being followed up by
SRNA through appropriate channels.
The recommendations are as follows:
• The questionnaire utilized for this
survey be further developed into a
Statement of Performance
Expectations for Beginning Diploma
Graduates in Sasftatchewan.
• Each employing agency state in
writing Its own performance
expectations for beginning graduates
on a progressive basis, as: end of first
week, end of sixth week, of third
month, of sixth month and of first year.
• In the interest of safe patient care:
1 . Hospitals of 50 beds or less develop
jointly an orientation program
designed to their needs and utilize it
consistently before requiring
graduates to accept full responsibility
on evening and night shifts.
2. Hospitals of 51 beds or more
reassess their current orientation
programs and nursing assignment
practices and adapt them to better
prepare beginning graduates to
assume charge nurse responsibilities
on the evening and night shifts.
3. The findings of the "Assessment of
the Plains Health Centre
Twelve-Week Orientation Program for
Nurses in their Initial Employment
Following Completion of a Basic
Nursing Education Program, ' which
indicate that with a planned and
supervised orientation program,
beginning diploma graduates are
capable of meeting the defined
agency expectations for clinical
performance within the prescribed
time period, be recognized as
supportive evidence of the effects of
an orientation program.
• The dangers inherent to patient
safety when beginning graduates are
required to assume responsibilities
beyond their reasonable ability to
cope (I.e. within 6 weeks or 12 weeks)
be recognized by hospital trustees
and administrators and appropriate
steps be taken to prevent this
occurrence.
• Funds necessary for the
provision of adequate orientation
programs in all hospitals including
fundsforthe required instructional and
relief staff be provided.
• In order to assist the beginning
graduates in the transition from the
student to the employee role,
representatives of nursing meet
regularly to reassess general and
specific performance expectations
and orientation requirements.
• That a follow- up survey be done I
by sending the questionnaire to 1975 I
diploma graduates upon completion of I
one year of wori< experience.
Core Committee members of
SRNA's Committee on Registration
and Admission to Membership
Involved In conducting the survey
were: Sister Bernadette Bezaire,
director of nursing at St. Paul's
Hospital, Saskatoon — chairman;
Marion Jackson, Saskatoon:
Patricia Kraus, Wakaw; Ina Watson,
Saskatoon; Kitty O'Shaughnessy
Secretary, SRNA staff.
N.S. occupational health
nurses hold seminar
"She is a member of a team. She is
involving herself with the activities of '
the safety man, the Industrial
engineer, as well as with the
physician. She has tremendous
opportunities to improve health
services to all in the world of work."
It Is in this light that Frances
Moss, executive secretary of the
Registered Nurses Association of
Nova Scotia sees the occupational
health nurse.
Speaking at the Third Spring
Seminar for Occupational Health
Nurses, held in Halifax In May, Moss
said she believes occupational health
nurses are in a very strategic position
right now, especially with the new
emphasis on prevention (health)
rather than cure.
"To some of us with an all-hospital
background, you are Indeed In an
enviable position dealing as you do,
basically, with healthy people."
Moss says occupational health
nursing is a specialty. Practitioners of
this specialty must apply professional
nursing principles to developing and
carrying out a nursing service that is
tailored to the environment of the
Industry or facility as well as to the
needs of the employees.
The Canadian Nurse July 1977
The two-day seminar focused on
the functions and qualifications of
occupational health nurses as well as
progress made in the formation of a
province-wide association of
occupational health nurses.
Coordinator of the seminar was
Margaret Grice who is president of the
Halifax-Dartmouth Group.
Separate collective
bargaining body
for Alberta
Following an example set by eight
other provinces, members of the
Altierta Association of Registered
Nurses are now considering a
proposal which would serve to set
apart as independent their collective
bargaining body.
Since 1974 the AARN has been
made up of two divisions:
the Professional Development
Division which is responsible for
protection of the public by assuring
that members maintain an acceptable
standard of practice
• the Collective Bargaining
Program which is responsible for
development and negotiation of
employee contracts.
Membership in the Professional
Development Division of AARN
numbers 12,000 registered nurses.
Approximately 7,000 nurses
participate in the Collective
Bargaining Program.
There is apparent
misunderstanding regarding the
responsibilities of the Collective
Bargaining Program as delegated by
the Alberta Labour Act and those of
the Professional Development arm as
delegated by the Registered Nurses'
Act. In order to clarify these roles, the
Provincial Council of the Association
has initiated action to provide for
complete autonomy of the Collective
Bargaining Program.
The proposal now before the
membership would establish the
Collective Bargaining Program as
independent of AARN and would
provide enough time for the orderly
development of this completely
autonomous body.
B.C. nurses join
public employees
The Latxiur Relations Division of the
Registered Nurses Association of
British Columbia has voted to join that
province's Public Sector Employee
Coordinating Council (PSECC). The
Council is an informal coalition of
organizations representing public
employees in British Columbia.
The Labour Relations Division is
the collective bargaining arm of the
RNABC, with collective agreements
covering atxaut two-thirds of the
Association's 19,000 members.
The decision to join the Council
was made by 168 voting delegates to
the Division's annual convention. That
convention was held on May 1 0, one
day tsefore the full association's
three-day annual meeting. Both
sessions were held at the University of
British Columbia.
The Council's objectives are:
• to provide a united voice for
members on matters of common
concern to public employees in B.C.
e to coordinate efforts to promote
the interests of public employees
• to educate the public in matters
that will advance and protect the rights
of public employees
• to share information dealing with
matters of mutual concern.
Did you know?
Working under fluorescent lights is not
good for you! Not only can the glare
cause a general ill feeling, nausea,
eyestrain and headaches, fluorescent
lighting has been linked to bone
disease and tooth decay in test
animals, eye problems, certain
learning difficulties and emotional
depression. In 1967, Soviet
researchers stated that people
worthing under artificial lighting are
susceptible to functional disorders of
the nervous system and Vitamin D
deficiency, weakening of the body's
defences and aggravation of chronic
diseases.
In Canada, no one has studied
the effects of lighting on humans as
yet. Maybe we should.
Health happenings in the news
Widespread interest in the fiber
content of the American diet has
resulted in a surge in consumption of
bran cereals according to a report in
the Journal of School Health. 'Total
pound sales of ready-to-eat bran
cereals have increased 20% during
the last year in the U.S. (Data from
A.C. Neilsen Company). "Consumers
have reacted strongly to widely
publicized medical studies reporting
health benefits from diets in which the
amount of fiber is greater than in most
American diets," Dr. Robert B.
Gravani, Ph.D., Science Director,
Cereal Institute, Inc., stated.
Much of the current interest in
fiber results from reports by Dr. DP.
Burkitt, a British surgeon, who
observed that rural Africans whose
diets are high in fiber-containing foods
have a low incidence of several
important diseases, including
appendicitis, hemorrhoids,
diverticular disease and cancer of the
colon. Since these same diseases are
much more prevalent in the United
States and other countries where diets
are low in fiber, researchers theorize
that lack of fiber may play a role in the
development of these diseases.
While many foods of plant origin
contain fiber, the amount varies from
one type of food to another. Some
breakfast cereals are convenient
sources of fiber. As an aid to
consumers, the percentage of fiber in
breakfast cereals containing
significant amounts is increasingly
being shown on packages.
The amount of crude fiber in the
following foods is:
High bran content cereals ....7.5%
40% bran cereals. ...3.5%
Raisin bran cereals. ...2.5%
Wheat germ ...2.0%
Whole wheat cereals
(shredded, flaked or formed).. ..1.8%
Hot whole wheat cereals ....1.8%
Hot oat cereals. .1.1%
Whole wheat bread.. .1.6%
Discovery that one strain of gonorrhea
has recently acquired total
resistance to penicillin, is a sign of
things to come according to Dr. Alex
Morrison head of the federal Health
Protection Branch. Health and
Welfare Canada.
Dr. Morrison predicts that
"Scientists have begun the first lap of
what may become a life and death
race with bacteria, as more and more
of the 'bugs' outwit antibiotic strains."
He points out that, as bacteria acquire
resistance to one antibiotic drug,
scientists race to create another drug.
He does not know if a time will come
when researchers lose their perilous
game of leap-frog.
"It is now ultimately a problem for
the drug industry which must increase
its efforts to synthesize new drugs," he
says, noting that many of these newer,
more exotic antibiotics have far more
unwanted side effects than penicillin,
which "is eminently safe for ail but the
few people who are allergic to it "
Antibiotic resistance will sharply
drive up medical care costs, experts
predict, tsecause the new antibiotics
are far more expensive than the old.
The Council on Dmg Abuse has an
action plan available which can help a
community in preventing drug
abuse. Free copies of the Community
Conference Action Plan are available
from: Council on Drug Abuse,
56 Explanade St. East, Suite 303,
Toronto, Ontario, M5E 1A7.
Did you know ...
CNA Rules and Regulations have
been revised to permit the submission
in writing to the resolutions
committee by any association
member or ordinary member of a
resolution signed by that member,
throughout the year and up to the
beginning of the 12th week preceding
the annual meeting. The board of
directors shall have the right, at any
time up to the date of the annual
meeting, to submit resolutions relating
to the business of the board. „
The Canadian Nurse July 1977
CONGENITAL
DISL
HIP
tir^^
TED
Celia Nichol
^
When parents are faced with the fact that their Child has congenital dislocated
hip, a potentially serious disability, their initial reaction is often one of alarm.
They may grow more perturbed when they are confronted with the
responsibility for the home care of their small infant, especially if the child
now wears an unwieldy body cast or bulky abduction splint. Medical
intervention constitutes an important part of the child's treatment. But the
nursing care that the parents can give their child will depend to a large extent
on how well the nurse is able to teach the parents. Effective teaching and
support of the parents throughout the child's lengthy course of treatment
depends on the nurse's understanding of the disability, her awareness of the
infant's psychosocial needs, her rapport with the child's parents and practical
know-how ...
The Canadian Nurse July 1977
Glossary
• Abduction — the lateral movement of the
limbs away from the median plane of the
tjody
• Adduction — the lateral movement of the
limbs towards the median plane of the
body
• Anteversion — tipping or bending
forward
• Avascular necrosis — death of bone or
tissue due to a poor blood supply
• Congenital Dislocated Hip — an
anomaly in which the head of the femur
lies outside the underdeveloped
acetabulum or hip socket in a stretched
elongated joint capsule.
• 'Dislocatabie' Hips — hips that are
basically unstable; the femoral head may
be passively dislocated from the
acetabulum
• Innominate Osteotomy — the incision or
transection of the innominate (hip) txjne
• Myotomy — surgical division or
dissection of a muscle
• Reduction
position
restoration to normal
• SuUuxation of the Hip — the lateral and
upwards migration of the femoral head
from its normal position. Unlike
dislocation, in subluxation the femoral
head is still in the acetabulum.
• Tenotomy
tendon
surgical transection of a
Congenital Dislocated Hip has all the
potential of a serious and crippling anomaly.
Early discovery of the problem can usually
mean complete correction through medical,
surgical and nursing management, but the
chance of successful treatment declines
remari<;ably as the infant grows older.
Understanding the disability and its treatment
is one important consideration in providing
thorough nursing care.
Congenital dislocated hip is a condition
that affects t>etween 1 .5 to 1 .7 infants in every
1,000 births. ' In more than half these cases,
the condition is bilateral. ^ It is estimated that
one in 60 to 80 infants are born with u nstable or
dislocatabie hips, but that only 12% of these
babies will progress to the point of actual
dislocation. ^ CDH appears eight times more
frequently in girls than in boys " and shows a
familial tendency in 20 to 30% of recorded
cases. * Specific child care practices increase
the incidence of the anomaly in some
countries.
There are a number of theories regarding
the hereditary and environmental factors
contributing to CDH. In utero, the hip joint of
the fetus develops by being held in a position
of acute flexion. A baby born with dislocatabie
hips exhibits an unusual degree of hip joint
laxity (possibly due to genetic factors or the
mother's hormones during pregnancy). If, in
the first few weeks of life, this baby's hips are
passively extended from the uterine position of
flexion, the hips may dislocate or sublux.
Passive extension of an infant's hips may
occur during a breech delivery, where the
incidence of CDH is 30%,^ or because of child
care practices that adduct the infant's hips with
tight blankets or cradle boards, as seen in
Germany, Northern Italy, or according to the
custom of some North American Indians.
Persistent dislocation or subluxation of
the femoral head from its normal position in the
acetabulum leads to secondary changes in the
hip joint, changes that prove more severe and
less reversible with the increasing age of the
child. These changes include:
• acetabular dysplasia, resulting in a
shallow, maldirected acetabulum
• an increase in the normal femoral neck
anteversion
• hypertrophy of the stretched elongated
capsule
• contracture and shortening of the
muscles crossing the hip joint, the iliopsoas
and adductors
• delay in ossification of the femoral head
• development of a secondary false
acetabulum in the ilium, if dislocation
continues.
Diagnosis and Treatment
Diagnostic signs of CDH vary according
to the age of the child, and treatment of the
anomaly depends upon the age of the child at
diagnosis. The following is a summary of
diagnostic signs and treatment according to
the child's age:
Birth to three months
Instability of the child's hip joint can be felt and
sometimes heard through the Ortolani test. In
this test, the infant's flexed hips are abducted
to produce the 'click " of reduction, a sign
usually present only in the neonate. As the
baby's hip gradually tightens in the dislocated
or subluxed position, limited abduction
becomes the more important diagnostic sign.
Asymmetry of the child s gluteal skin folds are
also an important indicator of CDH at this age.
Treatment for eariy diagnosed CDH
consists of gentle reduction of the dislocation
and maintenance of the hips in the stable
flexed abducted position. This may perhaps be
done initially with plaster and/or a splinting
device such as the Frejka Pillow, Pavlic
Harness, or other abduction splint. In the very
young infant whose hips are not too unstable,
bulky diapering with several diapers or towels
may be used to keep the child's hips in a stable
position. This course of treatment is followed
for two to four months until the joint capsule is
The Canadian Nurse July 1977
tighter and the femoral head has stimulated
the development of the acetabulum. A child
treated at this age can be expected to develop
a normal hip.
Three to 18 months
In an older child, the adduction contracture of
the hips is more pronounced. There may be an
apparent shortening of the involved leg, and
the perineal area may be wider than normal,
particularly in the child with bilateral CDH.
"Telescoping" can be felt as the child's femur
moves within the thigh. As she begins to walk,
the child will have a Trendelenberg gait, in
which she shifts her body weight to the
affected side. If she has bilateral CDH, the
child will have a waddling gait. X-rays will
reveal acetabular dysplasia and delay in
ossification of the femoral head, which is
displaced upwards and laterally in varying
degrees from its normal position.
Initial treatment at this age involves the
use of Split Russell or Bryant's traction to pull
the femoral head to a position opposite the
acetabulum and to loosen the tight adductor
muscles. This is followed by percutaneous
adductor tenotomy, closed or if necessary
open reduction and the application of a hip
spica cast. The cast maintains the child's hip
in the position of greatest stability, usually 90°
to 110° flexion and 50° to 60° abduction.
The child's hip will be immobilized in this
way for three to 1 8 months depending on
radiographic evidence of progress and the
doctor's preferred mode of treatment. The cast
is usually changed several times during this
period. Following cast removal, the child may
be maintained in an abduction splint for a
variable length of time, during which her
normal activities are gradually resumed. The
prognosis for normal hip development is good
for 80% of the children treated at this stage, the
better prognosis for younger babies.^
18 months to five years
In the older child, the secondary changes
Induced by CDH are much more severe and
usually a longer period of traction is required
for treatment. Skeletal traction is occasionally
used. Subcutaneous adductor tenotomy or
open adductor myotomy may be followed by
an attempted closed reduction. Because there
is only a 30% success rate forth is procedure at
this age,** open reduction may be combined
with reconstructive surgery. Innominate
osteotomy, a procedure aimed at redirecting
the acetabulum to obtain a better hip joint, may
be necessary. Even with this approach, results
of treatment are not as successful as those
obtained by treatment in the fi rst th ree months
of the child's life.
Five years and older
Fortunately very few children with CDH reach
the age of five without diagnosis. The severity
of secondary changes at this stage usually
prohibits success even with extensive bony
surgery. In adult life, only palliative
procedures may be done to alleviate the pain
of severe arthritic changes.
Certain complications accompany the
treatment of CDH, among them:
• redislocation and avascular necrosis of
the femoral head
• fracture of the femoral neck or
subtrochanteric region due to prolonged
immobilization
• nerve paralysis.
Nursing Care
Treatment of the child with congenital
dislocated hip involves the cooperative effort
of a variety of medical and paramedical
wori<ers. Nurses working in many areas,
whether in the newborn nursery, public health,
pediatric, clinic and office settings, have an
opportunity to detect CDH in a child. Th6ir
careful observations, or the concern
expressed by parents should alert them to
signs of possible problems. If nurses have any
suspicions about the possibility of CDH they
should encourage parents to seek medical
attention for the child immediately.
Parent teaching is perhaps the most
important aspect of nursing the child with
CDH. After all, it is the parents who will be
providing most of the direct care to the child
while she is in an awkward cast and/or brace.
The nurse needs a thorough understanding of
the condition, its treatment, and normal child
growth and development in order to teach and
support the parents adequately in their care.
An awareness that the treatment of CDH
deprivestheinfantofthe normal opportunity to
carry on certain developmental tasks is
required to ensure that special provisions are
made by the parents to meet the child's needs.
When an infant with CDH is admitted to
the hospital for traction, her parents are
usually very anxious, in need of reassurance
and emotional support. Often they have just
received the news of a potentially severe
congenital problem. Initially, they may be
horrified at the traction apparatus applied to
their baby, but after they are helped to deal
with these initial reactions, they are ready for
explanations and ready to begin to participate
in their child's care.
Nursing the infant in traction involves the
use of general principles of traction care,
including observation of the neurovascular
status of the limb(s) in traction and the
condition of the traction apparatus.
Psychological considerations of the baby's
care need not be neglected. Some doctors
allow the infant to be taken out of traction for
feeding , so that for this period of time, the child
can be cuddled. Surrounding the baby with
brightly colored bumper pads, possibly
brought from home, may give the child a
greater feeling of security. If it is feasible with
the home situation and in accordance with
hospital policy, the mother may be
encouraged to take part in her baby's hospital
care. Diversion through the use of mobiles,
toys and freq uent staff visits also help the child
to be more comfortable.
Care of the child in a hip spica
After adductor tenotomy and closed reduction,
the child is placed in a long or short leg hip
spica cast. At first many parents are
overwhelmed by the size of the cast and the
prospect of caring for the baby in this cast at
home. While the child is in the hospital and her
cast is drying, the nurse can gently reassure
the family and tell them what they need to
know in order to care for the baby at home. Her
instructions and demonstrations can be
supplemented by a written information sheet
that the parents can refer to when they take
their baby home.
Skin care
Good skin care is a very important aspect of
nursing the baby in a spica and it is necessary
to promote healthy skin and to prevent cast
sores. Each day, the baby should be washed
and dried on all exposed areas of her body and
as far under the cast as her mother's fingers
can reach. Several times daily, alcohol should
be rubbed on the baby's back, on bony
prominences and along cast edges. This helps
to refresh and toughen the baby's skin.
Parents should be told to avoid the use of
powders and lotions. They should also be
cautioned against tucking extra padding along
cast edges in an attempt to protect the child's
skin — this only creates pressure points and
predisposes to skin breakdown.
Care of the cast
Keeping the cast dry and clean is one of the
most challenging aspects of the child's
physical care. Most hospitals initially set the
child on a Bradford Frame with a urinary
drainage system to ensure thorough drying of
the plaster without soilage with urine and stool.
The child may or may not be sent home with
this setup, depending upon hospital policy.
Parents are often quite perturbed by the
appearance of the frame and its use ought to
be explained. Whether or not the child is to be
nursed at home on a Bradford Frame, her
head should be elevated to promote downhill
drainage of urine. This may be accomplished
by placing blocks underthe frame at the baby's
shoulders, or by raising the head of the
mattress. The mattress should have a
waterproof cover.
Careful diapering is important for
protection of the cast, and the baby's skin. The
mother should be shown how to diaper her
The Canadian Nurse July 1977
baby while the child is in the spica. Rrst, the
diaper is folded so that it is slightly larger than
the opening In the cast that it is to fill. Then, a
piece of plastic food wrap is cut, slightly larger
than the folded diaper. The diaper is then
placed on top of the food wrap. The mother
should be shown how to tuck both diaper and
plastic well under the cast edges, so that the
wrap is on the o utside and extends beyond the
diaper to prevent it from touching the cast.
Disposable diapers may be cut to size and
inserted in a similar manner, with the plastic
backing against the cast surface.
Diapers should be changed frequently. If
the cast does become soiled it may be wiped
clean with a damp cloth and a cleansing agent
without bleach, such as Bon Ami.* A wet cast
can be dried with a hair drier turned to the cool
setting.
"Petalling" the cast
Rnishing the cast edges with waterproof
adhesive tape will assist in keeping the inside
and outside of the cast dry and in smoothing
the rough edges that could abrade the infant's
skin. "Petalling" is usually done by the nursing
staff two days after the application of the cast,
when the plaster is completely dry. If the baby
goes home before her cast is dry, the mother
should be carefully instructed in the
application of tape petals. If necessary,
provision can be made for the community
nurse to assist the mother with this procedure
in the home.
Before petalling the cast, the nurse should
make sure that the cast is properly trimmed to
allow adequate breathing and eating room at
the abdomen and space for diapering in the
perineal area. On short leg spicas, the nurse
can check to see that the cast is properly
trimmed — a poorly trimmed cast can create
dangerous pressure in the popliteal fossa.
Signs to watch for:
Parents who care for their child while she is in a
cast need to be told about certain signs that
should be brought to the attention of their
doctor without hesitation. Such signs
include:
• swelling of the baby's extremities
• discoloration or coldness of the baby's
toes
• an unusual odor or elevated temperature
without apparent cause
• unusual irritability of the child
• softening or breaking of the cast. If the
cast softens or breaks, it may no longer
maintain the child's hips in the correct position.
• signs that the baby appears to be
outgrowing the cast.
Psychosocial needs of the baby
In her contact with the parents, the nurse is
given the opportunity to assess their ability to
meet the child's psychosocial needs, and to
provide them with the necessary guidance.
Most infants, although initially fmstrated by
their immobility, adjust to it very well. Older
children who are used to walking prior to
treatment, may find adjustment more difficult,
and therefore need appropriate support.
The infant in the hip spica should not be
left to lie in her crib all day. She needs
stimulation and body contact in order to
develop well. Her mother can be encouraged
to vary the child's position. The child can be
propped up in a stroller or chair with pillows,
allowed to crawl on the floor, and be cuddled in
her mother's lap. Some imaginative parents
have constnjcted special chairs for their
children, chairs that they can continue to use
when the cast is removed and an abduction
splint is being used.
The baby needs diversionary toys and
mobiles. Parents should be cautioned against
giving her small toys that might be slipped
inside a cast. They should be taught to check
the cast from time to time for the presence of
small toys or bits of food that could cause skin
breakdown.
Caring for the Child in a Splint
Care of the child in an abduction splint is
generally the same regardless of the child's
age. To the parents of the neonate, the brace
is tangible evidence that their baby is not
normal, and they may need help in accepting
the problem. Parents of the older baby who is
graduating from the cast to the splint will
probably welcome the splint as a sign of
progress, although they invariably feel
discouraged at the length of time that
treatment requires.
The doctor orders the amount of time that
the child is to spend in the splint, and the
parents should be told to follow this schedule
carefully. Initially, the baby usually spends 23
hours a day in the brace; the brace is removed
only for baths and diaper changes. As the
child's acetabulum develops, the time she
spends in the brace is usually decreased.
Good diapering is just as essential for the
child in the splint as it is for the child in a cast.
For the child in an abduction device like the
Frejka pillow or bulky diapering, the heavy
covering of the baby's perineum may
predispose her to diaper rash, particulariy in
hot weather. Frequent changes aid in keeping
the splint clean and the skin healthy.
Parents may be advised to place young
infants on their abdomens for sleeping, as this
position further helps to keep the child's hips in
the corrective position, as does carrying the
baby in a straddling position on her mother's
hip.
Parents of older children need to be
cautioned against using Jolly Jumpers** for
their children. The use of walkers should also
be discouraged. The child should not be
encouraged to stand, cruise or walk in her
braces. The nurse needs to understand how
difficult and frustrating it is for parents to have
to discourage their child's mobility. Older
children often begin to walk in their splints,
despite all opposition — sometimes the use of
a sitdown toy car will discourage this tendency.
Persistent ambulation in the brace should be
reported to the doctor as many feel that this
may contribute to unwanted forces on the hip.
Public Health Involvement
The public health nurse has an important
role to play in aiding the family of the child with
GDH. If she has not been involved with the
detection of the problem, her first contact will
generally follow a referral from the hospital
where the baby is being treated. She can help
the family learn to care for their child when she
first comes home, and reinforce the teaching
done at the hospital before the baby's
discharge. In addition to teaching, she can
provide ongoing support and reassurance to
the parents as they begin to adjust to their
baby's disability. To provide realistic teaching
and support, it is important that she maintain a
close contact with the child's doctor and with
the clinic or hospital where the baby is being
treated.
* Bon Ami is a registered trademarl( of Standard
Household Products Corp.
** Jolly Jumper is a registered trade mark of
International Pediatric Products Limited.
The Canadian Nurse July 1977
Lisa, in a long leg hip spica cast,
sitting propped up on a chair with a
pillow. Note the tape "petals" around
the perineal, ankle and (not seen)
abdominal areas.
Photos courtesy ot Ch/ldren s Hospital of Eastern Ontano
When Lisa was only three months
old, her mother noticed that the
child's right hip had limited
movement, and began to find it
increasingly difficult to clean the
crease in the child's right groin. A
month later, Lisa's pediatrician
referred her to an orthopedic
surgeon who confirmed through
examination and X-rays that Lisa's
right hip was dislocated.lt was the
doctor's opinion that at birth, Lisa's
hip had a predisposition to
subluxation, but that without
treatment, it had progressed to
dislocation a month before
diagnosis. (Lisa's six-week
examination had revealed no
abnormal findings.) At four and a
half months old, Lisa was admitted
to hospital for treatment.
A weel( t>efore her surgery,
Lisa was placed in Bryant's
traction. This marked the beginning
of her family's adjustment to the
long period of her treatment. Her
mother had to face the immediate
problem of how to breast-feed Lisa
and the family and staff aimed at
keeping her happily entertained
while she was in traction. But these
details of care were only part of the
larger problem of learning to accept
that Lisa, who seemed so 'normal',
had a serious defect, one with the
potential of long-lasting effects.
On Lisa's admission to
hospital, the nurses spent a good
deal of time with her mother,
encouraging her to verbalize her
feelings, answering her questions,
and trying to prepare her for Lisa's
further care in a hip spica cast.
A week after admission, Lisa
was taken to the operating room
where a percutaneous adductor
tenotomy, closed reduction and
application of a hip spica cast were
performed under general
anesthesia.
Initially, Mrs. M. was
overwhelmed by the size of her
daughter's cast. However, she
became more comfortable with it in
the two days before Lisa's
discharge, and gradually, with the
help and encouragement of the
nurses, she t>egan caring for Lisa
herself. The appearance of the
Bradford Frame bothered her at
first, and she was reassured to
learn that she wouldn't have to use
it at home. On Lisa's discharge day,
a nurse "petalled" her cast with
waterproof tape and final
arrangements were made for a
public health nurse to visit Lisa and
her family at home.
Mrs. M. managed well at home
— much better than she had
Imagined. Lisa's sisters and
brothers were delighted to have
their baby sister back at home, and
kept her happy by playing with her.
To her mother's amazement Lisa
adjusted quite happily to her cast
and seemed quite comfortable in it.
Mrs. M's main problem lay in
keeping the cast clean and dry, but
following the guidelines given to
her at the hospital, she grew
confident and successful in this
aspect of her daughter's care.
After five weeks at home, Lisa
was readmitted to the hospital for a
one-day stay and her hip spica was
changed under general anesthesia.
Examination proved that both hips
were stable, and X-rays showed the
right hip to be in good position.
Mrs. M. was a little anxious
taking Lisa home that day as her
daughter's cast was still wet, but
the nurses in the day care unit
offered advice to her on how to dry
the cast. Two days later, the public
health nurse, already familiar to
Lisa's family, came to assist Mrs. M.
in applying tape petals to the cast.
Mrs. M. was much more
comfortable caring for Lisa in her
second cast, and wasn't perturbed
I ne v^anaaian nurse
X-ray showing Congenital Dislocated
Hip in a twenty-month-old child. Note
the upward and lateral displacement
and delayed ossification of the right
femoral head as well as the oblique,
dysplastic acetabulum.
even when the cast broke at Lisa's
right thigh. She just tool< her
daughter to the hospital plaster
room where the damage was
quickly repaired.
Two and a half months after the
initiation of treatment, Lisa's hip
spica was removed for good; her
X-rays showed centering of the
femoral head and good
development of the acetabulum.
Mrs. M. was thrilled to have Lisa's
cast removed, although she was
somewhat worried about injuring
Lisa now that her hip was protected
only by a plastic abduction splint.
it was a day of celebration in the M.
household.
From then on, Lisa made
regular visits to her doctor for
examination and X-rays that
indicated continued improvement
in her hip. Initially Mrs. M. was
disappointed that Lisa's progress
in the brace seemed so slow; she
had hoped that the brace would
only be necessary for a few weeks.
Gradually, with help from an
understanding doctor and nurse,
she accepted Lisa's slow but
steady progress and found
encouragement in her small steps
towards improvement.
Three and a half months after
the cast was removed, Lisa was
allowed out of her brace for four
hours each day. Two months later,
she reached the stage where the
brace was only necessary during
the night . By this time she had
developed her own way of crawling
in the brace — she sat on her
bottom and pushed herself
backwards much to her family's
amusement.
At 13 1/2 months old, nine
months after the initiation of
treatment, Lisa stood for the first
time. By this time, her brace had
proclaimed old age. Mrs. M. had
been told not to replace the brace
after it had worn out. A month later,
Lisa was cruising, and at 1 6 months
of age, to the joy of her family, she
began to walk independently.
Lisa will continue to visit her
doctor, increasing the intervals
between visits so that the doctor
can check her hips and record her
development. Her prognosis to live
a healthy, active and normal life is
excellent, thanks to early and
comprehensive treatment. *
References
1 Trachdjian, Mihran O. Pediatric orthopedics.
Vol. 1. Toronto, Saunders, 1972. p. 130.
2 Salter, Robert B. Textbook of disorders and
injuries of the musculoskeletal system. Baltimore,
Williams & Wilkins, 1970. p. 98.
3 Trachdjian, op. cit.
4 Salter, op. cit.
5 Trachdjian, op. cit.
6 Ibid. p. 131.
7 Salter, op. cit. p. 100.
8 Ibid.
Bibliography
1 Larson, Carroll B. Orthopedic nursing, by...
and Marjorle Gould. 8ed. St. Louis, Mosby, 1974. p.
64-66.
2 Marlow, Dorothy R. Textbook of pediatric
nursing. 3ed. Toronto, Saunders, 1969. p. 210,
299-232.
3 Salter, Robert B. Textbook of disorders and
injuries of the musculoskeletal system. Baltimore,
Williams and Wilkins, 1970. p. 98-101.
4 Trachdjian, Mihran O. Pediatric orthopedics.
Vol. 1. Toronto, Saunders, 1972. p. 129-176.
Celia Nichol (B.Sc.N., Ottawa University)
author of "Congenital Dislocated Hip,"
presently works in the Nephrology and
Urology Clinic at Children's Hospital of
Eastern Ontario in Ottawa. In the past year,
she has also done part-time teaching at
Algonquin College in their 'Pediatric Update'
nursing program. Celia has worked as Public
Health Nurse for Renfrew County and District
Health Unit and as Public Health Nurse in the
Orthopedic Outpatient Department at
Children's Hospital. She is also the author of
"Legg-Perthes Disease," published in The
Canadian Nurse ;n June of 1976.
The author would like to thank Dr. W. Mclntyre
for his patient teaching and helpful advice in
the writing of this article. Dr. Mclntyre is the
head of Orthopedic Surgery, Children's
Hospital of Eastern Ontario.
The Canadian Nurse July 1977
A Gift of Tomorrow
connaction
Five years ago, Patricia was an active
young person who loved to dance, to
sicate, to bowl and to travel. She was
learning to swim and had plans to take
up skiing the following winter. The
events of a few moments changed all
of that. Now, as she says, she lives in a
chair. This is her story of what it's like
to become a paraplegic.
Patricia Harcourt French
As a paraplegic, mine is a silent cry of
desperation — "I want to live." I want to live —
but not as I do now in a tiny 16"x16" world. I
want to live as I did before, doing all the things I
used to do — knowing the fascination of things
left undone because of the certainty that there
will be a tomorrow. My tomorrow died the day
of my accident.
Each of us knows that death will come
eventually, that it is the completion of the life
cycle. But we are not aware of it daily; it is a date
with the future and so we do not think of it. We
are too taken up with the challenge of living. As
a paraplegic my emotions are mixed: there is
fear of living and fear of death and the
unknown.
The past five years have passed so
quickly that it surprises even me. It has been a
period of heartbreak, pain, both physical and
mental, hopelessness, and loneliness. For
me, that is surprising — I, who never knew the
meaning of the word, and yet it is not
loneliness in the true sense of the word. It is the
fact that I cannot get up and go, do all the
things I loved to do. And, of course, there have
been many, many tears — enough to fill an
ocean.
As a child I can recall how I hated to see
anything caged, never thinking that one day I
would be trapped in a prison such as this.
Perhaps time will teach me the true meaning of
mind over matter' and this chair will cease to
be a prison! Have I thought too much of bodily
freedom? Someone who is free might think so.
But is that not the goal of each of us — to keep
ourselves — mind and body — free? It seems
to be a vicious circle. Why are we not taught as
children that freedom of the mind is far more
important than physical freedom so that when
it is taken away we are more able to cope with
its loss? A foolish thought — it takes time,
patience and effort to learn the true meaning of
mental freedom.
It never entered my mind, as I suppose it
never enters the mind of most of us, that I
would become a paraplegic. These things only
happen to someone else! And then one day I
was faced with the fact that I was paralyzed
and I had to learn all that goes with the
helplessness of a useless body. Oh, you learn
to live or at least exist. You are taught the
necessary transfers, the routine of daily living
and, of course you improvise as you go along,
meeting every situation with an attempt to
overcome it, or a would you please do this or
that for me.' You are even taught to get in and
out of your chair but often when the need
arises your teaching goes by the board and
then you know the humiliation of dragging
yourself to a telephone and asking for help. It is
like watching proud animals in a circus being
put through their paces. It brings no pleasure
to watch the dignity of these once proud beasts
destroyed.
Why is it when we are brought in all
battered and bruised and probably near death,
and doctors know that we will be confined to
wheelchairs for the rest of our life, that we are
not left to die with some dignity? Surely that is
our right. You will say the doctors are doing
what they must — abiding by their oath. But I
wonder whether anyone has ever stood
outside himself and watched this procedure —
each person doing his share to complete the
■finished' product on an ' assembly-line.' Do
these people ever think of our physical and
mental anguish during our progress down this
assembly-line? No, that is not part of their job.
And so,eventually,you leave the hospital to
embark on another phase of your new life.
Rehabilitation
At the rehab center, you go through days,
weeks, months even years of fighting for a new
way of life. It is here that you slowly come to
realize what it is to be confined to a wheelchair.
Each little hurdle you come up against and
eventually surmount brings its own share of
heartache, mainly because it is something you
had no knowledge of before and so do not
know how to contend with. Some of the
incidents I could never put down on paper. I
can only compare this learning process to tha
of a baby who has the mind of an adult.
The months stretch ahead. You learn
again to do all the simple things that you
learned as a child. The time this takes differs
from person to person. You fight for days just
to lift a leg onto a bed for a transfer ; you learn to
use your arms in place of your legs and to
strengthen them with various exercises so that
eventually they compensate, in the activity of
daily living, for the loss of your legs. But, ma/ce
no mistal<e, nothiing can ever compensate for
the loss of one's legs.
When you enter this new world there are
so many things to contend with all at once. At
the same time you must surrender your
privacy. And so you fight all the harder to cling
to your last shreds of identity because this is all
that separates you from the crowd. This is your
pride, your heritage, your individuality. And so
the fight continues from day-to-day,
minute-to-minute. You overcome one obstacle
only to be deflated by another!
A disabled person learns very early to
take just one step at a time. As Dr. Schweitzer
said, it is better to light a small candle than to
remain in darkness. I sometimes think that
before my accident I was a great big
chandelier. When it shattered into a million
pieces, all that was left was a tiny candle. Now I
often stumble and fall because the glow from
that candle encircles a very small area, but
recently I have been surprised to find that
others have seen and followed that little light
as well — like moths gathering around a flame
A wise man once said: "You only have thii
moment, tomorrow is a gift from God." How
very true for a paraplegic or quadriplegic.
Do we not live on borrowed time? *
Patricia Harcourt French, auf/70/-or'/4 Giftof
Tomorrow," has learned to cope with her
disadvantages and now holds a responsible
position as medical secretary to a
neurosurgeon In a Toronto hospital. Her
Interests Include meeting new people,
gourmet food, sketching, reading, crewelling
and taking care of plants. When she wrote "A
Giftof Tomorrow" three years ago, she says it ■
was not Intended for publication but simply a
way of expressing her thoughts and feelings
The Canadian Nurse July 1977
The Canadian Institute of Child Health:
A Personal
Responsibility
On July 1st, 1977, the Canadian Institute of
Child Health began operation in Ottawa. The
purpose of the Institute is to act as an advocate
on behalf of children regarding their health
needs. What relevance will the Institute have for
us as nurses involved directly in the care of
children? How can we actively participate in its
aim to improve the health of our children?
Shirley Post, a nurse involved with the
developmentofthelnstitutesince its beginning
says nurses are in a key position to help ...
Sharon Andrews
The Canadian Nurse July 1977
Shirley Post's involvement with the Institute of
Child Health really began a full fwo years
ago. The Hospital for Sick Children
Foundation in Toronto commissioned her to
examine the need for an Institute of Child
Health in June of 1975. For six months Shirley
travelled across Canada talking to people and
organizations concerned with child health.
After compiling her data she submitted her
report to the Foundation in April of 1976.
Shirley's research and study led her to
endorse the concept of an Institute. Now the
Hospital for Sick Children Foundation and the
Canadian Council on Children and Youth
have agreed to co-found the Institute of Child
Health.
I talked to Shirley about her involvement;
past, present and future.
Q. A considerable amount of time
passed, Shirley, from when you finished
your study to this announcement of the
formation of the Institute. Were you
beginning to doubt it would ever be
formed?
Shirley: Oh no, by the time I finished the report
I was really convinced that we needed some
sort of an organization in Canada that really
spoke out as far as child health was
concerned. I guess I had talked to enough
people and identified enough issues that I
really felt it was time someone started to take
action in some of these areas. You know, there
were times when I told myself this was an
important enough thing that if The Hospital for
Sick Children Foundation didn't act on it I'd do
it myself, even if initially it was just trying to get
groups of mothers together.
Q. Why do you believe it is so important?
Why does Canada need an Institute of
Child Health?
Shirley: Well, what has tended to happen in
Canada, and what I feel is one of our biggest
problems, is that children have become lost in
the overall picture. That, because there hasn't
been anyone there to ask, "Hey, what about
the kids?" or "How is this policy or that
legislation going to effect the children ? " quite
bluntly, children have, very often, been
overlooked. Did you know there are eight
million children in Canada right now?
Q. Quoting the Institute's press release you
define health as "complete physical,
mental and social well-being and the
mission of the Institute is to be an effective
and useful force to im prove the health and,
therefore, the quality of life for Canadian
children". Considering this involves some
eight million people that's almost
awe-inspiring.
Shirley: I think it's important to remember that
we're not calling for a revolution. I mean there
are some very worthwhile child health
programs in the country but the problem is,
they're spotty both regionally and
What we have to do in Canada is change
some of our priorities. We have to work
together to put these programs into a more
integrated network of services for the child.
Q. The institute is to take a
"multidlscipllnary" approach to child
health. What is it you mean by this?
Shirley: You see, we feel a lot of the problems
in child health today are not strictly medical. A
lot of them are classified by some people as
"new morbidity" problems. These are things
such as learning disabilities and all of our
teenage problems like suicide, venereal
disease and unwed mothers. The doctor alone
won't be able to solve all these problems. It's
really going to take the cooperative efforts of
all of our professional people — our doctors,
nurses, psychologists and teachers. We really
have to work together towards a common goal.
Q. In your report to the Foundation you
point out that during the course of your
travels across Canada you talked to
200-300 people about child health. Who
was it you talked to?
Shirley: I talked to doctors, nurses and other
people in the health care profession. I talked to
university professors. But, more importantly, I
talked to a lot of parents and consumers and
really anyone who would listen to me. In some
areas I was on television and open-line radio
shows telling people that I was there and
talking to them about the study I was doing. As
a result of those appearances I got a number of
letters and phone calls from people who
wanted to talk about issues they thought were
particular problems.
Q. What did the people you talked to have
to say? What were some of their worries?
Shirley: There were different things. For
instance, I remember school teachers talked
to me about what they thought was the poor
state of health of the children in their
classrooms. They were worried because their
students weren't getting proper nutrition, their
immunizations weren't up-to-date. The
children were coming to school, a lot of them,
neglected — dirty — and the teachers were
concerned about the general state of health of
these children. They would point out to me
they couldn't teach a child if he hadn't had a
good breakfast or a good dinner or if he hadn't
been put to bed so he'd have a good night's
sleep. If a child sleeps in the classroom he's
not going to be able to learn anything.
Q. What about the organizations you spoke
with? What were their reactions to your
study?
Shirley: If I can use an example, the Canadian
Pediatric Society has been very interested in
the Institute. We talked to them about it and
they were very supportive. They had a
conference in Montebello a number of years
ago, I guess it was about five years ago, called
Unmet Needs in Child Health. The point I'm
The Canadian Nurse July 1977
23
ying to make is I didn't discover ttie wheel
lyself, we know we've had these problems for
: long time. But I guess the thing is, even
.ithough the Pediatric Society had the
Conference and talked atxjut a lot of these
jnmet needs, " nothing had happened since
:ne conference. Nothing had been done. This
s where we hope the Institute is going to be
: fferent. We're going to be action oriented and
.ere going to take some of the reports and
3commendations on child health and see if
• e can't get something done.
Q. How? I mean I'm sure every organization
begins very ideaiisticaliy only to find
themselves immobilized by red tape and
administration a few years later. How will
he Institute avoid this and be action
oriented?
Shirley: How? Well, you don't do it
overnight and I think you have to have your
long range objectives in the back of your
mind all the time. We'll need some sort of
comprehensive, integrated plan for child
health. Then we'll have to ask ourselves just
what that means and what kind of guidelines
we'll have to set up to follow our plan. We'll
have to decide just what the elements in this
grand plan are to be. Then, and only then, will
we be able to start picking up these pieces, or
elements, one at a time. We'll try, I think, to get
other organizations and people right across
the country interested in them.
I'll give you an example. Let's take chronic
care children with long-term problems. We've
got a lot of these kids around right now. We
could get people to take a look in their
community, or region, at what kinds of services
ve available for those kids. We should get
^eople to look at those services, not just in
terms of acute hospital care, but in terms of
primary care and of follow-up care. What's the
role of the Crippled Children's Society in their
area? What's the role of the school, the
Department of Education? What kind of
recreational facilities are available for
handicapped children in their area? Is there an
emergency or a crisis center? If parents need
to get away for a weekend or for a holiday,
what happens to these children?
I think what the Institute can do is provide
the questions. We'll have to get community
groups, medical groups and nursing groups
looking at these questions, asking
themselves, "Have we got this in our
community, is it possible to have this in our
community? And how can we put the pieces
together to get an integrated, comprehensive
system of health care for this particular child?"
Q. Do you then see the Institute as a
coordinator, so that you provide the
impetus for this kind of discussion and/or
action?
Shirley: Yes, that's right, impetus is the right
word. I see the Institute as being the impetus or
the catalyst for getting some of these things
before the public or before national
organizations. Our function will be to say,
■'Let's stop a minute and take a look at that kind
of thing. Can we do that better, or should we
have a provincial, or even a national, policy on
that?"
I think it's important to mention that there
are a lot of good health care programs in
various areas around the country. I think, if we
could, the Institute would serve an important
role even if we put people who don't have a
particular kind of program in one area of the
country in touch with people from another area
who have.
Q. How do you propose to do this? How
would the Institute act as a catalyst?
Shirley: I think there are many ways to start.
I've mentioned the Canadian Pediatric
Society. I'm also very interested in getting the
Canadian Nurses Association involved. At
their annual meeting in Halifax last year the
CNA passed a resolution in which they
supported the idea that they should get more
involved with child care and child health.
One of the things I think the CNA might do,
that would be most useful, would be to take a
look at what nurses are doing in nursing
curriculums right across the country to see if it
is appropriate to the promotion of child health
— checking to see if people are really teaching
growth and development as well as teaching
some of the social problems concerning
children.
At a national level I think we could take a
look at the graduate education programs for
pediatric nurses; trying to find out just what a
pediatric nurse is and how a nurse
should/could go atxjut getting extra training in
pediatric nursing. What kind of programs do
we have in Canada where the nurse can get
this kind of graduate education? One of the
complaints I hear from a lot of directors of
nursing, not just at Children's Hospitals, but
also directors of nursing who have Pediatric
Units in their General Hospitals is it is very hard
to find pediatric nurses who have had
experience or who have had extra pediatric
training.
Nursing and nurses are just Ijeginning to
get interested in research and I think this whole
area of child care and pediatric child care is
one area where nurses could make valuable
contributions by getting some studies started.
Slit.
0
\
The Canadian Nurse July 1977
Q. In many ways the Institute sounds very
much like It will serve as an educator.
Shirley: Education will be a big component of
our program. For example, we've got to
educate the professionals as far as children
are concerned insofar as they must learn to
play a broader role or be more aware of the
broader aspects involved in child care. I think
it's important that we stress growth and
development with our nurses, our medical
students and our social workers. It's important
for us to make them aware it's not just the sick
child in the hospital they should learn about or
understand but also the role of the child in the
community. What's going to happen to that
child in the community when he goes home
because so often now just a few weeks later
he's back with the same old problem? In that
regard I think hospitals, in addition to their
education, service and research components
are going to have to add another component
which is really social responsibility.
Q. What about research in general? Will the
Institute sponsor studies themselves or
will they encourage others to get it done?
Shirley: Yes, well certainly we're going to be
doing some research but I guess the way I see
us doing it is by encouraging other people.
We'd encourage those people who wanted to
do projects in certain areas or wanted to take
on certain research or a certain study. We
would support and help them rather than doing
a lot of the research ourselves. But in the
same vein we do intend to set up task forces to
look at particular problems in certain areas.
When you go to look at a problem you're
certainly going to have to do research in terms
of looking at what has already been done,
collecting up the studies and the data and
making some recommendations about what
you can do.
Q. Perhaps we can talk about some
specifics right now. What are some of the
problems in child health you found through
your study that you think the Institute
might look into?
Shirley: Of course the Institute's Board of
Directors will be responsible for deciding just
what things the Institute will do first. Right now,
we've not set any priorities but we have
received a number of suggestions. As far as
specific problems go there are several groups
of children we could talk about. There's the
preschooler and the infant, fvlany people say
we should start there. In this area we would
worry about immunization, proper nutrition,
genetic counseling and early screening for
things like hearing and vision disabilities. The
argument here is the fact that if you catch
things early it's going to be less costly and
cause less emotional trauma. So there is a
possibility the preschooler and infant will be an
area we will concentrate on.
The other area that a number of people
are saying we should put most of our efforts
towards, or do something about, is the
adolescent. These people point out there
really isn't any one group interested in, or
working with, the adolescent problem. We
know from statistics that adolescent suicides
are on the increase. We know that despite
contraceptive measures and sex education
there's been an increase in the number of
adolescent unwed mothers.
Q. How could the Institute help
adolescents?
Shirley: We'd have to go to the teenagers.
That is, we'd have to go back to the school
system. We'd take a look at what's going on in
the high schools in terms of physical
education, counseling and sex education.
I think the question we have to ask
ourselves is how are we going to reach these
young people at this stage in their life? Some
people say we're not even trying right now, that
things like physical fitness in our high schools
are no longer compulsory, that health
education or sex education is poorly taught
and often not taught by nurses or doctors or
appropriate people. I think in this case we'll
have to go back and work within the school
system.
Q. How can we as health care workers
reach the preschool child? School is the
great organizer where we can contact the
children en masse, but how do we reach
those who are not yet at school?
Shirley: There are some good pilot projects
around the country in that area. They have an
excellent one in Yarmouth, Nova Scotia and it
The Canadian Nurse July 1977
was funded by a special grant. They had a
small group of professionals there (a
psychologist, a person to test vision and
hearing, etc.) and their goal was to bring these
children in, all the children in the county, at
three years of age. The parents were sent a
little notice that this service was free and
available and, you know what, the people
came! They brought their children in from all
over the county. A lot of things were picked up
early with these children and very often time is
our most serious problem. We say that a child
has a learning problem but we don't find out
■itil he's in Grade One or has failed that he
really can't see straight or he can't hear what is
being said.
It is important to realize that there are
people doing this kind of thing right now. It's
just a matter of getting it organized throughout
the country and getting our priorities straight.
Speaking more generally about the kinds
of problems we'll have to look into at the
Institute and as health care workers, I can
mention the unique problems of native
children, the disparities of wealth and nutrition
in Canada as well as the problems created in a
single parent family.
Q. Shirley, what is it that not the Canadian
Nurses Association, but the Canadian
nurse can do for child health? I'm referring
here to both the working and the
non-working nurse.
Shirley: That's a good point because in the
long run if we're going to change things, we
have to take child health on as a kind of
personal responsibility. I think nurses are in a
great position to take a look at where they sit as
individuals versus the child. Nurses are in the
community, in the neightx)rhoods and they
should ask themselves what they can do right
there to improve the quality of life and the
health of the children in their own area. What is
really going on?
For example, I think there's lots of things
nurses working in children's units in our
general hospitals can do. For twenty-five years
now we've been saying parents should have
more liberal visiting hours, that children need
not only physical care but emotional care and
support, that means play programs. Nurses
should ask themselves what kind of liaison
they have with the school system, are the
children in their units able to carry on their
studies? You know, I really don't believe that
we can sit and wait for someone else to do it.
That's the crux of the issue, it's up to us.
Q. The nurse is in a unique position in that
she is the one who has contact, immediate
contact, with children. Associations or
organizations can't really take a class of
thirty children into their boardrooms to talk
to them or observe them. How then can the
pediatric nurse, or general duty nurse
become more knowledgeable about the
problems of child health?
Shirley: Her nursing education should have
made her aware of what a healthy child is all
about. I think nurses have also been
introduced during the course of their education
to a lot of community resources. They should
have a pretty good idea of what is available in
their community, of what could be available in
their community and of what's needed there.
I think if the country has spent money to
educate you as a nurse then you have a
responsibility to give some of that back or have
some commitment to your community to be the
resource person in that community. You can
be the resource person in many ways. A lot of
nurses just lack confidence to do this when
they've really got a lot of skills to offer.
I sincerely believe nurses can make a real
contri bution to the i mprovement of ch ild health
in this country, after all, there's a lot of
manpower out there — or should I say
nurse-power?*
Shirley Post, Registered Nurse, Tororito
Western Hospital, 1955, received both her
Bachelor of Science in Nursing Education
(1967) and her Master's in Health
Administration (1972) from the University of
Ottawa. She vi/as Director of Nursing at the
Children's Hospital of Eastern Ontario, Ottawa
until May of 1975 when she began her
association with the Hospital for Sick Children
Foundation.
26
The Canadian Nurse July 1977
Behavioral Therapy:
Its application to reduce disruptive behaviors
of the elderly in nursing homes
Nurses who care for the elderly in nursing homes and auxiliary hospitals
have many goals. They provide for the health, recreational, social and
emotional needs of their patients. They also strive to increase their
patients' levels of self-care and self-respect. Unfortunately, because
many patients exhibit disruptive behaviors — striking staff or other
patients, throwing temper tantrums, lying on the floor in corridors,
refusing to take medication and so on, these desirable goals cannot
always be met. What nurses need, in addition to their specialized,
medically oriented training, is training in a consistent strategy for
handling these problems. Behavioral therapy provides this strategy. Larry MacDonald
This article is adapted from a presentation at a
Nursing Home Seminar on the Management of
l\/lentally Retarded in Nursing Homes and Auxiliary
Hospitals at the Bethany Care Centre in Calgary,
Alberta on November 4, 1976.
When Mrs. A. lay down in the corridor and
beat her hands and feet on the floor, a friendly
visitor stopped to console her. A nurse and a
nurse's aide also appeared and coaxed and
cajoled her into getting up and going back
into her room. Mrs. S., on the other hand,
exhibited no disruptive behavior that day. She
was left to her own devices to get on with her
normal activities.
What really happened in this hypothetical
case is that Mrs. A. was rewarded for her
disruptive behavior. She received a great deal
of sympathy and attention. Mrs. B.'s normal
behavior was taken for granted. This anomaly
lies at the root of behavioral therapy.
Behavioral therapy, well planned and
conscientiously applied, can foster good
relationships between nurses and their
patients and increase the well-being of
patients and the confidence of the nurses
working with them. Used successfully, it can
even cut down on your work load. But
behavioral therapy cannot be taken lightly; it
must be approached seriously and executed
with attention to detail and with the full
cooperation of all the staff concerned.
The importance of consequences
The basic assumption of behavioral
therapy is that the causes of behavior are in
the environment, not in the individual. The
major cause of behavior is what happens as a
result of that behavior.
ine uanaaian Nurse juiy 1977
A patient who is behaving appropriately
seldom gets the attention of a busy nurse or
nurse's aide. It's the patient whose disruptive
T^ behavior demands attention who gets
attention. In other words, the squeaky wheel
gets the grease. All patients enjoy the nurse's
attention. If a patient does not receive this
attention for appropriate behavior, he may
attempt to obtain it by being disruptive.
A very good example of patients' behavior
being influenced by attention comes from a
project in the United States conducted by
behavioral therapist Jack Michael. Dr. Michael
was called in by a large general hospital to
increase the number of elderly patients
participating in physical therapy. The physical
therapy took place in a large room with
exercise equipment in the middle and chairs
along the walls. Although patients were
• expected to exercise during the physical
therapy periods, most were sitting in the chairs
and only a few were exercising. Dr. Michael
observed that most of the time of the physical
therapists, all attractive young women, was
spent in cajoling and persuading the seated
patients to begin exercising. After a patient
was up and exercising, the therapist quickly
left him and went to encourage another seated
patient to participate.
When examined in terms of
consequences of behavior, this situation is a
perfect example of the therapist "greasing the
squeaky wheel. " The therapists paid most
attention to inappropriate behavior. In other
words, the consequence of inappropriate
behavior was attention.
To solve this problem, Michael suggested
that the therapists t)egin to fuss over and pay
attention to the men who made some effort at
ercising and that they disregard the ones on
L v.e sidelines. Within two days, the men's
exercising had increased to such an extent
that the attending physician had to tell them to
slow down lest they succumb to a heart attack
from overexertion!
Note that in this example there was no
discussion of 'motivation." The behavioral
therapist placed the emphasis entirely on the
behavior itself and on arranging the
consequences for more appropriate behavior.
The procedure sounds simple; control the
consequences and control the behavior. While
the principle is simple, its application is not.
Behavioral therapy requires a great deal of
thought and effort and consequences must be
applied consistently and precisely.
Inconsistent application of consequences can
lead to anxiety and frustration for both the
patients and the nurses who are required to
care for them.
Steps in Behavioral Therapy
In starting any strategy of behavioral
therapy the following six steps must be
followed:
1 . Define the target behavior — A "target
behavior " is any observable behavior you
want to change. Target behaviors must be
defined so precisely that everyone can agree
when they occur. Stay away from labels; for
example, instead of saying that a patient is
"depressed " or "aggressive, " say that the
patient remains in his room by himself a certain
percentage of the day, or that he hits other
patients a certain number of times each day.
Usually, if you can count how often the
behavior occurs, your definition is sufficiently
precise.
2. Record Ijaseline — A "baseline" is a record
of how often the behavior occurs. Baselines
are obtained fora numberof reasons. Firstly, a
baseline verifies that a particular behavior
problem does exist; sometimes, nurses
perceive a problem as being worse than it
actually is. The charge nurse in a nursing
home, for example, once told me that one of
her patients was clogging the toilet almost
daily. When careful baseline records were
kept, the behavior was shown to be occurring
once every four days, on the average, and
usually when the patient was not allowed to
attend his crafts class because of other
behavior problems.
Secondly, a baseline is used for
comparison purposes. Before you try to
change behavior, you need to know how often
that behavior is occurring. Comparing the
frequency of behavior before and after
attempts are made to change that behavior will
allow you to determine whether your approach
is successful.
Thirdly, a baseline will provide you the
opportunity to observe the consequences of
behavior. What happens after a patient
misbehaves? After a patient throws a temper
tantrum, for example, do nurses attempt to
calm him down or do they ignore him? Usually,
close observation and careful recording during
the baseline period will give you some idea of
the consequences that are maintaining the
disruptive behavior.
3. Decide what consequences to use —
Useful consequences for changing behaviors
are generally things that the patient likes.
Some patients like to spend time talking to the
nurse; others enjoy cleaning up the cafeteria
after meals, or setting the table before meals;
some enjoy beer, some ice cream, and so on.
These "likes" have to be determined
separately for each patient. Sometimes you
can ask the patient what he would like as a
consequence for a particular behavior. Other
times, you may have to determine what the
patient likes by observation. These 'likes " can
then be used as consequences to increase
appropriate behaviors.
4. Begin behavior-change program — In
the majority of cases, you will begin a
behavior-change program by providing the
proper consequences for appropriate
behavior and ignqring inappropriate behavior.
Consequences should be applied Immediately
after appropriate behavior occurs and every
time the behavior occurs. It is imperative in the
early stages of a behavior-change program to
ensure that the consequences are applied
consistently.
How can you arrange for consequences
to be applied immediately after a behavior
occurs? For example, how do you follow a
patient's behavior of "talking appropriately to
other patients " with the consequence of
"setting the table before meals?" The solution
is to devise a "token system. " These tokens
can be given immediately following certain
behaviors: the patient, of course, can trade in
the tokens in exchange for something he likes.
Nurses wishing to devise token systems
should read some of the literature on the
subject as there are many things to consider if
success is to be achieved.
One final but important consideration
must be understood. Behavior-change
programs are not conducted without a
patient's knowledge. On the contrary, the
patient's or a guardian's opinion and informed
consent should always be obtained before
starting any behavior-change program. It is a
patient's right to refuse to participate in the
therapeutic process; if he refuses, the program
The Canadian Nurse July 1977
should not be conducted. If the patient is able
to communicate and understand, explain to
him that you are setting up a program to help
him get along better with other patients, spend
more time with other patients, bathe more
frequently, or whatever is seen as a desirable
goal for that particular patient. Then explain
the program : if he behaves one way, such and
such will happen; if he behaves another way,
something else (or nothing) will happen.
Sometimes, you can even write a contract
stipulating that the patient agrees to behave in
a certain way while the nurse agrees to provide
certain consequences. But remember, it is
entirely unethical to carry out a program
without the informed consent of either the
patient or, if the patient is j udged incompetent,
his guardian.
5. Evaluate success — If after several days
of applying consequences for appropriate
behavior, you find that the target behavior is
decreasing in frequency relative to baseline,
then continue the program until the behavior is
at the desired level. If the behavior is not
changing, then you must re-examine the
program to find out what went wrong. A
change in the consequence or in the technique
in administering the consequence may be
required before the target behavior will
change.
6. Maintain the appropriate behavior —
Once the appropriate behavior is occurring at
the desired level, you will want to decrease the
number of consequences. This procedure
requires a gradual and systematic shift from a
situation where consequences are applied
every time the appropriate behavior occurs to
a situation where they are applied less
frequently. Although many consequences are
required to change behavior, fewer
consequences are required in order to
maintain behavior.
In addition to these six essential steps,
keep careful records of the frequency of
inappropriate behavior throughout all phases
of your behavior-change program. This will
enable you to determine exactly what is
happening to that behavior at any point in time.
These records will hold you accountable for
your actions. If you have been consistent and
used the proper consequences, your records
will show a decrease in disruptive behavior.
On the other hand, if you have not carried out a
precise and consistent program, your records
will show no change in the behavior.
These basic features of behavioral
therapy, if implemented with thought and
consideration forthe dignity of patients, can go
a long way toward eliminating the disruptive
behaviors of most elderly patients in nursing
home settings.
Some Problems
Of course, when any treatment strategy is
implemented problems occur. Behavioral
therapy in nursing home settings is no
exception. A variety of problems must
inevitably be faced.
• Attitudes of Staff — Many nurses excuse
the misbehaviors of elderly patients,
particulariy those who have been diagnosed
as senile, mentally ill, mentally retarded or
minimally brain dysfunctioned. What these
nurses fail to realize is that their expectations
of what a patient can do influence what that
patient w;7/ do. If you have low expectations of
a patient because of his diagnostic label, that
patient will respond accordingly and you can
expect to see dependency behaviors and
misbehaviors occurring frequently. These
attitudes occur to a greater degree among staff
in nursing homes where behavioral therapy
programs have not been implemented.
Usually such homes have many "squeaky
wheels."
Another problem is that some nurses see
behavioral therapy as being too mechanical
and too objective. Actually, these features
should be considered arguments supporting
the use of behavioral therapy as they make
nurses responsible and accountable for their
actions and forthe behaviors of their patients.
Finally, staff may complain that
behavioral therapy requires additional work for
an already overworked staff. It's true that
designing behavior-change programs,
recording behaviors, and delivering
consequences consistently takes a great deal
of time and effort; however, in the long run,
wori<loads tend to decrease as patients
become more self-reliant and less
troublesome.
• Lac/c of Support — For behavioral
therapy to be successful, it must be sanctioned
at all levels within the nursing home.
Administrators, supervisors, and front-line
workers should be in close agreement that the
approach is a viable treatment strategy. Such
broad concurrence is, of course, the ideal and
is not likely to occur in every nursing home;
however, my experience has been that greater
support increases the success rate of
behavioral therapy programs. One staff
member in disagreement with this treatment
strategy can unwittingly sabotage any
behavior-change program.
• Lack of Consistency — Related to the
issue of support is consistency in applying
consequences. This is very important if
behavior changes are to be expected. There
are many reasons why consequences are not
applied consistently. Some nurses or nurse's
aides are simply not cooperative or they are
apathetic towards trying anything new. Shift
changes may cause disruption in a program.
Or, nurses may be ovenworked or simply
inattentive to the behaviors of their patients —
particularly appropriate behaviors. Some
nurses and nurse's aides are natural
therapists: concerned and interested in their
patient, enthusiastic, sympathetic, and most of
all, consistent. Others are not. However, even
the most disgruntled nurses can be
encouraged to assume a more positive role if
consequences are provided to them by their
superiors and col leagues at appropriate times.
Remember, patients aren't the only ones
whose behaviors can be changed through the
proper use of consequences.
Some Benefits
In spite of the problems you are sure to
encounter when using behavioral therapy, the
benefits will be worth the effort.
• Increased positive contact between
nurses and patients — When nurses provide
more and more consequences that patients
like, nurse-patient relationships will become
more positive. The treatment strategy of
behavioral therapy focuses attention on
appropriate behaviors instead of inappropriate
behaviors; this decreases the number of
negative contacts. The result is an
improvement in the overall emotional climate
in the nursing home.
• Increased well-being of patients —
Patients who engage in disruptive behavior to
The Canadian Nurse July 1977
gain staff attention do not have a fiigti regard
for themselves nor do they feel very content
J with their life in general. Studies on behavioral
I therapy programs generally show that patients
I not only becxime less disruptive, but show a
general improvement in initiative,
responsibility, and social interaction. This
outcome is entirely predictable. Behavioral
therapy requires the patient to put the burden
of responsibility for appropriate behavior on
himself, thus increasing self-respect.
• Increased staff confidence — Very often,
nurses confronted with disruptive behaviors
are at a loss what to do. Behavioral therapy
provides them with a plan of action. It's
objective and it works. If it doesn't, the nurse
can determine why. As programs are
implemented and patients begin to behave
appropriately, the nurses are rewarded for
theirefforts, thus increasing their confidence in
their ability to meet the needs of patients.
• Decreased work load — Although
alluded to earlier, this benefit should be
reiterated here. As patients become more
well-behaved and more self-sufficient, they
require less supervision. Instead of cleaning
up messes, delivering reprimands or arguing
with patients, nurses can spend more time with
their patients in a positive fashion.
Conclusion
Worthing out a strategy of behavioral
therapy takes time and its application requires
patience and attention to detail. The
successful application of behavioral therapy*
brings benefits to both nurses and their
patients. Nurses will have more time and
energy to devote to their real goals —
providing forthe physical and emotional needs
of their patients and helping patients increase
their own levels of self-care and self-respect.
Patients will find their rewards in their growing
self-esteem and self-sufficiency.*
The author emphasizes that this paper is not
intended as a working manual in ttehavioral
therapy. Additional knowledge and expert
supervision are required in order to establish
these programs successfully.
Bibliography
1 Atthowe, J.M. Jr. Preliminary report on the
application of contingent reinforcement procedures
(token economy) on a chronic' psychiatric ward, by
... and L. Krasner. J. Abnorm. Psychol. 73:37-43,
Feb. 1968.
2 Ayllon, Tesdoro. Token economy: a
motivational system lor therapy and rehabilitation,
by ... and Nathan Azrin. New York,
Appleton-Century-Crofts, 1968.
3 Baltes, M.M. Creating a healthy institutional
environment for the elderly via behavior
management: the nurse as a change agent, by ...
S.L. Lascomb. Int.J. Nurs. Stud. 12:1:5-12. Mar.
1975.
4 Bemi, Rosemarian. Behavior modification
and the nursing process, by ... and Wilbert E.
Fordyce. St. Louis, Mosby, 1973.
5 Braun, Stephen H. Ethical issues in behavior
modification. Behav. Thar 6:1:51-62, Jan. 1975.
6 Grossman, J. A. A token economy program on
a mixed chronic and geriatric ward, by. ..and D.W.
Killian. Paper presented at the 25th annual meeting
of the Gerontological Society. San Juan, 1972.
7 Hoyer, W.J. Reinstatement of verbal behavior
in elderly mental patients using operant procedures,
by ... et al. Gerontologist 14:2:149-152, Apr. 1974.
8 — . Application of operant techniques to the
modification of elderly behavior. Gerontologist
13:1:18-22, Spring 1973.
9 Labouvie, Vief G. Operant analysis of
intellectual behavior in old age, by ... et al. Human
Dev. 17:4:259-272, 1974.
1 0 LeBow, Michael D. Behavior modification: a
significant method in nursing practice. Englewood
Cliffs, N. J., Prentice-Hall. 1973.
1 1 Libb, J.W. Token reinforcement in an
exercise program for hospitalized geriatric patients,
by ...C.B. Clements. Percept Motor Skills
28:957-958, Jun. 1969.
12 MacDonald, M.L The ethics of using
behavior modification with the institutionalized
aging: a practical analysis. J. Long-Term Care
Admin. 4:42-46, 1976.
13 — . Reversal of helplessness: producing
walking behavior in nursing home wheelchair
residents using behavior modification procedures,
by ... and A.K. Butter. J. Gerontol. 29:97-101, Jan.
1974.
14 Mueller, D.J. Resodalization of regressed
elderly residents: a behavioral management
approach, by ... and L. Atlas. J. Gerontol
27:390-392, Jul. 1972.
15 Peterson, Linda Whitney. Operant approach
to observation and recording. Nurs. Outlook
15:3:28-32, Mar. 1967.
1 6 Schaefer, Halmuth H. Behavioral therapy, by
... and Patrick Martin. Toronto, McGraw-Hill, 1969.
Larry MacDonald (Ph.D., Psychology,
University of Wisconsin) is director of
Behavior Management Services, a branch of
Services for the Handicapped in Edmonton,
Alberta.
He has worked as a research
psychologist at the Wisconsin f^edical
College and acted as a private consultant to
nursing homes in the U.S.
30 The Canadian Nurse July 1977
Helping young
ostomy
patients
^ j^emselves
The Canadian Nurse July 1977
Sandy Morrison is now a happy and well adjusted six year
old. Over a year ago she came to our hospital for the
surgical construction of an ileal conduit. As Enterostomal
Therapist I was familiar with the prot}lems I had to deal with
in teaching adolescents and adults about stoma care, but
how was I to teach a five-year-old child about it?
Hildegard Tisdale
We began counselling Sandy's parents, and
especially her mother, approximately one
month prior to the child's hospitalization. At
this early stage Sandy's mother was very
anxious and reluctant to have her child go
through the trauma of ostomy surgery. During
my first visit with Mrs. Morrison I realized I
needed extra help.
I called upon the services of our pastoral
care unit, social services, psychotherapy
and the pediatric nursing staff. Together we
formed a team and each member of our team
visited Sandy's mother daily for one week. At
the end of that week she talked openly about
the upcoming surgery and asked many, many
questions. Working as a team we helped Mrs.
Morrison come to understand and accept her
daughter's ileal conduit surgery.
Even so, I was troubled as to how I would
approach Sandy. This concern led me to
arrange a meeting between myself and the
Pediatric Head Nurse. There we decided to try
a new approach to the problem. We called our
solution Ostomy Play Therapy; attempting to
teach the child ostomy care through play.
All through the parental counselling I had
no idea what my little friend looked like or how
she might react to our approach. On Sandy's
admission to our pediatric unit I found she was
a sweet, blond-haired, blue-eyed little girl who
was soaked in perspiration as she was moving
only with the aid of a walker.
As therapist my first goal was to reduce
Sandy's fear and give her an understanding of
what was to happen to her and why.
Sandy was scheduled for an ileal conduit
to overcome urinary incontinence caused by a
neurogenic bladder due to a
myelomeningocele. We had one week before
surgery, so we got started on our planned
project right away.
Play Therapy
I gave Sandy a doll that she decided to call
Susie. On the doll's abdomen I had glued a
stoma. I also gave her several ostomy
pouches, micropore tape, a night drainage
bag, syringes, surgical sponges, tubing,
crayons and, of course, the ostomy coloring
book "All About Jimmy."
Carefully I explained what each item was
used for and why we used it. At first Sandy was
reluctant to handle the equipment, but, on my
second visit she was more relaxed and ready
to play with it.
Repeatedly I explained all the items and
their functions. During this time I used the doll
as a model and then transferred my actions to
the child. The floor nurses reinforced my
teaching by playing with Sandy and her doll at
other times in the day.
On the third morning of therapy Sandy
was ready to tell me all about her doll's
surgery. She gave reasons for giving our
"pretend patient " injections, why she was
wearing a stoma bag, and having tubes go into
her arm (I.V.). Sandy really seemed to
understand what was happening.
By the fourth morning Sandy had
mastered the pouch opening and closing
device and she knew the importance of closing
the valve after emptying the pouch.
Her stoma site was marked and Sandy
went off to the O.R. I affixed a post-op pouch to
the stoma in the operating room. A small
catheter was left in the stoma. A straight
drainage bag was connected to the catheter to
facilitate unobstructed drainage of urine.
After surgery the operating and recovery
room staff told me they had never seen such a
well-prepared child. Not once did my young
friend pull at any of the tubings or object to
anything that was happening to her.
Post-op
On the first post-op day Sandy greeted
me smiling and already sitting in a chair. She
was still connected to intravenous feeding and
bedside drainage. I questioned her about all
the tubes and she told me each one's purpose.
Sandy said she didn't mind them after all, they
were going to make her feel better.
I checked her stoma, then her urinary
pouch for leakage, and explained my actions
to her. Now I brought the doll back into the
picture. I asked Sandy to check the doll's
pouch for leakage, just as I had checked hers.
Sandy went through this task without
hocitatinn
The Canadian Nurse July 1977
On the second post-op day my little
patient greeted me with "my baby's bag is
leal<ing." Now that was serious business. We
discussed our course of action and soon
corrected the situation. We bathed the doll,
carefully dried the stoma site, laid down a skin
barrier, attached a new stoma bag and picture
frame taped the area with micropore tape.
Sandy did ninety percent of this work. Oddly
enough it was not until after the doll was "dry"
that I got an opportunity to ask Sandy if she
was alright. She assured me she was.
Sandy improved daily and was ready for
discharge three weeks after surgery. At that
time I measured her for a semi-disposable
appliance. The stoma was quite edematous
post-surgically and therefore we had
continued to use post-op pouches.
Sandy's parents were taught how to care
for the stoma, how to assemble and drain the
pouch, and how to clean and care for the
equipment. All this was done with Sandy's
participation. We also gave her parents
detailed written instructions to take home with
them. Family education was vitally important
for Sandy because the Morrisons lived almost
250 miles from the hospital.
The semi-disposable (permanent)
appliance arrived at the hospital during the
patient's fifth post-op week. Unfortunately
Sandy had suffered a setback and had to be
readmitted to hospital with a bowel obstruction
fight around this time.
Follow-up
A couple of days after emergency
surgery, I showed my friend the new pouches
and how they were assembled. Sandy was
very eager to try those nice pink and blue
pouches. She picked a pink pouch, we applied
it and it stayed affixed for seven days.
Sandy and her parents made several
follow-up visits to the hospital after the
surgery. These visits showed both Sandy and
her parents were happy and well-adjusted to
the ileal conduit, its care and management.
Recently, Sandy started school and her
teacher lets her leave the classroom to empty
the pouch whenever necessary.
Sandy, the youngest in a family of four
daughters, is the only child with a serious
medical problem. But this doesn't prevent my
young friend from active play with her sisters or
her friends.
As an Enterostomal Therapist, Sandy
was my first experience with a very young
patient at a possible teaching age. Happily our
use of play therapy succeeded and Sandy has
been able to adjust well to her stoma. Ostomy
play therapy has since been used on other
young ostomy patients in our hospital with
equally satisfying results.*
HildegardTisdale, fl./V./A., E.T., theauthoro.
"Helping Young Ostomy Patients l-ielp
Themselves," graduated from the Ottawa
Civic Hospital School of Registered Nursing
Assistants in 1973. Immediately after
graduation she attended the Harrisburg
General Hospital School for Enterostomal
Therapists in Harrisburg, Pennsylvania. She
was certified in IVIarch, 1974.
Hildegard worked briefly at the Ottawa
Civic Hospital and the Ottawa Ostomy Centre
on a part-time basis. Then, late in 1974, sht
moved to Thunder Bay where she has beer
working as a full-time Enterostomal Therapist
at St. Joseph's General Hospital. She is the
only Enterostomal Therapist in northwestern
Ontario and therefore sen/es all ostomates ir
that region. She also acts as a consultant to all
hospitals and community services in
northwest Ontario.
Twice a year Hildegard joins a Ivlobile
Team and conducts Ostomy Clinics and
educational services in other northern
centers. She is an active member of the
Thunder Bay Ostomy Association and the
United Ostomy Association.
Clinical Wordsearch
1 Hyperalimentation
2 Ileum
3 Sigmoidoscopy
4 Gallstones
5 Liver
6 Jaundice
7 Pylorus
8 Hydrochloric Acid
9 Banana
10 Mesentery
11 Hepatitis
Answers
Puzzle no. 7 (appears on page 39)
1 2 Pancreozymin
1 3 Peristalsis
14 Volvulus
15 Vagus
16 Bowel
17 Oral
18 Enzyrnes
19 Mucus"
20 Hernia
21 Bernstein
22 Pill
23 Duodenum
24 Chyme
25 Occult Blood
26 Ulcer
27 Colitis
28 Gastritis
29 Appendectomy
30 Bolus
31 Gland
32 Oddi
33 Nervous
34 Fats
35 I.V.C.
36 Faeces
37 Tube
38 N.P.O.
39 Lait
40 Tongue
41 Solids
Hidden Answer: Fitness prevents fatne-
The Canadian Nurse July 1977
Privacy:
the forgotten need
The unique function of tine nurse is to assist the individual, sick or well, in the performance of
'hose activities contributing to health or its recovery (or to peaceful death) that he would
oerform unaided if he had the necessary strength, will or knowledge ...to do this in such a way
as to help him gain independence as rapidly as possible when independence is achievable
This aspect of the work of nurses they initiate and control; of this th^^e masters". '
Ellen D. Schultz
Since the beginning of the history of
nursing", assistance to the individual has
oeen considered as being at the core of all
nursing activity, regardless of the setting
or nursing function performed. The first
step in this care-giving process is, of
necessity, the identification and
determination of the needs of the person
who will receive this care. No one would
presume to deny a healthy person the
need for and right to privacy. Yet this is a
need that is too often overlooked in
planning the nursing care of
institutionalized individuals, particularly
those in a psychiatric care setting.
Nursing process involves diagnosing
individual needs and their various
fluctuations and from this diagnosis
planning an individual treatment
approach that utilizes the complete
environment. When writing about the
therapeutic milieu, the subjects that
authors in the field of nursing most often
include are ones such as occupational
and recreational activities, the setting of
patient goals, locked or unlocked wards
and patient governments. There can be
no arguing the fact that these are
significant areas of interest. But so is
privacy, and yet this is an area that is not
adequately dealt with in nursing literature
or in our hospitals.
"Privacy implies both the freedom to
remove ones self from the tensions of
interacting with others and the freedom to
interact with certain people without having
to respond to the intrusions of others."^
In other words, privacy offers
freedom from the pressures of
togetherness.
The overall function of privacy is to
increase the number of options available
to the individual so that he can behave in
ways appropriate to his particular
purposes.
People need privacy in order to
maintain psychological, spiritual and
physical well-being. Paul Rosenblatt
suggests people seek privacy for the
following reasons:
34
Tlw Canadian NurM July 1977
— to protect others
— to avoid punishment
— to protect ourselves from the threat of
evaluation
— and to fulfill modesty norms.^
Sidney Jourard describes privacy as
a way of seeking change. A person
usually needs to leave the presence of
other people in order to depart from the
vi^ay he has always been when with them.
"Being with" other people suggests a
contract from one person to act and react
before others the same way he always
has." Other people can serve to chain a
person to his present identity and make
any amount of deviation from this very
difficult.
An individual can find privacy
"backstage" or away from the interfering
eyes of the public. For it is here that a
person can "get things together," it is here
that all public rules may be violated.
Privacy in our institutions
In the past lack of privacy has been
used in institutions to control behavior or
to encourage conformity to assigned
roles. But one of the results of lack of
privacy can be both patients and those
caring for them treating witnesses (other
people) as "non-persons." We may carry
out, in front of others, activities
traditionally done in an atmosphere of
privacy. This kind of behavior can only
result in a defeat of the milieu's goal of
increased socialization and improved
interactions.
In order to get an idea of just how
patients feel about the issue of privacy I
prepared a questionnaire and presented it
to fifty hospitalized psychiatric patients.
The results are presented below.
These responses would seem to
indicate:
• most patients find it easier to talk to a
staff person when privacy is provided
• most patients prefer a private or
double room
• most patients have sometime during
the day when they want to be alone
• most patients surveyed rated their
need for privacy as either average or high.
Increased privacy can be provided in
our institutions by modifying the structure
of the living environment (Psychiatric
Unit). Conference rooms which can be
used for nurse-patient interactions should
be an important part of this environment.
New units could be constructed with
primarily private and double rooms.
These rooms must themselves offer
privacy. They should, for example, have
curtains on the windows and doors that
patients can close.
There are ways to increase the
amount of privacy available to patients
without making major structural changes
to the environment. A unit policy might be
established that discourages patients
from going into other patients' rooms and,
instead, encourages socialization in
lounges. For patients in semi-private
rooms, arrangements can be made
between the roommates for them to use
the room alone at specific times.
"The posture, position and location of
the nurse can contribute to or detract from
the nursing ethic of private or confidential
conversation. If the nurse sits or stands
closely to the patient, facing them for ease
in vision and hearing, then the one-to-one
situation is enhanced and the sense of
privacy assured."^
Unfortunately, a therapeutic milieu
that offers privacy also offers the
opportunity for seclusion. This puts
greater responsibility on the hospital staff.
They must encourage a seclusive patient
to socialize. Nurses must be even more
aware of patients' feelings, particularly
depressed patients with suicidal
tendencies. This necessitates adequate
nursing staff and a freeing of the nursing
staff from nonessential activities.
Patients have indicated a need for
privacy and cooperation from staff is
required to make the necessary milieu
changes. The nurse holds the distinction
of being the one person who can "make
the most direct and unique contribution to
milieu therapy."**
PATIENT QUESTIONNAIRE
*1
Question
Number of Responses
1
, 1. It is easier to talk to a
staff person when ...
Privacy Is
Provided
48
Other People
Are Around
1
Makes No
Difference
1
2. Which type of room would
you prefer if the cost was
not a concern?
Private
22
Double
20
3-4 Bed
8
3. Does this statement apply
to you?
"There are times each day
that 1 prefer to be alone,"
Yes
45
No
5
4. How uo you ralo your need
Low
Average
High
The author of "Privacy : the forgotten need,"
Eiien Schultz, is currently an Instructor with
the School of Nursing at the University of
(Minnesota in Minneapolis. She graduated
with her Bachelor of Arts in Nursing from the
College of St Scholastica, Duluth, l\/linnesota.
She received her Ivlaster's of Science in
Nursing from the University of Minnesota
where she specialized in psychiatric nursing.
Immediately after graduation Ellen worked for
a time as Psychiatric Head Nurse at Mounds
Park Hospital in St Paul, Minnesota.
References
1 Henderson, Virginia. The Nature of Nursing,
MacMillan Publishing Co. Inc., New York, 1966.
2 Cosby, Paul. Privacy love and in-law
avoidance, by ... and Paul Rosenblatt. Unpublished
paper, 1971 p. 277.
3 Rosenblatt, Paul C. Lectures in family social
science, 1973.
4 Jourard, Sidney M. The transparent self:
self-disclosure and well-being. 2ed. New York, Van
Nos Relnhold, 1971. p.68.
5 Bermost, Loretta S. Interviewing in nursing, by
... and Mary J. Mordan. New York, MacMillan, 1973.
p. 57-58.
6 Hofling, Charies Kreimer. Basic psychiatric
concepts in nursing, by ... et al. Philadelphia,
Lipplncoft, 1967. p. 83.
Bibliography
1 Bermosk, Loretta S. Interviewing in nursing,
by ... and Mary J. Mordan. New York, MacMillan,
1973.
2 Brenton, Myron. Pwacy /waders. New York,
Coward-McCann, 1964.
3 Cosby, Paul. Privacy love and in-law
avoidance, by ... and Paul Rosenblatt. Unpublished
paper, 1971.
4 Ernst, Morris L. Privacy: the right to be let
alone, by ... and Alan Schwartz. New York,
MacMillan, 1962.
5 Ginsberg, Frances. Patients need privacy —
and may sue if they don't get it, by ... and Barbara
Clarke. Ivlod. Hasp. 118:6:110, Jun. 1972.
6 Goffman, Erving. Behavior in public places:
notes on the social organization of gatherings. New
York, Free Press, 1 963.
7 Jourard, Sidney M. The transparent self:
self-disclosure and well-being. 2ed. New York, Van
Nos Relnhold, 1971.
8 Hofling, Charles Kreimer. Basic psychiatric
concepts in nursing, by ... et al. Philadelphia,
Lipplncott, 1967.
9 Lewis, Alfred B. Jr. Some neglected Issues In
milieu therapy, by ... and Michael Seizor. Hosp.
Community Psychiatry 23:293-298, Oct. 1972.
The Canadian Nurse July 1977
EXPANDED
ROLES IN
RESHRATORY
NURSING
The 'expanded role of the nurse' is a phrase that has gained
considerable popularity, a concept that has received a good deal of
attention in both nursing education and literature. But in concrete terms,
what does it mean for nurses, their patients, and other members of the
health care team? In the articles that follow, two Canadian nurses
describe their individual experiences with the development of expanded
roles in respiratory nursing.
36
The Canadian Nurse July 1977
The Respiratory Nurse Clinician for Quality
Ella MacLeod
For several years, the nursing department at
Prince Edward Island Hospital in
Charlottetown had been requesting approval
forthe position of a nurse clinician. Finally, the
support of our nnedical staff and the Board of
Trustees gave us the opportunity we had been
waiting for — the chance to develop a quality
care program in respiratory nursing. Since the
beginning of our program, the acclaim for our
service from physicians, nurses, patients and
community members has been so great that
we feel that other hospitals might like to share
in our experience.
From the beginning of our program, we
were fortunate in having a nurse on staff with
the education, experience and expertise
necessary for giving care to patients with
respiratory disease. She had the teaching
ability and initiative necessary for helping
other nurses and patients, and was energetic
enough to devote additional time to
establishing rehabilitative programs and do
research studies. We also had an internist on
staff who was keenly interested in respiratory
disease, and wanted to set up a respiratory
department.
"Starting from Scratch..."
In our small hospital, it took major
reorganization and cooperation to begin a
comprehensive new program. We got
undenway by finding a 'niche' that could be
identified as the respiratory room. The next
step lay in assembling all our hospital
respiratory equipment, taking inventory of our
supplies, and studying the many types of
respiratory diseases treated at our hospital,
together with the modes of treatment.
When this was accomplished, we began
to write out our philosophy and decide upon
the objectives of our program. Working slowly,
we read current literature, gathered ideas from
other staff members, and experimented to
establish the most suitable working hours for a
program of optimum effectiveness. Finally, we
drew up a job description that outlined working
relationships and established hours of work.
We defined the respiratory care unit as:
"a separate unit established within the hospital
for the purpose of providing a high quality of
care to patients with respiratory problems on
an in-patient, out-patient basis",
and the respiratory care clinician as:
"a person who has acquired background
knowledge, expertise, and experience in
caring for patients with respiratory problems; is
skilled in techniques for meeting emergency
situations; provides for improvement of
nursing care through teaching and assisting
staff, and works under the guidance of
physicians in charge. "
In order to fulfill this description and meet
our objectives, the clinician's role was
considered in four areas:
• her functions in promoting patient care
• her role in teaching
• her job as manager of a department
• her expectations for her own
self-development.
Patient Care and Teaching
The main concern of our program is with
patient care and teaching. The nurse clinician
makes daily visits to all in-patients receiving
respiratory therapy, either helping with care
and treatments herself, or supervising the
patient's nurse in planning and giving care.
She visits patients on continuous ventilation,
assesses the progress of patients being
weaned from the ventilator, monitors patients
receiving I.P.P.B. therapy, and does chest
The Clinical Nurse Specialist: An Individual
Lee Robinson
In the past few years, the role of the clinical
nurse specialist has claimed the attention of
both nursing education and our professional
literature. Experience with this new role
however, has occurred largely in the United
States; it remains a relatively new concept in
Canada. It was only in April, 1976 that the
Registered Nurses Association of Ontario
produced a comprehensive statement on the
clinical nurse specialist.' Because it is so new,
there is still variation in the interpretation of the
role. Documentation of individual experiences
with this role is important; through it we can
fully explore its contributions to patient care.
The experience of a clinical nurse specialist in
the Regional Chest and Allergy Unit of St.
Joseph's Hospital in Hamilton., Ontario is
described here.
The Regional Chest and Allergy Unit
includes the practices of four chest physicians.
These physicians practice in a newly opened
out-patient unit which provides care to
respiratory patients. A clinical nurse specialist
has worthed with the group since July, 1973.
There are three broad responsibilities in the
position: patient care, education and research.
1 . Patient Care
For the clinical nurse specialist, the primary
area of responsibility lies in the follow-up of
close to 100 patients with chronic respiratory
disease, usually chronic bronchitis,
emphysema, or asthma. Patients are referred
to the nurse by the four chest physicians. The
pattern of referral is illustrated in Figure 1 .
Sometimes the nurse supervises the total
out-patient respiratory care of the patient;
sometimes the physician takes on this
responsibility while the nurse provides
educational and supportive care: usually,
there is a give and take of responsibility
depending on the patient's needs. In all
instances, there is a close working relationship
between the patient, nurse and physician.
Though planned home and unit visits for
the purpose of clinical assessment and/or
therapeutic interventions do occur, perhaps
the most significant contribution the nurse
makes to both patients and families is
immediate accessibility. The nurse's use of a
long-range bell-boy insures that the patient will
be able to get in touch with her according to his
needs. The nurse is prepared to help the
patient who calls her by:
• giving advice regarding straightforward
adjustments to his therapeutic regimen
• making a home visit or an-anging a unit
visit if this seems necessary
• organizing prompt attention when a
significant clinical problem arises
• arranging additional services such as day
care, home care, and social assistance
• listening to all the patient's concerns,
however small, so that his anxiety related to
health problems is minimized.
The nurse's case load varies over time as
patients and families are all at various stages
in learning to live comfortably with their
disability. The goal is to make the patients as
independent of the health care system as
possible. Once patients have learned to
monitor their conditions skillfully and to adjust
their treatment appropriately, close follow-up
can be discontinued. When a patient has
demonstrated appropriate self-management
of disease related problems and has achieved
a life-style that is not unnecessarily hampered
by his disability, then nurse-patient contacts
are markedly reduced.
The Canadian Nurse July 1977
37
Care
physio, suctioning etc.
She is also responsible for the newly
admitted respiratory patient, for beginning his
treatments and helping to plan his program of
care. She works with the physiotherapist in
teaching patients prior to chest surgery, and
visits these patients post-surgery to assess
their condition and help with their care.
Education of the patient and his family is
seen as a very important factor in health
promotion, and for this reason, the nurse
clinician is very involved in helping the patient
and his family to understand his disease. She
instructs the patient in rehabilitative measures,
teaches him self-care and management of his
own treatments, and helps him to understand
ways in which he can prevent further problems.
She is responsible for teaching families to help
with the patient's care at home. Families are
much more fully prepared to cope with the
problem of the patient's illness when they
understand more about the disease and the
way in which it affects the patient and learn
something about the equipment and drugs
used by the patient with the consistent encou-
ragement of the nurse clinician. When neces-
sary, the clinician also makes arrangements
with the public health nurse for follow-up care.
In-patient therapy is not the only
responsibility of the nurse clinician. An
important component in the establishment of
our program was an out-patient chest clinic for
patients suffering from chronic obstructive
lung disease. Here the nurse clinician works
closely with the physiotherapist. The goals of
the program are:
• to improve the quality of daily life for
patients by lessening breathlessness and
improving their level of physical activity
• to reduce the number of hospital
admissions necessary to the patient.
The out-patient program includes
instmction in chest clearing, breathing
retraining, and patient education about the
disease itself; it also permits ongoing
assessment and evaluation of C.O.L.D.
patients. This part of our program has great
value in improving patient morale. The
patient's fear of his symptoms has been
largely overcome by the emotional support
that is provided through the creation of a "club"
environment, where patients learn from each
other.
Working with Staff
As quality patient care is our aim, all staff
members are taught by the nurse clinician to
develop skills in nursing the respiratory
patient, and staff teaching takes up a good part
of the clinician's day. In addition to the daily
individual teaching and supervision of staff,
she participates in wori<shops, ward clinics
and seminars and has a planned educational
program in the school of nursing, for nurses
from other hospitals, and for nurses taking
refresher courses. She has also had
wori<shops with maintenance men and
orderlies to teach them safety measures in
handling equipment such as oxygen or
compressed air, and has provided educational
programs for hospital chaplains and medical
interns.
Continuity is a must for quality care. To
promote continuity, the nurse clinician chaired
a committee that developed standard nursing
care plans for patients with pneumonia,
asthma and chronic obstructive lung disease.
She also developed an educational teaching
plan for the rehabilitation of C.O.L.D. patients
and established with the physiotherapist a
preop and postop course for surgical patients.
Perspective
Respiratory Patient
visits family physician
Family Physician
Resolves
w
4 >
the problems q^ Refers to
ithout referral Chest Phys
cian
Chest Physician
Makes recommen
and sends patient
to family physician
respiratory follow-
— or — — or —
dations Follows the patient's Refe
back respiratory problem for Nurs
for an extended period
up without referral
rs to Respiratory
e Specialist
Respiratory Nurse Specialist
Flgure 1. Proces.
5 Leading to Nurse Referral
2. Education
The second aspect of the role of the nurse
Involves educational input to meet the needs
of other professionals and students. Some of
the educational responsibilities are informal,
for example, the sharing of experience in the
care of specific patients. Other responsibilities
are more formal.
Informal responsibilities include
discussions with others providing care to
respiratory patients familiar to the nurse. For
example, joint home visits are made with
community nurses who visit the most severely
limited patients on a regular basis. This allows
the patient, the respiratory nurse specialist
and the community nurse to work closely
together in helping the families. In this way, a
three-way dialogue is established to ease
communication whenever a problem arises. It
also provides the respiratory nurse with an
opportunity to share with the community nurse
some of ttie clinical assessment skills and
therapeutic concepts which are specific to
individual patients.
More formal educational responsibilities
include participation in workshops, seminars,
or conferences. There are an average of three
The Canadian Nurse July 1977
The nurse clinician also participates with
the physician in new methods of care and
treatment. She worked closely with the doctor,
for example, in establishing safer controls and
assessment of patients by exercise stress
testing, so that rehabilitative activities would
not exceed the patient's cardiac tolerance.
In September 1975, when Beclovent*
inhalers became available in Canada, the cli-
nician, under the guidance of the physician,
started a study on their use. Fourteen carefully
selected out-patients were closely observed
and evaluated for the effectiveness of this new
form of steroid.
Expired flow testing and 'stop smoking'
clinics are added to the list of duties performed
by the nurse clinician. She has established a
library for books, journals and reference
material at our hospital. Each month she
submits a summary of her work to the director
of nursing to be included in the report to the
Board of Trustees.
We are proud of our program. In addition
to providing comprehensive respiratory care
and teaching for both staff and patients, we
feel that our nursing department has made an
Important and effective effort towards
prevention. In a time when health care trends
swing towards health promotion and
prevention of illness. 4>
Ella MacLeod (R.N., St. John General
Hospital School of Nursing; B.N., McGHI
University; M.S., Boston University) author of
"The Respiratory Nurse Clinican for Quality
Care," has recently retired as Director of
Nursing of Prince Edward Island Hospital, to
become the director of public health nursing
with the provincial government in
Charlottetown, Prince Edward Island. She
has been a teacher with the St John General
Hospital School of Nursing, St John, New
Brunswick, a consultant with the Department
of National Health and Welfare, and the first
nurse member appointed to the P.E.I. CiviJ
Service Commission. Ella MacLeod is a
former president of the Association of Nurses
of Prince Edward Island and past CNA board
member
' Beclovent Inhaler is a registered trade mark of
Allen and Hanburys.
The photo on page 35 shows
Etta Connolly, R.N., Respiratory Nurse
Clinician, and Mabel Davies, tvl.C.P.A.,
Physiotherapist, teaching and supervising an
I.P.P.B. treatment taken by Phillip Henderson,
a patient with extrinsic asthma.
or four requests for participation in organized
educational projects each year. These are
usually accepted. In addition, a clinical
appointment with McMaster University School
of Nursing allows the nurse to contribute to the
learning experiences of several
undergraduate and graduate students each
year.
3. Research
Formal studies have not been undertaken up
to the present time, but several co-operative
efforts are beginning to materialize within the
Regional Chest and Allergy Unit and the
School of Nursing at McMaster University. It is
hoped that some studies can soon be
undertaken to look at the special needs of the
chronically disabled respiratory patient.
Summary
Clinical nurse specialists are a relatively new
breed of practitioner on the Canadian health
care scene. The role descrit)ed here has made
a knowledgeable respiratory nurse specialist
available to patients, other professional
colleagues, and students. Feedback from all of
these sources has been favorable and the
position has certainly provided a great deal of
professional satisfaction to the nurse. i>
Lee Robinson (R.N. , Winnipeg General
Hospital School of Nursing; B.N., University of
Manitoba; M.Sc.(A), McGill University),
author of "The Clinical Nurse Specialist: An
Individual Perspective" is presently Clinical
Nurse Specialist for the Regional Respiratory
Programme at St Joseph's Hospital in
Hamilton, Ontario, and Assistant Clinical
Professor at the McMaster University School
of Nursing. Her previous nursing experience
includes positions as clinical instructor in
medical-surgical nursing at the Winnipeg
General Hospital School of Nursing and at the
Massachusetts General Hospital School of
Nursing in Boston, Massachusetts.
References
1 Registered Nurses Association of Ontario
statement on the clinical nurse specialist —
approved. RNAO Ivlemo, 76-2:8, Jun. 18, 1976.
The Canadian Nurse July 1977
39
Clinical Wordsearch no. 7
777/s is another in a continuing series of clinicai
word searct) puzzles reiating to different areas
of nursing, by Mary Elizabeth Bawden (R.N.,
B.Sc.N.) who presently works as Team Leader
in the Rheumatic Diseases Unit, University
Hospital, London, Ontario.
Solve the clues. The bracketed number
indicates the number of letters in the word or
words in the answer. Then find the words in the
accompanying puzzle. The words are in all
directions — vertically, horizontally, diagonally,
and backwards. Circle the letters of each word
found. The letters are often used more than once
so do not obliterate them. Look for the longest
words first When you find all the words, the
letters remaining unscramble to form a hidden
answer. This month's hidden answer has three
words. (Answers page 32). ^
HERAT
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1 Parenteral nutrition often administered Into
the subclavian vein. (17)
2 Not to be confused with ilium. (5)
3 Procedure during which the distal portion of
the colon can be examined. (13)
4 Calculi which form in the gallbladder. (10)
5. A large lobed abdominal organ, f5;
6. A condition characterized by yellow sclera
and skin. (8)
7 The lower third of the stomach. (7)
8 Chemical of the gastric juice which lowers its
pH. (12, 4)
9 High potassium monkey food. (6)
10 Fold of peritoneum attaching the intestine to
the posterior abdominal wall. (9)
1 1 Inflammation of the liver. (9)
12 A hormone of the duodenal mucosa which
stimulates the secretion of pancreatic
enzymes to the gut. (12)
1 3 Contraction and relaxation of the muscles of
the intestine, resulting in propulsion of the
contents. (1 1)
1 4 Intestinal obstruction caused by looping of
the bowel. (8)
15 The tenth cranial nerve. (5)
16 The intestine. (5)
17 Pertaining to the mouth. (4)
1 8 Organic compounds found in the body, many
of which act as catalysts. (7)
19 Its chief constituent is mucin. (5)
20 Inguinal, hiatus, or umbilical. (6)
21 Test to diagnose esophageal reflux; no
relation to Leonard. (9)
22 Sometimes bitter to swallow. (4)
23 The first portion of the small intestine. (8)
24 Material produced by the action of gastric
juice on ingested food. (5)
25 Lady Mactjeth would surely have welcomed
this to hide the most obvious evidence of her
crime. (5, 6)
26 An erosion which may be cratered. (5)
27 Inflammation of the colon. (7)
9ft Inflammatinn nf thp ctnmflrh /Qi
29 Removal of the subsidiary addition to a book
or document. (12)
30 A quantity of food entering the esophagus in
one swallow. (5)
31 May be exocrine or endocrine, organ which
secretes a specific substance. (5)
32 Oddly enough, it's a sphincter. (4)
33 Many functional diseases have a or
psychological aspect to their etiology. (7)
34 The last food substance to leave the
stomach; now if it would just leave the
hips!C4;
35 Intravenous cholangiogram. (3)
36 Waste products of the digestive process. (6)
37 Nasogastrk; or levine. (4)
38 Nil per os. (3)
39 Frenchmen with ulcers drink it. (4)
40 Best kept in check or cheek. (6)
41 Unlike liqukJs can't be drunk. (6)
40
The Canadian Nurse July 1977
]Vaincs and Faces
CNJ talks to
Hallie Sloan
It's a far cry from nursing in the Yukon
to coordinating activities at tfie
Canadian Nurses Association but that
is part of the route that Hallie Sloan
has tal<en in her professional life since
her graduation from the Vancouver
General Hospital School of Nursing.
Having lived in almost every part of
Canada while working as a nurse for
the Armed Forces, and later, settling in
Ottawa as Director of Nursing,
Canadian Forces Medical Services,
Hallie came to CNA in 1968 to
coordinate the ICN Congress held in
Montreal the following year. With this
year's ICN Congress held last month
in Tokyo, she was once again involved
in preparations for an international
nursing rendezvous. This time, her
responsibilities focused on recruiting
well-known Canadian nurses to
participate in panel discussions
relating to current nursing issues — a
task which she completed early in the
Spring.
As nursing coordinator, one of
Hal He's main roles deals with the
secretariate function of the
association — a task she shares with
many others at CNA. These functions
include preparing executive
committee reports, reports for board
meetings and the CNA annual and
biennial meetings. Organizing
meetings, inviting people to attend,
preparing agendas and collecting
background material is no simple task
... Besides this, she is often involved in
trying to find nurse experts who will
provide nursing input and represent
your association on various
government and non-governmental
committees. Such committees deal
with issues relevant to nursing such as
child abuse and neglect, drug
information, and family planning for
example.
Part and parcel of her job is
answering letters from nurses who
wish to take part in the ICN Nursing
Abroad program. In Canada, the
program is set up to help those
Canadian nurses who wish to wori< or
study in another country — and that
includes nurses seeking employment
in the United States. Since CNA is
aware of those states in the U.S. which
have reciprocity with Canadian
registration, Hallie advises nurses
going to the U.S. or to any country to
make use of the Nursing Abroad
program rather than going through
employment agencies.
On the international scene,
Hallie's involvement with CNA's
nursing projects funded by the
Canadian International Development
Agency (CIDA) is going to be one of
her favorite duties. Until recently, this
function was managed entirely by Dr.
Mussallem, executive director of CNA.
Last year, CNA was involved with
such programs as: providing Nursing
Unit Administration Courses in Zaire,
Haiti, Botswana, and until recently,
Lebanon; helping the University
School of Nursing in Havana, Cuba,
set up library services, AV aids and
otherteaching aids; sending film strips
to a nurse in the outback of Malawi;
developing regional Nursing
Examinations in Commonwealth
Carribean Schools of Nursing; training
nurses at the supervisory level to work
in rural communities in Botswana; and
other projects. These services are
carried on in the name of all Canadian
nurses to assist in the development of
their fellow nurses around the world.
All in all, the job of nursing
coordinator at CNA provides a full and
interesting day for Hallie and as she
states, "the best part is meeting so
many fantastic nurses from all across
Canada."
Verna Huffman Splane, past
Principal Nursing Officer for Health
and Welfare Canada has been elected
2nd Vice-President of the
International Council of Nurses at the
16th Quadrennial Congress held in
Tokyo recently. She has just
completed a four-year term as 3rd
Vice-President of ICN and is currently
a special lecturer on nursing issues in
national and international health at the
University of British Columbia School
of Nursing.
Splane's nursing career has
included many national and
international assignments for which
she has received numerous awards
and honors from her nursing
colleagues.
Alice J. Baumgart has bieen named
Dean of the School of Nursing at
Queen's University, effective
September 1, 1977. She succeeds
Dean E. Jean M. Hill, who is retiring
after serving in this capacity for nine
years.
Right now, Baumgart is
completing her doctoral studies at the
University of Toronto. She received
her M.Sc.(Applied) from McGill
University and her B.Sc.N. from the
University of British Columbia.
Baumgart has previously wori<ed
on the faculty of the School of Nursing
and Division of Interprofessional
Education at the University of British
Columbia. She has acted as a
consultant in tiasic nursing education
to other institutions in various parts of
Canada.
Her academic research activitie
have focused on the continuing
learning needs of nurses,
nurse-physician teamwori< and
compliance with medical regimens
In 1970, Baumgart was the first
Canadian to be awarded a Milbank
Foundation Feltowship. Under the
auspices of the Milbank Foundation
she has travelled wkjely in North ani
South America viewing innovations ii
health sciences and professional
health education.
In 1973 Baumgart was awards
the 3M Nursing Fellowship by the
International Council of Nurses.
Louise Lemieux-Charles has joinei
the staff of the Registered Nurses
Association of Ontario as project
co-ordinator of the Association's
Nursing Process Project. As overall
co-ordinator she will be responsible
for liaison with the steering and
regional committees, evaluation of th(
project and preparation of a report
outlining the project's activities and
results.
Lemieux-Charies recently
completed her M.Sc.N. in community
mental health at the University of
Toronto. She also holds her B.Sc.N
from the University of Ottawa and a
diploma in nursing from Ottawa
General Hospital.
Edythe Huffman, director of nursinc
at the Grace Hospital in Calgary, Alta.,
was named 1 977 Nurse of the Year by
the Alberta Association of Registerec
Nurses during the association's
celebrations of its 60th anniversary.
The award was presented to Huffman
by the Hon. Justice Tevie H. Miller in
recognition of her contribution to both
her community and her profession.
In making the award, the
association recognizes Huffman's
imaginative direction of the maternity
care in which her hospital specializes
An example of this is the arrangemen
of the post-partum/nursery staff so
that the nurse looks after both mothers
and batiies, a concept that has taeer
well received.
Huffman is involved in community
association projects, such as the
Anti-Suicide Line in Calgary and is an
active memtier of her professional
association.
The Canadian Nurse July 1977
Calendar
Mary E. (Sally) Robertson (B.Sc.N.,
Mt. St. Vincent University, Halifax) has
begun a "summer residency" at CNA
House to complete the requirement for
the program leading to a Master's
degree in Health Administration at the
Faculty of Management Sciences.
University of Ottawa. Her residency at
CNA is entitled "An internal Study of
the Effectiveness of the
Organizational and Managerial
Effectiveness of CNA." In preparing
her preliminary paper on tfie current
status of CNA and its managerial
activities, she will seek to identify
problem areas and determine future
objectives of the organization.
Previously, Robertson has been
an instructor in clinical nursing and
sciences, a consultant in nursing
education and administration for the
Hospital Commission of Nova Scotia
and a di rector of i nservi ce ed ucational
programs and nursing in Arizona.
Constance A. Swinton (R.N., Royal
Alexandra Hospital School of Nursing,
Edmonton; B.N., McGill University;
M.P.H. University of Michigan) on loan
to CNA from the Canadian
International Development Agency,
has recently completed a six-week
feasibility study regarding the
possibility of creating an "intemational
unit" within CNA. In the course of her
study, she reviewed CNA's present
involvement in intemational projects
and has made recommendations for
future development in intemational
nursing.
Swinton, who has worthed in
Indonesia with CARE/MEDICO as a
consultant in community health and
soon to leave for Nepal to wori< on a
community health development
project, believes that it is important for
Canadian nurses to be more involved
in overseas wori<. The focus of
intemational health development, she
stated, is on the preparation of local
people to help themselves in
developing services for their own
villages and communities. These
self-help efforts can be facilitated with
Canadian funding and professional
guidance especially in the rural areas
of the developing world where the
need is the greatest.
CNA is already assisting other
national nursing associations abroad
in improving nursing education and
practice in their own countries. An
"intemational unit" Swinton argues
would serve to inform CNA members
of the needs of nurses In developing
August
countries and solicit their support and,
secondly, would provide the means by
which assistance can be directed to
nurses abroad. As a coordinating
body, the unit would also provide
scope for interested nurses across
Canada to take part in intemational
health development.
Connie Swinton has been
director of education and projects at
the national office of the Victorian
Order of Nurses; public health
consultant with child and adult health
sen/ices, Heeilth and Welfare Canada
and an assistant professor in the
population unit, School of Hygiene,
University of Toronto.
International Association for
Enterostomal Therapy 1977
Conference to be held at the Town
and Country Hotel. San Diego.
California, on August 14-17. For
information contact; Melba Connors,
Conference Chairman. 124 E. Lewis
St., San Diego, CA 92103.
MEDINFO '77 — Second world
conference on medical informatics. A
four-day conference to be held in
Toronto at the Harbour Castle Hotel
on August 8-1 2, 1977. For information
contact; M.L. Barrett. Medinfo '77
Organizing Committee, 212 King St
West, Suite 214, Toronto, Ontario,
M5H 1K5.
September
Emergency Nurses Association of
Ontario Annual Conference to be
held September 12-14, 1977 at the
Skyline Hotel, Ottawa, Ontario.
Contact: Heien McPhee, Supervisor,
Emergency Department, Ottawa
Civic Hospital, 1053 Carting Ave.,
Ottawa, Ontario.
Fourth Annual Meeting of the
Ontario Psychogeriatric
Association to be held on Sept.
19-21, 1977. Theme; Bringing
Continuity to Care. Contact; Dr. M.
Farquhar. P. O. Box 14, Postal Station
"C", Toronto, Ontario, M6J 3M7.
initial Assessment and
Management of Patients with Acute
illness and injury. A two-day seminar
sponsored by the Emergency Nurses
Group, a special interest group of the
RNABC. To be held on Sept. 30 - Oct.
1, 1977 at the Four Seasons Hotel,
Vancouver, B.C. Contact; Linda J.
Clark, do Emergency Nurses Group,
Box 86824, North Vancouver. B.C.
Annual Conference of Northern
Ontario Operating Room Nurses to
be held September 16-17, I977atthe
Sheraton Caswell Hotel in Sault Ste.
Marie, Ontario. For information
contact; Mrs. A.M. McPhee, R.N.,
General Hospital, Sault Ste. Marie,
Ontario.
Clinical Appraisal Audit, a one-day
seminar to be held on Sept. 26, 1 977
in the Orange Theatre, Health
Sciences Centre, University of
Calgary, Calgary, Alberta. Contact:
Jocelyn Lockyer, Administrative
Assistant, Faculty of Medical
Education, The University of Calgary,
2920 24th Ave. N.W.. Calgary,
Alberta, T2N IN4.
October
Sixth Annual General and Scientific
Meeting of The Canadian
Association on Gerontology to be
held October 13-16, 1977 in Montreal
at Loews "La Cite" Hotel. Contact:
Blossom T. Wigdor, Ph.D., Director,
Psychology Sen/ices, Queen Mary
Veterans Hospital, 4565 Queen Mary
Road, Montreal, Quebec, H3W 1W5.
28th Annual Meeting of the Ontario
Public Health Association to be held
on Oct. 18-21, 1977 at the Skyline
Hotel in Rexdale, Ont. Contact; Kae
Sutherland. OPHA, 7 Carlis Place,
Port Credit, Ontario, L5G 1A8.
12th Operating Room Nurses
Conference to be held by the O.R.
Nurses of Nova Scotia on Oct. 18-20,
1977 in Halifax. Contact; Miss L
Hirtle, R.N., Halifax Infirmary (OR),
1335 Queen St., Halifax, Nova Scotia.
Annual Rehabilitation Nursing
Course for Registered Nurses and
Registered Psychiatric Nurses to be
heW Oct. 1 7- Nov. 4, 1 977 at Wascana
Hospital, Regina, Sask. For
information, mite.Mrs. Audrey Baton,
Co-ordinator of 1977 Rehabilitation
Nursing Course, Wascana Hospital,
23rd Avenue and Avenue 'G', Regina,
Saskatchewan. S4S 0A3.
Did you know ...RAH
The class of 73 of the Royal
Alexandra Hospital, Edmonton is
having its five year reunion in the
summer of 78. All RAH '73 graduates
are asked to send in a resume, name
and address for a new annual class
newsletter along with a
self-addressed stamped envelope to:
Roseanna Burchert. 13112-42nd
Street, Edmonton, Alta., T5A 2V5.
Include any suggestions for five year
reunion. Please submit by August 31.
The Canadian Nurse July 1977
Information is supplied by the
manufacturer: publication of this
Information does not constitute
endorsement.
Wliat's New
Stack Finger Splint
A new finger splint has been
introduced by Link America, Inc.
Known as the Stack Finger Splint, it is
designed to support the distal joint of
the finger in extension, while
permitting unrestricted movement of
the proximal interphalangeal joint.
The splint is fixed to the middle
phalanx with a small strip of adhesive
tape, thus elevating the distal joint to
its extended position.
The Stack Finger Splint is made
of flesh-colored plastic, which is
perforated for ventilation and
maximum comfort. Available in six
different sizes.
For further information contact
Link America, Inc., 10 Great Meadow
Lane, E. Hanover, NJ 07936.
Two Organizers
An electronic diary is an aid to
senior executives and professionals.
About the size of a quality pen-pencil
desk set with modern sculpture
styling, It is entirely electronic and
battery-operated (standard batteries
last one year), clock and special
reminder sheets are built in.
The electronic signal is activated
by bridging the 1 5-minute intervals
with lead pencil provided. A buzzer
rings intermittently for 2 minutes
ahead of reminder, cancelled by push
button.
Plan-A-Year is designed around
the 28-day month, showing weekends
separately. Available in 3 sizes. Desk
top (1 6" X 1 2"), desk or wall (24" x 16")
or wall (36" x 24"). The wall size has a
specially treated surface for
information that must be changed.
Furtfier details from: Nan-Neil
Limited, Box 100, Coe Hill, Ontario,
KOL IPO.
Portable Aspirator
Vernitron introduces a portable
aspirator (Model No. 1600) for quiet,
continuous usage in nursing homes,
hospitals, dentists' and physicians'
offices — or anywhere that a compact,
portable aspirator with strong suction
and positive, fail-safe regulation may
be needed.
The aspirator includes a
float-type cut-off valve contained in a
secondary reservoir which switches
the unit off, should the collection bottle
be permitted to overfill. Thus the pump
and motor are protected against
damage from fluid contamination.
The 0-20 inch suction capability
of the Model No. 1600 is displayed on
an extra large, 2 1 /2 " vacuum gauge
dial with a 270° scale calibrated in
inches of pressure. The compactness
of the aspirator is enhanced by an
aluminum case which completely
encases the motor and pump
assembly. The case is equipped with
an easily accessible, balanced
carrying handle. A cord wrap is also
provided for easy storage of the
three-conductor hospital-grade cord
and plug.
The Model No. 1600 Sorensen
aspirator is provided with a 64 oz.
glass collection bottle graduated in
cubic centimeters, and equipped with
a snap-fit, molded rubber bottle cap
and fittings. The bottle is secured in a
stainless steel bottle holder. The
overall size of the unit is 1 4"x 8 1 /2" x
10 1/2" and the net weight is only 15
lbs. The Vernitron Model No. 610
mobile stand is available for use with
this aspirator.
For information contact:
Vernitron Medical Products, Inc.,
Sales Department, 5 Empire Blvd.,
Carlstadt, New Jersey 07072.
New "AI<ro-Sii" Foley Catheter
An irritation-free service life two to
three times longer than that of
conventional latex catheters is
claimed for a new Foley catheter
announced by Akron Catheter, Inc.
Termed a 'new generation " of
catheter, it carries the trade name
"Akro-Sil. "
Made from a homogeneous
mixture of latex and silicone the new
catheter combines the best features of
each material.
The low porosity of the Akro-Sil
catheter's surface minimizes the
build-up of calculus deposits, which
are the major cause of irritation in
indwelling catheters.
Because the permeability of the
new material is much lower than that
of silicone and equal to that of latex,
the Akro-Sil catheter's balloon 'will
remain securely inflated for as long as
the catheter is in use. In addition, the
material's elasticity provides complete
balloon recovery on deflation so that
removal trauma is avoided.
For information contact: Akron
Catheter, Inc., Akron, Ohio 44313.
Surgical Grounding
Pad System
Medical Plastics Inc. has an
Electro-Surgical Grounding Pad
System that includes two sizes of flat
disposable grounding plates for
grounding the routine electro-surgical
patient, plus a new small pregelled
disposable foam self-adhering
grounding pad that contours to the
patient's body and is ideal for the
difficult to ground patient.
One patient cable is used with
both grounding plates and the
grounding pad. It is clear, with visible
wires to allow inspection of the
connection prior to, and during, each
procedure.
Cable connector provides a
positive contact and is adaptable to all
electro-surgical units.
The M.P.I. Surgical Grounding
Plate System comes in different styles
and sizes and provides safety,
convenience, and economy for the
operating room.
For information write: Medical
Plastics, Inc., 15318 Minnetonka
Industrial Road, Minnetonka, Minn.
55343. U.S.A.
Blood Pressure Unit
Manoscope Inc. is offering a new
blood pressure unit designed for both
professional and home use. The
unique self-locking circular cuff can be
easily applied to your arm without
assistance.
The unit also features a recording
manometer. Two hands automatically
follow the pressure dial and are simply
released by a push button. The
systolic pointer locks in on the high
reading and the diastolic pointer locks
in on the low reading by pushing a
control button. This eliminates the
memory factor and allows the
readings to remain even after the cuff
has been deflated.
Another feature allows two
stethoscopes to be connected
simultaneously to aid in teaching
people to read their own blood
pressure accurately. The complete
unit also contains a record-keeping
diary and an illustrated instruction
booklet.
Approximate irice: $49.95. For
further information, write:
Manoscope, P.O. Drawer 1956,
Clearwater, Florida 33517.
The Canacfian Nurse July 1977
Push-Button
Sphygmomanometer
Propper Manufacturing Company
has introduced a sphygmomanometer
with one-finger push-button control for
easy deflation and a blue-faced dial
with white numbers, affording clear
visibility to the practitioner only.
The "Push-Button" tm
Sphygmomanometer represents a
completely new concept in measuring
a patient s blood pressure in that the
push-button valve eliminates the
old-fashioned knob-turning device,
offering increased accessibility, speed
and control of air release. Both the air
release and inflation bulb
mechanisms are connected to form a
single, sturdy, convenient unit The
new connection removes the need to
hang the manometer on the cuff . Also,
support is built into the bulb for quick
inflation.
For information write: Propper
Manufacturing Company Inc.,
Diagnostic Instrument Division, 36-04
Skillman Avenue, Long Island City,
New Yorl< 11101.
Pediatric O.R. Pad
Ml Systems, Inc. has now made
available a Pediatric O.R. Pad
consisting of four small electrodes
mounted precisely on a foam pad. It is
applied to the infant's back to provide
accurate monitoring of the infant's
heart during open heart or chest
surgery. It is also excellent for use
during special applications where
reduced size is desired on adult
patients.
MI'S pediatric O.R. Pad is
pre-gelled with a low chloride gel and
gives high electrical performance. It is
easily applied after peeling off the
protective liner. (It is also available
non-gelled, if desired.)
Mis pediatric OR. Pad comes
with its connecting wire as an integral
part of the unit and with either male or
female adapter cable. It is also
available with a built-in cable that will
adapt to the traditional five-lead cable
and another to fit into other existing
systems.
Mi's pediatric OR. Pad is packed
in a moisture-proof bag with freshness
guaranteed for one year.
For furthier information write: Ml
Systems, Inc., 782 Burr Oak Drive,
Westmont, IL 60559.
Visual Scheduling System
A visual staff scheduling system,
the Beanstalk, consists of
wall-mounted modular and boards
and inch square colored cardboard
tabs clipped into plastic holders. The
tabs can be written on and dropped
firmly into place anywhere in the gnd
pattern.
The system provides a complete
overview of the nursing staff complex
at a glance, yet the system itself is
simple and easy to maintain.
Details of tfiis system and
many similar applications are
available from: Kentron Sen/ices, 50
Firwood Crescent, Islington, Ontario
M9B 2W2.
New ^4-Labstlx for Detection of
Urinary Tract Infection
Ames Company has extended
their range of dip and read urine
chemistry tests, with the addition of
NITRITE to their LABSTIX reagent
strip. Nitrite is specifically for the
detection of urinary tract infection.
Research has shown that an alarming
incidence of such infection is detected
among asymptomatic patients.
Extensive testing has shown that
N-LABSTIX can detect 92% of urinary
tract infections where urine was
incubated in the bladder four hours or
longer. The addition of the Ames nitrite
test brings to six the number of tests
available on N-LABSTIX, the others
being pH, Protein, Btood, Glucose,
Ketones.
For information contact: Ames
Company, Division of Miles
Laboratories Ltd., 77 Belfield Road,
Rn)idale Ontario.
If you
hate to
change
dressings,
change to . .
Effective wound care without the bother
of absorbent dressings.
The Holhster Draining-Wound Management Sys-
tem lets you
Examine the wound in seconds by lookmg right
tf\iougt> the odor-bainer fluid-barner transparent
film
Treat the wound l)y ronioving just the Access Cap
Assess and measure exudate without removing
anything (rom the patient
This unique alternative to absorbent dressings is
ideal tor any wound where drainage is expected
For a welcome change from dressing changes, try
the Holhster Draining-Wound Management System
Write today tor free evaluation samples You've got
to see through it to believe it I
)llisreR
Hullnlei liicoifKiidlml ,?ll E.»-=lChic<tgoAwe Chicago Illinois 60611
Disliibuled in Canada hy Holli^let Liiniled Wlllowdale OnlarioM?J IPS
.'PViight 19/7 Holliblef IncOfporated All Rights Reserved
The Canadian Nurse July 1977
Audiovisual
A scene from "Crisis Intervention.
m Mental HeaKh
Crisis Intervention
This is a set of two filmstrips
which has tieen introduced by
Nurseco to illustrate the concept
of psychological crisis and to teach
step-by-step techniques for nursing
intervention. The films are designed:
• to enable nurses to differentiate
between adaptive response to a loss
and a state of crisis
• to describe behaviors indicative
of a person in a hazardous or crisis
state
• to specify nursing intervention
based on assessment of the balancing
factors
• to apply the filmstrip content to
patients in a clinical setting.
Part one of "Crisis Intervention"
explains the dynamics of crisis theory ;
the hazard, losses, precipitating
event, assessment and minimum
inten/ention goals. Part two
demonstrates intervention planning
and evaluation.
The complete set of filmstrips and
materials is available for $125.
Additional information may be
obtained from Nurseco, P O. Box 145,
Pacific Palisades, California 90272.
The Adolescent Iliad
A twenty-five minute color
documentary concerning the
behavior-modification program at
a state hospital. The film shows
young people under treatment for
serious emotional problems including
dmg abuse, aggression, stealing,
running away from home, withdrawing
and dropping-out of school. The
dynamics of the behavior-modification
program lead to acceptance of
responsibility through scenes of
confrontation and awal<ened
self-awareness. Produced by Lauren
Productions the film can be purchased
for $315 or rented at $35. For
information contact City Films Ltd.,
376 Wellington Street West, Toronto,
Ontario, M5V 1E3.
Adolescence and
Learning Disabilities
Six nationally recognized
innovators define the tasks of
adolescence and offer specific
suggestions and techniques for
helping the learning-disabled student
acquire the skills necessary for
survival after he/she leaves school. A
25-minute color film by Lauren
Productions that is available for a $35
rental fee or a $380 purchase price.
For information contact City Films
Ltd., 376 Wellington St. West,
Toronto, Ontario, M5V IE3.
■ Nutrition
Eat, Drink and Be Wary
This 21 -minute color film
presents a critical examination of
our eating habits. The topics
discussed include nutritional losses in
food processing, food additives and
the role of the food manufacturer in
changing our diets. The film was
produced in 1 975 and is available at a
$295 purchase price or a $25 rental
fee from Gordon Watts Films, 865
Sheppard Avenue West, Downsview,
Ontario, M3H 2T4.
For Tomorrow We Shall Diet
A young woman sets out to tose
20 pounds. Through the course of
her diet both she and the viewer
discover the need to change our
eating habits, the dangers of fad diets,
the relationship between calories and
energy output and the importance of
proper nutrition and exercise. The film
is a 24-minute color presentation
available from Gordon Watts Films,
865 Sheppard Avenue West,
Downsview, Ontario, M3H 2T4;
purchase price $335, rental fee $25.
■ Obesity
Human Dynamics of
Weight Control
Doctor Jimmie Holland outlines
the sources and types of obesity,
and then discusses the
relationship of both psychological
states and socioeconomic status to^
obesity. This 26-minute slide/tape
presentation is available for $17.70
from Communications in Learning,
2929 Main Street, Buffalo, New Yort<.
Behavior Modification
Component in the
Treatment of Obesity
This program reviews the effects
of psychological aspects in
causing and treating the
problems of obesity. The patient's
moods, anxieties and activity levels
are considered with behavior
modification used as a treatment
modality. This is a 37-minute
slide/tape presentation that is
available for $26.40 from
Communication in Learning, 2929
Main Street, Buffalo, New York.
■ Family Planning
Birth Control:
The Choices
A 25-minute color film presenting
the uses, limitations and side
effects of the usual methods of birth
control, as well as tubal ligation,
vasectomy and abortion. A physician,
a birth control counselor, and several
young people relate their experiences
and explore the choices available to
them. The film is available from
Gordon Watts Films, 865 Sheppard
Avenue West, Downsview, Ontario,
M3l-i 2T4. Purchase price $350, rental
fee $25.
Vasectomy
Animation describes the male
reproductive system and
vasectomy surgery. Interviews
with men and their wives tell of
reasons for havi ng a vasectomy and of
their feelings, fears and satisfactions.
This 17-minute color film is available
from Gordon Watts Films, 865
Sheppard Avenue West, Downsview,
Ontario, M3H 2T4; purchase price
$240, rental fee $21.
■ Pediatrics
Infant Failure to Thrive
Dr. Harry M. Beirne discusses the
'failure to thrive' syndrome in
infants and young children. He
emphasizes the so-called "maternal
deprivation" group. This is a
25-minute slide/tape presentation
that is available for $1 1 .40 from
Communication in Learning, 2929
Main Street, Buffalo, New York.
■ Medicine
Team Up to Control Infection
A 15-min. color film shows how all
levels of hospital personnel can help
to control infection. Available in 16 mm
from the Librarian, Canadian Hospital
Association, 25 Imperial St., Toronto,
Ontario MSP 1C1.
■ Rehabilitation
The Curb Between Us
A 15 1/2-min. color film
documenting a young man's struggle
to rebuild his life after a disabling
accident and nine months in hospital.
It explores such questions as: How
does it feel to become disabled? What
are the prejudices directed against
anyone who is different? Can the
problems and needs of the disabled
be solved? How can the able help the
disabled? Available from the
Canadian Film Institute, 303
Richmond Rd., Ottawa, Ontario, K1Z
6X3.
Vocational Rehabilitation in a
Community Hospital
This 27-minute, color film shows
a hospital-based program of
vocational rehabilitation for victims of
arthritis and other chronic ailments.
Step-by-step it follows actual patients
and the program's professional staff
through the full rehabilitation process:
job counseling, aptitude testing,
evaluation and instruction, and
placement service. To request this film
contact the Canadian Film Institute,
303 Richmond Road, Ottawa, Ontario.
K1Z6X3.
The Canadian Nurse July 1977
Resumes are based on studies placed
by the authors in the CNA Library
Repository Collection of Nursing
Studies.
Research
w
Public Health Nursing
An Analysis of the Application
of the Concept of
Family-Centered Care in Piiilic
Health Nursing Visits.
Nursing research conducted at
the University of Toronto,
Toronto, Ont. by Rosella
Cunningham. (B.Sc.N., M.P.H.).
This exploratory study was
designed to determine if
family-centered care was a reality or a
cliche in public health nursing services
offered by official health agencies in
1976.
In this project the criteria for
giving family-centered care included
evidence that the nurse-
1. Interprets public health nursing as
family-centered.
2. Is concemed about all members of
the family,
3. Has talked with all the family
members to assess and identify
problems or potential problems
related to health promotion and early
case-finding,
4. Is aware of the effect of the problem
on the family,
5. Is aware of the effect of the family
on the problem.
Data were collected by observing
one home visit made by each of 20
randomly selected public health
nurses. These visits were to families
who had received at least two
previous visits in the last six months
and spoke and understood English.
Folkjwing the visits, the nurse's record
was reviewed and the nurse was
interviewed using an interview
schedule. Instruments were
developed to record these data.
The data were analyzed
according to the five criteria, and
factors that influence the
implementation of family-centered
care were listed.
The observations of home visits
made in this study were highly
encouraging: 15% of the nurses met
all stated criteria and the majority
rated very high (40% met at least 4
criteria and 55% met 3 or more
criteria). It should be emphasized that
while 2 nurses met none of the criteria
for family-centered care, that does not
mean they were failing to give good
individually-centered care. The fact
that 80% of the nurses observed were
aware of and concemed with the
interweaving of problems,
personalities and environment
showed they had an excel lent base for
providing family-centered care.
Recommendations for improving
family-centered care are directed to
nurses, agencies, educators, and
researchers.
• Continuity of Care
The Effects of Continuity in
Nurse- Patient Assignment
among a Selected Group of
Preoperative Aortocoronary
Bypass Patients. Toronto, Ont,
1976. Thesis (M.Sc.N.),
University of Toronto by Julia M.
Pelletier Hosa.
The purpose of the study was to
investigate systematically the
effects of two different methods of
preoperative nurse-patient
assignment on selected preoperative
and fxjstoperative indicators in
aortocoronary bypass patients.
A convenience sample of 24
patients, admitted to a large
metropolitan hospital for their first
elective aortocoronary bypass
surgery, was chosen. The investigator
visited each patient in his home
preoperatively to obtain formal
consent and administer a test of state
anxiety: Zuckerman's Affect Adjective
Check List (AACL) — Today f=orm.
Upon admission to the hospital,
patients were randomly assigned to
one of two groups as in accordance
with a randomized block design:
1) DN-PAC group where patients
experienced daily nurse-oatient
assignment changes on each shift,
each day preoperatively; and
2) CN-PA group where patients
experienced continuous nurse-patient
assignment on each shift, each day
preoperatively. The investigator again
administered the AACL the evening
before surgery. Data were also
collected in relation to postoperative
indices of analgesia requirement in
the first 48 hours postoperatively, time
spent in the Intensive Care Unit, and
assessment of patients ability to deep
breathe, cough and move extremities.
A postoperative interview was
conducted with the patient to survey
the patient's ability to recall having
"his nurse " preoperatively, the
importance to him of having "his
nurse," and the extent to which he
related to the nurse and/or others as
sources of support. Data pertaining to
the patient's perceptions of his
preoperative nursing care were also
collected.
Findings demonstrated that
patients' scores on the AACL did not
differ significantly between the two
groups either at home or in hospital. It
was found that foreign born,
unmarried and more highly educated
patients scored higher on the AACL
than did their counterparts.
There was no statistically
significant difference between the two
groups in patients' time spent in ICU,
analgesia requirement or in the
patient's ability to deep breathe,
cough and move extremities.
Eight of the 12 CN-PA patients
could remember having "their nurse "
preoperatively; 11 of the 12 DN-PAC
patients could not. If given the option,
1 8 of the 24 patients stated they would
like to have had the same nurse
assigned to them for a period of time
preoperatively.
Only three of the 24 patients
reported discussing worries with their
nurses preoperatively. Twenty
preoperative patients interacted with
postoperative patients. The majority
stated that they found such interaction
to be supportive.
There was no difference between
the groups in patients' overall level of
satisfaction with their preoperative
nursing care. However, in choosing
what they liked tiest about their
preoperative nursing care, patients in
the CN-PA group chose with greater
frequency than the DN-PAC group,
items which described the nurse's
supportive role. Conversely, DN-PAC
patients chose items which described
the nurse's technical role with greater
frequency than the CN-PA group.
Continued research of continuity
of care is recommended. Planned
utilization of other surgical patients as
sources of support requires further
examination. The provision of a
routine home visit by a staff nurse to
reduce the preoperative
aortocoronary bypass patient's and
his family's anxiety is recommended.
Research should be conducted to
identify groups of patients who may
exhibit a predisposition to greater
anxiety.
Did you know ....
In California, Govemor Edmund
Brown Junior recently signed into law
a "right to die " measure. The new law
allows a person to prepare in advance
a "living will," which legally permits the
renrKDval of life-support equipment,
such as respirators, if death is
"imminent. " The law protects health
personnel against legal actksn and
does not permit insurance companies
to label such deaths as suicides.
Intemationally, Sweden legalized
passive euthanasia in 1964. In Italy,
euthanasia is a crime only if a patient
is under 18, mentally retarded or
"menaced under the effect of fear. "
Other European countries have
similar legislation. (The Amencan
Nurse, Dec. 15/76)
The Canadian Nurse July 1977
Books
s^.:
TheNursing Process: A Scientific Approach
to Nursing Care by Ann Marriner. 241 pages.
St. Louis, The C.V. Mosby Company, 1975.
Approximate price $7. 10. Reviewed by
trmajean Bajnol<, Assistant Professor, Faculty
of Nursing, Ttie University of Western Ontario,
London, Ontario.
This bool< represents an attempt to compile
theoretical concepts related to the nursing process.
The components of the nursing process identified
and discussed are assessment, planning.
Implementation, and evaluation. Each chapter
represents a component of the nursing process, and
contains Marriner's writings plus a number of
selected readings which Illustrate and/or expand the
component. An extensive annotated bibliography Is
also Included with each chapter. All in all, the book
provides an excellent package of readings and
references pertinent to the nursing process.
The introductory chapter provides a concise
outline of what is to follow. The author, however,
does not define nursing, nor does she Identify the
importance of a conceptual framework of practice In
guiding the nursing process. One might assume that
this work represents a conceptual basis for practice.
Because IVIarriner provides no rationale for her
beliefs her conceptual basis Is not clearly identified.
This omission makes It difficult to see any unity in
Maniners discussion of the nursing process.
The chapter on assessment Is complete, with a
myriad of nursing techniques and tools for collecting
descriptive data about the client. Marriner states that
the assessment phase of the nursing process ends
with the nursing diagnosis. Her definition of this
concept is unclear, and It Is addressed as something
apart from assessment. Because assessment
begins with screening, which assumes
categorization of raw data, It Is mandatory that a
diagnostic framewori< be used throughout this
phase. The carefully selected readings related to
assessment and diagnosis strengthen this chapter.
Chapter three stresses priority setting, written plans
and nursing conferences In the planning phase of
the nursing process. Again the readings at the end of
the chapter are both Interesting and appropriate.
With the recent emphasis on the importance of
identifying patient outcomes, perhaps more space
could have been allotted to this topic.
In the chapter describing the implementation
component of the nursing process. Marriner
discusses the concept of teaching/learning almost
to the exclusion of any other nursing strategy. Surely
nursing strategies are not limited to teaching and
communication. The selected readings at the end of
this chapter are extensive and offer a variety of case
studies describing nursing problems and strategies.
In the final chapter on evaluation, Marriner
briefly discusses the Issue of assessing patient
progress then proceeds to address nursing audit,
systems analysis and performance evaluation.
Evaluation that Is intimately part of the nursing
process Is the means whereby the nurse and client
measure actual client outcomes against
predetermined outcomes. The broader concept of
evaluation Includes provider outcome measures,
client outcome measures, and total program
effectiveness. It is most important that we clearly
distinguish provider outcome, client outcome and
program evaluation. Also Important Is that nurses
not confuse assessment, (that Is, the precursor to
decision) and evaluation, that determines the
effectiveness of intervention. Since Marriner
focused on provider-oriented performance
measures, the notion of measuring effectiveness
was lost or at least confused. The selected readings
In this chapter relate to program and provider
performance evaluation.
In summary, Marriner has succeeded in
presenting a much needed compilation of
information related to the nursing process. This book
would be an excellent resource for both faculty and
students involved in teaching and learning the
nursing process.
Teaching Children with Developmental
Problems — A Family Care Approach,
Second Edition, by Kathryn E. Barnard and
MarceneL. Erickson. 182pages. St. Louis, The
C.V. Mosby Company, 1976.
Approximate price $6.25.
Reviewed by Karin von Sctiilling, Associate
Professor, Sctiool of Nursing, fi^cMaster
University, Hamilton, Ontario.
This is the second edition of a book formerly
titled Teaching ttie t^entally Retarded Ctiild — A
Family Care Approach. As the new title Indicates,
the focus has shifted from a specific group of
handicapped children — the mentally retarded to a
wider scope, which more Inclusively refers to
"children with developmental disabilities" of any
nature.
Apart from some up-dating in the chapter on
Nursing Responsibilities, including a new chapter on
Group Discussions with Parents, and an expanded
index section, the new edition presents few changes
in organization and content.
The book Is organized into four major sections.
The first two sections deal with Identifying overall
nursing responsibilities regarding the disabled child
and his family. Emphasis Is on recognition of
problems, with considerations for developmental
and learning principles within the family context. The
third and fourth sections focus more specifically on
the application of principles by providing methods of
assessment and observation and practical
suggestions for assisting the child In his
development and the learning of self-care skills.
The authors emphasize that the helping
professions, with their knowledge and support, can
play a decisive role in assisting parents to assess
and meet the developmental needs of their disabled
child, particularly during the critical periods of
Infancy and the preschool years. This offers support
for the trend of family care for disabled children.
The section on family considerations provides
essential understanding; here the authors
recognize that parents cannot assume an effective
teaching role with their child unless the crisis of
having a disabled child has been resolved with
adaptations which mobilize energies for a positive
and realistic approach to the child's development.
The new chapter on Group Discussions with Parents
explores benefits and offers practical suggestions
for the employment of this method In assisting
parents to deal with their own as well as the child's
problems.
The organization of contents offers access to
any area of Interest. Each section and each chapter
could be utilized Independently for practical
purposes. Throughout the book, summary charts
provide organized and detailed information. Both the
professional wori<er and/or parents will find this
book a practical and valuable source of assistance
when dealing with a disabled child.
One could question the wisdom of changing the
title for the second edition. The content, its focus on
primary developmental skills with associated
assessment tools and detailed teaching-learning
strategies. Is primarily designed for application In
work with retarded children. Will the omittance of a
clear reference to "The Mentally Retarded" in the
title, reduce the recognition and access of this book
to Its primary field of usefulnes — teaching the
mentally retarded child?
Introduction to Physiological and
Pathological Chemistry by L. Earle Arnow,
Ninth Edition, 491 pages. Saint Louis, The C.V.
Mosby Company.
Approximate price $12.55 Reviewed by David
Khol(har, Halifax Infirmary School of Nursing,
Halifax. Nova Scotia.
Scientifically, we are passing through an
exciting era. Physiological and Pathological
Chemistry seems to achieve Its objectives from the
learning perspective.
The problems of ecology are arising from
pollution of the environment by wastes of all kinds.
Detergents, Insecticides, hydrocarbons, and
radioactive materials — these wastes make It
Imperative that modem students have a background
in the basic sciences. It Is necessary to be grounded
In physical and chemical sciences before anything
more than a superficial descriptive acquaintance
with living organisms can be achieved. The student
will therefore profit most from his course In
pathology, If he has some knowledge of biological
chemistry preferably Including organic chemistry.
The subject matter Is adequately treated, and
one is particularly impressed with the fact that this
The Canadian Nurse July 1977
text contains many areas that are often omitted.
The main points in each chapter are clearly and
concisely explained; this facilitates both learning
and teaching. The book includes a discussion of the
latest basic chemical, biochemical and
microbiological principles. The illustrations are
excellent, but at times too complicated. It seems to
me that the text is too advanced for use in diploma
nursing or paramedical courses but would be of
considerable use to university students.
The material is sufficient and presented in an
interesting way, generating student interest and
motivation.
Childbearing: A Nursing Perspective by Ann
L. Clark and Dyanne D. Alfonso. 945 pages.
Philadelphia, FA. Davis Company, 1976.
Approximate price $23. 70
Reviewed by F.L. (Nan) Sparks, Associate
Professor, University of Calgary, Faculty of
Nursing, Calgary, Alberta.
Clark and Alfonso have utilized a conceptual
frame of reference in their delightful new
testbook Childbearing: A Nursing Perspective. As
the authors state in the preface, a conceptual
approach "is one way to organize knowledge and to
apply it appropriately for nursing intervention." The
text is successful in its goal. Not only is basic
matemity knowledge presented, but there is also a
wealth of information in the book regarding the role
of nursing.
The text is divided into several units, with
contributions to many units from experts in other
fields. Unit Two outlines some psychosocial
concepts such as Joy, Touch and Sensuality,
Frustration and Conflict, Anxiety, Loss and Crisis,
concepts absent from or limited in other matemity
nursing texts. The authors go on to further integrate
and apply these concepts in later units on
pregnancy, labor, delivery, and the post-parfum
period.
Unit Three focuses on cultural perspectives in
childbearing and includes a cultural assessment
framewori< which will aid in understanding various
family responses during pregnancy and delivery.
Although emphasis is given to this new
psychosocial material, basic physiological content
has not been neglected. Several guides are included
in the text for physiological assessment of nutritional
status, prenatal care, maternal risk factors and
examination of the neonate.
Unit Ten deals with Crisis During Childbearing
and includes chapters on adolescence, abortion,
prematurity, death and abnormalities. Unit Eleven
presents for discussion some legal, moral, and
ethical issues such as cultural warping of childbirth,
population problems and child abuse. These last two
units are an interesting and necessary addition to a
contemporary basic matemity textbook.
The authors state that the book was written for
students learning the profession of nursing but that it
might also be a useful review of matemal-neonatal
nursing for nurses in clinical practice. In either case,
this is an excellent, easily read, current and
well-researched book.
Total Parenteral Nutrition, edited by Josef E.
Fischer, M.D., 454 pages. Little, Brown and Co.,
Boston, 1976.
Approximate price $25.00
Reviewed by Ttierese Koazk, R.N., Paediatric
Parenteral Nutrition Nurse, Vancouver General
Hospital, Vancouver, British Columbia.
"Total Parenteral Nutrition has been a reality in
this country for less than ten years, but already
thousands of patients are in its debt, many for their
lives." The thirty contributing authors of this book, all
leading experts in their fields, examine this important
contribution to the treatment of our patients and
discuss general principles, clinical applications, and
supplemental techniques to central parenteral
nutrition.
In the first part of the txx)k, the authors discuss
the particular needs of various patients with respect
to their underlying problems, solutions available with
their varying constituents, as well as some of the
complications associated with central venous
parenteral nutrition. Techniques associated with
prevention of such complications are reviewed.
However the frequent problems with fluid and
electrolytes often encountered in parenteral nutrition
are not stressed sufficiently.
Phillips and Colley, hyperalimentation nurses at
Massachusetts General Hospital, have discussed in
detail specific aspects related to the nursing care of
the patient on parenteral nutrition stressing the
importance of preparing the patient for the therapy
and the precisran and accuracy involved in insertion
and care of this vital lifeline. Education of all
personnel involved is demonstrated as tieing
extremely important — particularly impressive is a
workshop day in which the theoretical background of
hyperalimentation therapy and its associated
nursing care is presented and discussed. The wori<
conference is available to selected applicants
(nurses) within the hospital as well as to outside
visitors. Several practical suggestions for
organizing a Parenteral Nutrition Unit are discussed.
The second part of this book deals with specific
aspects of management in the treatment of patients
with specific systemic diseases. Patients in renal
failure, severe cardiac disease, inflammatory bowel
disease, intestinal fistulae, hepatic failure, burns,
and pediatric patients may each develop specific
problems related to their condition and require close
and careful management with respect to the
administration of intravenous feeding. Advances
(Continued on p. 48)
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The Canadian Nurse July 1977
already made such as ambulatory parenteral
nutrition are exciting and help to convince us that this
llfesaving technique is tnjiy a milestone in medicine.
The final part of this book includes techniques
supplemental to central parenteral nutrition. It is
disappointing to find that the chapter on peripheral
administration of isotonic lipids and amino acid
preparations is included in this section, rather than
as an alternative technique to central venous
feeding. The importance of including fat in the diet is
stressed. Elemental diets or more commonly called
"space diets" are fast becoming an accepted and
popular supplement to central parenteral nutrition,
as we stnjggle to feed our patients via the normal
route of ingestion. Complications of elemental diets
make us aware of the need for more research in this
area.
I do recommend this book as an excellent
source of reference in this field. The illustrations
and in depth presentations are designed to teach
those seeking more understanding of parenteral
nutrition.
Bedside Diagnostic Examination Srd
edition, by Elmer E. DeGowin and Richard L.
DeGowin. 952 pages. New York, MacMillan
Publishing Company, Inc., 1976. Canadian
Agent: Collier MacMillan Canada Limited,
Toronto.
Approximate price $12.95
Reviewed by Rene A. Day, Assistant
Professor, Faculty of Nursing, University of
Alberta. Edmonton, Alberta.
As the title suggests, this text is designed to
prepare the medical clinician to use history taking,
physical examination and lab tests to arrive at a
diagnosis. However, the book can certainly be used
by nurses involved in physical assessment.
The first three chapters provide a thorough
introduction to the physical examination and stress
the importance of obtaining a good history. The four
basic skills of inspection, palpation, percussion and
auscultation are very well presented.
Two types of examinations are described; the
screening examination of clients presumed to be
well and having no symptoms, and the diagnostic
examination to find a disease that is causing
discomfort or dysfunction. Examples are given
illustrating the order for performing physical
examinations in different settings, i.e., beginning
with the client sitting as in a clinic setting versus
beginning with the client lying in bed as in a hospital
setting. These two examples are of real benefit to
nurses in helping to organize all the components of
the examination into an integrated whole that will be
most effective and least tiring for the client.
The remainder of the book describes each body
system, reviewing the anatomy and physiology,
pertinent information to be collected in the history,
and the specific techniques of the examination. An
important feature of the book is the inclusion of sixty
key symptoms or common complaints and a list of
possible causes of each. Small hand drawn
diagrams throughout help to clarify the written
material. The final chapter is an alphabetical
summary of common disease conditions with
definitions, signs and symptoms, and lab results.
This book would not be suitable as the first or
only reference for nurses learning physical
assessment; it is too detailed and complex. A good
knowledge of medical terms and/or a medical
dictionary is required. Basic understanding of
anatomy and physiology and the related sciences is
assumed by the authors. It is not a book to be studied
from cover to cover. Rather, it provides an excellent
reference for information about assessment of
specific body systems, disease conditions and key
symptoms. Because the focus is diagnosis, the book
would be a valuable resource to aid any nurse who is
in a position to make decisions about the need to
refer clients to physicians.
Right and Reason: Ethics in Theory and
Practice 6th ed. by Austin Fagothey, 484
pages. The C.V. Mosby Company, St. Louis
1976. Approximate price $13. 15
Reviewed by Ina Watson, Associate Professor
of Nursing, College of Nursing, University of
Saskatcfiewan, Saskatoon, Saskatchewan.
This book is the sixth edition of Right and
Reason written by Father Fagothey. It was
written with the young college student foremost in
mind. The purpose is to present major philosophical
theories to enable the individual to establish, orto be
able to defend, positions on ethical and moral
questions.
The fi rst half of the book deals with major topics
such as ethics, responsibility, pleasure, intuition,
reason. The emphasis in the second half is on the
dignity of the human person — such subjects as
government, education, health, and war and peace
are discussed.
There are thirty-seven units in the book. Each
unit follows the same pattern. The problem is stated ;
arguments pro and con are presented; a summary,
and questions for discussion are provided. The units
are wntten in a logical manner and in ordinary
language. The summaries are of particular interest
as it is here and in the conclusions that the
convictions of the author come through. These-
convictions are stated clearly and concisely, and the
reader will be challenged to think in a logical manner
about individual ethical and moral values.
Several of the units are of particular interest to
the profession of nursing. The unit on Health
discusses the problem of man's stewardship over
himself. Questions discussed are:
— When may a man risk his life?
— How much care must be given to health?
— Are mutilation and sterilization justified?
It would be helpful if the units on Society-Family
and Sex were read together. In these units many
questions are discussed: why men live in society and
what society is; marriage as a natural or
conventional institution; and the place of love and
sex in marriage.
Although the audience for this book is the young
adult, it is timely and interesting reading for all age
groups. It is not a book that will be read at one or two
sittings. It is a book to be taken in small bites,
digested then resumed.
Clinical Anatomy and Physiology for Allied
Health Sciences by Paul D. Anderson,
Toronto, W.B. Saunders Co., 1976.
Approximate price: $11.85
Reviewed by Jean W. Spalding, Chairman,
Nursing Program, Toronto East General
Campus, Centennial College. Scarborough,
Ontario.
The positive features of this textbook for
students in allied health sciences are
numerous. It is written in a style that is readily
comprehended, at a level for beginning students in
this field. When additional information is available on
any subject, the source is clearly identified. The
diagrams and tables are excellent. Some
information is included in the clinical implications of
the disease process, which is usually an area of
considerable interest for students and can be
utilized as a positive teaching resource. The outlines
at the conclusion of each chapter provide a good
source for review, and the questions provide
assistance for self-directed learning. The glossary,
prefixes, and suffixes are also valuable aids to assist
the student to comprehend this subject.
Each chapter includes significant information.
Chapter I on the Human Organism presents very
complex information that is written with clarity, and
can be readily understood by beginning students.
Chapter II on Radiologic Health is the introduction of
current information, a valuable addition in this text.
Information on Fluids, Electrolytes and Acid-Base
Balance is placed in each chapter in the appropriate
physiological context. It would add to the value of
this text to have a chapter devoted to th is information
because of the difficulty many students encounter in
understanding this material and its significance in
clinical experience.
If this textbook is to be used as a textbook for
nursing students in a diploma nursing program,
there are some omissions and areas that need an
increased amount of information to provide the
student with the necessary background for
decision-making and clinical experience.
Some of the areas that require an increase in
depth are:
• In the Voluntary Nervous System the accurate
identification of the areas of decussation of the major
ascending and descending tracts of the spinal cord
should be included.
• The significant cranial nerves should include
the origin, the pathway, the termination and the
function.
• In the clinical manifestations of the Respiratory
System, it would seem necessary in today's society
to Include significant data on cigarette smoking in
relationship to health and disease.
• Chapter 18 on Digestion and the Alimentary
Tract would benefit from increased information on
the teeth, the duct system of the biliary apparatus
and the physiology of the liver.
• Chapter 20. The female reproductive system is
in insufficient detail to provide a thorough
background of normal anatomy and physiology for
gynecological and obstetrical nursing.
These comments are not meant to indicate a
strongly negative impression of this textbook. I feel
that students should use more than one text for
information, and schools have libraries for such a
purpose.
It was a good experience for me to read this text;
I feel it has good potential for use an a text in the
health sciences field.
Library Update
Publications recently received in the Canadian
Nurses Association Library are available on loan —
with the exception of items mari^ed 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 Intertibrary Loan
only.
Requests for loans, maximum 3 at a time,
should be made on a standard Interlibrary Loan form
or by lettergiving author, title and item number in this
list.
If you wish to purchase a book, contact your
local bookstore or the publisher.
Books and documents
1 . Alpert, Joseph S. fvlanual of coronary care, by...
and Gary S. Francis. Boston, Little, Brown and Co.,
C1977. 142p.
2. American Nurses' Association. Economic and
General Welfare Department. Sample contract
items for local units. Kansas City, Mo., 1976. 54p.
3. Annuaire de statistiques sanitaires mondiales.
Vol. 2, Maladies infectieuses: cas, d^c^s et
vaccinations 1973-1976. Geneve, Organisation
The Canadian Nurse July 1977
mondiale de la Sant6, 1976. 1v. 303p.
4. Association des Hopitaux du Canada. Revue
statlstigue des hOpitaux du Canada 1977, par John
Crysler. Toronto, 1v. 1p.
5. Baly, Monica E. Professional responsibility in the
community health services. Aylesbury, Eng., HM &
M, C1975. 95p.
6. Bergeref, J. Abr6g6 de psychdogie
pathologique, theorique et clinique. Paris, Masson,
1976. 325p.
7. Blanc, Daniel. Foie. voles blliaires et chirurgie
digestive, par... J.-L. Preel et J.-M. Hay, Paris,
Masson, 1977. 101 p.
8. Bower, Fay Louise. The process of planning
nursing care; a model for practice. 2ed. St. Louis,
Mosby, 1977. 153p.
9. Brown, Amoid. Physiological and psychological
considerations in the management of strol<e. St.
Louis. Green 1976. 83p.
10. Burrell, Zeb L. Critical care, by... and Lenette
Owens Burrell. 3ed. St. Louis, Mosby, 1977. 427p.
1 1 . Busse. Eward W. Behavior and adaptation in
late life. 2ed. Edited by... and Eric Pfeiffer. Boston,
Little, Brown 1977. 382p.
12. Campbell, Helen. Mary Lambie; a biography.
Wellington, New Zealand Nursing Education and
Research Foundation, 1976. lOOp. R
13. Conway, Barbara Lang. Pediatric neurologic
nursing. St. Louis, Mosby 1977. 361 p.
14. Canadian Hospital Association. Canadian
hospital statistical review 1976. prepared by John
Crysler. Toronto, Canadian Hospital Association,
1977. 175p.
15. Cohn, Victor. Sister Kenny. The woman who
challenged the doctors. Minneapolis, University of
Minnesota Pr., 1975. 302p.
16. Couture-Chartrand, Jeannine. L'archivistique
medical. Montreal, Editions Intermonde, c1975.
101 p.
1 7. Current issues and strategies In organization
development, edited by W. Warner Burl<e. New
York, Human Sciences Press 1977. 448p.
18. Deblock, Nic J.I. Elsevier's dictionary of public
health: in six languages, English, French, Spanish,
Italian, Dutch, and German compiled and arranged
on an English alphabetical basis. Amsterdam,
Elsevier Scientific Pub. Co., 1976. 196p. R
1 9. De Blois, Stella. Cours de pharmacologie a
fusage des infirmieres, par... et Marguerite Potvin,
36d. Quebec, Presses de runiversit6 Laval, 1974.
279p.
20. Directory of international statistics. New York,
United Nations, 1975. 1v. 296p. (UN Statistical
papers series M No. 56) R
21 . Downs, Florence S. A source book of nursing
research, ed. 2 compiled by... and Margaret A.
Newman. Philadelphia, Davis, c1977. 200p.
22. Falconer, Mary W. Aging patients; a guide for
their care, by... Michael V. Altamura and Helen
Duncan Behnke. New York. Springer, c1976. 276p.
23. Grissum, Marlene. Womanpower and health
care, by. . . and Carol Spengler. Boston, Little, Brown
and Co., c1976. 314p.
24. Health and development, edited and presented
by Kevin M. Cahill, Maryknoll, N.Y., Orbis Books,
C1976. 101 p.
25. Health research: the systems approach, edited
by Harriet H. Werley et al. New York, Springer,
C1976. 330p.
26. Hepworth, H. Philip. Canadian day care
standards 1976. Ottawa Canadian Council on
Social Development 1976. 48p.
27. — . Services for abused and battered children.
Ottawa, Canadian Council on Social Development,
C1975. 90p.
28. International Symposium on Circumpolar
Health, 3d, Yellowknife, Northwest Territories. Can.,
1974. Circumpolar health. Proceedings of..., edited
by Roy J. Shephard and S. Itoh. Toronto, University
of Toronto Press for Health and Welfare Canada,
C1976. 678p.
(Continued on p. 50)
CURITY
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& More Effective Catheterization
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From A Superior Matericil
i.T-j«ni.in»ii:iin»;Yir«fiTiTJg»:[
ie supenor rjenormance or t
Catheter is readily apparent when compared with devices <
other materials. Smoother and more pliable than latex or coaiea
latex, it discourage^the encrustation of urinary salts in the
drainage lumen. And because there is less clogging encrustation,
drainage is improved while infection risk and patient irritation are
reduced ... all removing the need for frequent catheter changes.
In addition, the silicone material enables the construction of a thin
but strong outside wall and a large drainage lumen. This results
in a greater flow rate and enables clots to be more easily expelled.
From every point of view, the Curity 100 ' Silicone Foley
Catheter is the logical choice. Your Kendall representative can
provide full details.
KenoAU
Innovators In Patient Care
KENDALL CANADA 6 CURITY AVENUE
TORONTO. ONTARIO M4B 1X2
The Canadian Nurse July 1977
(Conlinued from p. 49)
29. Jones, Bruce V. e6. Jones' animal nursing. Rev.
2ed. Edited by R.S. Pinniger. Oxford, Pergamon Pr.,
C1976. 496p.
30. Kilpatrick, S. James. Statistical principles in
health care information. Baltimore, University Park
Pr., C1973. 228p.
31 . Kogan, Benjamin A. Health; man in a changing
environment. New York, Harcourt Brace
Jovanovich, c1970, 1974. 790p.
32. Laycock, Samuel Ralph. Sexuality et Education
familiale. Traduit de I'anglais. Ottawa, Novalis,
C1969. 151 p.
33. McWhinnie, John R. Health field indicators:
Canada and provinces, by... Barbara J. Ouelletand
Jean-Marie Lance. Ottawa, Dept. of National Health
and Welfare, Long Range Health Planning Branch,
1976. 98p.
34. Medical and health annual 1977. Toronto,
Encyclopaedia Britannica, c1976. 447p.
35. Methodology in social research. Edited by
Hubert M. Blalock Jr., and Ann B. Blalock. New York,
McGraw-Hill, c1968. 493p.
36. Metrot, Jacques. Le secourisme; savoir pour
agir, par... et Xavier Emmanuelli. Paris, Chancerel,
c1976. 91 p.
37. Mitchell, Pamela Hotsclaw. Concepts basic to
nursing. 2ed. New York, McGraw-Hill, 1977. 575p.
38. National League for Nursing. People, power,
politics for health care. Papers presented during a
conference of the Northwest Regional Assembly of
Constituent Leagues for Nursing in Washington,
DC, on April 8 and 9, 1976. New York, c1 976. 88p.
(NLN Publication number 52-1647)
39. — . Dept. of Diploma Programs. Toward
excellence in nursing education; a guide for
diploma school improvement 3ed. New York,
C1971, 1977. 58p. (NLN Publication number
16-1656)
40. — . Division of Nursing. Co//aboraf/on for qua//fy
health care: education of beginning practitioners of
nursing and utilization of graduates. Papers
presented during four regional conferences
1975-1976. New York, c1977. Hip. (NLN
Publication number 14-1654).
41 . Navarro, Vincente. Medicine under capitalism.
New York, Prodist, c1976. 230p.
42. Nurse, Gaynne. Counselling and the nurse; an
introduction. Aylesbury, Eng., HM & M, c1975.
109p.
43. Payne, Beverly C. The quality of medical care:
evaluation and improvement. Chicago, Hospital
Research and Education Trust, c1976. 157p.
44. Peitchinis, Jacquelyn A. Staff-patient
communication in the health services. New York,
Springer, c1976. 165p. R
45. The planning of change, edited by Warren G.
Bennis et al. 3ed. New York, Holt, Rinehart and
Winston, C1976. 517p.
46. Powell, Mary. Orthopaedic nursing. 7ed.
Edinburgh, Churchill Livingstone, 1976. 635p.
47. The practice of emergency nursing, by James
H. Cosgriff and Diann Laden Anderson.
Philadelphia, Lippincott, c1975. 488p.
48. Proceedings of the Information Broker,
Free-Lance Librarian; New Careers, New Library
Services Workshop held at Drumlins, Syracuse,
New York, Apr. 3, 1976. Syracuse, NY., School of
Information Studies, Syracuse University, 1976.
30p.
49. Quality control and performance appraisal,
volume two; a reader consisting of eight articles
especially selected by The Journal of Nursing
Administration editorial staff. Wakefield, Ma.,
Contemporary Pub., 1976. 48p.
50. Remen, Naomi. The masculine principle, the
feminine principle and humanistic medicine. San
Francisco Institute for the Study of Humanistic
Medicine, c1975. 105p.
51. Robinson, Corinne Hogden. Normal and
therapeutic nutrition, by... and Marilyn R. Lawler.
15ed. New York, Macmillan, c1977. 739p.
52. Rolstin, Hilda. The Hospital for Sick Children,
School of Nursing, Toronto, written by... for the
Alumnae Association. Toronto, 1972. 94p. R
53. Skydell, Barbara. Diagnostic procedures; a
reference for health practitioners and a guide for
patient counselling, by... and Anne S. Crowder.
Boston, Little, Brown and Co., c1976. 248p.
54. Smith, Genevieve Waples. Care of the patient
with a stroke; a handbook for the patient's family
and the nurse. 2ed. New York, Springer, c1976.
166p.
55. Stevens, Barbara J. First-line patient care
management Wakefield, Ma., Contemporary Pub.,
C1976. 182p.
56. Storrs, Alison N.F. Geriatric nursing. London,
Ballifere Tindall, c1976. 229p.
57. Taber's cyclopedic medical dictionary. 1 3ed.
Edited by Clayton L. Thomas. Philadelphia, Davis,
C1977. 1v. (various pagings) R
58. Wales, LaRae H. A practical guide to
newsletter editing & design; instructions for printing
by mimeograph or offset for the inexperienced
editor Ames, Iowa, Iowa State University Pr. c1 976.
51p.
59. Walter, Stephen D. Methodological
developments in the use of attributable fraction for
health priorities and strategies in Canada, Ottawa,
Long Range Health Planning Branch, Health and
Welfare Canada, 1976. 116p.
60. Warwick, Donald P. The sample survey, theory
and practice, by... and Charles A. Lininger, New
York, McGraw Hill, 1975. 344p.
61 . Webster, George. The law of associations; an
operating legal manual for executive and counsel.
New York, Matthew Bender, 1 976. 1 v. (loose-leaf) R
62. White, Donald K. Continuing education in
management for health care personnel: a second
opinion. Chicago, Hospital Research and
Educational Trusts, c1975. 54p.
63. Williams, Sue Rodwell. Nutrition and diet
therapy. 3ed. St. Louis, Mosby, 1977. 723p.
64. Wilson, Margaret A. Equivalency evaluation in
development of health practitioners. Thorofare, N.J.
Slack, C1976. 146p.
65. Wing, A.J. The renal unit, by... and Mary
Magowan. Toronto, Lippincott, 1975. 281 p.
66. Women: their use of alcohol and other legal
drugs; a provincial consultation — 1975, edited by
Anne MacLennan. Toronto, Addiction Research
Foundation of Ontario 1 976. 1 44p.
67. World health statistics annual. Vol. 1. Vital
statistics and causes of death, 1973 - 1976.
Geneva, World Health Organization, 1976. 839p.
68. World health statistics annual. Vol. 2. Infectious
diseases; cases, deaths and vaccinations, 1973 -
1976. Geneva, World Health Organization, 1976.
303p.
69. World health statistics annual. Vol. 3. Health
personnel and hospital establishments, 1973 -
1976. Geneva, World Health Organization, 1976.
340p.
Pamphlets
70. Alberta Association of Registered Nurses.
Position statement on professional nursing
practice. Edmonton, 1974. 4p.
71. American Nurses Association. Division on
Psychiatric and Mental Health Nursing Practice.
Statement on psychiatric and mental health nursing
practice. Kansas City, Mo., c1976. 30p.
72. Canadian Association of University Teachers.
Handbook of lobbying. Ottawa, 1976, 1v. (various
pagings)
73. Dussault, Ren6. La r^forme des professions au
Quebec, par... et Louis Borgeat. Quebec ville, Office
des Professions, 1975. 44p.
74. Groupe de travail pour 6tudier les programmes
de d6pistage du cancer du col de I'ut^rus. Le
d^pistage du cancer du col uterin. Rapport du
Groupe... constitu6 ci la demande de la Conference
des sous-ministres de la Sant6. Montreal, Tir6 ci part
de I'Union M6dicale du Canada, juillet 1976.
995-1047p. President du groupe: R.J. Walton.
75. Hill, Gerry B. Dynamic models of health care
systems. Ottawa, Long Range Health Planning
Branch, Health and Welfare Canada, 1977. 24p.
76. National League for Nursing. Council of
Associate Degree Programs. From student to
worker: the process and product Papers
presented in New York City, May 24-26, 1976,
during a workshop entitled "From Student to
Worker: the Process and Product. New York,
C1976. 43p. (NLN publication number 23-1657)
77. — . Council of Home Health Agencies and
Community Health Services. Why experiment with
health care delivery. Papers presented at the
annual meeting Mar. 17-19, 1976, Washington,
D.C. New York, c1976. 40p. (NLN publication
number 21-1651)
78. — . Division of Research. Nurse-faculty 1976.
New York. 1977. 15p. (NLN publication number
19-650).
79. Registered Nurses Association of British
Co\umb\a. Annual report 1976-1977. Vancouver,
1977. 36,T
80. Saltman, Jules. Drinking on the job; the
$15-billion hangover. New York, Public Affairs
Committee, c1977. 28p. (Public affairs pamphlet
number 544)
81 . Work Group for the Formulation of Community
Nursing Standards, Sept. 27-Oct. 8, 1976. Port of
Spain, Trinidad. Final report. Caracas, Venezuela,
Pan American Health Organization, Pan American
Sanitary Bureau, Regional Office of the World
Health Organization, 1976. 17p.
82. Wynn, Margaret. Prevention of handicap of
perinatal origin; an introduction to French policy
and legislation, by... and Arthur Wynn. London,
Foundation for Education and Research in
Child-Bearing, 1976. 32p.
Government documents
Canada
83. Commission du Syst6me M6trique. Bureau
National de R6dacteurs & la Pige. Liste des
rMacteurs a la pige des m^dia imprimes et
6iectroniques quisontabonnes au bureau. Ottawa,
1977. 31 p.
84. Conseil canadien des relations du travail.
Rapport 1975-76. Ottawa. 1v. (various pagings)
85. Conseil du Tr6sor. Manuel de gestion du
personnel. Supplement de la legislation sur le
personnel, Ottawa, 1976. 1v. (various pagings)
86. Labour Relations Board. Report 1975/76.
Ottawa, Minister of Supply and Services Canada,
1976. 1v. (various pagings)
87. Health and Welfare Canada. Departmental
Library Services. Rehabilitation and the
handicapped; a layman's guide to some of the
literature — a bibliography, by . . . in collaboration with
the Social Services Programs Branch. Ottawa,
1976. 184p.
88. Laws, statutes etc. Citizenship Act S.C. 1976,
c.108, Ottawa, Queens Printer, 1976. 22p
89. — . Quarantine act. Office consolidation. R.S.,
C.33 (IstSupp.) amended by 1974-75-76, c.97 and
quarantine regulations established by P.C.
1971-2818 amended to P.C. 1976-2785. Ottawa,
Supply and Services, 1977. 31 p.
90. Lois, statuts etc. Loi sur la citoyennete. S.C.
1976 c.108. Ottawa, Imprimeur de la reine, 1976.
22p.
91. — . Loi sur la quarantaine. Codification
administrative. S.R. c.33 (ler Supp.) modifie
1 974-75-76, c.97 et le rfeglement sur la quarantaine
etabli par C. P. 1 971 -281 8 modifie ^ C. P. 1 976-2785.
Ottawa, Approvisionnements et Services, 1 977.
31 p.
92. Metric Commission. National Freelance Writers
Bureau. Print and broadcast freelance subscriber.
Ottawa, 1977. 31 p.
93. Secretaire d'Etat. Programme de Promotion de
la Femme. Annuaire canadien des groupes de
The Canadian Nurse July 1977
femmes, 2ed. Ottawa, Approvisionnements et
Services Canada, 1977. 200p.
94. Secretary of State. Women's Program.
Directory of Canadian women's groups, 2ed.
Ottawa. Supply and Services Canada, 1977. 200p.
95. Sant6 et Bien-fetre social Canada. Services de
la biblioth6que minist6rielle. Readaption des
handicapes: guide populaire et bibliographie
selective, par... en collalxsration avec la Direction
des Programmes de services sodaux, Ottawa,
1976. 184p.
96. — . Sexuality et adolescence; guide pour un
professeur. Ottawa. 1976. 6 pts. in 1.
97. Treasury Board. Personnel management
manual. Personnel legislation supplement. Ottawa,
1976. 1v. (various pagings)
United States
98. Dept. of Health, Education, and Welfare. Center
for Disease Control. Sfate legislation on smoking
and health 1976. Atlanta, Ga., National
Clearinghouse for Smoking and Health, 1976. 73p.
(DHEW Publication number (CDC) 77-8331)
99. Division of Nursing. The doctorally prepared
nurse. Report of two conferences on the demand
for and education of nurses with doctoral degrees.
Bethesda, Md., 1976. 104p. (DHEW Publication
number (RRS) 76-18)
Studies deposited in CNA Repostory Collection
100. Boisclair, Laurent. Valeurs de travail des
hommes engages dans le nursing. Montr6al, 1969.
93p. Th6se (M.Nurs.) — 1969. R
101. Doucet, Th6r6se. Les besoins relatifs aux
activit6s de la vie quotidienne Chez des jeunes
adultes malades mentaux. Montreal, 1973. 78p.
Th6se (M.Nurs.) — IVIontr6al. R
102. Hazlett, C. Employment opportunities for
nurse practitioners in Alberta. A report submitted to
the University of Alberta Ad Hoc Committee on
Employment Opportunities for Nurse Practitioners,
by...S.StinsonandJ. Moore, Edmonton, 1977.46p.
R
103. Rosen, Ellen F. A study of the expressed
concerns of an obstetrical patient experiencing a
long term hospital stay. London, 1 974. 83p. Thesis
(M.Sc.N.) Western Ontario. R
1 04. A study of patient requirements for nursing
care. Final report. Vancouver General Hospital,
1977. 59p. Research director: Ruth Robinson.
Advisory Committee for the Nursing Manpower
Study. R
1 05. Winsor, Ina Veldor. A study of the validity of
the psychological corporation entrance
examination for schools of nursing as a selection
tool and predictor of success for nursing
candidates. St. Johns, 1974. 83p. Thesis (M.Sc.N.)
— Memorial University. R
Audio-visual Aids
106. Association des m6decins de Langue
frangaise du Canada. Sonomed, serie 3. no. 11.
Montreal, 1973. 1 cassette. Contents: — C6t6A. La
dyspareunie, — La frigidity et le dysfoncfionnement
orgasmique. — C6t6 B. L'infertilit6.
107. — . Sonomed, sene 3, no. 72. Montreal, 1973.
1 cassette. Contents. — C6t6 A. Le diab^te. —
Indications et effets secondaires des anabollsants.
— C6t6 B. — La c6phal6e migraineuse.
1 08. Educational Film Distributors. Film catalogue,
Toronto, 1976. 1v.
1 09. Library research: the nursing indexes.
(Filmstrip) New York, American Journal of Nursing
Co., 1 976. 4 rolls col. and 4 audio cassettes 20 mins.
Contents. — Overview. — Nursing Studies Index.
International Nursing Index. — Cumulative Index to
Nursing Literature. R
1 1 0. L'office de la telecommunication Education de
I'Ontario. La boite TVO. Toronto, VIPS/OTEO,
1975. 1v. (loose-leaf)
West Coast Opportunity
Director, Nursing Service Division
A challenging opportunity exists for an individual with strong
management skills to assume full responsibility for the Nursing
Service Division of a Hospital in Vancouver, B.C.
The hospital, which consists of approximately 500 beds, is a fully
accredited acute care teaching hospital functioning as a Regional
Referral Center.
Applicants must have a Masters Degree in Nursing, a record of
successful experience as a senior Hospital Nursing Manager, and
the capacity to provide professional leadership and to share in the
decision-making process as part of the senior hospital
management team.
Applicants should be familiar with innovative approaches to the
provision of nursJng service and be interested in working in a
progressive and stimulating environment.
The salary, with an attractive fringe benefits program, will be of
interest to those currently in the $27,000-$28,000 range.
Reply in confidence, giving full personal details, to W. F. Forrest.
Woods, Gordon & Co.
MANAGEMENT CONSULTANTS
BOX 10101, PACIFIC CENTRE.
700 WEST GEORGIA STREET
VANCOUVER. B C. V7Y 1C7
A member of the Canadian Association of Management Consultants
AN
OPEN
INVITATION
FROM
FORT WORTH
TEXAS
To our Canadian colleagues to
obtain some more experience in
nursing — American Nursing Its
different, more relaxed and very
challenging. We w/ould like you to
have an insight into our way of
doing things.
The Tarrant County Hospital Dis-
trict is located In the Ft Worth-
Dallas area, the center of exciting
Texas living and will astonish you
with Its wealth of entertainment,
restaurants, theaters, concerts,
museums, rodeos, parks, etc.
Only hours away from the Gulf of
Mexico, Las Vegas, New Orleans,
and Mexico. The Tarrant County
Hospital District is a progressive
450-bed county teaching hospi-
tal dedicated to complete
community care: it offers the op-
portunity to see a total picture of
American medicine. The hospital
provides an extensive orientation
to the American way of nursing
and the American way of life
through an especially prepared
"acclimatization' program de-
signed for our Canadian col-
leagues. Reciprocity in the state
of Texas is dependent on a score
of 350 points on the final SRN ex-
amination in English only or for
the Board eligible. For those who
qualify for employment, we will
provide temporary housing, lib-
eral salaries, holidays, and an
emergency medical plan.
Interviews will be held during the
months of August and September,
so contact us for information and an
application.
Write to:
George R. Jennings
Director of Personnel
Tarrant County Hospital District
1500 S. Mam
Fort Worth, Texas 76104 USA.
The Canadian Nurse July 1977
Cla.s.sified
AdviM'l l.si»iiii»ii<.s
British Columbia
British Columbia
United States
Psychiatric Head Nurse required for a 16-bed Psychiatric Unit
located m the Northwest of B.C- R.N.AB.C. contract is m effect.
Qualifications: Must be eligible for registration in B.C. Previous Head
Nursing experience essential. Baccalaureate degree preferable. Ap-
ply rnwnting to: Mrs. F.Quackenbush. R.N. .Director of Nursing. Mills
Memonal Hospital. Terrace. British Columbia. V8G 2W7
Operating Room Nurse required for an 87-bed acute-care hospita'
located in Northern B,C R.N.A.B.C contract is in effect. Residence
accommodations available. Apply in wnting to; Mrs. F. Quackenbush.
R.N., Director of Nursing, Mills Memonal Hospital, Ten-ace. Bntish
Columbia, V8G 2W7.
Experienced Nurses (eligible for B.C. registration) required tor
409-bed acute care, teaching hospital located m Fraser Valley, 20
minutes by freeway from Vancouver, and within easy access of
vanous recreational facilities. Excellent onentation and continuing
education programmes. Salary: S1 184.00 to $1399.00 per month.
Clinical areas include Medicine. Surgery, Obstetrics, Pediatrics,
Coronary Care, Hemodialysis. Rehabititation, Intensive Care,
Emergency. Apply to; Nursing Personnel. Royal Columbian Hospital,
New Westminster. British Columbia. V3L 3W7.
Registered Nurses — required immediately for a 340-bed accredited
hospital in the Central Interior of B.C. Registered Nurses interested in
nursing positions at the Prince George Regional Hospital are invited to
make inquiries to Director of Personnel Services. Pnnce George
Regional Hospital, 2000 - 15th Avenue, Pnnce George, Bntish Col-
umbia, V2M 1S2.
Experienced General Duty Nurses required for 134-bed hospital.
Basic Salary $1,122 -Si. 326 per month Policies in accordance with
R.N-A.B.C Contract. Residence accommodation available. Apply in
wnting to: Director of Nursing. Powell River General Hospital. 5871
Arbutus Avenue, Powell River, British Columbia, V8A 483.
Manitoba
Director of Nursing for new 32-bed Heafth Centre, 1 2 acute and 20
personal care bed. in Boissevain, Manitoba. Qualifications: must be
eligible for registration in Manitoba, Preference given to applicants
witti university preparation in nursing or nursing administrative ex-
perience. Salary in accordance with Manitoba Health Services Com-
mission allowance. Position open July 1 5. 1977. Apply in writing giving
resume to: Ms H, Fletcher, Administrator, Boissevain Health Centre,
Box 899, Boissevain, Manitoba. ROK OEO.
Ontario
Help Wanted — Supervisor Pubic Health Nursing required for a
generalized Public Health Nursing Programme. Degree in Nursing
Saence preferred, generous fringe benefits, salary commensurate
with experience and qualifications. Forward resume to: Miss E.L.
Flaxman. Director, PubSc Health Nursing, Haliburton, Kawartha. Pine
Ridge Distnct Health Unit. P.O. Box 337, Cobourg, Ontario, K9A4K8.
Registered Nurses — Florida and Texas — Immediate hospital ope-
nings in Miami. Fort Lauderdale, Palm Beach and Stuart, Florida and
Houston, Texas. Nurses needed for Medical-Surgical. Critical Care.
Pediatrics, Operating Room and Orthopedics. We will provide the
necessary wori< visa. No fee to applicant. Medical Recnjiters of Ame-
rica. Inc., 800 N.W. 62nd St., Fort Lauderdale, Florida 33309, U.S.A.
(305) 772-3680.
Come Soutti! Warmth & Beaches — Mild Winters. We represent
hundreds of clients that are seeking Canadian nurses to join their staff.
These situations are vaned, and income levels are excellent up to
$14,000 (U.S.) for ICU/CCU supervisors; $13,500 for shift super-
visors, and up to $1 2,000 for general duty staff nurses. Situations may
require state licensure exam: however, temporary permits are availa-
ble without examination. Our fee is paid and H-1 Visa assistance
provided. For complete details send your resume and full particulars
to: Medical Search, 3274 Buckeye Road, Atlanta, Georgia. 30341.
(404) 458-7831.
Registered Nurses Needed — 114-bed Joint Commission approved
hospital located in Sardis, Mississippi. Ideal climate with large recrea-
tional area nearby and large metro area 72 km. away. Competitive
salary and benefits, with relocation loan available. Contact: Jeanna
Harris, R.N., Assistant Director of Patent Care Sen/ices, North
Panola Regional Hospital, P.O. Drawer 160, Sardis, Mississippi,
38666
Positrons Vacant — Registered Nurses required for a 16-bed
Psychiatric Unit located in Northwest B.C . opening in June 1977
Psychiatnc training or expenence essential RNABC contract is in
effect. Apply m wnting to: Mrs. F. Quackenbush. R.N., Director of
Nursing, Mills Memonal Hospital. 4720 Haughland Ave., Terrace.
Bntish Columbia. V8G 2W7.
General Duty Nurses for modern 35-bed hospital located in south-
ern B C s Boundary Area with excellent recreation fadlilies Salary
and personnel oolfaes in accordance with RNABC. comfortable
Nurse s home. Apply. Director of Nursing, Boundary Hospital, Grand
Forks, Bntish Columbia, VOH 1H0.
RN or RNA, 57 ' or over and strong, without dependents, to care for
160 pound handicapped executive with stroke. Live-in, U yr. in To-
ronto and Vi yr. in fTiami. Preferably a non-smoker. Wage: $200.00 to
$220.00 weekly NET, depending on experience plus Miami borius.
Send resume to: M.D.C.. 3532 Eglinton Avenue West, Toronto, On-
tano, M6M 1V6.
Public Health Nurse (qualified) required for generalized program in
Ontanos vacationland. Allowance for degree in nursing and usual
fringe tienefits. Apply to; Director of Nurses, Muskoka-I^rrv Sound
Health Unit, P.O. Box 1019, Bracebridge, Ontario, POB ICO.
Nurses — BNs — Immediate Openings in Florida — California —
Ar1(ansas — If you are expenenced or a recent Graduate Nurse we
can offer you positions with excellent salaries of up to $1300 per
month plus all benefits. Not only are there no fees to you whatsoever
for placing you, but we also provide complete Visa and Licensure
assistance at also no cost to you. Wnte immediately for our application
even if there are other areas of the U.S. that you are interested in We
will call you upon receipt of your application in order to arrange for
hospital interviews. Windsor Nurse Placement Service, P.O. Box
1133, Great Neck, New Yort< 11023. (516-487-2818)
Nursing
Instructors
and
Public Health
Nurses
Are needed to work
in AFRICA
Sierra Leone — Tutor to teach State
Enrolled Community Health Nurses and a
Public Health Nurse to promote a Nutrition
Health Programme for pre-school children in
60 State Clinics.
Ghana — Tutor to teach Medical-Surgical
Nursing to students of 3 year SRN
programme.
For more information, please contact:
CUSO Health — 14
151 Slater Street
Ottawa, Ontario
KIP 5H5
Quebec
Registered Nurse required beginning of September 1977 in Co-ed
Boarding School in country. Applicant must live-in and share duties
with another resident nurse. Apartment with maid service provided.
Excellent working conditions. Liberal holidays. Applications stating
qualifications and experience to: Comptroller, Bishop's College
School. Lennoxville. Quebec, JIM 1Z8.
Australia
We have many vacanaes for Registered Nursing Sisters and other
para-medical staff. For details please wnte to: Hospital Staff
Agency, 388 Bourke Street, Melbourne, Victoria 3000. Australia.
United States
Registered Nurses — Dunhill, wrth 200 offices in the U.S.A., has
exciting career opportunities for both new grads and experienced
R.N.s. Send your resume to: Dunhill Personnel Consultants, No. 806
Empire Building. Edmonton, Alberta. T5J 1V9. Fees are paid by
employer.
HEAD NURSE
INTENSIVE CARE
UNIT
Applications for the above position are
now being accepted by this 300 bed fully
accredited General Hospital. We offer an
active Staff Development Programme,
Competitive Salaries and Fringe Benefits
based on Educational bac(<ground and
experience.
Apply sending complete resume to:
Director of Personnel
Stratford General Hospital
Stratford, Ontario
N5A 2Y6
The Canadian Nurse July 1977
ASSOCIATE
DIRECTOR
OF NURSING
Applications are invited for the position of Associate Director of
Nursing in a 500 bed accredited general hospital.
THE POSITION:
As a member of the Nursing Administration team, this position
requires a nurse with innovative qualities and ability to organize,
delegate, and direct the work of others.
The applicant must have an enthusiasm for initiating and following up
new ideas, projects and programmes.
MINIMUM QUALIFICATIONS;
Must be currently registered in the Province of Ontario. Preference will
be given to candidates with a B.Sc.N. and experience in Hospital
Administration.
Apply In writing to:
Director of Personnel
Belleville General Hospital
Belleville, Ontario
K8N 5A9
LAMBTON COLLEGE
DIRECTOR, NURSING PROGRAMS
The diploma nursing program has approximately one
hundred full-time students. The program philosophy is
centered on the nursing process and the acceptance by
students of personal responsibility for their learning. Major
responsibilities of the Director include program evaluation
and development, ongoing student development, full
integration of an extensive learning resources complex as
a major teaching resource, and a continuing program of
staff development.
The Director reports to the Academic Vice President.
Salary is commensurate with the responsibilities of the
position. An advanced degree is preferable but successful
experience and demonstrated results as a nurse, teacher
and administrator are Important criteria. An Ontario
registration is mandatory.
Resumes should be submitted In confidence to the
Personnel Officer, Lambton College, Sarnia, Ontario,
NTT 7K4.
Make yourself at home
in Philadelphia. . .
Art. History. Good restaurants and theatre.
Universities. An active social life. They're
all here in Philadelphia. And so are we.
Temple University Hospital serves a large
urban community in the midst of the city.
It's a teaching hospital where a nurse can
really get involved. At Temple, a nurse's
life is anything but routine. And your life
after hours? That's up to you.
So if you're looking for a place to call
home, consider Temple. We're now
offering a Nurse Internship Program for
those nurses with no more than six
months' clinical experience. It
enables you to meet your 6
month clinical requirement for
transfertoSpecialCare
Units while you are working
Get in touch with
Ms. Judy May, Temple
University Hospital, 3401 North
Broad Street, Philadelphia, Pa. 19140. (215)
221-3152. We're an equal opportunity employer.
Temple University Hospital
NURSING EDUCATION CHAIRPERSON
required by
CARIBOO COLLEGE
RESPONSIBILITIES
Organization and administration of an education program leading
to nurse registration. Development and administration of a
curriculum which will make available to enrolled students a high
standard of nursing education. Acquisition, allocation and
development of faculty expertise. Establishment and maintenance
of relationships between community health agencies and the
nursing education program.
QUALIFICATIONS
Master's Degree or equivalent experience. Experience in
administration in nursing practice and/or education. Experience in
nursing practice of at least five years duration. Demonstrated
teaching atnlity. Eligibility for nursing registration in British
Columbia.
Cariboo College is a comprehensive community college located in
the British Columbia interior offering university transfer, career,
vocational and continuing education services. The Chairperson of
Nursing must provide leadership tor the Nursing Program, both
within the College and the supporting community health agencies.
Send applications with supporting resume to:
The Principal
Cariboo College
P. O. Box 860
KAMLOOPS, British Columbia
V2C 5N3
The Canadian Nurse July 1977
Associate
Executive Director
Applications are invited for the position of
Associate Executive Director, Canadian
Nurses Association, Ottawa.
Candidates must be members of the
Canadian Nurses Association, have a
master's degree or equivalent and have at
least five years' administrative
experience. Bilingualism an asset.
Interested applicants are asked to submit
their curriculum vitae, in confidence, to:
Executive Director
Canadian Nurses Association
50 The Driveway
Ottawa, Ontario
K2P 1E2
Advertising
rates
For All
Classified Advertising
SI 5.00 for 6 lines or less
S2.50 for each additional line
Rates for display
advertisements on request
Closing dale for copy and
cancellation is 6 weeks prior to 1st
day of publication month.
The Canadian Nurses Association
does not review the personnel
policies of the hospitals and agencies
advertising In the Journal. For
autheni'c information, prospective
applicants should apply to the
Registered Nurses Association of
the Province in which they are
interested in working.
Address correspondence to:
The Canadian Nurse
50 The Driveway
Ottawa, Ontario
K2P 1E2
^
UNITED STATES
OPPORTUNITIES
FOR REGISTERED NURSES
AVAILABLE NOW
IN CALIFORNIA
FLORIDA
MISSISSIPPI
NEW ORLEANS
TEXAS
WE PLACE AND HELP YOU WITH:
STATE BOARD REGISTRATION
YOUR WORK VISA
TEIVIPORARY HOUSING - ETC.
A CANADIAN COUNSELLING SERVICE
Phone: (416) 449-5883 OR WRITE TO:
RECRUITING REGISTERED NURSES INC.
1200 LAWRENCE AVENUE EAST, SUITE 301,
DON MILLS, ONTARIO MSA 1C1
j^/^/\r
NO FEE IS CHARGED
TO APPLICANT&
OPEN 7 DAYS A WEEK.
Director of Nursing
Applications are invited for the position of
Director of Nursing in a 22-bed active
treatment hospital. The town is located on a
major highway 85 miles northwest of
Edmonton.
This position carries responsibility for the
co-ordination direction and supervision of the
activities of all nursing service departments.
Applications should be in writing including
age, qualifications and experience, with
references and date of availability.
Salary commensurate with qualifications and
experience.
Please apply to:
Administrator
Mayerthorpe General Hospital
Mayerthorpe, Alberta
TOE 1N0
Applications for tlie
position of
Supervisor
Operating Room and
Recovery Room
are now being accepted by this
300 bed fully accredited hospital.
We offer an active staff
development programme.
Salaries and fringe benefits are
competitive, based on
educational background and
experience. Temporary
accommodation available.
Apply sending complete
resume to:
The Director of Personnel
Stratford General Hospital
Stratford, Ontario
N5A 2Y6
Co-ordlnator — Obstetrics
including Neo-Natal ICU & Case Room
Nursery
The Victoria General Hospital, a 398-bed
acute care facility, seeks applications for the
challenging management position of
Co-ordlnator — Obstetrics.
The successful applicant will be responsible
for the total management of the Obstetrical
Unit. Will represent nursing in the planning
and development of a new hospital with a
66-bed Regional Obstetrical Unit.
B.Sc.N. degree or equivalent plus
demonstrated competence in obstetrical
nursing and administration.
Apply to:
Personnel Department
Victoria General Hospital
841 Fairfield Road
Victoria, British Columbia
V8V 3B6
Head Nurse
with preparation and/or
demonstrative competence in
Psychiatric Nursing and
Management functions, required foi
Head Nurse appointment. To be
responsible for participation in the
organization, initiation, and the
management of a New Psychiatric
In-patient Unit.
Please apply, forwarding
complete resume to:
Director of Personnel
Stratford General Hospital
Stratford, Ontario
N5A 2Y6
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, September
Limited to 8 participants
Applications now being accepted
For further information, please write
to:
Co-ordlnator of In-service Education
Foothills Hospital
1403 29 St. N.W. Calgary, Alberta
T2N 2T9
The Canadian Nurse July 1977
ASSISTANT DIRECTOR OF NURSING
GERIATRIC NURSING SERVICES
AND
ASSISTANT DIRECTOR OF NURSING
LONG TERM PSYCHIATRIC NURSING
SERVICES
(2 positions)
The Department of Health, Psychiatric Services Branch,
Saskatchewan Hospital, North Battleford, requires two Assistant
Directors of Nursing. Under the supervision of the Director of Nursing,
the Assistant Directors will be responsible for all areas of
administrative and clinical nursing services within their specific units.
This will include the co-ordination of planning between the clinical
disciplines to provide both quality nursing care and rehabilitation
programs and to establish objectives, policies, and procedures for
their units.
The successful applicants will have a Bachelors or Masters degree in
nursing, supplemented by several years experience at the
administrative level.
Salary: $14,604 — $17,736 (Nurse 4 — B.Sc.N.)
$15,156 — $18,456 (Nurse 4 — M.Sc.N.)
$17,028 — $20,868 (Nurse 5 — B.Sc.N.)
$17,736— $21,744 (Nurse 5 — tVI.Sc.N.)
The level of these positions is currently under review but will be either
at the Nurse 4 or Nurse 5 level.
Competition Number: 604114-7-584 Closing Date: As soon as
possible.
Forward your application forms and/or resumes to the Public
Service Commission, 1820 Albert Street, Regina, SAP 2S8,
quoting position, department, and competition number.
YOUR FUTURE IS HERE
/dibena
GOVERNMENT OF ALBERTA
NURSES
Alberta Hospital Ponoka, 60 miles South of Edmonton, has
positions available for General Duty and Psychiatric
Nurses. This hospital, an active treatment psychiatric
facility of the Alberta Social Services and Community
Health Department, requires nursing staff to provide all
aspects of professional nursing care on a rotating shift
basis.
Qualifications: Graduation from an approved school of
nursing. Must be eligible for registration with the respective
professional Alberla Associations. Salary range from
$11,748 to $13,812 per annum. (Currently under review).
Competition No. 9184-4
To remain open until suitable candidates have been
selected.
Apply to:
Alberta Government Employment Office
5th Floor, Melton Building
10310 Jasper Avenue
Edmonton, Alberta
T5J 2W4
The following positions are available now for a 450 bed active treatment hospital situated in a
year-round recreational area:
1.
PATIENT CARE CO-ORDINATOR
The Patient Care Co-Ordinator is responsible to the Director of Nursing Services for the daily administration of
selected patient care areas.
The successful applicant must be eligible for registration in the province of New Brunswick. Post Basic
Preparation preferred. IVIinimum of 5 years experience in a supervisory capacity.
Salary: $1,089.00 — $1,219.00 per month
(allowance for post basic preparation).
Excellent fringe benefits.
2.
RN— INSTRUCTOR— GN5
STAFF EDUCATION
Qualifications: Eligible for registration in New Brunswick with practical experience in hospital work. Bachelor of
Education or Baccalaureate degree in Nursing.
Salary: $1,089.00 — $1,219.00 per month
The purpose of the job is to plan or implement workshops, courses, and programs related to staff orientation and
education under the direction of the Director of Staff Education.
On any of the above positions — please apply in writing with a complete resume:
Employment Manager
Saint John General Hospital
P.O. Box 2100
Saint John, New Brunswick
E2L 4L2
The Canadian Nurse July 1977
can go a long way
...to the Canadian North in fact!
Canada's Indian and Eskimo peoples in the North
need your help. Particularly if you are a Community
Health Nurse (with public health preparation) who
can carry more than the usual burden of responsi-
bility. Hospital Nurses are needed too... there are
never enough to go around.
And challenge isn't all you'll get either — because
there are educational opportunities such as in-
service training and some financial support for
educational studies.
For further information on Nursing opportunities in
Canada's Northern Health Service, please write to:
Medical Services Branch
Department of National Health and Welfare
Ottawa, Ontario K1A0L3
Name ,
Address
City
Prov.
MJu Health and Welfsiu Sante et Bien-etre social
Canada
Canada
Index to
Advertisers
July 1977
^
Abbott Laboratories
Cover 4
Connaught Laboratories Limited
Cover 3
Equity Medical Supply Company
47
Hoi lister Limited
43
Kendall Canada
49
Reeves Company
5
W.B. Saunders Company Canada Limited
3
G.D. Searle
Cover 2
Advertising
Gerry Kavanaugh
The Canadian Nurse
50 The Driveway
Ottawa, Ontario K2P 1E2
Advertising Representatives
Richard P. Wilson
219 East Lancaster Avenue
Ardmore, Penna. 19003
Telephone: (215) 649-1497
Gordon Tiffin
2 Tremont Crescent
Don Mills, Ontario MSB 2S1
Telephone: (416) 444-4731
G£13
IWember of Canadian
Circulations Audit Board Inc.
CLINICAL SPECIALIST
(Medical — Surgical Nursing)
Required by a 240 bed acute care hospital
RESPONSIBILITIES:
— To assist with a Quality Assurance Program
— To plan, implement and evaluate a primary nursing
program
QUALIFICATIONS:
— Must be eligible for registration in Manitoba
— Masters Degree in Nursing preferred
— B.N. with experience will be considered
Inquiries may be directed to:
M. Willard
Administrative Assistant — Nursing
Victoria General Hospital
2340 Pembina Highway
Winnipeg, Manitoba
R3T 2E8
Continued health
protection for Canadians
from Connaught
New Fluval
Bivalent Influenza Vaccine
The National Adnson^ Committee on Immuniz-
ing Agents recommends that a bivalent (A/ Victoria/
3/75-like and B/Hong Kong/5 /72-like) inactivated
influenza vaccine be made available for use in
Canada for the 1977-1978 influenza season.
A/Victoria strain, in particular, has caused
many deaths worldwide since it was first identified in
1975. In anticipation of Canada's need, Connaught
will now pronde Fluval, a high quality, bivalent
influenza vaccine.
Fluval is designed for those most \ailnerable to
the complications of flu: the elderly, the debilitated,
the diabetic and those v\-ith chronic cardiac, pulmo-
nary- and renal disease. It can also be used for other
groups or individuals in essential senices for whom
influenza vaccine may be desirable.
Last year the demand for a vaccine with an
antigenic content of A/Swine flu xirus was especially
great. Connaught was the major Canadian company
that supplied the vaccine to every province in the
countrj'. This year and in the years to come, Canada
can continue to depend on Connaught to fill its need
for protection against flu uruses.
With Fluval, Connaught expands its wide range
of immunizing agents to include a readily available
and competitively priced vaccine for today's most
prevalent influenza strains.
Supplies of Fluval will be available in time to
meet the expected demand for flu immunization.
New from Connaught
Fluval
In keeping with our tradition of
professional responsiveness.
s
Connauirht Laboratories
175-5 Steeles Avenue West
VViUowdale, Ontario, Canada M2N 5T8
tHo eawBMdiawB
MBMmmo
August 1977
ES7607615935
977
58 HARDER AVE N 4PT 3
OTTiiWA CNT
X
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^
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^^^Ji
■S i.-.TCSKS/f-:'
^C^
J^i
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A. Style No. 9323 - Dress. Sizes; 8-18.
;tyle No. 9366 — Pant suit. Si.
^H» eanndinn
nmmme
August, 1977
The official journal of the Canadian
Nurses Association published
monthly in French and English
editions.
Volume 73, Number 8
Calendar
4
News
12
Audiovisual
54
ICN Meets in Tokyo
6
Books
54
Burn Update
Sandra LeFort
16
Library Update
55
Clinical Wordsearch No. 8
Mary Bawden
27
Coping with Pain
Marilyn Savedra
28
Nutrition and
the Burn Patient
Rosemarie Repa Fortier
30
Outpost Nursing in
Northern Newfoundland
J. Graydon. J. Hendry
34
New Horizons for Nursing:
Part 1- Professional
Responsibility
38
Part II-
Nursing Practice
Around the WorkJ
41
laryngectomee Leaflet
Deborah Vandewater
48
Idea Exchange:
Well Woman and
Health Awareness Clinic
Glenda Doucet
51
Cover photo: When a group of nurses
from Tokyo Women's College Medical
Hospital wanted to say "welcome to
Japan" to their counterparts from
around the world attending the 16th
Quadrennial ICN Congress, they
chose a program of traditional music
performed on Instruments such as the
koto — the 13-stringed Japanese
zither. Dressed in the traditional
Japanese kimono, some of the
performers are pictured during a
reception hosted by the Japanese
Nurses Association. (Photo courtesy
International Council of Nurses).
The views expressed in the articles
are those of the authors and do not
necessarily represent the policies of
thfi Canadian Nurses Association.
ISSN 0008-4581
Indexed in International Nursing
Index. Cumulative Index to Nursing
Literature. Abstracts of Hospital
Management Studies. Hospital
Literature Index, Hospital Abstracts.
Index Medicus. The Canadian Nurse
IS available in microform from Xerox
University Microfilms. Ann Arbor.
Michigan. 48106.
The Canadian Nurse welcomes
suggestions for articles or unsolicited
manuscripts. Authors may submit
finished articles or a summary of the
proposed content. Manuscripts should
be typed double-space. Send original
and carbon. All articles must be
submitted for the exclusive use of The
Canadian Nurse. A biographical
statement and return address should
accompany all manuscripts.
Subscription Rates: Canada: one
year, S8.00: two years, SI 5.00.
Foreign: one year, S9.00: two years.
SI 7.00. Single copies: SI. 00 each.
Make cheques or money orders
payable to the Canadian Nurses
Association.
Change of Address: Notice should be
given in advance. Include previous
address as well as new. along with
registration number, in a provincial/
territonal nurses association where
applicable. Not responsible for
journals lost in mail due to errors In
address.
Postage paid in cash at third class rate
Montreal, P.O. Permit No. 10,001.
- Canadian Nurses Association
1977.
§
Canadian Nurses Association.
Sn Thp Dnupwav Ottawa Danarta
The Canadian Nura* Auguat 1977
c^mericas
number 1 shoe
foryOung women
in white!
THK
mm
SHOE
V
/
SOME STYLES ALSO AVAILABLE IN COLORS . . . SOME STYLES 3V2-12 kkfKk-E. ABOUT 26.00 to 37.00
For a complimentary pair of white shoelaces, folder showing all the smart Clinic styles, and list of stores selling them, write:
THE CLINIC SHOEMAKERS • Oept. CN-8 , 7912 Bonhomme Ave. • St. Louis, Mo. 63105
The Canadian Nurse August 1977
IVr.s|)i»c-<iYC»
With apologies to Wolfgang von
Goethe and to Hans Schmitz...
Our family being inveterate readers —
the kind who for lack of anything else,
are sometimes reduced to reading the
small print on bread wrappers — it was
not really surprising to find myself
poring over a garden catalogue at
three o'clock on a recent night that
proved too warm for sleeping. What
was surprising or at least
thought-provoking were some of the
comments that the author, a
landscape artist for 20 years in this
country, had to make about the
relationship between successful
gardening and character
development.
"Gardening," as Hans Scfimitz
sees it, is "a great teacher, not only in
skills and knowledge but more so in
virtues. A garden reveals the
character of its owner. Without
sincerity, a searching mind and
devotion, one will not be able to
develop his garden to maturity.
Maturity ... an attainment that seems
to have lost its value in these days of
over-emphasis on staying young.
Gardening teaches patience, finding
of truth, refining of taste and, in the
long run, influences the character of
nations."
On reflection, it seems to me that
a strong case could be made for the
existence of a close parallel between
tending plants and caring for people.
Perhaps "gardenculture ' and health
care have more in common than
might, at first, seem likely. And
perhaps health professionals like
nurses have something to team from
Hans' words of advice to
would-be horticulturists. For example,
reading on, we find:
on knowledge — "it is wise to inform
yourself diligently to avoid
disappointment."
on patience and timing — "Don't
uncover too early any rose. Wait till
lilacs bloom or birches sprout. "
on solicitude — "Your plants will very
quickly reward you for any extra care
you give them."
on health promotion — "Remember,
to prevent is better than to cure."
Finally, Hans has a few
comments on the occupational
hazards of his profession, some of
which must sound familiar to nurses.
Summers are short in Ottawa, he
says, and during the "njsh season" his
staff work under tremendous pressure
... too much to do, not enough time to
do it property and not enough
adequately trained people. In the
winter, there is always the threat of
unemployment.
On "bad days," the frustrations
and uncertainties of this type of
existence must seem ovenwhelming.
What is it that gives him the
incentive to keep on? One of his
inspirations, he says, comes from a
quotation by German philosopher
Wolfgang von Goethe that has some
bearing on the work that each of us
has chosen, whether it involves caring
for plants or people, 'I know well
enough that one does not receive
thanks for what was made possible
after the impossible was demanded —
still and however. I will not refrain from
undertaking the best I can. '
— M.A.H.
Editor
M. Anne Hanna
Assistant Editors
Lynda FItzpatrick
Sandra LeFort
Editorial Assistant
Sharon Andrews
Production Assistant
Mary Lou Downes
Circulation Manager
Beryl Darling
Advertising
Gerry Kavanaugh
CNA Executive Director
Helen K. Mussallem
IkM'oiii
^m^ m
This month CNJ takes an informed
and informative look at the care of the
burn patient. The series of three
articles starts on page 16.
In this issue, too, is something
just a little different — an article that is
intended only indirectly for CNJ nurse
readers. 'Laryngectomee Leaflet"
was written by Detiorah Vandewater
for patients undergoing surgical
treatment for cancer of the larynx. We
hope that you will make use of this
teaching tool in pamphlet form by
passing it along to any of your patients
who might use it.
Diabetes is a universal disease
that is encountered most frequently in
urban and industrialized countries,
among older populations and
generally in more affluent societies. In
Canada, approximately 5% of our 23
million people are or will become
diabetics in their lifetime. Next month,
• Elizabeth Laugharne describes
Tri-Dec, the Tri-Hospital Diabetes
Education Centre in Toronto and
shows how three hospitals can pod
their resources to provide a
shared-cost educationail program for
di abetics and those who care for them.
• Author Elizabeth Crosby
discusses the program at the
Edmonton General Hospital Diatietic
and Metatwlic Centre and looks at the
emotional adjustments of the parents
and the diabetic child to the disease.
• Carol Polowich and Ruth Elliott of
the University of British Columbia
explore the unique probtems of the
adolescent diabetic.
The Canadian Nurse August 1977
At jLast... '
a Canadian supplier '
for^nurses needs
No worrying about Customs — No duty to pay.
STETHOSCOPES
DUAL HEAD (LITTMANN TYPE)
in 6 pretty colours Enceptional
sound transmission, admstable
lighiweiflfit binaurals. Has DoI^
diaphragm and Ford type beli
wilh NON-CHILL ring Compiei.-
wilh spare diaphragm and eat
pieces Choose red, blue, green
Silver (Kvith tilach tubing), gold
gray No 110 S17.85 •■ch.
SINGLE HEAD TYPE As above
but withoul bell Same large
diaphragm for high sensiltvity
No 100 S11-95 MCh.
SPHYGMOMANOMETERS
MERCURY TYPE. Tne ultimate
accuracy Folds into light but
-ugged metal case. Heavy duty
. "Lfo cutf and indation system
No 430 S59.00«sch.
ANEROID TYPE. Rugged and
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Calciiclai'
September
New Directions in Children's
Mental Health International
Symposium, co-sponsored by
Thistletown Regional Centre for
Children and Adolescents and the
Department of Psychiatry, University
of Toronto and The Hospital for Sick
Children Foundation, on Sept. 14-16,
1977 at the Skyline Hotel, Toronto,
Ontario. Contact :Orw//e C. Green, 1 1
Farr Ave., Rexdale, Ont., M9V 2A5.
The Nursing Process in Mental
Health and Psychiatric Nursing to
be held on Sept. 28-30, 1977 at the
University of Toronto. Fee: $75.
Contact: Dorothy Brooks, Continuing
Education Programme, Faculty of
Nursing, University of Toronto, 50 St
George St, Toronto, Ont
W5S 1A1.
Infection Control: Basic
Techniques. A one-day seminar
sponsored by the Infection Control
Nurses Calgary Group to be held in
Calgary, Alta. on Sept. 30, 1977.
Contact: Ursula Rusl<owski R.N.,
Infection Control and Staff Health
Nurse, Alberta Children's Hospital,
1820 Richmond Rd. S.W., Calgary,
Alta.
Sexuality and the Disabled. A
seminar sponsored by Planned
Parenthood Newfoundland/Labrador.
A three-day seminar to be held in St.
John's, Newfoundland on September
22, 23 and 24. Resource persons are
Beverley Thomas and Dr. I^ichael
Barrett. Contact: Barbara Collier,
R.N., Planned Parenthood
Newfoundland /Labrador, Fort
William Building, Factory Lane, St
John's, Nfld.
October
35th Annual Convention and
Educational Programme of the
Canadian Health Record
Association to be held at the Four
Seasons Hotel, Vancouver, British
Columbia on Oct. 12-17, 1977.
Contact: Janef l^ilner. Executive
Director, Canadian Health Record
Association, 187 King Street East,
Oshawa, Ont. L1H 1C3.
Ontario Occupational Health
Nurses Association Annual
Conference to be held at the
Connaught Hotel, Hamilton Ontario on
Oct. 26-28, 1977. Theme: We believe
in tomorrow. Contact: Lorna Roche,
Medical Centre, BP Refinery Canada
The Executive Nurse — a three-day
program for nurses in management
positions in acute-care facilities,
chronic-care facilities, public health
and occupational health
organizations. To t5e held in Calgary,
Alta. on Oct. 3-5, and in Toronto on
Oct. 19-21, 1977. Tuition: $150. (Tax
deductible). Contact: R.M. Brown
Consultants, 1115- 1701 Kilborn
Ave., Ottawa, Ontario, K1H6M8.
(613) 731-0978.
American School Health
Association 51st Annual
Convention to be held in Atlanta,
GeorgiaonOct.12;16, 1977. Contact:
American School Health Association,
ASHA National Office, P.O. Box 708,
Kent, Ohio, 44240.
Annual Joint Meeting of the
Canadian Heart Foundation,
Canadian Cardiovascular Nurses
and the Canadian Cardiovascular
Society to be held at the Inn on the
Park Hotel, Toronto on Oct. 17-18,
1977. Contact: Mr. E. fVIc Donald,
Canadian Heart Foundation, One
Nicholas St, Suite 1200, Ottawa,
Ont, KIN 7B7.
7th Annual Calgary Interagency
Pediatric Seminar — "Their Future
— Our Responsibility." A two-day
seminar to be held on Oct. 20-21,
1977 in Calgary, Alberta. Fee:$25.
Contact: Nancy Clyne, Pediatric
Nursing Coordinator, Foothills
Hospital, Calgary, Alberta, T2N 2T9.
The Treatment of Skin Disorders in
Occupational, Ambulatory and
Hospital Settings to bie held at the
University of Toronto on Oct. 20-21,
1977. Fee: $50. Contact: Dorofhy
Brooks, Continuing Education
Programme, Faculty of Nursing,
University of Toronto, 50 St George
St, Toronto, Ont, M5S lAI.
The Management of Motivation. A
two-day program for all health care
managers to be held in Calgary, Alta.
on Oct. 6-7, 1977 at the Holiday Inn
and in Toronto on Nov. 10-11, 1977 at
the Royal York Hotel. Tuition: $120.
(Tax deductible). Contact: RM.
Brown Consultants, 1115-1701
Kilborn Ave., Ottawa, Ontario,
K1H 61^8.
Getting Through to People. A
two-day program for anyone who
wants to become better at establishing
personal relationships through the use
of more effective communicating
procedures. Enrolment limited. To tie
presented on Oct. 26-27, 1977 at the
Royal York Hotel in Toronto. Tuition
$120. (Tax deductible). Contact:R./M
Brown Consultants, 1115-1701
Kilborn Ave., Ottawa, Ontario,
K1H 6M8.
International Conference on
Cancer and Environment to be held
on Oct. 13-14, 1977 at the Hotel
Bonaventure, Montreal, Quebec.
Contact: The Secretariat of the
Conference, Institut d'
hemologie-oncologie de /Montreal,
Hdpital du Sacre-Coeur, 5400 Gouin
Boulevard W., Montreal, Quebec,
H4J IC5.
November
17th Annual Conference of the
Operating Room Nurses' Group of
Quebec to be held at the Skyline
Hotel, Cote de Liesse Road, IVIontreal i
on November 1-3, 1977. For further
information contact: Mrs. J.
Verronneau, The Montreal General
Hospital, Operating Room, 1650
Cedar Avenue, Montreal, Ouebec.
Critical Care Symposium sponsored
by the Toronto chapter of tfie
American Association of Critical Carol
Nurses to be held in Toronto on
November 14-15, 1977. Contact:
Conference and Seminar Services,
Humber College of Applied Arts and
Technology, P.O. Box 1900, Rexdale,
Ont,M9W5L7.
21st Annual Symposium on
Rehabilitation, co-sponsored by the i
Ontario IVIarch of Dimes and the
Ontario Society for Crippled Children
on Nov. 5, 1977 in Toronto. Contact:
T^e Ontario March of Dimes, 90
Thorncliffe Park Drive, Toronto, Ont,
M4H IM5.
Role Playing as a Teaching Method
and a Therapeutic Technique to be
held Nov. 3-4, 1977. Fee: $60.
Continuing Care of those who have
come into End Stage Renal Disease
to be held on Nov. 17-18, 1977.
Fee: $50.
Intrauterine Assessment of the
Fetus to be held on Nov. 15, 1977.
Fee:$25.
Counselling the Emotionally
Mentally Disturbed Patient Part 1 to
be held Nov. 28 to Dec. 2, 1977.
Fee: $125.
All courses to be held in Toronto.
Contact: Dorothy Brooks, Continuing
Education Programme, Faculty of
Nursing, University of Toronto,
Toronto, Ont, M5S1A1.
The Canadian Nurse August 1977
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Address
The Canadian Nurse August 1977
More than 12,000 nurses from all corners Of the world attended the 16th
Quadrennial Congress of the International Council of Nurses staged by
the ICN in Tokyo from May 30 to June 3, 1977. The Congress theme, New
Horizons for Nursing, gave participants and observers an excellent
opportunity to discuss the latest trends in nursing education and
practice and to explore how the nursing profession can increase its
contribution to the overall planning and delivery of health care for all
people.
ICN meets in Tokyo
Viviane Suben/iola
In an atmosphere of friendliness and
hospitality established by ICN's host
association — the Japanese Nursing
Association — registered nurses and
students gathered in the huge Nippon
Budokan Hall to witness deliberations
of the Council of Representatives and
hear papers and panel discussions
presented by nursing leaders of the
world.
The opening ceremony was held
in the presence of Their Imperial
Highnesses Crown Prince Akihito and
Crown Princess Michiko and other
Japanese dignitaries. The presidents
and secretaries of ICN member
associations, many of them wearing
their native dress, were led in the
traditional procession by Japanese
nursing students.
Nine new member
associations were formally
welcomed to ICN membership: Fiji,
Mauritius, Puerto Rico, Swaziland, St.
Lucia, Paraguay, Sudan, Western
Samoa and Honduras. "The
significance of admitting these new
associations to ICN memtiership
reaches far beyond merely swelling
the numtjer of members ," said ICN
president Dorothy Cornelius. "It
means that the influence and
colleagueship of nurses united in an
international community has
penetrated new territory, thus
benefiting not only ICN and the new
memtjer associations, but also the
people of their countries to whom they
provide nursing services."
Following the admission
ceremony for the nine new ICN
members, 68 of ICN's 87 memtier
associations responded to
the roll call. Congress participants,
who packed Budokan Hall to the top of
its three tiers of tjalconies, were then
aware that their congress had begun.
Congress participants were able
to view nursing practice and talk with
Japanese nurses at a series of visits to
hospital and health facilities including
a general hospital, ICU and CCU
units, a children's hospital, a hospital
for the elderly, a maternity hospital, a
health center and a cancer center, as
well as to educational facilities for
basic, post-basic and specialized
programs. Nursing exhibits arranged
by the JNA, other memt)er
associations and ICN were displayed
at the Science Museum, where films
and video-tapes were also shown
daily.
The busy week of speeches,
debates, reports, questions and
reactions of nurses from around the
globe ended as Dorothy Cornelius
passed the ICN chain to newly elected
president Olive E. Anstey and left
Accountability as her watchword for
ICN.
Wearing the gold chain of office,
composed of medallions bearing the
watchwords of her predecessors,
Anstey announced her two goals for
the next quadrennium: the
improvement of the social and
economic welfare and status of nurses
and nursing, and the promotion of
more resources both financial and
human to the further development of
primary health care.
The 17th Quadrennial Congress
is to be held in Kansas City, U.S.A.
Three plenary sessions on
issues that confront the profession
today took place during the congress.
The sessions — on practice,
education and professional
responsibility — attracted capacity
audiences and stimulated
considerable sharing of information
among the representatives of the
various countries in attendance.
A report on two of these sessions
— What's New in Nursing Practice
Around the World and New
Dimensions of Professional
Responsibility — begins on page 38 of
this issue.
The session concerned with
Changing Directions in Nursing
Education was broken into two parts,
a debate and a panel discussion.
Debate centered on the assigned
topic. "Resolved that
technologically-oriented laboratories
(programmed instruction, films,
video-tapes, etc.) are superior to
traditional forms (lecture, discussion,
demonstration, etc.) for teaching
nursing procedure. "
Speaking for the resolution were
M. Josephine Flaherty, dean and
professor. Faculty of Nursing,
University of Western Ontario,
London, Ontario, and Hiroko Usui,
professor. Department of Nursing
Principles and Practice, School of
Nursing, Chitia University, Chiba,
Japan.
Speaking against the resolution
were Rosette-Aline Poletti, director,
Le Bon Secours School of
Nursing, Geneva, Switzerland, and
Syringa Marshall Burnett, lecturer,
Advanced Nursing Education,
University of West Indies.
Leading off the debate, Flaherty
and Usui said that technology gives
students an opportunity to pursue
leamino activities at their own soeed
and when they are ready to learn. This
helps prevent boredom on the part of
the quick students and frustration on
the part of students who require more
time tor certain segments of their
learning experiences. This method of
teaching also gives students an
opportunity to learn how to continue
their education independently.
They also argued that technology
provides an opportunity for teachers to
use their time more effectively in order
to meet needs of individual students
and to put additional emphasis, if
appropriate, on certain aspects of the
curriculum.
Finally, it was felt that
technological materials cost less and
that the potential for use, re-use and
combination with various types of
materials are limitless.
Poletti and Marshall Burnett
argued that in the field of nursing, it is
not the techniques which are difficult
to master, but rather the application of
these techniques to human beings.
Demonstration by a "flesh and blood "
teacher and countec-demonstration
under the guidance of the teacher
make for individualized teaching. The
teacher is able to be a role model, to
act in the here and now, within the
reality of the situation that the student
is sharing and which is not always
ideal.
The results? No official winner
was announced but, as one of the
judges remarked in her summary of
the proceedings: "Traditional teaching
methods and technology, used wisely,
should complement each other.
Technique is an extension of the
human personality — not a
replacement of it."
For the nurses in the audience,
the session gave them the opportunity
to share the reactions of
representatives of a broad
cross-section of countries and
delegates. At one point, more than 30
nurses were li ned up waiting for a turn
at the mike.
Nursing education
Primary health care — what it is,
its effect on the people who receive it
and the preparation of primary care
providers — was the subject under
discussion by three panelists during
the second half of the education
session. The basic distinction
between primary and secondary
health care and the implications for
nursing education were outlined by
first panelist Alice Akita, Nursing
Department, University of Ghana,
Legon, Ghana. She defined primary
health care as an approach that
provides comprehensive, simple,
inexpensive and effective services
that are easily accessible to all
members of a community, both sick
and well, to improve their living and
health conditions.
In contrast, secondary health
care was defined as being a second
level and specialized health care
which operates within a referral
system where patients are referred
from the primary health care level for
the attention of hiaher cadre
personnel. It demands more
sophisticated material and manpower
resources and therefore is
comparatively expensive.
"In contrasting primary and
secondary health care, it has become
obvious that in the face of world-wide
economic crisis, primary health care
appears to be the required approach,"
Akita said.
The panelist suggested that rural
sociology, community organization,
principles of community and health
care be incorporated into the nursing
curriculum, that nursing education
shift its emphasis from urban to rural
setting and that the nurse's role be
redefined to correspond with the
change of focus.
Two new types of nursing care
that deal less with caring for the sick
and more with keeping people well
were described by Madeleine
Leininger, dean and professor of
nursing, University of Utah, Salt Lake
City, USA.
Called primary and transcultural
nursing care, the new methods "draw
on the social sciences, the liberal arts
and humanities to learn about normal,
healthy and people-centered
behaviors and to integrate or
incorporate these knowledges into
nursing instruction."
Concerning transcultural nursing,
Dr. Leininger said "Nurses are
beginning to discover that health care
is largely culturally-determined,
culturally-defined and requires
cultural knowledge about people's
values, beliefs and practices in order
to provide effective, safe and
satisfying nursing care to people of
different cultural backgrounds. " She
predicted the full impact of
transcultural nursing will not be
realized in the US and elsewhere for
another decade.
"Both primary and transcultural
nursing have ageneralist approach to
assist people with their nursing and
health concerns. Both should be
based upon community and cultural
life patterns to meet the diverse needs
of people," she added.
Areas in which primary health
care nurses should be skilled and the
problems associated with their
preparation were the topics of
discussion by Mo-lm Kim, first
vice-president of the Korean Nurses
Association. "The nurse giving
primary care must have broad-based
skills in such areas as a knowledge of
health and major deviationsfrom it; an
orientation to the family and
community; a sense of colleagueship
and accountability along with critical
judgment which recognizes
knowledge and the need for
knowledge.
"In addition, skills in supervision
and administration, an understanding
of the primary health care delivery
system and the roles of each of the
professionals in it, and the ability to
collect and analyze data and ut ilize the
techniques of evaluative research are
skills which the primary health care
nurse must possess, " she said.
The Canadian Nurse August 1977
Panelists
The Canadian Nurse August 1977
USSR observers
Although the Soviet Union is not a
memtier of the ICN, since there is no
national nursing association as such
in the USSR, two health professionals
from behind the Iron Curtain did attend
the ICN Congress in Tokyo as
observers.
Natalia Vorobrva, a physician by
education but nowa trade unionist' by
her own description, was one of them.
At a press conference during the
Congress she outlined the basic
principles of health services in her
country. "The aim of health care in the
Soviet Union, " she said, "is the
promotion of active longevity."
Prevention was a major theme of
Vorobrva's comments.
Socioeconomic and medical
undertakings emphasize the
prevention of diseases and the
elimination of their causes. Much
attention is devoted to the way of life,
to the environment (air and water
pollution, conditions of labor and
humanization of industrial
environment), to opportunities for rest
and recreation and to higher spiritual
standards of people. "The future
belongs to preventive medicine; only
social hygiene can cope with ailments
of society," she said.
Health care was described as a
team approach, with physician, nurse
and other health care wori<ers. Each
territory has one or more polyclinics,
according to population needs. A
dispensary system has also been
established as a special preventive
measure for the early detection of
disease, especially in those employed
in industry. "It is easier to prevent than
to cure," she commented.
"The salaries of doctors and nurses
are parallel to those of heavy industrial
labor wori<ers," the observer said, "but
we are trying to convince lay people
that our wori< is more stressful than
lifting in industries."
Programs leading to the basic
nursing diploma are the only types of
nursing education offered in the Soviet
Union at the present time. The lack of
university education for nursing is
seen as a problem which has caused
many people to turn away from
nursing because they have the
potential and desire for a university
education. Vorobrva said that they
hoped to learn from other ICN
participants in the area of nursing
education.
There is no separate national
nursing organization in the USSR, but
nursing is just one part of the total
Medical Wori<ers Union. Therefore,
the Soviet Union has been in contact
with ICN for a number of years, but is
not a member of the Council of
National Representatives.
Joining Vorobrva on the ICN visit
was llga Bisenieik, matron at Paul
Stradin Latvia Republic Clinical
Hospital and chairman of the Council
of Nurses, Latvia.
A grand total of 180 nurses
including 15 Canadians took part in
the 12 special interest sessions held
during the Congress. Topics forthese
sessions were chosen to complement
the plenary sessions on nursing
practice, education and professional
responsibility.
Representatives of the nursing
profession in Canada served as
moderators and panelists at several
sessions, including two all-Canadian
presentations on The Changing Role
of the Nurse and The Need for Higher
Education among Nurses. Panelists
at the discussion on the changing role
of the nurse included:
Irmajean Bajnok, assistant
professor. University of Western
Ontario school of nursing, London,
Ontario: Stephany Grasset,
community health nurse, Vancouver,
B.C.: Rita Lussier, consultant in
continuing education in nursing,
Montreal, Quet^ec: Gladys Smith,
director of nursing service. Glace Bay,
N.S. and moderator. Rose Imai,
acting principal nursing officer. Health
and Welfare Canada, Ottawa,
Ontario.
"In order that educational
programs continue to be relevant to
the needs and desires of the
population, nursing educators are
faced with the dua! responsibility of
responding to the many different
social, political and economic forces
affecting nursing and also preparing
nurses who can practice in the
present, as well as in the year 2030,"
according to panelist Irmajean
Bajnok.
Bajnok identified some of the
factors that have affected and will
continue to affect nursing education in
Canada: the economic problems of
providing health care to the masses,
the increased focus on
professionalization, consumerism, the
increased political nature of Canadian
society, and changing health needs of
the population.
She outlined how nursing
education has developed in the light of
these external factors. "Our students
are a more heterogeneous group: they
are being prepared from a nursing and
a health focus. More attempts are
being made to teach collaboration or
health team approaches to care.
"More than ever before, our nursing
students are focusing on wori<ing
together, respecting patients' rights
and value systems, and promoting
patient involvement in health care
decision-making. "
Panelist Stephany Grasset
identified teamwori< and technology
as "cornerstones on which modern
health care services are built —
teamwort< to provide adequate
medical and health services for the
forty million people who will populate
Canada by the year 2000; technology
to make the miracle of the computer
work for medicine and bring safer,
surer treatment to the masses.
"If nursing is to survive and grow as
a profession, it has to keep abreast of
technological advances, for the day is
gone when the doctor was the only
competent person to whom the patient
could be entrusted," she said.
Referring to teamwork, Grasset
explained that recognition of the many
facets of primary health care has
resulted in the proliferation of
paramedical health wori<ers, the nurse
assuming a major role, both in the
hospital and in the home.
Grasset identified some of the
reasons and circumstances leading to
the changing role of the nurse
including: the lack of primary
physicians, the increased proportion
of elderly people, rapid urbanization
and large areas of sparsely populated
countryside, the widespread abuse of
drugs and alcohol, increased violence
and suicide, psychological disorders
among both adults and children, the
trend toward hospital admission for
investigation and the use of hospital
emergency departments for
non-urgent and minor illnesses.
"Some nurses still think we should
avoid change, " she said, "But this is
not possible. Nursing as a profession
will ch ,nge — either becoming more
responsive to the people's needs for
health car^ or go the way of all
changing conditions and become
extinct.
'In recent years, Canadians have
come to regard government services
not as a privilege, but rather as a basic
right," according to panelist Gladys
Smith who supported her statement
with vivid examples.
"I submit that if we place our
emphasis on the area of human
responsibility, introduce more
monitoring and control, a positive
approach to solving many of the
inequities and injustices in the area of
human rights could be achieved," said
Smith.
"The nurse, in her many settings
and skills, in collaboration with others
in the health field, and provided a
framewori< within which to move, is in
a key position to act as a monitor and a
counselor in health related
responsibilities, " she contended.
Fourth panelist Rita Lussier
described continuing education as
"the four corner meeting place " for
nurses in order that they may better
understand their role and identify the
needs of the community they serve.
"Nurses must be able to identify
what they need to learn " the panelist
explained "as most nurses have
trained in a hospital base, the
orientation has been to hospital care.
However, emphasis has shifted
toward an expanded role of the nurse,
both in the community and the hospital
settings. More money is being spent
for inservice education; it is up to the
individual to take advantage of it. "
Higher education
Panelists in the discussion on
higher education consisted of
Canadians: Odile Larose, director of
the nursing sector, Order of Nurses of
Quebec, Nicole David, clinical nurse
specialist. Centre Hospitaller
Maisonneuve Rosemont Montreal;
Marie-Th6r6se Choquette, director
of professional education, Montreal;
Jeannine Pelland-Baudry, associate
professor. Faculty of Nursing,
University of Montreal; and
moderator, Jeannine Tellier
Cormier, president of the ONQ.
Retiring ICN president Dorothy
Cornelius of the USA (above right)
hands over the chain of office to
Australian Olive Anstey who will
serve as president for the 1977-81
quadrennium. In the photo on the left,
Soviet observer Natalia Vorobrva
(center) is pictured with ANA
president, Anne Zimmerman (right).
The Canadian Nurse August 1977
The Council of National Representatives (CNR) is the governing body of
the International Council of Nurses and consists of the president (or
proxy) of each of the ICN member associations — 87 as of June 1977. The
CNR discusses international nursing issues and sets policy for the
nursing profession. It operates on the democratic principle of one vote
for each country represented.
CNR holds policy
session
Highlights of the action taken by the
CNR in Tokyo this year included:
• approval of a policy statement
encouraging career mobility within the
nursing profession (see box);
• approval of a policy statement on
international migration of nurses (see
box);
• approval of an operational
statement and guidelines concerning
the action of the nurse in safeguarding
the human environment;
• approval of a revised statement
on nursing research (see box);
• approval of a recommendation
that ICN member associations study
the (1974) WHO Expert Committee
Report on Community Health Nursing
and that associations undertake
cooperative action with health
authorities in order to further the
provision of health care within the
needs and resources of individual
countries.
The statements and guidelines
were presented to memtsers of the
Council of National Representatives
as part of the Report of the ICN's
Professional Services Committee on
activities during the last half of its
four-year term of office.
The operational statement on
safeguarding the human environment
approved by the CNR reiterates the
ICN conviction that the contribution of
nurses in this area is of such
importance that national nurses
associations should use every
opportunity to encourage nurses at all
levels to involve themselves, both as
professionals and as citizens, in
preserving and improving the
environment. The guidelines that
accompany the statement are
directed to "nurses as practitioners,
educators, administrators and
citizens." The guidelines and
operational statement support a policy
statement on the role of the nurse in
safeguarding the human environment
adopted by the CNR in Singapore in
1975.
Other action
As the governing body of the
International Council of Nurses, CNR
members elected the 15-memberlCN
Board of Directors for the 1977-1981
quadrennium (see September CNJ).
In addition, the CNR acted to:
1 . continue its present system of dues
assessment rather than adopt a
sliding scale,
2. accept a resolution endorsing
collective bargaining by nurses and
recommending that member
associations promote and maintain
programs to prepare nurses "to utilize
effectively the collective bargaining
process as a means of resolving their
employment concerns."
3. accept a proposal from Canada that
the ICN consider the development of a
position statement on "the role and
responsibility of the nurse in alerting
appropriate authorities to the high risk
of disease transmission due to
increased international travel."
4. accept a report from Cleo Doster,
chairperson of the Student Assembly
that met during the Congress.
5. Take note of a request from Canada
thatthe Board review ICN's statement
of purposes, objectives and functions
to assess its relevancy and that the
Board take whatever action is
necessary.
INTERNATIONAL MIGRATION OF NURSES
I Migration of nurses is an international phenomenon . Along with migration are
I the important issues of unequal economic and social developments which
I lead ICN to believe that measures should be taken to formulate realistic
[policies and plans of action.
ICN and its memtier associations support and promote high standards of
Inursing practice and therefore recognize and are concerned about tfie
■impact that international migration of nurses may have on the quality of health
Icare.
The reasons and consequences of international movement differ from
ountry to country.
ICN urges nurses associations to initiate and/or participate in a study of
i phenomenon and examine national policies in regard to immigratbn and
nigration of nurses, in order to:
assess requirements for nursing manpower;
maintain the high level of health care in the country;
ensure that foreign nurses have qualifications equivalent to those
quired of nationals for licensure;
assure that foreign nurses have conditions of employment which are not
BBS favorable than those of nationals in posts involving the same duties and
Bsponsibilities;
assist nurses with their problems in regard to intemational migration and
NURSING RESEARCH
The International Council of Nurses is convinced of the importance of nursing
research as a major contribution to meeting the health and welfare needs of
people. The continuous and rapkJ scientific developments in a changing
world highlight the need for research as a means of identifying new
knowledge, improving professK>nal education and practice and effectively
utilizing resources.
IC N believes that nursing research should be socially relevant. It should
look to the future while drawing on the past and being concerned with the
present.
Nursing research should include both that which relates to a total
research plan and that which may be undertaken independently. In nursing
research available resources of different levels of sophistication should t)e
utilized and research should comply with accepted ethical standards.
Research findings should be widely disseminated and their utilization and
implementation encouraged when appropriate.
ICN believes that nurses should initiate and carry out research in areas
specific to nursing and collaborate with related professions in research on
other aspects of health. Nursing research should involve nurses practising in
the area under study.
National nurses associations are urged to promote the development and
utilization of nursing research in cooperation with other interested groups.
CAREER MOBILITY IN NURSING
Career mobility in nursing is the movement of nurses to more advanced
levels of nursing practice, to different levels of nursing practice, or to positions
in which different functions predominate. It must iDe supported and sustained
by means of a related educational system.
There are advantages in career mot>ility for the individual, the nursing
profession and society. Career mobility enables nurses to achieve personal
career goals within the limits of their atiility. It contributes to the nursing
profession by raising the competency of its members. Career mobility can
forward society's aims of meeting the identified needs of the specific country
by modifying or expandng the composition and supply of nursing personnel.
The increasing numtjer of nurses interested in other nursing positions,
the efforts of the nursing profession to promote expanding roles and the
interest of governments in improving the level of nursing care in their
countries — all carry an inherent commitment to provide the means for
motiility in nursing. It is therefore essential that nurses associations,
governments and other bodies facilitate the attainment of career goals by
means of an articulated educational system that provides opportunity for
nurses to move from one type or level of nursing to another. At the same time
it is important not to lower the ultimate standards but to have a system that
permits nurses to progress on the strengttis of previous education and
experience.
For such an educational system it is necessary to identify the core of
knowledge, skills and scientific principles for first level nursing practice. The
programs should be flexible and enable second level nurses to fill the gaps in
their preparation in order to meet the requirements for first level nursing
practice. First level nurses should be able to build upon their preparation in
order to qualify for upward or lateral motjility into other clinical or functional
areas.
ICN believes in the importance of career development within the
profession. ICN calls upon its memtser associations to examine the systems
of practce, service and education in their countries and to initiate or
cooperate in the development of an educational system which will promote
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The Canadian Nurse August 1977
Bfews
West Coast nurses
stage 65th annual
RNABC meeting
Health services, according to British
Columbia's Minister of Health Robert
McClelland, are among the things we
take for granted now but may not be
able to afford in the future unless we
plan wisely and spend well.
McClelland, who was keynote
speaker at the 65th annual meeting of
the Registered Nurses Association of
B.C., was making his first major
address to the nurses in that province
since assuming office two years ago.
"The health care system has been
under great pressure, especially in
terms of cost containment, " said
McClelland, "and many of your
members are aware of that. I must let
you know that I recognize the pressure
that many of you have been working
under."
But while acknowledging that
"cost containment postures had some
unpleasant effects," he asked nurses
to "recognize that as a government we
had few options. Our options still are
somewhat restricted if we expect the
health system to maintain its present
shape and objectives."
McClelland described his ministry
as "extremely interested" in the
RNABC Quality Assurance Program
which got underway a year ago. The
health minister asked for "clear
evidence that patients themselves are
involved in the authorship of some
standards. If we are serious about
consumer participation, we have to
involve the patient who, until recent
times at least, has been assumed to
lack the capacity to understand the
complex basis of the illness and the
treatment."
McClelland descritDed the
RNABC action in setting up a Latxir
Relations Division in 1976 as
"absolutely essential" and noted "how
pleased I am that RNABC has gone
such a long way toward separating its
professional and economic interests."
He said that the association's
professional interests, as defined by
the Registered Nurses Act, coincide
with the public interest — the act
reflecting the legislative view that
RNABC is the best mechanism to
govern nursing in B.C.
But McClelland declared that
professional concerns should not be
tied too closely to "economic interests,
wages and salaries, working
conditions, and so on. It is not really
acceptable any more in the view of
anyone responsible for the
administration of public policy that
there be an intertwining or
intermingling of public and private
interests."
"I appreciate that the separation of
the labor relations responsibilities may
have been painful, but it really was the
only responsible route. I hope that
those of your members who feel
somewhat antagonized because of
this move will realize that the only
other option might have been total
public control with the licensing
authority vested directly in
government. "
Resolutions
Among the resolutions approved by
voting delegates attending the annual
meeting were ones dealing with the
provision of emergency aid, public
health programs, health promotion
and health care planning. Delegates
committed the association to:
• urge the Attorney General's
Department of B.C. to introduce an
"Emergency Medical Aid" Act,
othenwise known as the "Good
Samaritan Act, " to protect those
rendering emergency aid at the scene
of an accident from liability.
• make known its belief that the
quality of public health nursing
services in the Province of British
Columbia is severely affected by the
restrictions placed on the hiring for
vacated public health nursing
positions; and request the Ministry of
Health to lift the hiring "freeze" for the
vacated public health nursing
positions.
• seek from ttie Premier of B.C. a
statement outlining the direction that
health care for the province will take in
the future
• urgethe provincial governmentto
notify the RNABC of any intent to
create new facilities for housing both
the well and ill elderly population.
• consider a move to make
experience in specialty areas, namely
the operating room and the
emergency room, compulsory in all
programs preparatory to nurse
registration in B.C.
Executive committee
Three Vancouver nurses will hold top
offices in the RNABC over the next two
years. They are president Sue
Rothwell: first vice-president,
Stephany Grasset; and second
vice-president Lois Blais.
Under by-law amendments
adopted at the annual meeting, a new
executive structure,expected to take
effect later this year will see Rothwell
continue as president, Grasset
serving as vice-president and Blais
becoming a director-at-large.
The trio was elected in a
province-wide mail ballot this spring
that drew the highest association voter
participation in recent years. Some 37
per cent of the membership voted this
year, compared to 26 per cent in 1 973,
the most recent contested election.
President's address
Retiring president Thurley Duck,
addressing RNABC members at the
conclusion of her term of office,
focused her remarks on the
relationship between the professional
association as a whole and the newly
established Labor Relations Division.
Although there are differences in
priorities, role definitions and
strategies, she pointed out, the two
facets of organizational life reflect
"very necessary efforts towards the
general goals of increased earnings,
professional autonomy, prestige, high
quality wori< performance, and a
sincere concern for service to
individuals andgroups of people in our
province.
"It would be ludicrous to believe that
the union side of our organization (and
yes, union is a legitimate word to use)
does not have any interest in
standards of nursing practice,
safety-to-practice, education of
nurses both basic and continuing,
relationships with government,
discipline, and all of those other
matters of concern to the association.
It would be equally absurd to believe
that the so-called professional arm is
not at all interested in the regulation of
relations between employers and
employees through collective
bargaining. To adopt either of these
stances, one in prime favor over the
other, would have the very definite
effect of denying reality."
Quality assurance
off to flying start
Close to 1 000 Saskatchewan nurses
have participated in a series of
workshops and meetings connected
with the SRNA quality assurance
program since it was launched ten
months ago.
The goal of the five-year program
is the improvement of nursing
practice. The long-range plan is to
establish standards and criteria of
nursing practice, implement ongoing
evaluation, and effect improvement
action. Professional accountability will
be demonstrated.
Since September, 1 976, a total of
989 nurses have attended either the
one-day or two-hour sessions on
quality assurance given by SRNA
nursing consultant, Marjorie Hewitt.
Wori<shops are on a voluntary basis
and are sponsored by individual
hospitals, regions or local chapters.
Pediatric audiology
workshop aids nurses
A wort<shop on pediatric audiology,
attended by public health nurses and
RNA's from Ontario, Quebec, New
Brunswick and Prince Edward Island,
was held at Queen's University in
Kingston, Ontario early in June.
Coordinator of the event was
Marie Heintzman, head audiologist, at
Kingston General Hospital. This j
year's workshop was the fourth to be J
organized. The 1978 workshop is
scheduled for the week of June 5th.
The week consisted of 20 hours ,
of intensive lectures on such topics as ,
anatomy and physiology of the ear, j
pathology and treatment, |
psychological implications of
deafness, embryology of the ear,
genetics of deafness, audiological ^
assessment of children from birth to i
six years, optimal usage of hearing
aids, and interdisciplinary assessment
of the additionally handicapped child.
The nurses also received
approximately 15 hours of practical
training in hearing screening of
elementary school children, babies,
hearing impaired children and
mentally and physically handicapped
children.
The Canadian Nurse August 1977
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The Canadian Nurse August 1977
\i»\Y.S
NS nurses attend
68th annual meeting
"The responsibilities and demands
may be heavy but the rewards for
active participation in your
professional association far outweigh
the contribution, "Gladys Smith,
president of the Registered Nurses
Association of Nova Scotia told
memtjers attending the association's
68th annual meeting in Sydney in late
June.
"Health Care in Nova Scotia — Is
There a Crisis?" was the theme of the
meeting and was the topic discussed
by a symposium consisting of
representatives of government,
hospital administration, and the
nursing and medical fields. It was the
consensus of nurses participating in
the discussion that government
planners of health care are not taking
the long-term view nor are they
consulting with those who form the
largest body of health professionals,
the nurses.
Rose Imai, acting Principal
Nursing Officer for Health and Welfare
Canada, spoke on the new
federal -provincial financing
arrangements and their implications
for health care and also outlined the
proposed federal Social Services Act.
She faced a barrage of questions from
those present. A resolution passed
later by the RNANS asked that the
association keep members well
informed on the implications for
nursing of all intended or actual
legislation concerning health matters.
Glenna Rowsell, recently
appointed director of Labour Relations
Services for the Canadian Nurses
Association, spoke on "The
Professional Association and the
Union."
"Perhaps the most vital question to
be answered is how can we wear two
hats and look well in the eyes of the
profession and the public," she said
and described the real issue as "how
can the professional organization and
the union function in their respective
roles and also work together in the
name of nursing?" Working together,
she emphasized, can give strength to
both groups.
Three amendments to RNANS
by-laws were passed. These had to
do with raising the current registration
fee from $50 to $75, requiring all
members to carry malpractice
insurance, and empowering the
executive to levy an additional fee
each year as a premium for the
insurance.
Life Membership was bestowed
on Florence Gass, who recently
retiredasDirectorof Nursing Services
at the Victoria General Hospital,
Halifax after more than twenty years
service.
The Award of Merit was given to
Or. Jane Hallburton for her
contribution to nursing education in
the province.
Ten resolutions were passed;
three requested government to make
seat belts mandatory, to establish
standards for ambulance vehicles and
training of ambulance attendants, and
to upgrade standards for fire safety
procedures for senior citizens
wherever they may reside. Other
resolutions called for a petition to be
prepared for the Minister of Health and
the Minister of Social Services to
utilize more effectively registered
nurses in the promotion and
maintenance of health in N.S., and a
request to be sent to the Minister of
Health that when opportunities
become available that the skills of
qualified women in high level positions
be utilized on Boards and
Commissions in the health service.
Did you know ...
Cases of leprosy — once considered a
world scourge — have tripled in
Canada within the past 12 years. A
total of 99 cases were reported in
Canada in 1976, up from 38 in 1965.
Two-thirds (68) of the cases were in
Ontario, with the remainder distributed
across the country from B.C. to
Newfoundland.
The Canadian Nurses Association is
holding its annual meeting and
biennial convention for 1978 on June
25-28 in Toronto's Royal York Hotel.
For information contact: The
Canadian Nurses Association,
50 The Driveway, Ottawa, Ontario,
K2P 1E2.
Margaret Nixon heads
Manitoba interest group
Nurse practitioners in Manitoba have
joined forces to create an active
organization that, within the past year,
has prepared a brief addressed to the
government of that province and
organized three educational
seminars. Although memtDership in
the group remains small
(approximately 16 prepared nurse
practitioners and 10 nurses
functioning as primary care
providers), the seminars have been
enthusiastically received.
Speakers at the most recent
seminar covered a variety of problems
occurring in primary care settings
including: pregnancy, rape,
emergency care, alcoholism and child
abuse.
Dr. John Warrington, Department
of Allergy and Immunology, Health
Sciences Centre, Winnipeg,
discussed present trends in the
identification and treatment of patients
with allergy. He pointed out that
allergy desensitization is still fraught
with many problems, the most serious
being the possibility of an anaphylactic
reaction; treatment now
recommended includes
desensitization only after more
conservative management has not
been effective.
Child abuse was the topic of an
address by Dr. Ken McRae, director.
Child Development Clinic, Children's
Centre, Winnipeg. He encouraged
nurses to consider early identification
of a potential abuse situation, e.g.
during the pre- or immediate
post-natal period, protection of the
child and rehatDilitation and support of
parents, as primary objectives in
dealing with this problem.
Dr. Bill Davidson, associate
professor. Department of
Therapeutics and Pharmacology,
University of Manitoba, related the
recent research experience involving
the use of Antabuse implants in the
treatment of alcoholics. His study to
date has demonstrated promising
positive results with the experimental
group of alcoholics with implants
reacting to alcohol intake and a high
percentage subsequently staying dry,
the control group not reacting and
returning to drinking again.
Many nurses in rural Manitoba
provide emergency care at the scene
of roadside and other acadents. Dr
Gerry Bristow, Director,
Casualty, Health Sciences Centre,
Winnipeg, discussed trends in
emergency care emphasizing
maintenance of the airway in
unconscious accident victims, tfie
value of expertise in cardiopulmonary
resuscitation and safety when moving
patients.
Christine Rollo from Pregnancy
Information Service, and Francis
Karpa, Rape Crisis Centre, explained
the services of these Winnipeg-based
groups. Nurses were encouraged by
both speakers to contact their groups
for either consultation or referral when
dealing with patients requiring help.
The seminar concluded with a
business session during which
Margaret Nixon accepted
chairmanship of the group,
succeeding Lynn McClure. The group
plans to hold their next seminar in
November, 1977.
ICN seeks director
The International Council of Nurses is
now accepting applications for the
position of executive director of the
ICN. The successful candidate will be
expected to assume the position by
January 1, 1978 and to reside in
Geneva while filling the position.
Criteria for eligibility include:
• membership in a national nurses
organization (ICN member);
• fluency in English and good
working knowledge of French or
willingness to learn;
• up-to-date nursing knowledge;
• international work experience;
• managerial and leadership skills
and experience.
Applications should include a
detailed statement of experience,
education and professional activity
and give the names of three referees,
including the present employer and
the national nurses association.
Applications, typed in duplicate,
should be addressed to: M/ss Barbara j
N. Fawkes, Executive Director,
International Council of Nurses, P.O.
Box 42, CH-12n, Geneva 20,
Switzerland, and the envelope
marked: "Application — Executive
Director. "
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1
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The Canadian Nurse August 1977
What you need to know about burns
Sandra LeFort
The Canadian Nurse August 1977
You are a nurse wor1<ing in a small rural hospital. Your head nurse has
been asked to send one of her staff to the emergency department to
help care for patients who are on their way in from a fire. You are sent.
Going down in the elevator, you try and remember what is most
important about treating these patients. Your contact with burn pa-
tients has been minimal, though — in fact, you recall that only once as
a student did you have to look after a patient with a severe burn. The
most vivid memory is the smell of a pseudomonas infection growing
under the eschar — an odor so strong that it seemed to permeate the
whole room. But what else? You recall some priorities of care —
patent ainway, I.V. fluid , lots of it — but still as you step off the elevator,
you ask yourself — what is really happening to the patient with a
severe burn?
Caring for a patient with burns is a task that requires you to have some
knowledge of the fundamental pathological, physiological and psy-
chological changes that can occur. There is no mystique about good
burn nursing, only a need to understand and to be aware of what is
going on. The proper utilization of this knowledge will enable you to
give good nursing care to patients with burns.
If you are that nurse in the elevator wondering what happens to a
burn patient, what the priorities of care are, what treatment he should
receive, this article should be of some help. It is a review of the basics
of burn care with some new ideas on treatment and nursing care. We
might all be that nurse one day.
18
The Canadian Nurse August 1977
Burn Update
First Aid
The most common burns are thermal,
those caused by fire, hot objects or hot liquids.
If you are the person at the scene of a burn
accident, your immediate management of the
burn or scald will depend on the site of the
burn injury and the setting in which it occurs,
whether at home, place of worl< or outside.
Remember that the most important factors are
the area and extent of the burn rather than the
depth. Also, burns in the very young or very
old, even though small, should be considered
serious and hospital treatment should be
sought.
In general, thefollowing guidelines should
be followed:
1. Eliminate the cause of the burn by
smothering the flames, switching off the
current etc.
2. Check the respiratory status of the
person. If the fire was in an enclosed space,
suspect respiratory problems. Listen to the
person breathe. Is he wheezy? Does his chest
feel tight, sore or burning? Is he coughing and
gasping for air? Are his face and nostrils
singed with soot? Are nasal hairs singed? If
the answer is yes to any of these, then smoke
has probably entered the lungs, a condition
that can result in irritation, pulmonary edema
or respiratory failure. Removal of the person to
a fresh atmosphere and/or mouth-to-mouth
resuscitation may be necessary. Be sure that
clothing does not restrict chest movements.
3. Make the victim comfortable. If the burns
are extensive, the victim should lie down. If
there is respiratory involvement, elevate his
head.
4. Treat the burn wound. If the burn is small
such as a scald from hot liquid, immediately
immerse the part in cold water or flood it with
water. This is the only treatment that has been
found to decrease the degree or depth of a
burn. It will also ease the pain. At all costs,
avoid smearing the area with greasy or
powdery preparations such as butter, soap or
flour. These trap heat and may increase the
severity of the burn. If blisters are present, do
not break them.
When the person feels some relief,
remove the part from the water and cover with
a dry dressing or anything clean such as a
towel. Bandage the area securely but loose
enough to allow for edema. Before bandaging,
remove any jewellery or anything restrictive
that will impair circulation in edematous areas.
If fingers or toes are burned, bandage each
digit separately leaving the tips exposed.
Check for warmth of fingertips.
If the patient has deep burns, do not try to
remove charred particles or clothing. To
relieve pain, apply cold, wet compresses.
If a large body area is involved, treat for
shock by keeping him warm. Wrap the victim in
clean sheets and blankets to prevent chilling,
to reduce the risk of contamination and to
conceal bad burns from him.
5. Give oral fluids In limited quantities only if
the person has severe burns, is conscious and
not vomiting and if medical assistance will be
delayed. Often, victims will be very thirsty. The
ideal solution to give is Haldane's solution —
one teaspoon of salt and one-half teaspoon of
sodium bicarbonate (baking soda) in one quart
of water. Give only one or two ounces at a time.
Check for vomiting and aspiration.
6. Stay with the patient and provide
emotional support until an ambulance or other
assistance arrives.
Chemical burns
Accidents involving corrosives are met most
commonly in industry and can be very severe.
In all cases, seconds count. Remove any
saturated clothing while flooding the area
repeatedly with water. Prolonged drenching
under running water is essential to remove the
corrosive. Most industrial plants also provide
buffer solutions that can be applied after the
water.
Eye burns are also treated by drenching
with water. The eyelids must be opened to
allow the water to be poured into the eye. Eye
burns are particulariy frightening and the
patient needs to be told that the water will ease
the pain and that help is on the way. Bandage
both eyes with a dry sterile gauze if available.
Electrical burns
Electricity can cause burns or burn-like tissue
damage from the heat generated from
electrical sparks and arcs, or by an electric
current passing directly through the body.
Electrical burns may cause cardiac arrest due
to ventricular fibrillation. Muscle spasm may
throw the victim away from the point of contact
and cause other injuries such as broken
bones. Initiate CPR if breathing and heartbeat
have ceased. Otherwise, treat as for thermal
burns.
Skin
A severe burn constitutes a major threat
to life. It disrupts the integrity of the skin and
consequently can have an effect on every
major body system . As the largest organ in the
body, the skin is a complex combination of
tissues that serves:
• to protect the body from infection and
injury
• to prevent loss of body fluids
• to regulate body temperature
• to excrete wastes through perspiration
• to synthesize vitamin D and absorb drugs
• to provide a cosmetic effect for the
individual, playing a large part in his
self-identity and body image
• to act as a sensory organ.
A severe burn results in decreased function or
complete loss of the two most important
life-preserving functions of the skin:
protection from infection and fluid loss.
The skin or integument consists of two
main layers: the epidermis and the dermis.
The thin surface layer of the skin is the
epidermis. It is non-vascular consisting of
distinct layers of epithelial cells, which when
mature, cornify to form a protective layer of
dead cells. In burns, excessive fluid and
electrolytes are lost due to damage of the
stratum corneum, the outer epithelial layer.
The innermost epithelial layer, the stratum
germinativum, provides for the natural
regeneration of epithelial cells. These cells
must be present if new skin is to grow. (See
Figure 1)
The epidermal appendages — the hair
follicles, sebaceous glands and sweat glands
— extend into the dermis, the second
anatomical layer of the skin. These
appendages are surrounded by a thin layer of
epithelial cells from the stratum germinativum
that can provide for skin regeneration.
As the supporting and nutritional layer for
the epidermis, the dermis contains a large
blood supply and nerve endings; it is composed
mostly of collagenic fibers. If this layer is
injured, perception of pain, temperature and
tactile sensation is destroyed or impaired. If a
burn reaches this level, collagen leaks from
the surface of the burn wound providing a rich
nutritional medium for bacterial growth.
3
O)
Anatomy of the skin
Nerve endings
Sebaceous
gland
Hair tolllcle
Sweat gland
Blood vessel
Epidermis
Dermis
_ Subcutaneous
Muscle
Bone
The Canadian Nurse August 1977
Assessment of burns
One of the first considerations in caring for
the patient with burns is to determine the
extent and severity of the injury. Treatment of
the burn is directly related to severity which is
influenced by five factors:
1. Size of the burn. This is expressed as a
percentage of the total body area. The "Rule of
Nines" is a quick method of estimating the
extent of body burns in the adutt. The head and
each arm count as 9%; each leg, anteriortrunk
and posterior trunk count for 18%; perineum
counts for 1 %. This method however tends to
be an overestimation of the size of the burn.
A second method by Beri<ow, is more
accurate and accounts for change in
proportion by age. For example, Beri<ow's
chart takes into account that a child's head is
proportionately twice as large as an adult's.
Both these methods require the use of
diagrams, shading the burned area, both
anterior and posterior, and from that,
calculating the percentage of body burned.
All emergency departments should have
charts available for quick assessment.
2. Depth of the burn. Current terminology
expresses depth of burn as full-thickness or
partial-thickness, rather than the old
classification of first, second, and third degree
burns. Apartial-thickness burn can involve the
epidermis and part of the dermis and is able to
heal without grafting. New skin can resurface
from epithelial cells. This is equivalent to a first
or second degree burn. Adeep dermal burn is
a partial-thickness burn that f req uently has the
gross appearance of a third degree or
full-thickness burn. It can heal without grafting
since epithelial cells remain around hair
follicles and sweat glands in the dermis. Often,
infection, trauma or a decreased blood supply
converts the burn to a full-thickness burn if skin
grafting is not done. A full-thickness burn
always requires grafting. The entire dermis is
destroyed along with possible damage of
muscle and bone. (Figure 2)
3. Location of the burn. Burns to the face,
hands, neck, external genitalia and joint
surfaces are considered severe burns. Any
burn to the upper body is more serious than to
the lower body.
4. Age. The young and old are particularly
susceptible to the complications of burns such
as septicemia, respiratory problems, renal
failure etc. If a young person sustains burns
but was previously healthy, he has a good
chance of surviving no matter how large the
burn.
5. Presence of other diseases such as
respiratory and heart disease, as well as any
chronic condition will complicate treatment.
The severity of the burn, the treatment
initiated and the patient's chance of survival
are dependent on all these factors. In general,
a burn of more than 1 0% of the body which
includes face, hands, feet or genitalia is
considered a major burn and will necessitate
hospitalization.
Most often, the initial assessment of a
burn patient will take place in the emergency
department. If there is a burn unit in your
hospital or if private rooms are available for
burn patients, he will be transferred after the
initial assessment. If you receive the patient
from emergency, be sure that tetanus
prophylaxis has been given.
Hospital personnel tend to be
overwhelmed when confronted by a severely
burned patient, pertiaps because of his
appearance . However, forthe burn victim who
has' no other injuries, treatment is not difficult
to initiate because priorities of care can be
anticipated in the immediate post-burn phase,
sometimes called the emergent phase. Some
emergency departments have pre-established
regimes of treatment and may have a 'burn
cupboard' or cart that contains all the
necessary equipment for immediate burn
care. Certain wards in hospitals that are set up
for burn victims also have a burn supply
cupboard for easy access.
04
0)
w
3
cn
Classification of burn wound
Depth
Appearance
Healing
First degree partial-thickness
epidermal layers
— red or pink
Epidermis peels in 3-6 days.
burn caused by exposure to sun.
— slight edema
No scarring.
hot liquids.
Second degree partial-thickness
epkJennis and dermis
1. Superticial
10-14 days with no scarring if it
burns caused by intense flash
— mottled, pink or red
has remained clean and
heat, contact with hot liquids or
— bistering and edema
untraumatized.
objects.
— moist
2. Deep dermal
Several months to heal on its
— varied appearance red, dull
own. Often, grafting done to
white, tan in color.
provide more durable skin
— reddened areas blanch on
coverage and better function.
fingertip pressure and then
refill
Third degree full-thickness burn
no visible epithelial cells left.
— blistered
Grafting required with split
caused by fire, chemicals.
Down to the dermal and
— can be moist or dry
— white,tan, brown, black or red
thickness skin grafts.
sub-dermal level
in color
Skin grafts done as soon as
— red areas do not blanch on
condtion is stable and skin is
pressure
available.
— wet or dry and has a sunken
appearance
— due to surface dehydration.
eschar (leathery covering)
may appear
— black networ1<s of coagulated
capillaries seen
Fourth degree full-thickness
subcutaneous fat, fascia.
— blackened and depressed
To achieve a granulating surface
burn.
muscle and bone.
— when the burn includes bone.
on which to apply a skin graft,
it appears dull and dry.
fenestration must be done
(multiple perforations reaching
into the marrow cavity of the
bone).
To test for depth of burn injury, try the HAIR TEST. If hair can be pulled out, then it's probably a full-thickness bum.
The Canadian Nurse August 1977
Priorities of Care
1 . Respiratory needs are the first priority. If
the patient inhaled smoke or if he has burns to
the face and neck, anticipate respiratory
difficulties. Gas or smoke inhalation can result
in irritation to the lungs, pulmonary edema,
pneumonia and respiratoryfailure. Check vital
signs frequently especially noting changes in
the respiratory or pulse rates. If the patient is
not "shocky" and experiences difficulty in
breathing, place him in the Fowler's position,
give humidified oxygen and suction gently as
necessary to remove secretions. Have the
patient cough and deep breathe to keep the
lungs well oxygenated. Blood gases should be
taken to assess respiratory function.
If a patent airway cannot be maintained,
the insertion of an endotracheal tube may be
necessary or a tracheotomy may be
performed as a last resort. Within 24-48 hours,
edema resulting from a circumferential burn to
the neck or chest may squeeze the trachea
and rib cage and thus compromise breathing.
Any circumferential burn (a burn that
completely encircles an area) can act as a
tourniquet and impaircirculation or, in the case
of a neck burn, close off the trachea. An
escharotomy may be done to relieve the
pressure. In this procedure, the doctor cuts the
skin along the neck lines until bleeding occurs,
thus releasing the pressure of the edema on
underlying structures.
2. Check for hemorrhage. Patients who have
sustained burns from automobile or other
accidents must be checked for injuries that can
result in hemorrhage. The burn wound itself
causes only minimal blood loss, so if bleeding
is evident, suspect a laceration or internal
bleeding. X rays and other tests may have to
be done at this time.
3. Prevent shock by meeting fluid needs. By
the time a burn victim arrives at the hospital, he
may already have lapsed into primary or
neurogenic shock. Lasting only for about 20
minutes immediately following an injury, it can
manifest itself as intense fear, terror and pain.
Vasodilation causes a fall in bipod pressure
and an increased heart rate. This state
frequently occurs in adults with severe burns
and may be fatal.
The more common cause of shock in burn
patients, however, is hypovolemia or loss of
circulating fluid, a state often called "burn
shock." It is the most crucial period during burn
treatment and is characterized by a major shift
in body fluid and electrolytes from the
intravascular and intracellular spaces into the
interstitial spaces.
Why a fluid shift?
In the body, 50-70% or two-thirds of body
weight is water, distributed into three
compartments: the intracellular, interstitial and
intravascular spaces (See Figure 3).
Normally, the fluid in these compartments is
constantly exchanged through a process of
diffusion and filtration that occurs in the
capillary bed. It is at this level that oxygen and
nutrients are exchanged for waste products.
The capillary membranes through which this
exchange takes place are freely penneable to
salt and water and selectively permeable to
proteins and other matter.
Maintenance of fluid volume within each
compartment is due to: colloidal osmotic
pressure — a pulling force exerted by proteins
on one side of the membrane that tends to
keep fluid in the intravascular space or blood
vessels; and hydrostatic pressure — a
pushing force at the arterial end of capillaries
that tends to drive fluid into the interstitial
spaces. These two opposing forces prevent
undue loss of fluid from the capillaries.
Electrolytes, found in all the fluid
compartments, play a large role in maintaining
the fluid balance as well.
In a burn injury, capillary dilation and an
increase in capillary permeability occur,
resulting in a fluid shift. Plasma, electrolytes
and plasma proteins escape from the
intravascular space into the interstitial space.
Edema is the end result with blister formation
in some areas. The lymphatic system, usually
able to take away the increased tissue fluid,
quickly becomes overioaded and is unable to
remove the excess.
This fluid shift continues for 24-48 hours
depending on the extent of the burn. The body
tries to compensate for the loss of blood
volume by vasoconstriction, increased heart
rate, decreased cardiac output, decreased
blood flow and oliguria. It is essential that fluid
replacement be initiated before shock occurs.
m
3
o>
Intra-
cellular '
fluid
Extra-
cellular
fluid
50%
Intracellular fluid
•?:^^ Intra vascular ^\V*'^'^
i .. , -
1 5% Interstitial fluid
Fluid compartments of the body
in an adult male
On admission, one or more intravenous
lines are started and fluid therapy is initiated.
Many different formulas have been developed
to calculate the approximate fluid
requirements but most use a combination of
colloids, crystalloids and water solutions.
Often, Lactated Ringer's solution (which has a
similar electrolyte balance to blood) and
albumin (to increase colloid osmotic pressure)
are used. Vitamins B and 0 are often added to
the I.V.
If possible, weigh the patient or ask a
family member the pre-burn weight of the
patient. This helps in calculating fluid
requirements. Well treated burn patients often
show a weight gain of 10-15% during initial
treatment.
The most important indicator for deciding
on how much fluid should be given \stitration,
that is, maintaining a careful balance between
intake and output to maintain normal vital
signs. In other words, you need to give enough
fluid to keep the urine output at 30 cc/hr.
In the initial post-burn period, a severely
burned patient may need massive amounts of
fluid e.g. up to 1 ,000 cc of fluid in one hour to
establish adequate intravascular volume.
On admission, a catheter must be
inserted and urine output and speciflc gravity
of the urine checked every hour.
Hematocrit should also be taken every four to
six hours to determine red blood cell
concentration. The hematocrit rises
immediately after a severe burn and then
decreases to preburn levels with adequate
fluid replacement. Anemia may develop later
as a result of RBC destruction due to thermal
injury.
In two to five days, this fluid process will
reverse. The capillary endothelial cells
regain their normal permeability and edema
subsides as the fluid returns to the
intravascular space. At this point, a massive
diuresis occurs. There is a subsequent rise in
blood volume, an increase in cardiac output
and a decreased hematocrit due to
hemodilution. There is a danger of pulmonary
edema or cardiac failure at this time due to fluid
overioad and change in electrolyte balance.
This diuretic phase is a sign that the body is
starting to repair the damage.
Although fluid replacement is of primary
importance, patients with major burns should
not be given fluid by mouth for the first two
days. Burn patients tend to develop a paralytic
ileus and may develop a stress ulcer, called
Curling's ulcer. Frequenfly, a naso-gastric
tube is inserted and Maalox given every
two-three hours.
After diuresis there is a period of negative
nitrogen blance and a reduction of protein
levels in the blood. A high-protein, high-calorie
diet should be started as soon as the patient
can tolerate it, usually by the fourth or fifth day
post burn.
During the initiation of life-saving
measures, the burn patient and his family need
reassurance about his condition. Burn patients
are conscious (unless there are other injuries
that render them unconscious) and are often
I n« ^^anaaian nur««
Hugun iv/t
extremely frightened, and in pain. Although
full-thickness burns are painless, most
patients have a mixture of partial and
full-thickness burns, and thus require pain
medication. Small doses of morphine I.V. are
given to reduce the pain and to act as a
sedative. Large doses of sedatives and
analgesics are avoided since they will mask
signs of respiratory depression. The patient
also needs frequent explanations about what
is being done and reassurance that the pain
will ease.
An initial dose of antibiotic, usually
penicillin (unless the patient is allergic to it) is
given on admission as prophylaxis against
B-hemolytic streptococcus.
4. Care of the burn wound. Sepsis or
infection rates high as a cause of mortality in
burn patients. With the loss of skin integrity,
these patients are extremely susceptible to
massive infections. All staff must maintain
strict sterile technique when in direct contact
with the patient. Good handwashing cannot be
stressed enough.
Local care of a burn wound Is often left
until the patient is transferred to a unit or a
private room. Local wound care can be
delayed up to four hours post-burn. If
cleansing is left until then, the patient should
be wrapped in a sterile sheet and covered with
a blanket.
On arrival to a ward or unit, the patient is
put on protective isolation. If possible, the
patient is placed in a bathtub (or hydrotherapy
tub or Hubbard tank) for cleansing. Special
plastic liners for tubs are now available. The
wounds can be washed in the tub with water
and mild detergent . Washing should be done
gently to remove debris. Never scrub a burn
wound since this could convert a
partial-thickness to a full-thickness wound.
Dead skin that can be removed is debrided in
the tub at this time but blisters are left intact
unless they interfere with joint function. If
necessary, the blisters can be punctured and
deflated but do not unroof them . Also, hair near
the burn wound should be shaved since it
tends to harbor bacteria.
This initial cleansing of the wound
provides an opportunity to re-evaluate the
burn wound itself — its size, extent and
appearance. Look closely for circumferential
burns that may require an escharotomy. This
is a good time to weigh the patient if this has
not been done before. A weight increase is
expected due to fluid replacement. Swabs of
the nose, throat, rectum and all burn sites are
taken for culture and sensitivity.
Once the wound has been well-cleansed,
topical therapy is initiated to control the
number of organisms. Almost all burn wounds
become infected to some degree. Most
frequently, infections are caused by
pseudomonas, staphlococcus aureus,
Candida albicans and B-hemolytic
streptococcus. In the past few years, a number
of new topical antimicrobial agents have been
introduced. They have in a sense
revolutionized burn wound care and have
succeeded in reducing the mortality rate of
burn patients, especially those with 40-60%
body burn. Systemic antibiotics are of
relatively little use in the treatment of burn
wound sepsis because of the decreased blood
supply to the area. However, antibiotics may
be given for other infections — pneumonia,
urinary tract infections or a full-blown
septicemia . Always monitor temperature
closely and be alert for complications such as
septicemia and septic shock. These can occur
anytime. They are a constant threat until
healing has taken place.
The choice of an antimicrobial agent
depends on the characteristic of the burn
wound and on the stage of care (See Drug
Chart). Be aware of the untoward symptoms of
each drug and be alert for them in your patient.
Dressings
There are three basic types of burn wound
dressings:
1 . Open or exposure method. This leaves the
burn wound open to the air with or without the
use of antimicrobial agents. Temperature and
humidity in the room are important as well as
the maintenance of isolation technique. Partial-
thickness wounds dry to form a protective
crust while full-thickness burns develop a dry,
leathery eschar. These serve to protect the
developing granulation tissue underneath.
If topical antimicrobials are used, a thin
layer of gauze can be applied for multiple
dressing changes. Wounds are cleansed and
medication reapplied at least daily.
2. Closed or occlusive dressings. This method
is rarely used except for some pre-graft and
post-graft stages. These dressings are left on
a burn wound for several days, preventing
observation by staff and encouraging bacterial
growth.
3. Wet dressings. These can be used
effectively only if the dressing is kept wet and
not allowed to dry out. Dry dressings are
placed over the wet dressing.
In all burn wound care it is most important
that the wounds be kept clean and that the
patient is comfortable. The prevention of
contractures essential for the patient's
rehabilitation is another area of concern. In
relation to this problem, the following areas
deserve special mention:
Hands: must be dressed and splinted into a
position of function from the very beginning.
Burned fingers must be bandaged separately,
being sure that no skin surfaces touch. The
th umb, whether burned or not, must always be
wrapped separately. Since it is harder to
correct a contracture than to prevent one, a
resting splint should be made on admission
(plaster of paris) until one can be obtained
from physio or the OT department.
A good splint should do the following:
— exaggerate wrist extension (since this is the
first hand function to be lost through
immobilization)
— emphasize the web space between the
thumb and the hand
— exaggerate flexion of the hand by keeping
the fingers straight. If the fingers are not
affected, a wrist cock-up splint can be used.
It is important that the splint is on the hand
snugly but not too tight. Watch for the
development of pressure sores. During the
early period of a bad burn, the patients hand
should be splinted for 24 hours except for
dressing changes.
Feet: Again, wrap burned toes separately and
place the feet in a resting foot splint.
Knees: If knees are burned, check that they
are extended when the patient is in bed.
Patients with knee burns tend to develop knee
contractures easily.
Hips: In patients with extensive burns that
include the groin area, be sure that the hips
are abducted approximately 15°.
Neck: Neck contractures develop quickly. A
burned neck must be hyperextended
preferably in a splint or by the use of a roll
under the nape of the neck with no pillow. (See
Rgure 4).
3
Neck hyper extended
Axilla
abducted 90°
MP joints flexed
Hips 15° abducted
Knees extended
Ankles 90° flexed
Positioning
for the burned patient
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MechanicaJ debridement of the eschar . .
and scissors.
Debridement
When dressings are changed, the leathery
eschar of a full-thickness burn and the slough
of a partial-thickness burn need to be
removed. Mechanical debridement of this
dead tissue can be done with forceps and
scissors by the nurse at the bedside or when
the patient is in the tub. Only dead tissue that
can be cut free without causing excessive
bleeding is removed. (See Figure 5).
Patient reactions to the pain of
debridement and dressing changes vary.
Generally, all patients need an analgesic
one-half hour prior to this procedure. Some
patients, anticipating that the pain will be
severe and feeling that they have no control
over the situation, become very tense during
debridement. Here are a few suggestions from
nurses who work with burn patients at the
Montreal General Hospital on how you can
help your patient deal with his pain.
• First of all, make a contract with the
patient by telling him exactly what you are
going to do. Trace out the area that you will
debride at this particular dressing change.
• Do not deny his pain. Tell him that you
know that it is going to hurt but that it is
necessary. Explain that the granulation bed
must be clean before it will accept a skin graft.
• Give him some control over the situation
by giving him a watch and saying something
like "I'm going to debride the eschar for 10
minutes. You tell me when the time is up."
Remember to keep your part of the bargain.
Although debridement is not pleasant for the
patient, this approach can help in easing his
anxiety.
Debridement can also b»e done surgically
in the operating room instead of at the bedside.
To prevent excessive blood loss, surgical
debridement is usually done soon after
admission. Various chemical enzymatic
debriding agents are being used in some
centers in Canada. One such agent, Travase,
selectively digests necrotic tissue by a
proteolytic action. Those who favor its use say
that it hastens the formation of granulation
tissue and wound healing. Others against its
use feel that its side effects outweigh its value
(See Drug Chart). When it is used, an
antimicrobial agent is also used.
Grafting
As we have seen, the ability of a burn
wound to heal and to produce new skin is
directly dependent on the depth of burn
damage. In full-thickness burns, grafting is
necessary for wound closure and should be
done as soon as possible to minimize infection
and loss of function. Grafting is often done in
partial-thickness burns as well, to provide
more durable skin coverage and better
function.
The source for a permanent skin graft is
the patient's own skin, called an autograft.
This skin can be taken from any area of the
body that is intact. If there is no available skin
for grafting, as in cases of large burns,
temporary grafts are used until the patient's
own skin is available. These temporary grafts
can be homografts — skin histiologically
compatible with the patient's and obtained
from family members or human cadavers or
lieterografts — skin coverings from animal
sources such as bovine, canine and porcine
tissue or those from synthetic materials such
as Teflon, and nylon-velour. These temporary
grafts serve to prevent evaporative water-loss
by acting as semi-permeable membranes and
to reduce the pain of healing.
There are two basic types of skin grafts:
1) split-thickness grafts which tend to take
better than a thicker graft and are most
frequently used in the initial management
phase, and
2) full-thickness grafts which produce a good
cosmetic appearance and are used more
commonly during later treatment.
When the granulation bed (burn wound
area) is clean, free from infection and has
developed a good blood supply, the area is
ready to be grafted provided that the patient's
condition is stable and he is in a good
nutritional state. The donor site can be
prepped as in any operative procedure or this
may be done in the operating room. Skin is
harvested from the donor site with a
dermatome. An occlusive dressing such as
"Scarlet Red" can be applied
to the donor site and left on for 7-10 days or the
site can be left open. With good care, donor
sites heal within 1 0 days to two weeks and can
be used many times. In the case of
full-thickness grafts, the donor sites will
themselves require a split-thickness skin graft
to heal.
Skin grafts may be applied in the OR or in
the patient's room. Dislodgement is the most
critical problem in the care of a skin graft.
Some hospitals have found that there is an
increased possibility of dislodgement during
the patient's trip back to his room after surgery
and in his transfer from the stretcher to his bed.
At the Montreal General Hospital, skin grafts
are applied by the staff nurses on the patient's
return from the OR. (See Figure 6).
Graft sites can be left exposed or covered
with a wet or dry dressing. The exposure
method allows for close observation of how
well the graft is taking. With the exposure
method however, the patient may need to be
immobilized with splints, slings or traction to
prevent dislodgement. If occlusive dressings
are applied, these are removed only on
specific order. A graft that is taking well will
appear pinkish-red and adhere smoothly to the
granulation bed. A graft that appears white or
darker than the original tissue indicates that
the graft is not taking.
I ne uanaoian Nurse August 1977
1. A leg ulcer that is ready for grafting.
4. Skin graft in place.
j Trimming the sidn graft for an exact fit.
5. Application of Steri-strips' to hold the graft in
place.
' steri-strips is a registered trademark of the 3M Company.
Burh Update
The Canadian Nurse August 1977
Update
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Emotional reactions
The person who suffers a severe burn will
need help and understanding to cope with the
tremendous problems he will have to face. He
will have to deal with disfigurement, possible
disability, unemployment, separation from
family, and perhaps loss of family members.
He will have to cope with a long period of
hospitalization and all that it entails —
tubkjings, exercises, debridement, grafting
and chronic pain. Although all illnesses seem
to Involve some expression of anxiety,
regression and depression, these reactions
are often markedly exaggerated In the burn
patient. Painful treatments on a long-term
basis tax his emotional resources and can
accentuate any psychological problems he
may already have. Pain can also distort his
sense of reality.
His relationship to the nursing staff is
often a love-hate relationship. No other aspect
of nursing requires the staff to inflict so much
pain in patients in the course of necessary
treatment. Obviously, this causes ambivalent
feelings in both the patient and the nurse. The
patient knows that the procedures are
necessary and realizes that the nurse is
helping him improve, but at the same time, he
sees her as the cause of his pain and may
express his anger in verbal abuse towards her.
Staff's reactions to this kind of behavior can
vary. Some nurses may feel that their nursing
skills are inadequate, that they should not be
causing so much pain. Others may mirror the
patient's emotion and become angry
themselves. Often, manifestations of this
anger can be seen when nurses withhold pain
medication or label the patient as a "baby" or
"difficult." In dealing with this situation, it is
Important that staff nurses objectively analyze
the reasons why the patient acts in a certain
way and then try to find ways of helping him
cope with all the things that are going on. Staff
meetings and consultations with psychiatry
are ways that can be used by the staff to
ventilate their own feelings and to discuss
approaches that might be used.
Families of burn patients also experience
intense emotions and need a great
deal of support to cope with their feelings. One
of the most effective means for the staff to
provide this support is to teach the family about
the situation. They need to know what is
happening to the patient and what to expect.
Knowing that the patient is receiving good care
does a great deal to alleviate their anxiety.
Effective and thorough teaching for the family
takes not only time and planning but also a
sense of caring on the part of the nursing staff.
Nursing the burn patient is not an easy
job. It demands specialized knowledge, good
technical and observational skills and insight
into hurfian behavior. The quality of nursing
care the burn patient receives will in large part
determine the extent to which he will heal
physically and adjust emotionally to this crisis. «
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• a topical anti-bacterial agent
used for 2' and 3° burns.
• diffuses through avascular
burn tissue to control infection.
Effectiveness
• effective against many
gram-negative and
gram-positive organisms
including some anaerobes
e helps prevent partial -
thickness wounds from
converting to full-thickness
wounds because of infection.
e helps prevent bacterial
invasion of unburned tissue.
Precautions
e safe use has not been
established diiring pregnancy,
• fungal colonization in and
below eschar may occur.
Side Effects
• pain or burning sensation on
application is common.
• allergic manifestations such as
rash, itching, facial edema,
swelling, hives, erythema.
• respiratory problems e.g.
tachypnea, hyperpnea,
hyperventilation due to
acidosis. Sulfamylon inhibits
carbonic anhydrase which in
turn causes f excretion of
sodium bicarbonate leading to
metabolic acidosis.
Application
e apply directly to burn wound
surface using a sterile tongue
blade, sterile gauze or by
sterile gloved hand.
• apply enough cream so that the
burn wound is not visible.
e may be left on the wound
uncovered or, it can be covered
with fine mesh gauze. May also
be used in occlusive dressing,
• usually applied twice daily and
as necessary.
Nursing Considerations
• cleanse wounds thoroughly
beiore new application e.g.
tubtjing is the best way to
remove cream or soak with 1 /2
warm normal saline and 1 /2
hydrogen peroxide to facilitate
easy removal.
• sedate 20 minutes before
dressing change due to
stinging sensation on
application.
e eschar fakes longer to slough
because eschar separation is
dependent on the proteolytic
action of bacteria.
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FLAMAZINE, SILVADENE
Generic Name
1% Silver Sulfadiazine Cream
Indications
e a topical anti-microbial agent
for adjunctive treatment and
prevention of infection in
severe burns.
Effectiveness
e tjest results obtained if applied
as soon as possible on a bum
wound that is well cleansed to
prevent subsurface bacterial
penetration.
• effective against
gram-negative, gram-positive
organisms as well as Candida
albicans.
Precautions
• caution with hepatic or renal
impairment. Kernicteais may
develop.
• fungal colonization in and
t)elow eschar may develop.
Interaction
• if used in conjunctbn with a
topbal enzyme, the silver may
inactivate such enzymes e.g.
travase.
Contraindications
• sulfonamide sensitivity.
■ do not use during pregnancy or
with newborn infants.
Side Effects
• although flamazine is painless,
such reactions as burning,
rash, itching, and one case of
interstitial nephritis have been
reported.
e toxic reactions associated with
sulfonamides.
Application
• apply topically 2-4 mm
thickness with sterile gloved
hand or sterile tongue blade,
e store in a cool place away from
the light,
• wound may tie left exposed or
an occlusive dressing may be
used.
Nursing Considerations
• cleanse wounds thoroughly
before new application. This
agent has a tendency to form a
crust if not removed at time of
dressing change.
e check carefully for signs of
purulent accumulation in
sut)eschar space and remove.
• dressings may have a slimy,
greenish-gray appearance but
this is not necessarily indicative
of gross infection. Check
cultures and clinical status of
patient.
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BETADINE OINTMENT AND 10%
SOLUTION
Generic Name
Providone-lodine N.F.
Indications
• a topical bacteriocidal ointment
tiiat can be used in conjunction
witti betadine 10% solution
during all phases of burn
wound care to prevent sepsis.
Effectiveness
• effective against a wide variety
of gram-negative and
gram-positive organisms,
fungi, yeasts, protozoa and
viruses.
• most effective for a 6-hour
period after application.
Contraindications
• iodine allergies.
Side Effects
• allergy reactions such as
irritation, redness, swelling.
• possibility of T3 and T4
elevation. Iodine levels will
return to normal after cessation
of therapy.
Application
• apply ointment with sterile
gloved hand or sterile tongue
blade so that burn wound is
completely covered.
• ointment is applied twice daily
at dressing changes. At 6-hour
intervals between dressing
changes, wet the dressing with
betadine solution.
• can also tie used over fresh
skri grafts or on areas that are
clean and healing.
• useful for the treatment of
burned ears. Apply q8h.
Nursing Considerations
• give pain medication 20
minutes before dressing
change.
• stinging or burning associated
with application is of relatively
short duration.
• betadine has a tendency to
build up a crust, therefore,
cleanse areas well e.g.
tubbing, shower or bedbath.
• detmde loose tissue, then
apply ointment.
• check for side effects.
■ tendency to stain material.
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SILVER NITRATE 0.5%
SOLUTION
Generic Name
Silver Nitrate
Indications
• a bacteriocidal agent used for
continuous wet dressings on
burn wounds and over skin
grafts.
Effectiveness
• penetrates only 1 to 2 mm of
burn eschar, therefore,
controls only surface bacteria
on the wound.
• treatment must be initiated
eariy Ijefore deep colonization
of the wound develops.
Interaction
• if used in conjunction with a
topical enzyme, the silver may
inactivate such enzymes, e.g.
travase.
Side Effects
• depletion of serum potassium
and sodum levels.
Application
• use 6-8 layers of 4-ply gauze
dressings, all thoroughly wet
with silver nitrate solution.
• debridement done at time of
dressing change.
• dressings must be kept wet
with silver nitrate solution at all
times between dressing
changes. If dressing Incomes
dry, concentrated solution can
cause damage to underlying
tissue.
Nursing Considerations
• amount of time spent on
dressing changes and staining
are problems.
• warm, soapy water helps
remove some stains from skin.
Tubbing helps.
• keep patient warm. Body heat
is lost through evaporation.
• once eschar is removed,
exposed areas of deep,
partial-thickness burns will tie
painful during dressing
changes. Give sedation.
• essential that patient receives
supplemental calcium,
potassium and sodium.
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Generic Name
Sutilains Ointment N.F.
Indications
• a topical enzymatic agent used
to dissolve and remove
necrotic tissue in 2' and 3^
burns.
Effectiveness
• selectively digests necrotic soft
tissue by proteolytic action and
facilitates removal of burn
eschar and purulent exudate to
hasten fonnation of granulation
tissue and hasten wound
healing.
• appears to have no effect on
normal tissue.
• treatment starts either
immediately or 3 days
post-burn and continues for 5-7
days.
• optimal activity level at body
temperature with a pH of 6.0 -
6.8.
• effectiveness seen within
24-48 hours.
Precautions
• do not allow enzyme to come in
contact with eyes. Flush eyes
with copious amounts of water
if this occurs.
• do not use on more than 15% of
body surface at a time.
Interaction
• enzyme may be rendered
inactive if applied in
conjunction with certain
detergents and antiseptics e.g.
silver nitrate, fiamazine.
However, sutfamylon and
fiamazine are often used
concun^ntly with travase with
apparent success.
Contraindications
• not to be applied if wounds
communicate with major body
cavities or near exposed major
nerves or nerve tissue.
• pregnancy.
Side Effects
• mild, transient pain probably
due to friction on nerve
endings.
• paresthesia.
• bleeding.
• transient dermatitis.
Application
• apply agent with a sterile
gloved hand as a thin layer
making sure to go into the
crevices of the wound and to
overlap 1/4 inch of skin all
around the wound.
• apply wet dressing of sterile
water or normal saline over the
ointment. THE DRESSING
MUST BE KEPT MOIST AT
ALL TIMES FOR THE
ENZYMATIC ACTION TO
OCCUR.
• apply travase 1 -4 times daily as
ordered.
• if wounds are infected, a layer
of topical anti-microbial can be
used over the travase. Wet
dressings are applied as usual.
Nursing considerations
• refrigerate travase to maintain
potency.
• clean wound area well and
keep area moist e.g. tubbing,
shower or wet soaks before
application.
• give medication at least 20
minutes before procedure.
• wet the dressings prn to keep
moist.
• observe patient for clinical
signs of sepsis.
• observe patient for dermatitis
or unusual bleeding.
Discontinue drug.
Th« Canadian Nurse August 1977
Acknowledgement: / would like to thank the
nursing administration department of the
Montreal General Hospital for their help in the
initial planning of this article. Special thanks
go to the staff of 5 West, Protective Isolation
Unit, and to the physiotherapy, dietetics,
occupational therapy, infection control,
psychiatry and photography departments at
the l^ontreal General for their cooperation and
assistance in the research and writing of this
article. Their help during my visit, particularly
the help and support of Anne Dickson, head
nurse, Jutta Yegavian, staff nurse, and
Susanna Jack, psychiatric nurse consultant,
is greatly appreciated. Lastly, I would like to
express my gratitude to the burn patients on 5
West for their help and cooperation during my
visit. — S.L.
Bibliography
1 Bernstein, Norman R. Emotional care of the
facially burned and disfigured. Boston, Little,
Brown, 1976.
2 Bradley, D. Poisoning, burns and scalds.
Nurs. Times 71:39:1542-45, Sep. 25, 1975.
3 Davidson, Shirlee P. Nursing management of
emotional reactions of severely burned patients
during tfie acute phase. Heart/Lung, 2:3:370-375,
May-Jun. 1973.
4 Feller, Irving, Nursing the burned patient by...
and Claudella Arctiambeault Jones. Ann Arbor,
Michigan, Institute for Burn Ivledicine, 1973.
5 First Aid, 3ed. St. John Ambulance, Ottawa,
1974.
6 Jacoby, Florence G. Nursing care of the
patient with burns, 2ed. St. Louis, Mosby, 1976.
7 Luckmann, Joan. Medical-surgical nursing: a
psychophysiological approach by ... and Karen
Creason Sorenson. Toronto, Saunders 1974.
8 Red Cross First Aid, 5ed. Canadian Red Cross
Society, Toronto, 1972.
9 Rinear, Charles E. Emergency. Part 3:
On-the-spot care for aspiration, burns and
poisoning, by ... and Eileen E. Rinear A/urs/ng 75,
5:4:40-47, Apr. 1975.
Some of the nursing staff from 5 West,
Protective Isolation Unit, ivlontreal General
Hospital who assisted in the preparation of
this article: From left to right: Back row:
Juliette Burke, Cathy Knowles, Donna
l^arshall, Martha Turnball.
Front row: Zenida Ramos, Wendy Ward, 'Anne
Dickson, Perely Spence.
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All photos courtesy of Joseph Donohue. Photography Department,
Montreal General Hospital. Montreal. Quebec.
Clinical Wordsearch no.Q
This is another in a continuing series of clinical
wordsearch puzzles relating to different areas of
nursing, by Mary Elizabeth Bawden (R.N..
B.Sc.N.) who presently works as Team Leader
in the Rheumatic Diseases Unit, University
Hospital, London, Ontario.
Solve the clues. The bracketed number
indicates the number of letters in the word or
words in the answer Then find the words in the
accompanying puzzle. The words are in all
directions — vertically, horizontally, diagonally,
and backwards. Circle the letters of each word
found. The letters are often used more than once
so do not obliterate them. Look for the longest
words first When you find all the words, the
letters remaining unscramble to form a hidden
answer. This month's hidden answer has five
words. (Answers page 31).
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1 Robert or George (5)
2 Type of tissue formed when soft tissue
wounds heal. (1 1)
3 Decreased amount of circulating fluid in the
body, (-h;
4 May result from being too close to the flame,
or new shoes. (8)
5 Excess of fluid in intercellular spaces. (5)
6 The temperature that must be reached in
order for a substance to burst into flame. (8)
7 What's burning in a Class "B " fire. (8)
8 The effect of a strong alkali. (9)
9 Too little blood or too much electricity causes
this state. (5)
10 Necessary to make cauldrons bubble. (4)
1 1 Includes both oral and parenteral fluids. (6)
12 Removal of foreign material and devitalized
tissues. (1 1)
1 3 Pertaining to the absence of disease-causing
microorganisms. (7)
14 AgNO= C6, 7)
1 5 A graft of skin in which three sides are freed
from donor site and fourth remains attached
to maintain blood supply. (7)
16 Deficiency of sodium in the blood. (12)
17 An odorless cream applied to burns which
does not precipitate CI as readily as AgNO^
and has the antibacterial action of
sulfonamides. (6, 12)
18 Caused by the invasion of pathogenic
organisms. (9)
19 Special tub for bathing burn patients. (7, 4)
20 Death of a cell or group of cells. (8)
21 Deformities which may result from healing of
third degree burns. (12)
22 A graft taken from the patient's own sk in. C70^
23 Graft not attached to donor site. (4)
24 A morbid condition resulting from the
presence of pathogenic bacteria and their
products. (6)
25 Skin transplant from a person other than burn
victim. (9)
26 Segment of skin taken from an animal such
as a pig or a dog. (10)
27 Render burns occlusive. (9)
28 Food substance necessary for building new
cells and tissue. (7)
29 Source of blood or transplants. (5)
30 Tfie chief cation of extracellular tx)dy fluids. (6)
31 What is decreased in #3. (6)
32 There's none off my back. (4)
33 This burn is relieved by antacids. (5)
34 Often necessary as a protective measure for
badly burned patients. (9)
35 There is usually a of body fluids in burn
victims. (4)
36 Often results from upset saucepans. (5)
37 Cause of ultra-violet burns. (3)
38 What's left of last year's burn. (4)
39 Sometimes felt more with 1 st degree than 3rd
degree burns. (4)
40 "Warm to touch" — as we say in the
profession. (3)
41 Appearance of burn of #37. (3)
42 One factor used in assessing the severity of a
burn. (3)
43 As necessary. (3)
44 A graft of skin between 0.010 — 0.035
inches. (5, 9)
The Canadian Nurse August 1977
Coping with pain:
Strategies of severely burned children
Marilyn Savedra
For the severely burned child awareness of
pain soon becomes all encompassing.
Because no previous experience he has had
could in any way prepare him to understand
what is happening, he "exists in a state of
confusion, fear, panic and hurt."' Pain may not
only be present as the child lies quietly in bed,
but accompanies almost every move he
makes, every nursing measure utilized in his
care, and every therapy ordered by the
physician. It is weeks and months before
helping no longer involves hurting. Anxiety
resulting from the traumatic situation and
communicated by concerned parents may
enormously increase the pain. Pain relieving
medication is limited for the child must be alerl
enough to cooperate with treatments and to
maintain adequate food and fluid intake.^
Nurses and others responsible for the
care of the burned child are constantly
involved in procedures which inflict pain,
attempting to get the child to cooperate in pain
producing experiences, and coping with the
child's response to pain. While nurses who
work with such children expect to cause pain
and to experience outbursts from the child they
are often unprepared for the intensity and
duration of the child's response.^
The question was asked, how does a child
cope with the intense, seemingly never ending
pain of an extensive burn? The answer came
from observation of five children hospitalized
with severe burns. Observations were made
several times a week at varying times of the
day and evening during the major portion of
the hospitalization.
Coping
As defined by Lazarus" coping refers to
strategies for dealing with threat. When threat
is perceived the child's actions are directed
toward reducing the anticipated harm the
threat engenders, t^urphy^ suggests:
"When a situation involves some threat, the
child's action in relation to the threat may move
in any one of several different directions; he
may attempt to reduce the threat, postpone,
bypass it, create distance between himself
and the threat, divide his attention, and the
like. He may attempt to control it by setting
limits, or by changing or transforming the
situation. He might even try to eliminate or
destroy the threat. Or he may balance the
threat with the security measures, changing
the relation of himself to the threat or to the
environment which contains it, but which also
Includes sources or reassurance."
The Children
The children studied ranged in age from
6.0 years to 9.5 years. All burns were primarily
second and/or third degree and covered
30 percent to 65 percent of body surface area.
In all cases the child's clothing had caught fire.
(See Table 1 ). Of the five, Sherri alone did not
survive, dying nine and one half weeks
postburn as the result of infection. One of the
children (Jane) was hospitalized in a private
room of a children's hospital. The other four
received care on a burn unit and for the major
portion of their stay were together in a six -bed
ward.
The Pain
The most intense pain occurred with the
direct care of the burn wound." ' Regardless of
the therapy, all of the children responded,
particularly during the first weeks, with
hysterical screaming while their burns were
being dressed. As grafting proceeded the pain
from the burn wound decreased but the donor
site became an additional source of pain.
As time progressed, some children
became less tolerant of the pain. Fifty-two
days postburn Jane screamed with greater
forcefulness than had been previously
observed. She said it hurt more. It was 85 days
postburn that Larry screamed during his
dressing change that he wanted to die. He kept
repeating "Oh God, I love you, " and cried for
God to heal his skin.
Sherri associated screaming with pain
and burns. Once when she heard someone
scream on a television show in another part of
the ward, she asked if I thought someone was
being burned and if the house was on fire. I
asked if she had screamed when she had
been burned. She replied that she had. a little,
because it hurt.
Strategies for Coping
Several strategies for coping with pain
emerged from the data. Categorization in part
was based on the work of Murphy^.
Reduction of Threat
Reduction of threat was a strategy used
consistently by two of the children. Pain was
anticipated and efforts were made to lessen
the expected pain.
My introduction to Jane came at the time
of a dressing change. Her nurse was removing
dried Sulfamylon with saline soaked gauze.
Jane was lying in bed naked, trembling, with
face drawn, hitting the bed with her foot.
Between her piercing screams, she pleaded,
"Don't hurt me Connie, I don't want you to hurt
me. Do it lightly." During painful procedures
she would repeat over and over, "Don t hurt
me. "
Sherri, too, used reduction of threat as a
strategy. At the time of tubbing and dressing
change she pleaded with nurses, "Go easy.
Go very, very easy. "
Postponement
Postponement was a frequently used strategy.
Jane regularly stated a need to sleep or rest
when tubbing and/or dressing changes were
announced. When Sulfamylon was removed
by hand she pleaded to be allowed "to dry '"
before more was applied. She also insisted at
times that she had to go to the bathroom just as
she was to go into the tub. On one occasion
her mother participated in Jane's postponing
strategy by counting to 25 before the treatment
was allowed to begin.
Jennifer was heard pleading with her
nurse not to be the first person to be put into
the tub. Sherri once wanted to wait six weeks
before having her dressing changed. Larry
tried to postpone pain producing situations by
asking if nurses were acting on doctor's
orders.
Bypass
An attempt to bypass a procedure was a
strategy used less frequently than
postponement. Jane once asked her nurse to
"just pretend to do the dressing change.
When told this was not possible she said she
wished to die Asked why, she replied that she
did not want to be hurt. Once Jane asked if I
thought she would have to have a bath if she
prayed to God. When asked what she thought
she replied that she would have the bath
because people were praying that she would
get well.
Jane, Sherri, and Larry most often used
the bypass strategy when routine care,
including position change, was to be carried
out. Sherri once said she did not need to go
into the tub. She reasoned that she did not
have a bath every day at home.
Creating Distance Between Self and Threat
Immobility of all of the children during a major
portion of their hospitalization made creating
distance between self and threat an
impossible strategy to be used.
Larry, toward the end of his
hospitalization, made an attempt to utilize it.
The Canadian Nurse August 1977
Burn Update
When told that his dressing needed to be
changed, he screamed that he did not want It
done because It hurt. He asked me to remove
his covers and pillows so he could get out of
bed. Jane on two occasions, involving a
dressing change attempted to keep her nurse
at a distance by kicking her legs.
Dividing Attention
Kenny most effectively used the strategy of
dividing his attention when experiencing pain
from needles. He wanted me to hold his hand
and tell him what to talk about during the
procedure. My suggested topic was readily
accepted. Once he started talking and then
stopped to check with the nurse giving the
injection to see if it was the right time for him to
talk.
Jennifer also asked me to hold her hand
during a dressing change. She still screamed
throughout the procedure but became smiling
and cheerful when it was completed. She
thanked me for holding her hand stating her
mother usually did so at such times.
Nurses attempted to get children to use
this strategy. Larry was urged to talk to me
while in the tub. He ignored the suggestion.
Jane screamed only intermittently during a
tubbing when a nurse read a story to her. She
appeared to listen. However, when I asked her
if she had listened to a story when she was in
the tub she said she hadn't because she was
too busy screaming.
Sleep
Withdrawal into sleep was a behavior
frequently used by Jane but used less
frequently by the children on the burn unit. It
was not always possible to determine when
sleep was a result of physical need or was
used to avoid a painful situation. Jane did use
sleep as a coping strategy. Once she told me
that if she was asleep she would not have to
have a shot. A nurse commented that when
Jane thought something would hurt she would
say she needed sleep. After surgery Jane
used sleep at least partially as a retreat.
Jennifer, when first admitted to the burn
unit, spent much time sleeping. Kenny,
throughout his hospitalization, spent
considerably more time during the day
sleeping than did Sherri or Larry.
Sherri did associate sleep with absence of
pain. Anesthesia was given at times prior to
the tubbing which preceded surgery. She, and
other children on the unit, would beg to be
asleep when they went into the tub so it would
not hurt.
Table 1
Data on Children
Names
Age (years) Body surface
at time of area burned
accident
Severity
Length of
hospitalization
Jane
7.10
45%
Primarily
3rd degree
1 1 4 days
Lany
9.5
62%
Primarily
3rd degree
118 days
Sherri
6,0
65%- 75%
Primarily
3rd degree
73 days
deceased
Kenny
7.9
30%
Primarily
3rd degree
47 days
Jennifer
8.9
32%
2nd and 3rd
degree
44 days
Responses to Crying of Others
For the severely burned child crying and/or
crying out appears to be associated with pain
and discomfort. It is distressing to the child and
he therefore attempts to control this behavior
in others as a mechanism for coping with his
own situation."
Jane and Larry were both intolerant of
other children crying. Jane while listening to a
child across the hall stated there was no
reason for him to cry like that. She had not
cried that hard, she said, when she was
burned. When Jennifer moaned and groaned,
l-arry suggested she be put in the tub room.
When Sherri was moved from the ward to a
semi-private room shortly before her death,
Larry told me the move had been made
because Sherri cried and disturbed people.
Discussion
All five of the children studied could be
classified as active copers.' Patterns of coping
could be identified for individual children.
While each was severely restncted in many
ways each made definite efforts to control the
environment. Because of the immobility
imposed for much of the hospitalization the
coping style of each was essentially verbal in
nature. The age of the children made this
possible.
It would appear from this limited sample
that postponement was frequently attempted
and was more common than attempting to
bypass the pain producing situation.
Strategies to reduce th reat were also common
while devices to divert attention were
infrequently used. Creating distance between
self and the threat was not physically possible
for the severely burned child.*
References
1 Brodie, Barbara. Emotional aspects in the
care of a severely burned child, by ... and Susan
Matern. /nfer. Nurs. Rev. 14:19-24, Dec. 1967.
2 Loomis, W.G. Management of children's
emotional reaction to severe body damage (burns).
Clin. Pediatr. 9:362-367, Jun. 1970.
3 Quinby, Susan. Identity problems and
adaptation of nurses to severely burned children, by
.. and Norman B. Bernstein. Amer. J. Psych.
128:1:90-95, Jul. 1971.
4 Lazarus. Richard S. Psychological stress and
the coping process. New York, McGraw-Hill, 1966.
5 Murphy, Lois Barclay, The widening world of
childhood. New York, Basic Books Inc., 1962.
6 Davidson, Shirlee P. Nursing management of
emotional reactions of severely burned patients
during the acute phase. Heart Lung 2:370-5.
May-Jun. 1973.
7 Faberhaugh, Shizuka Y. Pain expression and
control on burn care units. Nurs. Out. 22.645-50,
Oct. 1974.
8 Ibid.
9 Kuetfner, Marilyn C. A study of the passage
through hospitalization of severely burned Isolated
school age children. University of California, San
Francisco. 1973. Unpublished doctoral dissertation.
Coping with Pain: Strategies of Severely Burned
Children is reprinted with the pennission of the
author andthe Maternal-Child Nursing Journal. The
article first appeared in Volume 5, Number 3, Fall
1976 issue of the Journal.
Marilyn Savedra is presently Assistant
Professor, Department of Family Health Care
Nursing, Sctiool of Nursing, University of
California, San Francisco.
30
The Canadian Nurse August 1977
Nutrition ana the bum patient
Providing adequate fluids and a nutritious diet high in calories
and protein is one of the most important aspects in the
treatment of the burn patient. Satisfactory wound healing and
successful skin grafting are dependent on the patient's
optimal nutritional state. Here, a dietician discusses the
nutritional management of the burn patient and some aspects
of diet planning.
Rosemarie Repa Fortier
Nutritional needs of the burn patient
Hypermetabolism and hypercatabolism,
two states which characterize the body's
response to a burn injury, result in an increase
in energy and protein requirements.' One
source states that the basal metabolic rate of a
burn patient may be increased as much as
40-50% greater than normal.- To meet these
increased energy requirements, the burn
patient needs a diet high in calories.
High caloric Intake is also necessary to
minimize or prevent weight loss during the
post-burn period. The weight loss of a severely
burned patient during hospitalization may be
from 25% to 33% of his pre-burn weight,
depending on the percentage of body burn.'
The greater the burn, the greater the weight
loss.
The ideal caloric intake is determined by
the following equations proposed by
Pennisi:
Adult (20 kcals x kg body weight) + (70 kcals x
%burn).
Child (60 kcals x kg body weight) + (35 kcals x
%burn).
Once the calorie requirement has been
calculated, the protein requirement is
calculated as follows:
Adult (1 gm X kg body weight) + (3 gm x % burn).
Child (3 gm x kg body weight) + (1 gm x % burn)."
Initially, the protein requirements of the
burn patient are increased due to the loss of
body weight and to the great amount of
nitrogen lost during catabolism (the
breakdown of tissue). High protein intake is
necessary throughout the convalescent period
due to the continued loss of nitrogen from the
burn wounds.^ A low serum protein resulting
either from secondary infection to the burn site
or low dietary intake of protein rich foods may
decrease the rate of wound healing.^
Polyunsaturated fat is necessary in the
diet to prevent essential fatty acid deficiency,
which may occur during the catabolic phase. ^
Fats supply a concentrated source of energy
and are important sources of fat-soluble
vitamins. Carbohydrates supplying energy,
provide the remaining necessary calories in
the diet. Fat and carbohydrate must be present
in adequate amounts to be used as energy in
order to prevent the channeling of too much
protein for this purpose. This "protein-sparing
action" of carbohydrate allows a major portion
of protein to be used for its basic structural
purpose of tissue building.
Other nutrient requirements must also be
considered in the nutrition of a thermally
injured patient. Multivitamins should be
administered daily. An increased ascorbic acid
level is necessary to provide collagen
synthesis and promote capillary strength.
Vitamin A requirements are increased to
maintain healthy epithelial cells, which form
the body's primary barrier to infections. A
suggested dosage is 500 mg of ascorbic acid
q.i.d. and 50,000 units of vitamin A b.i.d.^ In
addition, others suggest 50 mg of thiamin, 50
mg of riboflavin, 500 mg of niacinimide and
600 mg of zinc sulphate.'* Iron rich foods
should also be stressed, as hemoglobin levels
often decrease following burn injury. An iron
supplement is often necessary.
Serum potassium is excreted in large
quantities during the early stages of thermal
injury. A 400 mEq supplement of potassium is
recommended per day, to maintain normal
serum concentrations.'" Potassium depletion
should be closely watched in cardiac patients
and in the elderly.
A high fluid intake is necessary to
compensate for fluid losses through
evaporation. A severely burned patient may
lose between 2.5 and 4.0 litres of fluid in
evaporation daily." High protein, high calorie
drinks can also be given.
Considerations in meal planning
Until resolution of post-traumatic or
paralytic ileus, the severely burned patient will
remain on I.V. fluids. Clear fluids are usually
administered three to four days post-burn. The
progression from full fluids to a full,
high-protein, high-calorie, high-fluid diet
follows as soon as the patient is able to tolerate
solid foods.
A nutritional history, illustrating food
preferences, should be completed with each
patient. Diabetes, cardiac, renal or liver
illnesses must be considered when the
patient's menu is prepared. Meals should be
presented attractively, considering contrast in
color and texture, as well as providing a good
variety in foods. A pattern of three meals
supplemented by high-protein, high-calorie
nourishments between meals is established.
Milk or milk nourishments, such as
milkshakes, eggnogs, vitaminized juices or
commercial high-protein liquid supplements
can be offered. Nourishments require regular
variation due to the long-term hospitalization
of these patients. They are essential in the
eariy post-burn stages when the patient's
appetite is poor.
Soft foods are advantageous during the
initial periods of hospitalization as they are
more easily digested. For patients with face
and neck burns, or burns around the mouth, it
may be necessary to offer pureed or minced
foods. A patient who has sustained severe
burns to arms, hands or fingers should be
Burn Update
uu
rn Up(
I II Kj\j\
given foods in a form that can be easily eaten.
Foods which are cut up or soft will eliminate
unnecessary effort. All patients should be
encouraged to feed themselves to help
overcome their feelings of helplessness. A
great deal of support is needed to overcome
the frustration or discouragement which a
patient may have in trying to eat his meals.
Good nutrition must be emphasized by
the health team throughout the convalescent
stages. Despite the patient's depression and
anorexia, his life may depend upon rigorous
nuthtional therapy. The high-protein,
high-calorie, high-fluid diet continues until
separation of the eschar and the grafting of the
burn wounds is complete.
Evaluation of nutritional management
Daily caloric intakes, showing the protein,
fat and carbohydrate intake, are required to
evaluate the success of the diet therapy. The
patient's weight should be recorded routinely,
at least twice a week. For greater accuracy,
the patient should be weighed at the same
time each day (preferably before breakfast)
and after the removal of wound dressings.
Establishing a weight loss of 10% body
weight as a limit is an important guideline for
the nutritional care of individuals with thermal
Injury.'^ However, this limit may not be
possible in patients with greaterthan 40% total
body burns. If the patient reaches a 10%
weight loss and his food intake is insufficient to
meet his caloric needs, an alternate feeding
method will have to be prescribed. A tube
feeding or hyperalimentation may be used as a
supplementoralternatefeeding method. Tube
feedings should be discontinued as soon as
possible due to the danger of respiratory
infection, aspiration and gastric dilation.'^
Central venous hyperalimentation may also
cause complications such as sepsis and
metabolic complications and therefore should
be used only with extreme care.'"
In summary, optimal nutrition is extremely
important for a patient who is burned, to
prevent negative nitrogen balance, to
minimize weight loss, to provide for adequate
wound healing and skin grafting and in the
case of children, to continue normal growth
and development. The nutritional
management of burn patients requires the
involvement of the health team — physicians,
nurses, psychologist, occupational therapist,
social wori<er and dietician — to achieve good
results.*
Rosemarie Repa Fortier is a graduate in
nutrition and dietetics from the University of
Western Ontario in London. She is presently
employed at the Montreal General Hospital as
a therapeutic and teaching dietician working
with patients on protective isolation,
neurology, psychiatry and obstetrics. She is a
member of the Canadian Dietetic Association,
the Corporation Professionnelle des
di^tetistes du Quebec and the Association
des di^tetistes autonome du Quebec.
References
1 Pennisi, V.M. Monitoring the nutritional care of
burned patients. J. Amer Diet. Assoc. 69:531-533,
July 1976.
2 Wilmore, D.W. Nutrition and metatx)lism
following thermal injury. Clin. Plast. Surg.
1:4:603-619, Oct. 1974
3 Larkin, J.M. Complete enteral support of
thermally injured patients, by ... and J.A. Moylan.
Amer J. Surg. 131:6:722-724, Jun. 1976.
4 Pennisi, op. dt.
5 Polk, H.C. Modern trends in care of the burn
patient, by... et al. Disease-a- Month 1-39, Oct.
1973.
6
Ibid.
7
Wilmore, op. dt.
8
Larkin, op. dt.
9
Polk, op. dt.
10
Wilmore, op. dt.
11
Polk. op. dt.
12
Wilmore, op. dt.
13
Polk, op. dt.
14
Larkin, op. dt.
Bibliography
1 Curreri, P.W. Dietary requirements of patients
with major burns, by ... et al. J. Amer Diet.
Assoc. 65:4:41 5-41 7, Oct. 1974.
2 Hinton, P. Biochemical changes in burned
patients. Posfgrad. Med. J. 48:144-147, Mar. 1972.
3 Zawacki, B.E. Does increased evaporative
water loss cause hypermetabolism in burn patients?
by ... et al. Ann. Surg. 171:236-240, Feb. 1970.
1
Burns
2
Granulation
3
Hypovolemia
4
Blisters
5
Edema
6
Ignition
7
Chemical
8
Corrosive
9
Shock
10
Fire
11
Intake
12
Debridement
13
Aseptic
14
Silver Nitrate
15
Pedicle
Clinical Wordsearch
Answers
Puzzle no. 8 (appears on page 27)
16 Hyponatremia
31 Plasma
17 Silver Sulfadiazine
32 Skin
18 Infection
33 Heart
19 Hubbard Tank
34 Isolation
20 Necrosis
35 Loss
21 Contractures
36 Scald
22 Autografts
37 Sun
23 Free
38 Scar
24 Sepsis
39 P^in
25 Allograft
40 Hot
26 Xenografts
41 Red
27 Dressings
42 Age
28 Protein
43 P.R.N.
29 Donor
44 Split thickness
30 Sodium
Hidden Answer: Where there's smoke there's fire
k
Ambulatoiy
CareManued
6 AMBULATORY CARE MANUAL
FOR NURSE PRACTITIONERS
Book of the Year Selection (American Journal of Nursing)
Ambulatory Care Manual for Nurse Practitioners picks up where
textbooks on physical examination leave off. Written expressly for
nurse practitioner(clinician), this text covers the diagnosis and
treatment of commonly seen conditions in adults. The reader is
taught to interpret signs and symptoms on the bases of history,
physical exam, and lab findings; formulate a diagnosis; and treat the
patient or (if indicated) refer him to a practitioner with special
expertise.
Individual chapters, except for the introductory material, cover
conditions of all body systems that are commonly seen in the
ambulatory care setting. Discussion of each condition includes
history, physical exam findings, lab data, treatment, complications
and follow-up. Each chapter has an extensive section on the phar-
macology of medications commonly used in treatment. Throughout,
the authors present guidelines for determining boundaries of treat-
ment.
Nurse Practitionas
Peter T. Capell, M.D.. Department of Medicine, University of
Washington /Medical Center, Seattle; and David B. Case, M.D.,
Assistant Professor of Medicine, New Yorl< Hospital-Cornell Medical
Center, New York.
Lippincott
400 Pages
1976
$15.95
From Lippincott
REHABILITATION: A Manual for the Care
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Designed to bring the many facets of rehabilitation together and to
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and therapeutic concepts. The authors have revised and reorganized
the second edition to reflect the current concepts of patient care
and to present the recent advancements in rehabilitation tech-
nology.
Gerald G. Hirschberg, M.D., F.A.C.P., Associate Clinical Professor
of Physical Medicine, University of California School of Medicine,
San Francisco, California; et al.
Lippincott 474 Pages 1976 $14.50
PAIN: A Sourcebook for Nurses
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A landmark study of a topic of immediate concern to all nurses.
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Edited by Ada Jacox, R.N., Ph.D., University of Colorado.
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REVIEW AND APPLICATION
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The first comprehensive review book in pharmacology for nurses
that serves as a concise self-study course. It is an excellent review
for practitioners returning to clinical nursing and as a useful source-
book for pharmacology review prior to board exams. Suitable
for any nursing program that integrates pharmacology throughout
its nursing courses, this text allows students to study drugs in an
applied and associate manner.
Susan E. Ralston, fl.A/., B.S.N. , M.Ed., Assistand Professor; and
Marion Hale, R.N., B.S., M.N., Assistant Professor; both of the
Department of Nursing, Georgia State University.
Lippincott 260 Pages 1977 $8.75
/5^ INDEPENDENT NURSING PRACTICE
^ WITH CLIENTS
This extraordinary new book is destined to be one of the more
talked about contributions to nursing literature. It presents the
rationale for independent practice, for giving care, for putting
nursing in its proper place in the health field as a practice discipline
that is the extension of the client, not an extension of the physician.
M. Lucille Kinlein tells how her independent practice came to be;
relates her philosophy of independent nursing practice with emph-
asis on how it differs from the medical model and medical practice;
and, in an extensive section on client examples, spells out the
results of nursing judgement and shows nursing measures and their
implemementation.
fA. Lucille Kinlein. R.N., B.A., M.S.N.E.
Lippincott 200 Pages 1977 $8.25
®
ADVANCED CONCEPTS IN
CLINICAL NURSING, 2nd Edition
Written by professionals active in their respective fields, this revised
second edition offers valuable guidance to students and practitioners
in developing expertise in the more complex and challenging aspects
of clinical nursing. It integrates current concepts of nursing assess-
ment and management throughout each chapter. Extensively revised
material includes the problems and needs of those undergoing
an abortion; genetic counseling and health requirements of those
with hereditary health problems; the immune process and care of
the allergic patient; mechanisms of shock; intensive care nursing;
and management of the burn patient.
Edited by Kay Corman Kintzel, R.N., M.S.N. With 29 Contributors.
Lippincott 784 Pages 137 Illustrations 1977 About S21.00
(j) Distributive Nursing Practice: A SYSTEMS
APPROACH TO COMMUNITY HEALTH
Based on a belief that most diseases stem from the ways people
live, this challenging book focuses on preventive health care based
on education and preventive treatment of populations "at risk"
because of environment, employment, heredity, and adverse health
practices. Specifically it assists practitioners to 1) utilized a systems
perspective for nursing intervention; 2) employ nursing practice
components independently and collaboratively to promote main-
tain, and restore health, prevent illness and facilitate health-abetting
a
CARDIOVASCULAR NURSING: Prevention,
Intervention, and Rehabilitation
In the past ten years, vast changes have occurred in the prevention
of cardiac disease and the care and rehabilitation of cardiac patients.
This book presents information on new technology, means of early
detection, and prevention of heart disease through reduction of
risk factors. It describes the means of assessing heart function,
current methods of treatment, and rehabilitation of patients with
chronic heart disease Throughout, the author stresses the nurse's
responsibility in providing complete, appropriate patient education.
By Jeanne Holland, R.N., M.S.
Little, Brown 233 Pages Illustrated 1977 $7.75
^.THE LIPPINCOTT MANUAL
OF NURSING PRACTICE
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
management in concise, outline form . . . instant information you
can put to immediate use.
Lillian S. Brunner, R.N.. M.S.; and Doris S. Suddarth, R.N.. M.S.N. ,
with four co-authors and three contributors.
Lippincott 1473 Pages Illustrated 1974 $23.50
for the Practitioner
behavior; and 3) develop professional roles for delivery of optimal
health services.
Joanne E. Hall, R.N.. M.S.; and Barbara R. Weaver, R.N., M.S.
Lippincott 530 Pages 1977 $15.00
J. B. Lippincott Company of Canada Ltd:
Please send me the books I have circled.
10
CLINICAL PROTOCOLS:
A Guide for Nurses and Physicians
Designed for portability and quick reference in the field, this
manual of clinical guidelines fits conveniently into the pocket of a
lab coat. The protocols themselves are divided between acute
problems and chronic diseases. The acute problems are based on
the most common presenting complaints seen in the ambulatory
adult care setting; and the chronic disease protocols include those
conditions most often followed by the nurse practitioner in a
continuing care clinic. The authors define an appropriate data base
for the common acute problems as well as the chronic illnesses
which nurse practitioners may be managing. Presented in a problem-
oriented framework, the protocol material outlines both subjective
and objective data and includes diagnostic, therapeutic and patient
education aspects of the plan. The rationale for each piece of data
is presented in the same sequence as the worksheet items.
Carolyn M. Hudak, R.N., M.S.; Assistant Professor Nursing and
Medicine at the University of Colorado Medical Center, Denver;
etal.
Lippincott
461 Pages
1976
$9.70
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CNB/77
The Canadian Nurse August 1977
The International Grenfell Association
In 1891 a young English doctor, Wilfred T. Grenfell, travelled to Labrador and was
appalled at the living conditions he saw there. The people of Labrador, isolated by
geography and climate, suffered malnutrition, tuberculosis, a general lack of any
medical care and a serious lack of schooling for their children.
This visit prompted Grenfell's return to Newfoundland the next year. This time he
came with staff and supplies, prepared to stay and give medical care to the Eskimo and
white families living In the isolated communities along the coast.
Remarkably the Grenfell International Association has had only three chiefs in its
eighty-five year history: the founder, Sir Wilfred Grenfell from England; his successor.
Dr. Charles Curtis from the United States; and the Association's current leader, Dr.
Gordon Thomas who is Canadian.
Gordon Thomas first went to northern Newfoundland in 1 946. At that time there
were only four full-time doctors on the coast and only twenty-five nurses for four
hospitals and five nursing stations. Communication was still carried out through Gerald
S. Doyle radio news bulletins. Travel was still by foot during the spring break-up
season, by schooner in the summer and by dog-team in the winter.
Today, the International Grenfell Association operates on a budget of over
$13,000,000 with a staff of more than 800 employees including some 150 nurses.
Through its fifteen nursing stations, four hospitals and a community health center the
Outpost Nursing
in Northern
Newfoundland
The medical care of the people In northern Newfoundland and Labrador Is
administered by the International Grenfell Association. Primary health care is
provided by nurses located at Grenfell Association nursing stations. One such
station Is located in Cartwright, Labrador, a town of 600, and it was here that
co-authors Jane Graydon and Judith Hendry carried out their investigation into
the special skills and knowledge demanded of nurse practitioners practicing in
remote areas of this country.
Jane Graydon There are usually two nurses at the Cartwright
Judith Hendry nursing station. For one month each last
summer both Jane and I acted as the second
nurse in this setting. We went to Cartwright to
become more familiar with the knowledge and
skills required of the nurse practitioner and to
gain some experience in this expanded role
ourselves.
Cartwright's population falls to about
three hundred in the summer because most of
the townspeople leave to spend this time
fishing in smaller communities along the coast.
Although we were there during the summer we
believe the situation descrit)ed here does
illustrate that which exists at other times in the
year.
The Nursing Station at Cartwright
Cartwright's nursing station is made up of
a clinic, a treatment room, in-patient facilities
for seven adults and three children, a delivery
room and living accommodations for the
nurses. There is a telephone and a radio
transmitter for communication with the
outside' world.
Each morning a physician in North West
River, Labrador attempts to contact the station
The Canadian Nurse
August 1977
Association serves approximately 50,000 people. The Association has moved into the
jet age using Air Ambulances to transport patients to hospitals rather than bringing
hospital ships to them.
The hospitals and medical work of the Association are now financed almost
entirely by govemment sources. The government of Newfoundland also provides the
aircraft vital to the modern health care program.
Health care work is centered at St . Anthony, Labrador. The hospital here maintains
a Grade A accreditation with an organized medical and nursing staff. It is affiliated with
Memorial University f^edical School and the Dalhousle University School of Outpost
Nursing. This summer the Grenfell Association has employed students from the
Memorial University School of Nursing as summer vacation relief.
The Grenfell International Association provides a complex system of health care in
a frontier area. Their system is based on the principle of multiple nursing stations that
refer to regional hospitals. The Grenfell system has been recognized as a model for the
delivery of health care throughout Canada's North.
The emphasis of the program is gradually shifting from the acute care of disease,
often in an emergency situation, to public health and preventive medicine. The results
of this trend towards preventive health care are just tieginning to be seen.
by radio transmitter. His job Is to determine if
there are any medical problems or concerns
and to inform the nurse of the progress of any
patients from Cartwright who have been
hospitalized.
A physician from North West River
Hospital visits Cartwright approximately once
a month. A clinic is held at this time and all
patients who need to see him have
appointments tx)oked. At least once a year a
dentist also visits the community.
Patients who need hospitalization are
usually sent to North West River by float or ski
plane. The weather often poses a threat to the
health care of the villagers because storms
and heavy fog are common along the coast.
Sometimes patients must wait in the nursing
station for several days before they can be
transferred to the hospital.
The Role of the Nurse Practitioner
In an isolated setting the nurse is
responsible for providing primary health care
to the entire community. In order to do th is, the
nurse in Cartwright sees people both in the
nursing station and in their own homes.
Patients are seen in the clinic on an
ambulatory, walk-in basis at designated clinic
times. A general clinic is held every day,
Monday through Saturday.
Each week the nurse holds a well-baby
clinic and a pre- and post-natal clinic. Specific
times are kept free of responsibilities at the
nursing station to allow for home visits.
In addition to these regular commitments,
the nurse must be available at all times,
twenty -four hours a day, seven days a week, to
see people on an emergency basis. She can
never be far from a telephone tsecause she
might be needed at any time.
Occasionally patients have to be admitted
to the nursing station. Their care adds another
dimension to the nurse's role. Here the nurse
has the help of local girls who work as nurses'
aides and perform some routine nursing tasks
for these in-patients. The aides attend to the
patient's hygenic needs, take temperatures,
serve meal trays and are available to answer
the patient's bell. But the nurse has the full
The Canadian Nurse August 1977
responsibility for supervising the care and
giving some nursing care herself. She
monitors changes in the patient's
condition and, as often as is necessary; she
alters the treatment plan in consultation, by
telephone, with the doctor in North West River.
Depending upon the patient's condition she
assesses him/her more or less frequently, not
only during the day but also at night.
Our Contacts with Patients
In order to assess the responsibilities of
the nurse practitioner in an isolated setting
Jane and I recorded each meeting we had with
patients.
During the two months we were in
Cartwright we saw 356 patients. All of these
patients were seen by one of us individually or
in the company of Jean, the regular nurse. A
few patients were attended to only by Jean and
they were not included in our study. Nor did we
include patients examined by physicians
visiting Cartwright for clinics.
We saw some patients more than once
and recorded each encounter as a separate
visit even when there were several in one day.
During the months we were there five patients
were admitted to the nursing station; our
numerous contacts with these in -patients were
not recorded.
We saw 50 of the 356 patients during
home visits. Most of these visits were
similar to those made by a public health nurse
in any other part of Canada: 32 of the 50 visits
were made to the elderly or to those
with chronic illnesses. Here we checked the
patient's health status and did any nursing
interventions that were indicated.
Another 13 visits were made to
people with acute health problems. Some
were for the initial assessment of a complaint
and others were to check on patients who had
recently been seen in the nursing station and
were now at home.
Several visits were made because the
patient concerned had no way of getting to the
nursing station whereas we had access to a
car and could get to them. The smallest
number of home visits, five , were made just for
the exchange of information. We made these
visits because some of the citizens of
Cartwright didn't have a telephone.
Analysis of Clinic Visits
• Assessment and Treatment
We saw the greatest majority of patients,
306, (or 87%) in the clinic. People came to the
clinic for a wide variety of reasons. (See Table
1 ) The most common reason was for
assessment and treatment of a specific
complaint; 134 patients were seen for this
reason.
We categorized specific complaints
according to the part of the body involved (See
Table 2) and in this way we were able to
determine which body systems were most
frequently assessed and treated. It was
interesting to find that virtually all of the body
systems were included, although the
frequency with which they were the sites of
complaints varied.
The two most commonly observed
problems were those involving the ear, nose or
throat (20%) and the respiratory system
(18%). Problems in these areas were usually
the result of infection.
• Prescriptions
The second most frequent reason for
people coming to the clinic was to get
prescriptions refilled. This accounted for 96
visits, (31.5%). There is no pharmacy in
Cartwright, therefore everyone who takes
medication has to go to the nursing station for
it.
People were usually given enough
medication to last one month. This meant they
were always seen at least once a month by the
nurse. At this visit Jean usually did
more than just refill the prescriptions; she
took time to ask about the patient's general
well-being and assessed his/her health
status. This meant patients with a history of
hypertension had their blood pressure
checked, weight taken and ankles assessed
for edema each time they came for their
antihypertensive medications. All patients with
a chronic illness were monitored in this way
and therefore any problems associated with
their condition could be discovered early and
an appointment could be made for the
individual to see the physician.
• First Aid
We saw twenty patients (6.5%) in the
clinic for first aid including suturing of wounds.
Most of these patients had abrasions or
lacerations that just required cleansing and
possibly the application of an antibiotic
ointment. In another setting some of this might
have been done by a family member but since
the nurse was available she was used for this
service. Five of the twenty patients had
lacerations serious enough to require sutures.
Twenty-six patients (8.5%) were seen for
dressing changes or the removal of sutures.
These treatments are usual nursing activities.
Implications for the Nurse Practitioner
Many of the patients we saw had chronic
illnesses. As nurses we had to know what to
look for when assessing a patient and the
usual response to treatment. Occasionally a
slight modification of the patient's treatment
regimen was necessary and we had to be
prepared to initiate this. But more often than
not the role of the station nurse was to monitor
the patient's condition, reinforce the need for
therapy and encourage compliance with the
treatment program.
Not all patients had chronic illnesses. We
also had to be prepared to give emergency
care. As the only health professionals In the
town nurses must be ready to treat any
emergency, whether cardiac arrest or
laceration requiring suturing.
Midwifery experience would be a definite
asset for the nurse practitioner in
an Isolated setting. Although no deliveries
occurred while we were in Cartwright, Jean
had to be competent In assessing the
antenatal patient and monitoring the progress
of a pregnancy. She had to recognize patients
at risk so she could make the appropriate
referrals.
Occasionally the equipment needed for
laboratory tests which would confirm a
suspected diagnosis was not available in the
nursing station and the patient had to be flown
to North West River for examination. Most
laboratory specimens had to be sent away for
analysis. It sometimes took several weeks
before the results were returned, therefore, it
was often necessary to commence treatment
prior to receiving complete laboratory results.
In these cases it was very important that we
gather data about the patient through his
history and physical assessment and make
appropriate decisions about management
based on an interpretation of this data.
The assessment of patients required the
utilization of the skills of inspection, palpation,
percussion and auscultation. Because there is
no doctor present to validate her findings, a
nurse in an isolated setting must be confident
in her ability to use these skills and recognize
abnormal findings. A physician can be
consulted by telephone but h is assistance can
only be helpful if the information he receives
from the nurse Is accurate and
knowledgeable.
Assessment of the eye, ear and
neurological system necessitated skill In the
use of the ophthalmoscope, otoscope and
reflex hammer.
Medication was administered to, or
prescribed for, 109 (or 81%) of the 134
patients seen for specific complaints. We
ifound that a good knowledge of phannacology
was essential for the nurse to function
adequately in this setting For example. It was
necessary to know what bacteria caused a
particular type of infection, the best antibiotic
to combat this bacteria, the usual dosage and
the preferred length of treatment.
We found that as well as being concerned
with the care of individuals it was essential for
Table 1
Care Required by Patients Seen in Clinic
Assessment and treatment of specific complaints
Refill of medications
Dressing change or suture removal
Rrst aid including suturing
Antenatal or postnatal check
Advice
Cast application or removal
Well baby immunization
Total
Number
Percentage
134
44.0%
97
31.5%
26
8.5%
20
6.5%
17
5.5%
6
2.0%
3
1.0%
3
1.0%
306
100.0%
Table 2
Patients Seen for Assessment and
Treatment of a Specific Complaint
Chief Complaint
Number
Percentage
Ear, Nose and Throat
27
20.0%
Respiratory
25
18.7%
Gastro-lntestlnal
21
15.7%
Integumentary
16
12.0%
Dental
11
8.2%
Genito-urinary
9
6.7%
Musculoskeletal
9
6.7%
Cardiovascular
6
4.5%
Eye
6
4.5%
Neuropsychiatric
4
3.0%
Total
134
100.0%
the nurse to be concerned with the health of
the community. She had to be cognizant of the
health and learning needs of the community
and prepared to take a leadership role in
relation to these needs.
It has long been recognized that nurses in
outpost nursing stations require certain skills
and knowledge beyond those usually acquired
In Canadian basic nursing education
programs.' In Cartwright the nurse was
responsible for diagnosing and managing
patients' problems, performing some minor
laboratory procedures and delivering most
multlparous women with uneventful
pregnancies. In order to meet these
responsibilities she had to be skilled in
history-taking, physical assessment and
decision-making. She also had to be
knowledgeable in pharmacology, community
nursing and the management of acute and
chronic Illnesses.
Our experience In Cartwright provided an
excellent opportunity for us to become more
familiar with the knowledge and skills required
of the nurse in an Isolated setting and to gain
experience in the role of the nurse practitioner.*
Jane E. Graydon and Judith M. Hendry, the
co-authors of "Outpost Nursing In Nortiern
Newfoundland," are presently assistant
professors In the Faculty of Nursing at the
University of Toronto. Graydon received her
B. Sc. N. from the University of Toronto and her
M.S. from Boston University. Hendry (R.N.,
Hospital for Sick Children) received her
B. Sc. N. from the University of Toronto and her
M.Sc.N. from the University of Western
Ontario.
Bibliography
1 Brigstocke, Hilary. The nurses of Brochet,
Canad. Nurse, 71:4:21-24, Apr. 1975.
2 Brown, Barbara G. Exploration of the
Expanded Role of the nurse in a primary care
setting, Nursing Papers, 6:2: (Summer, 1974.)
3 DuGas, Beverly Witter. Nursings expanded
role in Canada; Implications of the joint CMA/CNA
Statement of Policy. Nurs Clin. North Am., 9:3
523-533. Sep. 1974.
4 Keith, C.W. Leadership in nursing nortti of
sixty./Vurs. Clin. North Am., 6:3:479-488, Sep. 1971.
References
1 DuGas, B.W. Nursing s expanded role in
Canada: Implications of the joint CMA/CNA
Statement of Policy. Nurs. Clin. North Am.,
9:3:525, Sep. 1974.
The Canadian Nurse August 1977
part one
ProfessioTjal responsibility:
an international concern^
M^30-J«3 1977 TOKW
Some of the most energetic discussions in
nursing today focus on professional
responsibility and expanded horizons in
this area. Recognizing this, ICN's final .
plenary session was entitled "New
Dimensions of Professional Responsibility."
It was a discussion of some of the critical
issues involving increased responsibility:
Nursing Authority, Rights of Nurses and
Individual and Collective Responsibility.
The talks were informative, but they
also demonstrated the International
Congress's ability to allow nurses to share
information of common concern to all.
Excerpts from papers prepared for this
session are presented here for your
increased awareness.
Pholu cou'iesy of International Council of f^ursci,
There can be no question that nurses are in a
unique position to speak and to act with
authority. Nor can there be any doubt about
the need for nurses to carry their full weight
during the current realignment of power
relations In the health system. The fact that
they have not yet done so, according to
Huguette Labelie, former president of the
Canadian Nurses Association, must be
attributed to lack of confidence in their own
ideas, in the strategies they have been able to
develop and In their ability to influence others.
Labelie, formerly Principal Nursing Officer,
Health and Welfare Canada, Is currently
director general, Policy, Research and
Evaluation Branch, Indian and Eskimo Affairs,
Ottawa, Canada. "Our capacity to Influence is
enormous if only we can develop the
confidence to mobilize our own collective and
individual potential. Increasing our capacity to
influence — in other words, our power — Is
morally right and desirable to the extent that
this power is utilized in improving the health of
our population.
For the individual nurse,
accountability means
answerability and responsibility
for outcomes of nursing actions
rather than being responsible to
an immediate supervisor for these
actions.
"Nursing authority is a vital tool for individual
nurses and for the nursing collective. Four
factors affect nursing authority, including
knowledge, accountability, mastery of
competent interpersonal relationships and
power.
"The first factor associated with authority is
extensive knowledge of one's field along with a
good understanding of related areas.
Credibility as a respected practitioner comes
from demonstrated excellence based on
sound knowledge. We have only to recollect
our own feelings when confronted with
professional incompetence, in order to weigh
the primacy of this factor.
.•%' " ^^ ^^ ^^ ^^ ^^ _ ,
fr^^fi ii^^ fi"!^Mi iF^fH fi^^^i ir^fil n^^M I ir^lfl f?^^^
U^^SnJ vJ^j^y M^^ V^^jj M^JVV
"The second factor associated with nursing
authority is accountaljility. Collectively nurses
at the level of institutions and
professional associations foster accountability
through the development of codes of ethics,
standards of practice for entry into the
profession, and evaluation criteria. For
individual nurses accountability means
answerability and responsibility for outcomes
of nursing actions rather than being
responsible to an immediate supervisor for
these actions.
To have possession of knowledge and to
be accountable without mastery of competent
interpersonal relationships is like owning an
automobile and insurance without being able
to drive.
■'Within nursing fear of each other is
detrimental to understanding and close
collaboration. It also leads to prejudice. The
fear of each other held by nursing service and
nursing education, by graduates of hospital
programs and those of university and college
programs, by nurses working in hospitals and
those wori<ing in primary health care settings
eventually leads to prejudice and lack of
openness.
"The final factor associated with authority is
power. Nurses must realize the importance of
the political dimensions of public policy setting
and of development of operational policies. In
exploring strategies, nurses must plan to
influence the direction in the early stages of
development oral best to influence initiation of
specific policies and statutes instead of being
reactive once these have been formulated."
Mary E. Patten, the federal secretary of the
Royal Australian Nursing Federation and
former chairman of the joint ILO/WHO
conference on conditions of life and wori< of
nursing personnel, told nurses attending the
ICN Congress, "rights of nurses in many
countries around the world have tjeen
trampled on. neglected and opposed." She
urged nurses to make a personal commitment
to human rights and to the rights of nurses.
"The nurse as any other individual, can
meet his or her obligations appropriately only
when acting in his or her own right on the basis
of his or her own values, beliefs and
knowledge and not simply responding to the
expectations of others.
"The rights of nurses are transgressed daily
with demands to perform procedures with
which they are unfamiliar, demands that their
vision of the future conform with the vision of
others, and constant demands to stretch
available staff to cope with caring for more
people than is just.
... the rights of nurses are also
transgressed daily by nurses
themselves who, as individuals,
are content to act in response to
the expectations of others rather
than on the basis of their own
values, beliefs and knowledge.
"But the rights of nurses are also
transgressed daily by nurses themselves who,
as individuals, are content to act in response to
the expectations of others rather than on the
basis of their own values, beliefs and
knowledge.
"This attitude has done a great deal of harm
to nursing, and, I believe, to patients and
clients of nurses. It stems from the
transgression of the fundamental right of
human beings to act on their own physical,
psychological, ethical, moral, intellectual and
spiritual needs.
"Clearly, the rights of individuals are
dependent on pre-conditions existing in
society and from this it must follow that until
and unless these pre-conditions exist, it is a
mockery to speak about the rights of
individuals, let alone the rights of nurses. One
must conclude also that the rights of nurses in
such societies can hardly be met without
changing those conditions which thwart
freedom to speak, justice, honesty,
orderliness of the group and so on.
The good nurse is selfish to the
point of maintaining and
developing his or her own
character structure with no need
to fear the unfamiliar or simply
respond to the expectations of
others.
"The good nurse is selfish to the point of
maintaining and developing his or her own
character structure with no need to fear the
unfamiliar or simply respond to the
expectations of others. The selfish element is
crucial to the ability to work with people in the
promotion of health, the prevention of illness
and the care of the sick; worthing with people
instead of doing things for them or to them.
"In moving to further the rights of nurses we
have a responsibility and right as nurses to
examine some of the issues underlying our
planning and action, whether that planning
and action is directed specifically towards
improving pay. education or the social and
cultural conditions in which nursing personnel
work. The compression of mankind need not
give rise to increasing oppression and should
in fact release an enormous quantity of
psychic energy where individuals seek not
only to enjoy more and to know more but to
be more. The technology now at our disposal
and in particular the advent of the computer
can be u sed to th is end rather th an contri bute
to the "Big Brother" world of George Onwell's
7984."
The Canadian Nurse August 1977
~>?^ '^f^^^ V^^/*^ 'VF^ ^^&^^ ^Sr^ ^-=;?> <iy^ ^F^?^ ■^'Sr=-Vi V"^?/' '^S^^^ ^^^-^ '^S^^ ^^^•^ '^^'Sr^ ^^^'^ ''<!5r^
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Anne Zimmerman the president of the
American Nurses Association called on
nurses of the world to each play a part in "the
evolution from individual accountability to one
world of nurses accountable not only to the
consumer but to and for each other. "
Executive director of the Illinois State Nurses
Association for several years, Zimmerman has
served as chairman of the Commission on
Economic and General Welfare of the
American Nurses Association and received
ANA'S honorary membership award for her
work in promoting and defending the right of
nurses to organize and bargain collectively.
"As members of our professional
organizations and of the International Council
of Nurses we can see the results of our
struggle to promote health and the care of the
sick internationally. It is a humbling thought but
testimony to the future of the nursing collective
— its energy, its progress and its potential as
the universe of collectivity.
"No matter where we practice nursing we
are bound to certain professional
responsibilities (both collectively and
individually) as a result of our commitment to
the constant improvement of health care.
"Fulfilling these basic responsibilities and
achieving common goals and objectives are
dependent upon the ability of nurses, as a
collective body, to bring about innovations and
changes. This concept of the "nursing
collective" gives the profession a homogeneity
of purpose, policy and method of operation.
Within the collective, differences can be
debated and resolved, trends can be set, and
nursing's authority can be strengthened.
"The nursing collective has an obligation to
modify and expand the scope of its practice in
light of new demands for health services and
technological and scientific innovations.
Consequently, as nurses, we must assume
responsibility for identifying significant goals
and priorities and initiating innovative nursing
programs aimed at satisfying projected needs
for health and nursing care.
"One responsibility which has always faced
the nursing collective is developing an
effective method of self-regulation. If the
nursing profession is to assume a primary care
role and have a serious impact upon the
delivery of health care, nurses must be in a
position to assure the public of quality nursing
care.
As a health professional and
concerned citizen, each nurse has
an obligation to work toward
improving the health care system.
"Since the public holds the profession
accountable for the competence of its
practitioners, the nursing collective has an
obligation to establish certain standard
authoritative statements by which the quality
of nursing practice, nursing service, and
nursing education can be judged. To
implement and enforce these standards, the
nursing profession must be self-governing.
"Individually and collectively, the nurse's
first responsibility is to the consumer — our
patient or client. Within the nursing
environment, we must daily make informed
decisions and must have the autonomy
necessary to determine our own professional
activities. Nurses in practice must guarantee
that patients receive professional nursing
care. As members of the nursing collective, we
cannot postpone accountability.
"Closely allied with the quality of a nurse's
practice is his or her ability as an innovator. As
a health professional and concerned citizen,
each nurse has an obligation to wori< toward
improving the health care system. When
nurses have successfully integrated all these
concepts into their daily practice and their
approach to nursing, they can begin closing
tfie gap between what really is and what ought
to be — quality care for every person in every
setting. But accountability begins with the
individual nurse committed to caring for the
patient and to carrying out the standards of
practice. The issue demands dialogue,
discourse and decision-making before it can
have real meaning. We must also be
accountable to each other — to share new
approaches with our colleagues, to talk to
each other and once begun, to carry on the
dialogue."
(f
Nursitig practice around ,)
the world
The International Council of Nurses exists
to serve all nurses — regardless of
nationality, race, creed, color, politics, sex
or social status. One of Its most important
functions as an international organization
is to provide a vehicle for nurses
throughout the world to share common
interests and work together to develop the
contribution of nursing to the promotion of
health and care of the sick. Nowhere is this
sharing more apparent than during a
Congress such as the one which took place
in Tokyo last June.
All of the Congress participants had
much to offer their fellow nurses but one
session in particular seemed to offer the
nurses who attended an unparalleled
opportunity to discover what it's like to be a
nurse in another country, what we have in
common and what we can do to help each
other. Its title was self-explanatory:
Nursing practice around the world.
Excerpts from the papers prepared for this
session are presented here for your
information.
AFRICA
Eunice Muringo Kiereini is chief nursing officer of
Kenya. A graduate of Southampton General
Hospital in England, she obtained her midwifery
certificate from Simpson's /Memorial fraternity Unit
in Edinburgh, Scotland and her diploma in nursing
education /administration from the New Zealand
school of advanced nursing in Wellington. She is an
ex-officio member of the Nursing Council of Kenya
and represented the Government of Kenya at the
International Labor Conference in June in Geneva.
"Nursing in Africa faces tfie same forces of
chiange and cfiallenge encountered by
representatives of the profession in other
countries around the world — but with
important differences caused by imbalances in
technological developments and material
resources. Following the setback caused by
colonialism, independent African countries are
now beginning to establish well-planned
health care delivery systems and independent
nursing organizations and health services are
a top priority since officials believe that, in
order to be strong a nation must be healthy.
In Africa, we have had a corps of
'barefoot nurses' serving the
people for many years.
"One of the features of the new system is
a growing emphasis on family health' as
opposed to care for the individual. This new
concept has been well accepted in Africa
because of its practicability and also because
of the traditional emphasis on the family and its
extended role.
"In Africa we have had a corps of barefoot
nurses' serving the people for many years.
Nearly evfery country in Africa has experienced
difficulty in persuading doctors to serve in rural
areas and unsuccessful efforts in this area are
now being abandoned in favor of giving this
responsibility to other types of health workers.
The Canadian Nurse August 1977
The nursing personnel of Africa have accepted
the challenge and taken their position in the
forefront of providing primary health care — in
the jungles, mountains and desert lands.
These are the nurse clinicians of Africa. They
function on their own and make vital decisions
without referral to anyone.
"Most countries in Africa are now
preparing community nurses both at
registered level and at the enrolled level. This
is happening in Nigeria, Ghana, and Kenya.
tVlany other countries are planning to start this
program. The community nurse is a
practitioner in her own right. She is given
formal preparation to be able to diagnose,
prescribe and treat. Family health offers us an
intermediate dimension that is both easier to
grasp than public health and more operational
than medicine applied to the individual. If we
can find a way to apply this attractive concept
in practice, we might well have at our disposal
a logical and an important link between two
extremes and our ideal 'take-off point for a
coherent prophylactic and curative approach
towards many health problems.
In no other field has the
emancipation of women been of
greater importance than in
nursing.
"Another development which has taken
place is the preparation of male nurses. In
Kenya we have even gone a step further in
preparing male n urses in the field of obstetrics
where they are doing 'deliveries!' To begin with
this concept was opposed even by the nurses
The Canadian Nurse August 1977
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themselves, but when one argued that there
was no difference between a male nurse and a
male doctor doing obstetrics, the idea was
gradually accepted. We have now male
nurses working hard with their female
colleagues as practising midwives.
"In tracing the changes in nursing practice
we are aware that the struggle for political,
economic and educational freedom of women
is entangled in the fight for professional
advancement. In no other field has the
emancipation of women been of greater
importance than in nursing. Nurses have been
encouraged to struggle for greater autonomy
in practice and freedom from physicians'
control. Nurses have demanded better terms
of service and improved working conditiona
There has been a definite and calculated move
by nurses to control nursing affairs in the fields
of service, education, administration and
research.
"For many years, in Kenya, we have been
unhappy with the methods used in our staffing
patterns, particularly in the hospitals. The
Kenya Nursing Project,' is an attempt to
systematize and formalize nurse staffing
methodology. Patients are classified on the
basis of their nursing needs as 'minimum
care,' moderate care,' and 'intensive care.'
The Project will try to come up with tools which
will improve the quality of nursing practice in
In-patient units of government hospitals. A
committee known as the Nursing Standards
Committee' has been set up to define
standards for hospital nursing care.
"Africa is a continent which has had many
and varied developments. The scope for
nurses is absolutely unlimited. "
EASTERN MEDITERRANEAN
EnaamAbou-Youssef is associate professor at the
Higher Institute of Nursing, University of Alexandria
in Egypt and nurse-midwife educator at the African
Health Training Institutions Project Carolina
Population Center, University of North Carolina,
U.S.A. She is a member of the nursing advisory
panel for the WHO Eastern IVIediterranean Regional
Office and has sen/ed as short-term consultant to
several seminars and meetings on family health and
manpower development organized by WHO
tieadquarters and by the Eastern (Mediterranean
Office.
"Nursing practice in the Eastern
Mediterranean countries has a definite
contribution to make to the total development
of each of these countries. Nursing activities,
previously confined to the care of the sick and
disabled in hospitals, now are extending into
rural health centers, factories and industrial
plants, schools, maternal and child health
centers and nursing personnel in many
countries are involved with other types of
workers in health and community
development programs.
"The Eastern Mediterranean area
comprises Ethiopia, Iran, Israel, Jordan,
Letjanon, Pakistan and Egypt, an area of 4.8
million square kilometers. Forty-five percent of
the area's 167 million people are under 15
years of age.
"Nurses have been involved in national
health programs with community orientation
with specific goals such as family planning
programs in both Egypt and Pakistan, and
primary health care programs in both Iran and
Ethiopia.
"In hospital nursing, changes have been
taking place to improve the delivery of service.
In this domain, different levels of nursing
personnel are cooperating in the care of
groups of patients. In both Lebanon and
Jordan, the team approach has been very
successful in overcoming the shortage of
highly qualified nurses and yet maintaining the
same quality of care needed by the patients.
The complexity of the care delivered in certain
hospital units such as premature babies, ICU,
ecu, etc.. has necessitated that nurses
perform certain functions which require
special knowledge and skills. New categories
of specialized nurses are operating in these
units and carrying out highly technical skilled
nursing tasks such as monitoring patients.
Nurses in the Eastern
Mediterranean have been
assuming the responsibility for
certain activities traditionally
known to be within the domain of
medical practice.
'With utilization of medical technology as
well as development of nursing sciences,
specialization in nursing practice is getting to
be more and more a reality in the Eastern
Mediterranean area. Nurses have been
assuming the responsibilities for certain
activities traditionally known to be within the
domain of medical practice. One example is
the administration of I.V. solutions. In both
Lebanon and Egypt legal action has been
taken to allow nurses to perform I.V.s. It Is my
belief that, as development progresses in the
different countries of the Eastern
Mediterranean region, nurses will find more
opportunities to expand their roles in order to
meet the various health needs of the
population.
"Another area of nursing practice that has
advanced greatly in this area is disaster and
emergency nursing care. The fact that all the
countries of this region have been involved in
border disputes as well as encountering
natural disasters such as floods and
earthquakes imposed certain demands to
which nurses did respond . Courses have been
organized for training practitioners in the
different concepts and skills related to
emergency and disaster care. As a result, the
efficiency as well as effectiveness of nursing
staff at times of emergency has been
acclaimed in many of the official reports.
"Though problems and barriers do exist
and frustrate nurses who are interested in
change and innovation, there are also
indications and factors which tend to be
encouraging. Among these factors is the vital
interestof all sectors of the population in health
and their demands for better and more n ursing
services, of all different kinds and at all levels."
EUROPE
Kirsten Stallknecht is president of the Danish
Nurses Organization and also vice-president of the
Joint Council of Danish Public Seivants and
Salaried Employees Organizations of Denmark. A
graduate of University Hospital in Copenhagen, she
also holds a certificate in administration from the
school of Post-basic Education at Aarhus University
in Denmark. (Paper delivered by Inge Anderson,
first vice-president of the Danish Nurses
Organization).
"The growth of wealth in Europe in the 1 960's,
the increasing industrialization and change in
the demographic pattern (more people over
65), have caused the population to increase
their demands on the level of service of the
social and health service systems. But the
economic crisis has also made politicians from
all countries look very carefully at the
resources used.
In Europe nurses are both divided and
united in various groups as to social, cultural
and political systems, and within these groups
they work for higher quality and uniformity in
nursing in Europe.
One group, the oldest, covers the Nordic
countries (Denmark, Finland, Iceland, Norway
The Canadian Nurse August 1977
and Sweden). The NNF (Northern Nurses'
Federation) was established in 1920. Its main
purpose was to evaluate the education of
nurses according to the needs of society, and
in such a way that the education of nurses in
the five countries would be equal. Since then,
cooperation has expanded to include subjects
such as professional issues, salary and
employment conditions and research.
"Another group, the ENG (European
Nursing Group), was established in 1947 and
covers Austria, Belgium, France, Germany,
Greece, Ireland, Italy, Luxemburg,
Netherlands, Portugal, Spain, Switzerland,
United Kingdom and Yugoslavia.
"The main purpose of this group is to
collect information about the current situation
and future trends in education of nurses in
Europe.
"Educational questions have been the
most important subject for both groups, and
following the establishment of the European
Economic Community (EEC) it was natural for
the two groups to contact one another. The
first contact took place in 1969, and a third
group, the PCNL (Permanent Committee of
Nurses in Liaison with the European Economic
Community), was established in 1971. The
nine countries in the PCNL are Belgium,
Denmark, France, Germany, Ireland, Italy,
Luxemburg, Netherlands and United
Kingdom.
"During the last twenty years nurses in
Europe have come to realize that further
development of nursing standards and nursing
practice depends on the establishment of
nursing research. However, understanding of
and steps taken towards nursing research
have been sporadic as a whole, perhaps due
to the fact that education of nurses has
basically been given in nursing schools in
hospitals, and not at the university level.
"The economic crisis in Europe has
caused a reduction in the resources used for
health services. This situation naturally
influences the service level, and nurses must,
whether they like it or not, find new ways to
practice if standards of nursing practice are to
be maintained and developed. Therefore it is
tremendously important that nurses
participate in decisions about priorities and the
use of resources.
"One might well ask What should nurses
in Europe stake the future on, and how can
they do it?' One of the answers could be that
nurses must go on working on developing
research programs; programs in which the
fundamental aim is to find out how health care
and nursing practice can be developed In
accordance with medical and technical
progress, but also in such a way that the
human and social relations between nurses
and the population are not lost.
"Another answer could be that nurses
should try in as many ways as possible to
strengthen their influence both as a group and
as individual nurses in daily nursing practice. It
is not aquestion of power, but of the necessity
of the fact that politicians in all European
countries realize that good health care
standards cannot be provided without a
well-educated and freely-speaking nursing
profession.
"In the coming years the advance of
medical technology should naturally be
followed by similar advances in nursing care,
and society should develop a health care
system in which the population as a whole is
covered adequately in daily life, but it should
not be a health care system which enables a
hospital to carry out heart transplantations
when the ordinary working man may not have
access to necessary care for his children."
NORTH AMERICA
Rozella M. Schlotfeldt is professor of nursing,
Case Western Resen/e University, Cleveland, Ohio,
U.S.A. She has served on numerous national
advisory councils, commissions and boards in the
United States dealing with nursing and health
issues and is the author of over 90 individual
publications in professional and scientific journals,
book chapters, monographs and research reports.
"There is considerable evidence that a critical
mass of nurses in Canada and the United
States have developed a high degree of
professional self-awareness and have
become increasingly assertive concerning the
need for, the value of, and the consequential
nature of professional nursing practice.
Evidence indicates a number of other
changes:
• Nurses are growing increasingly
respectful of their need to demonstrate
independence as practitioners of a
professional discipline. They have set
standards for and are eager to be accountable
to those they serve for the gamut of nursing
pjactice.
• Nurses are increasingly concerned with
the delivery of scientific as well as humanistic
nursing care and are actively involved in
seeking to establish and enlarge the
knowledge base for the gamut of nursing
practice.
Photos courtesy of the Canadian Habitat
Secretariat and International Development
J
The Canadian Nurse August 1977
• Nurses are experimenting with new
organizational arrangements with a view to
finding effective and efficient means to deliver
high quality health care.
• And last, nurses are becoming
increasingly involved in the politics of health
care and gaining in society's recognition of
their earned right to influence the health care
system.
"Nurses, like other health professionals,
have been adversely affected by people's
fascination with illness and by their failure to
value health sufficiently. As a consequence.
North American society has become
medicalized' and the so-called health care
system has had its resources focused
primarily on providing illness care, in contrast
to health care. The consequence has been to
emphasize patients' dependence, rather than
human beings essential strengths.
"The Canadian government has given
great leadership in pointing up the need for
emphasizing each individual's responsibility
for seeking to be healthy and for the health
care system to focus on health promotion as
well as on disease detection, prevention and
cure. That trend is also developing in the
United States. Inasmuch as nursing's mission
as a field of professional endeavor is. and
always has been, to assess and enhance the
health status, health assets, and health
potentials of human beings, it is both inevitable
and timely that nurses' professional
self-awareness has been awakened.
"Nurses' professional self-awareness
has taken several forms. Some have claimed
an 'expanded role' and have alleged that
assessment skills, particularly as related to
It is both inevitable and timely ttiat
North American nurses'
professional self-awareness has
been awakened.
physical assessment in 'primary care
encounters,' represent delegated medical
tasks : others have claimed that assessment of
the physical, social, and emotional health
status of people has traditionally been an
integral part of the armamentaria of nurses
who fulfill the professional's role.
"There is now general acceptance that
nursing, like all other professional practice
disciplines, requires educated practitioners
who can apply selectively and with judgment
vast amounts of knowledge. It is recognized
that propeHy trained assistants can work
under the guidance and surveillance of
professionals who are responsible for
practice.
"Canadian nurses recognized their
responsibility for all of nursing practice long
ago and their license-granting procedures
clearly differentiate professionals from those
who assist them. It was only a decade ago that
nursing in the United States took the position
that two types of nursing practitioners should
be differentially prepared and cleariy
designated. Individual states are now
beginning to take action so that by 1985, all
persons entering professional nursing practice
complete requirements for a baccalaureate or
higher degree.
"There is growing acceptance of the value
and cost effectiveness of 'primary nursing' in
hospitals. A primary nurse gives total care to a
small group of patients on a twenty -four hour
basis by assuming responsibility for assessing
and planning for the care needs, providing and
evaluating the care, and tjeing accountable for
all ministrations, provided personally and by
nurse-associates. Several evaluations have
demonstrated the superiority of nursing care
rendered and the enhanced satisfaction of
patients and nurses when primary nursing is in
operation.
"The trend toward staffing hospital units
entirely with professionals is in evidence both
in Canada and the United States as a means to
ensure acceptable quality of service to
hospitalized patients who typically require
sophisticated care.
"Nurses are beginning to be recognized
as competent, primary care providers whose
talents can, if property utilized, enhance the
amount and quality of health services
provided. Additionally, by making competent
assessment and providing effective
interventions, they make substantial
contributions to reducing the costs of care.
WESTERN PACIFIC
Hsin Hsin Chung is director of nursing service.
National Taiwan University IHospital She obtained
her diploma in nursing from St. Lul<e's College of
Nursing, Tokyo, and studied for her B S. at Wayne
State University College of Nursing in Detroit.
U.S.A., and her M.S. at Washington University
College of Nursing, St Louis, U.S.A. She was
president of her national nurses association from
1971-73.
"For the past three decades, the nursing
profession in our country has accomplished a
remarkable development. A new educatbnal
system is being adapted to meet the urgent
shortage of nurses and many new nursing
schools have been established. Four-year
collegiate courses for nursing as well as
five-year junior college of nursing and
midwifery courses have been established both
in the public and the private universities and
junior colleges. All the nursing and midwifery
schools are under the direct control of the
Ministry of Education. New hospitals are being
built and there is a networi< of health stations
located in each township throughout the
island.
"However, accomplishment has been
measured in comparison with the developed
countries and therefore, in spite of all the rapid
and new developments, there seems to be a
vacuum or a gap to be filled if we wish to
continue to grow as a profession and to
maintain the profession's continuity.
"Modern industrialization and the
advancement of technology has made it
possible for the people of our country to enjoy
a period of relative affluence and peaceful
prosperity. The standard of living has been
raised; major causes of illness have changed
from acute contagious diseases to chronic
conditions ; the people are better informed and
finding more resources available to maintain
healthful living. But within the culture in which
we live and offering services to the people as a
helping profession, we should not be ignorant
about the folkways of maintaining healthful
living.
46
The Canadian Nurse August 1977
"In looking toward the future, may we
suggest that the Oriental way of life might be
adopted to enrich the quality of care. Nurses
can cultivate more sensitivity towards others'
ways of life and learn to regard the client as a
whole person with his particular beliefs, health
habits and position in his family and milieu.
Nurses who are defin ing a new and expanding
role should look at their daily performance
more closely and listen to what the people that
they are caring for really say and ask for.
"in the process of delivering care we have
been mainly concerned with the way in which
care is given and have often overlooked the
way this care is received... Though we have
much to learn from the West and have
benefited a great deal, we may have
unknowingly imposed on our people, our
standards of good nursing, although these
may not be exactly what people appreciate
most as helpful care forthem. For instance, we
think that morning care should include a bath
for a bed patient, but there are very few
patients in our country who can appreciate a
bed bath in the morning because, according to
our custom, a bath is usually taken in the
evening.
In contrast to the active, exact and
decisive Western way of life, the
Oriental way seems more
inclusive and has more
appreciation for the totality.
"The power of scientific discovery has led
us to believe that the logical way of thinking
should take precedence and irrational
superstitions should be totally discarded.
Professional performance should be in
accordance with scientific principles which call
for preciseness, punctuality and predictable
consequences. The nursing profession has
followed the path of scientific endeavor with
some degree of success. But in the area where
our professional members are trying to relate
to our fellow men, in playing the role of a helper
in restoring health for other human beings,
scientific knowledge has not yet given us the
full answers and we need to look for some
other elements elsewhere.
"The Oriental way of life appears to be
more reserved, with appreciation of tranquility
and a tendency to deal with others in a manner
which is more passive and resigned. It
emphasizes natural harmony and expects one
to be sensitive to his position in relation to his
surroundings. Oriental culture, on the whole,
places a great deal of emphasis on the return
to nature. There is no doubt that there is much
room for further study of the folkways of
maintaining healthful living and helping people
regain health. As members of a helping
profession for health, we should take time to
find out exactly what does help people,
especially to keep the older age group active
and alert.
"It makes a great deal of difference in
caring for a person whether one is loved and
respected in a family or rejected and feared.
We would like not only to equip our nurses with
more scientific theories and newertechniques,
but particularly to encourage them to become
more alert and sensitive to the needs of others.
The health worker without a heart and a will is
like a person without a life and acts as though
he or she is a living machine. We need a pair of
hands and a bright head as well as a warm
heart and a strong will of determination to
become useful nurses to help in restoring
health to others."
SOUTHEAST ASIA
Hilda de Silva is Chief Nursing Officer, l\Aedical
Services, Sri Lanka and president of tfie Sri Lanka
Nurses Association.
"The nursing profession was well known to the
people of Asia long before the introduction of
modern nursing in the 19th century by
Florence Nightingale. Then in 1878, the first
attempt to introduce a scientific system of
nursing into the hospitals of Sri Lanka was
made by the appointment of a superintendent
and a trained nurse from England. From that
time until 1952, the schools of nursing in Sri
Lanka were headed by English and American
nurses, but at present all the schools are
administered by Sri Lanka nurses.
"Advances in medical science have
placed emphasis on team wori< in dealing with
hospitals and patients. This team consists of
specialists, physicians, pathologists,
surgeons, anesthesiologists and nurses, as
well as engineers, architects, mathematicians,
etc. The nurse is an indispensable member of
this team. Both the physician or surgeon and
nurse are expected to share knowledge,
technology, decision-making and control of
resources with one another, with other
categories of health personnel, and with the
patient and his family.
"Present-day nurses in Sri Lankaare very
keen on continuing their education with a view
to improving patient care, and refresher
courses are being conducted regularly for
them. Another new feature in nursing
education is the in-service program conducted
in some provincial hospitals in Sri Lanka.
"In India the nursing curricula emphasize
the integration of public health in the basic
nursing program. This was the first step in
attempting to meet India's health needs and
was instrumental in spreading nursing from
the confines of hospital care to preventive care
and promotion and maintenance of community
health.
"The high maternal mortality rate in
Thailand led to the nursing emphasis in the
early days on maternity and infant care.
Thailand has developed a career ladder
pattern of nursing education from practical
nursing programs to baccalaureate programs,
special attention is being paid to develop
programs which include nursing
administration, leaching, cardio-thoracic
The Canadian Nurse August 1977
nursing as well as medical and pediatric
nursing. Higher education programs in nursing
administration and clinical nursing leading to a
Master's degree are carried out for nursing
personnel in health clinics in order to prepare
them for curative functions in areas where
doctors are not available.
"Family health is included in all courses in
nursing and midwifery. Since the population
explosion is one of the major problems facing
Southeast Asian countries today and about
80% of the population live in rural areas,
primary health care is given high priority. In
Thailand, nurses are allowed legally to
perform curative functions in the rural clinics
where physicians are not available and are
controlled by protocols. The referral system
has been a great success there. Insertion of
intrauterine devices as a method of preventing
pregnancy in family health care is also carried
out by nurses.
"Nurses throughout Southeast Asia are
now working in a number of specialized fields
— neurosurgical care units, coronary care
units, urological care units, plastic surgery and
burn units, and ENT units.
"In Burma the preventive aspect and
community care are given priority. Health
education is also given more emphasis. The
nurse is no longer confined to the hospital
ward only; home visits for follow-up care and
field work are now included in her training."
SOUTH AND CENTRAL AMERICA
Irma Sandoval Bonilla is associate professor and
director of tlie school of nursing, University of Costa
Rica in San Jos6, Costa Rica. She is currently
studying for her doctor of philosophy degree at the
University of Costa Rica and was awarded a 3M
Nursing Fellowship by the ICN in 1974. She was
president of the Nurses Association of Costa Rica
from 1972-74 and is a member of the National
Council of Nurses of Costa Rica.
"We cannot separate the innovations in
nursing from the changes that have taken
place in our societies. They are changes that in
the health field have modified, amongst other
things, the concepts of health, utilization and
delivery of services and health policies. At the
moment, nursing is passing through critical
times, influenced by both external and internal
factors. External changes, such as new health
policies, the demand for more and better
health care for all people, the need to bring
health care to rural areas, a fuller awareness
on the part of politicians and authorities of what
health means for the development of nations,
and many other changes have obliged or are
obliging the nursing profession to make drastic
changes in the traditional patterns as much in
the education of nurses as in the delivery of
services. These outside factors which are
independent of the nursing profession are
more important and significant than the
change factors evolving within our profession.
"I believe that the new concept of health
care, intimately linked to the factors previously
mentioned, will be understood to the degree
that we accept or reject the fact that nursing is
determined by the character of the social
structure prevailing in our respective
countries.
"Within the new conceptual framewori< of
the right to health, countries have proposed
changes in their health systems. As a result,
there have been changes in the role of the
nurse. Primary health care has been qualified
by national and international health bodies as
the point of entry into the health care system. It
is acknowledged that this care must be
intimately related to the patterns of life and
needs of the community and completely
integrated with other sectors involved in the
social, political and economic development in
the different countries.
"In nursing, it is hoped that the extension
or expansion of nursing's new role will be
fulfilled within the context of primary health
care. Some countries have stated whom they
consider as a primary care nurse. For
example, in the United States and Canada this
new kind of nurse has been designated as a
"nurse practitioner; " she is considered as a
specialized nurse capable of performing some
of the functions that until recently were only
performed by physicians.
We cannot separate the
innovations in nursing from the
changes that have taken place in
our societies.
"In Canada, the Canadian Nurses
Association and the Canadian Medical
Association issued a statement in 1973
accepting the new functions of nurses and
establishing norms for development within the
new spheres of activity. Primary care develops
within the individual context of each country
with the characteristics and peculiarities
typical to each one. The ideal would be for
nurses functioning in this extended role to
have the authority that the responsibility
assumed demands.
"The legal view of nursing is complex.
More energetic action is required on the part of
nurses to overcome the reserve expressed
about their extended role and to bring about
what has apparently been politically accepted
by our governments.
"The focus on primary care is one of the
changes in nursing practice. It is clear that in
some situations drastic or revolutionary
changes are needed in the criteria applied to
health services; in others, at least radical
reforms.
'Expanded nursing services are identified
in the following areas: community health,
pediatrics, adult health, family planning, family
health, obstetrics and geriatrics.
"Among the most important implications
of the extended role of nurses are the
following: training in primary care of
community members and nursing auxiliaries,
coordination and integration in manpower
planning and use of manpower resources for
the health sector, new concepts of nursing
legislation.
"To sum up, we will have greater
possibilities to resolve the legal implications of
the adoption by nurses of new functions, and
the training of nursing auxiliaries, community
members and other kinds of workers, to the
degree that the nursing profession takes the
initiative in opening dialogue with other
professionals in the health field, with
politicians and government authorities in order
to obtain the legal support that, at least in Latin
America and the Caribbean, has been
expressed by the Ministers of Health.
"The nursing profession as a whole needs
to be conscious of these changes and
stimulated, through a large variety of means, in
order to bring about the acceptance of radical
changes. This requires a concentrated effort
on the part of all nurses to further the
introduction of new types of nursing services,
in institutions as well as in the community. The
profession must be aware of the need to carry
out innovative or emerging programs and
participate actively in them. ^
The Canadian Nurse August 1977
8 ^
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The Canadian Nurse August 1977
Idea E.Ycha]ige
Well Woman and Health Awareness Clinic
Yarmouth Regional Hospital is a 159-bed genera! hospital in
Yarmouth, Nova Scotia. Since January of this year, a health
promotion clinic has been in operation at the hospital's Diagnostic
Complex to meet the health needs of women in the area. Since this
time, the clinic has seen many patients, young and old, of varied
backgrounds. Here, the author describes the aims, approaches and
initial experiences of the Well Woman and Health Awareness Clinic.
Glenda Doucet
The purpose of our project is to use a systems
approach in order to assess the need for
services that are not presently provided by the
health delivery or social welfare agencies in
Nova Scotia. Groups of women identified
certain gaps in the area of maintaining health
and preventing disease — early detection and
diagnosis of cancer or other diseases affecting
the female reproductive organs and the
absence of health counseling were major
concerns.
With grants from Planned Parenthood of
Nova Scotia and the Secretary of State, a pilot
demonstration project was established in the
Diagnostic Complex of the Yarmouth Regional
Hospital. Three nurses organized the Well
Woman and Health Awareness Clinic and are
now involved in its operation. The clinic has
only two full-time paid employees: a nurse,
who is the coordinator of the project, and a
secretary-receptionist who has six year's
experience as a medical receptionist. Both
employees are bilingual — a necessity for
effective service in this area of Nova Scotia.
Volunteers include six women physicians,
ten registered nurses, a dietitian, and those
from the community who have special skills
needed at the clinic from time to time.
Volunteers and staff work together and an
interdisciplinary approach is maintained for
the ten sen/ices provided by the clinic.
From screening to baby-sitting...
The services provided by our clinic
attempt to fill a gap, to make available a place
where people can come for testing,
counseling, health teaching and support. So
far, these services include the following:
• Screening
Medical and cancer screening is one of
the functions of our clinic. Initially patients are
seen by a nurse who takes patient histories
and blood pressure readings, tests urine for
glucose and ketones and does fingerprick
hemoglobin testing. The patient then sees a
woman doctor for a breast examination, pap
test, bimanual pelvic examination, and rectal
examination.
This clinic is mobile; it is held in the Clare
District at the Women's Centre — Les
Femmes Acadiennes de Clare — three times a
month. Clare District is a predominantly
French-speaking area 45 miles away from
Yarmouth. So far, 17 per cent of the patients
seen at the clinic have been been referred for
diagnostic tests. Twenty-two per cent of all
clinic patients were diagnosed as having a
problem that needed medical attention.
• Preparing Children for /Hospitalization
In order to help young children cope with
separation anxiety when they are admitted to
hospital, a service for preparing children for
hospitalization was organized at the clinic. A
nurse talks to parents and children about
admission procedures and hospital routines
and helps the parents to establish realistic
long- and short-term goals for the child
scheduled for surgery. Depending on the
child's age, play therapy with a Fisher-Price
Hospital" may be initiated by the nurse.
The family is then taken on a tour of the
hospital — to see the lab, x-ray department,
operating room area, children's ward, and
kitchen. The staff of the pediatric ward has
been telling us that prepared children adapt to
the hospital setting more easily, are less
* Fisher-Price Hospital is a registered trademark of
Fisher-Price Toys.
The Canadian Nurse August 1977
frightened and generally much happier with
their hospital stay.
• Family Planning
The clinic offers family planning
counseling to individuals or to groups.
Teaching in this area includes evaluation of
the risk of pregnancy to the individual,
explanation of basic anatomy and physiology,
and discussion of different birth control
methods.
• Sex Education In Schools
According to Statistics Canada, Nova
Scotia has one of the highest illegitimate birth
rates in Canada. Yarmouth, at 22 per cent, has
one of the highest rates in Nova Scotia. The
Well Woman and Health Awareness Clinic and
its supporters decided to use teaching in the
schools in an attempt to alter this situation.
The School Board has agreed that some
of the volunteer professional staff be allowed
to teach sex education in the schools,
beginning in September, 1 977. The curriculum
will include basic anatomy of male and female
reproductive organs, conception, pregnancy,
birth, contraception, sex roles, venereal
disease, drugs, homosexuality, and marriage.
A successful sex education class for parents
has been held in order to help them to accept
the idea of sex education in the schools and to
let them know what we will be teaching their
children.
• Growth and Development
In order to help parents to u nderstand and
fulfill their role, we teach them about general
growth and development and effective child
rearing practices. We are very fortunate in
having a local pediatrician who gives
bimonthly sessions on these topics.
• Teenage Counseling
Counseling is also available to teenagers
atthe clinic. This service is provided by a nurse
who talks to young people about major
problems and concerns of everyday living.
• Nutrition Counseling
A volunteer nutritionist offers nutrition
counseling to patients referred to the service.
She interviews each patient, obtains a full
dietary history and a nutrition recall. Most
nutrition counseling focuses on weight
reduction or help with special diets. Follow-up
visits are arranged as necessary. If patients
requiring nutrition counseling feel that they
live too far away for easy access to the clinic,
the clinic's nurse makes referrals to the public
health nutritionist visiting their area.
• Breast-Feeding
Breast-feeding classes have been
established at the clinic to encourage
soon-to-be mothers to breast-feed their
babies. This educational service is undertaken
by the nurse coordinator and a number of
volunteer mothers and nurse-mothers who
have breast-fed their babies. The classes
cover basic anatomy and physiology of the
breast and breast-feeding, preparation and
care of the breasts and nipples, positions and
procedures for breast-feeding, the manual
expression and freezing of breast milk, drugs
that affect lactation, and possible problems,
including sore and cracked nipples and
engorgement. The public health nutritionist
talks to expectant mothers at the clinic about
their own nutrition and about weaning the
baby, and introduction of solid foods to the
child.
• Ostomy Care
The South West Nova Ostomy Chapter
operates within the clinic to provide emotional
and psychological counseling and skin care
teaching to ostomates. A nurse makes home
visits, helps patients prepare for barium
enemas, and accompanies patients to the
x-ray department. The nurse responsible for
these services will be taking enterostomal
therapy training in Cleveland, Ohio in August
of this year.
• Baby-SittIng
The clinic offers baby-sitting services to
anyone using the hospital facilities. A charge
of 50 cents per hour for each family covers the
cost of juice and cookies for the children.
Volunteer baby-sitters look after the children.
Four Months
We have also developed a questionnaire
to assess patients' knowledge of and
experiences with the menopausal period. This
questionnaire is now at the pre-testing level.
The Well Woman and Health Awareness
Clinic has seen 744 patients in the first four
months of its operation. Our patients have
ranged in age from seventeen to eighty. They
are women from high and low socioeconomic
groups, from varied cultual backgrounds and
from as far as 75 miles away from Yarmouth. ^
Glenda C. Doucet, R.N., B.N., the author of
this month's Idea Exchange, graduated three
years ago from Dalhousie University School of
Nursing In Halifax, N.S. Between graduation
and a job first as one of the organizers and
then as coordinator of the Well Woman and
Health Awareness Clinic, she worked as a
nurse at a center for children with learning
problems. Of her work at the clinic, she says:
"fvly role is a dual one, including both
administration and nursing service. I
administer the program under the guidance of
the board of directors. Nursing tasks Include:
taking patient histories; operating the mobile
clinics; preparing children for hospitalization;
family planning counseling; coordinating
classes In breast-feeding and teaching some
sessions. "
Pampas
ives
you both
ahieak
Cee|)8
him 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
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.
rROCTER * GAKfiLE
54
The Canadian Nurse August 1977
Audiovisual
Ethics and the l-aw in Practice
Manuel Escott
Two areas of major concern to nurses — ethics and
the law — are examined in depth in a program just
completed by Ontario's Nursing Education Media
Project (NEMP).
The series of 18 videotaped programs with
briefs for teacher guidance was produced in
response to a demand from NEMP's members,
Ontario's 21 community colleges, the Registered
Nurses Association of Ontario, and the College of
Nurses of Ontario. Although the series is aimed
primarily at student nurses, NEMP officials believe it
will also be useful to all members of the health-care
team.
Certainly the timing of the program couldn't be
better; malpractice suits against hospitals and their
staffs are mounting, and the volume and nature of
those suits raise questions about the standard of
nursing education and health care.
"Now more than ever it is the nurse's personal
responsibility to be aware and informed," says
Marilynne Seguin, NEMP's project coordinator.
"She or he can no longer hide under the cloak of an
institution for protection. The nurse must bear
personal responsibility, personal liability. "
The $40,000 program was produced in
cooperation with another NEMP member, TV
Ontario. Professional actors are used in each film
and the scripts are based on real-life situations. The
hospital dramatizations were filmed on a ward at
Toronto's Orthopaedic and Arthritic Hospital.
Consultants were Dr. Abbyann Lynch, a philosophy
teacher at the University of Toronto and a former
teacher of ethics at several nursing schools, and
Dr.T. David Marshall, a physician-lawyer and an
internationally known authority on medical-legal
jurisprudence.
The law series covers topics such as consent,
negligence, mental health, coroners' inquests and
contractual relationships.
"Contractual relationships are important to
examine because nurses are often held responsible
for advice they've given given informally — say, to a
neighbor whose child has Ijeen injured or is ill,"
explains Seguin.
Preceding the law series is a 68-minute
videotape, "Charge: Incompetence, a Mock Hearing
of the Discipline Committee of the College of Nurses
of Ontario," that reenacts an actual hearing.
While the legal issues seem clear-cut, it is in the
ethical field that the lines tiegin to blur. Ethical
conduct is influenced to a large extent by upbringing,
religious belief and personal prejudices. Can a nurse
embittered by the experience of an alcoholic father,
for example, treat an alcoholic patient objectively or
will her efficiency be impaired by her prejudice?
Other facets examined in the ethics series, as
stipulated in the International Code of Nurses, are:
primary responsibility, competence and continual
learning, environment, safety, consent, truth,
confidentiality, and behavior control. No attempt is
made to attribute blame or define right or wrong
responses to a given situation. All the
dramatizations and briefs are designed to
encourage discussion and to explore the issues
from many standpoints.
The ethics series corresponds directly to the
problems confronting nurses in the wori<ing worid.
Nursing teachers will readily identify with some of
the ethical dilemmas posed, and will be able to ask
students: "What would you do in the same situation,
and what are your responsibilities? "
For example, few senior nurses have been able
to avoid the situation where a chronically ill patient
who is receiving a drug placetx) asks: "Why is the
medicine not helping my pain?'" How does she
reply?
Or take the case of the terminally ill patient who
refuses further treatment, although the health team
thinks some new therapy will help. Does the team
have an obligation to help change the patient's mi nd
or to respect his wishes to avoid further suffering?
What clearly emerges from this series is a
challenge to students to think about their own ethical
positions before they confront an actual situation.
Film producers hope that students will tiecome more
aware of the responsibility they will have to bear on
the job, more aware of the importance of their
decisions, more aware of the quality of life.
"All the issues raised in both the law and ethics
series are of paramount importance to nurses," says
Seguin. 'Doctors are usually considered as making
the larger ethical decisions, but nurses daily have to
make many judgments of equal importance to the
patient."
Nursing agencies in Ontario that are not NEMP
members can obtain the series by contacting: WPS,
Ontario Educational Communications Authority,
Box 200, Station 0, Toronto, Ontario, MAT 271.
Interested agencies outside the province
should contact: Marilynne Seguin, Project
Coordinator, Nursing Education Media Project,
Ontario Educational Communications Authority,
2180 Yonge Street, Toronto, Ontario, M4S 2CI.
Booli.s
Introduction to Bowel and Bladder Care by
Sister Kenny Institute Staff, Sister Kenny
Institute, Minneapolis, Minnesota, 1975, 35
pages.
Approximate price $2.90 Reviewed by Olive
Simpson, Assistant Professor, School of
Nursing, University of British Columbia,
Vancouver, B.C.
This booklet is a much-needed contributbn to
the care of those persons suffering from the loss of
bowel and bladder control. Preparing information
such as this (applicable to all health professionals,
and the client) is a difficult task. Diagrams and
pictures are well used within the text.
The authors intend the manual to provide basic
information on bowel and bladder function, along
with a general guide in the development of care
plans for those patients who do not have bowel and
bladder control. To assist readers to better
understand when the need for elimination is not
being met, the writers have included a short
description, with diagrams of the normal anatomy
and physiology of the urinary and gastro-intestinal
systems. Some pathology is included in the booklet
(eg. neurological conditions which affect bowel and
bladder control). Descriptive diagrams showing the
effect of trauma to the brain and spinal cord are also
incorporated in the text.
The development of bowel and bladder care
plans are described with measures which may be
used in assisting the individual to wor1< toward some
degree of voluntary bowel and bladder control. A
small section is included on external urinary
appliances and protective clothing.
Appendix A explains the procedure for the
insertion of a u rinary catheter. Appendix B describes
the collection of a sterile specimen of urine. The
writers have added a short glossary for the lay
person's benefit.
Library Update
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 rjof go out on loan. Theses, also
R, are on Resen/e and go out on Interlibrary Loan
only.
Requests for loans, mjiximum 3 at a time,
should be made on a standard Interlibrary Loan form
or by letter giving author, title and item number in this
list.
If you wish to purchase a book, contact your
local bookstore or the publisher.
Books and documents
1 . Acute myocardial infarction; reaction and
recovery, by Cromvi/ell, Rue L. et al. St. Louis,
Mosby, 1977. 224p.
2. Attschul, Annie Therese. Psychiatric nursing,
by., and Ruth Simpson. 5ed. London, Baillifere
Tindal, c1977. 375p.
3. American Society of Association Executives.
Memt)ers appraise their associations. An attitude
study conducted by Opinion Research Corporation
for the American Society of Association Executives.
Washington. 1972. 168p.
4. Argyris. Chris. Theory in practice; increasing
professional effectiveness, by... and Donald A.
Schon. San Francisco, Jossey-Bass, 1977. 224p.
5. Basler. Beatrice K. Health sciences librarianship;
a guide to information sources, by.. . and Thomas G.
Basler. Detroit, Gale Research Co., c1977. 186p.
6. Bernard, Paul. Manuel de I'infirmier en
psychiatrie. 3ed. Paris, Masson, 1977. 401 p.
7. Bernhard, Genore H. Hov\r to organize and
operate a small library; a comprehensive guide to
the organization and operation of a small library for
your school, church, law firm, business, hospital,
community, court, historical museum or
association. Fort Atkinson, Wis., Highsmith Co.,
1975. 47p.
8. Beyers, Marjorie. The clinical practice of
medical-surgical nursing, by... and Susan Dudas.
led. Boston. Little, Brown and Co., c1977. 1234p.
9. Blalock, Hubert M. Social statistics. 2ed. New
Yori<, McGraw-Hill, c1972. 583p.
10. Brisou, J. An environmental sanitation plan for
the Mediterranean Seaboard; pollution and human
health. Geneva, World Health Organization, 1976.
96p. (World Health Organization Public health
papers, no. 62)
1 1 Campbell, John P. Managerial behavior,
performance, and effectiveness, by... et al. New
Yori<, McGraw-Hill, c1970. 546p.
12. Chalumeau, Marie-Th6r6se. Precis
d'immunologie. Paris, Presses Universitaires de
France, 1976. 238p.
13. Clarke, Margaret. Practical nursing. 12ed.
London, Bailli6re Tindall, c1977. 384p.
14. Diekelmann, Nancy. Primary health care of the
well adult. New Yori<, McGraw-Hill, 1977. 243p.
1 5. Finch. Frederic E. Managing for organizational
effectiveness: an experiential approach, by...
Halsey R. Jones and Joseph A. Litterer. New York,
McGraw-Hill, c1976. 282p.
16. Grace, Helen K. Mental health nursing; a
socio-psychological approach, by. . Janice Layfon
and Dorothy Camilleri. Dubuque, Iowa, Wm. C.
Brown Co., c1977. 542p.
17. Gribble, Helen E. Gastroenterological nursing.
London, Baillifere Tindall, 1977. 309p.
18. Kase, Suzanne H. Costs of hospital-sponsored
orientation and inservice education for registered
nurses, by... and Betty Swenson. Bethesda, Md.,
U.S. Public Health Service, Division of Nursing,
1976. 169p. (U.S. DHEW Publication no. (HRA)
77-25)
19. Klausmeier, Herbert J. Concepfua//eam/ng and
development: a cognitive view, by... Elizabeth
SchweenGhatala and Dorothy A. Frayer. NewYoric,
Academic Press, 1974. 283p.
20. Laurent. Claude. Guide du diab^tique. Paris,
Expansion Scientifique Franpaise, 1976. 203p.
2^.Law. law, law, by Ruby, Clayton et al. Toronto,
Anansi, c1976. 109p.
22. Miller, Mary Ann. The childbearing family: a
nursing perspective, by... and Dorothy A. Brooten.
Boston, Little, Brown and Co., c1977. 495p.
23. The narcissistic condition; a fact of our lives and
times, edited by Marie Coleman Nelson. New York,
Human Sciences Pr., 1977. 300p.
24. Nursing management of diabetes metlitus,
edited by Diana W. Guthrie and Richard A. Guthrie.
St. Louis, Mosby, 1977. 283p.
25. Organization for Economic Co-operation and
Development. OECD and the environment. Paris.
1976. 84p.
26. Organization of emergency medical care,
edited by L.B. Shapiro and I. A. Ostrovskii. Baltimore,
Johns Hopkins Univ. Press, c1975. 165p.
27. Bpes, Peggy L. Nutrition in infancy and
childhood. St. Louis, Mosby, 1977. 205p.
28. Purchese, Gillian. Neuromedical and
neurosurgical nursing. London, Baillifere Tindall,
C1977. 342p.
29. Readey, Helen. Introduction to nursing
essentials; a hand-book. St. Louis. Mosby, 1977.
197p.
30. Rothman, Daniel A. The professional nurse and
the law, by... and Nancy Lloyd Rothman. Boston,
Little, Brown Co., c1977. 185p.
31. Smith. James P. Sociology and nursing.
Edinburgh, Churchill Livingstone, 1976. 179p.
32. Squire, Jessie E. Basic pharmacology for
nurses, by... and Jean M. Welch. 6ed. St. Louis,
Mosby, 1 977. 382p.
POSEY
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Posey Footguard — rigid outer
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Posey Key Safety Belt — designed
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lock onto the webbing. Key neces-
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The Canadian Nurse August 1977
®
CURITY
Tripaque Sponges
With the Distinctive Figure-Eight
Loops for easier X-ray detection.
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!1TY TRIPAQUE SPONGE has been designed and
manufactured to meet the rigid standards of the surgical
environment.
Tripaque Sponges are uniformly made and pre counted and
packaged in tens in waterproof, puncture proof and micro
organism-impermeable trays. For positive detection under
X-ray, they incorporate a distinctive "figure-eight" loop
which cannot be mistaken for or obscured by sinew, bone
or other anatomical detail.
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KENDALL CANADA/6 CURITY AVENUE
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33. Thiessen, G.J. Effects of noise on man. Ottawa,
National Research Council, 1976. 89p. NRCC No.
15383
34. Zilliox, Henny .On les appelait gardiens defous;
laprofession d'infirmier psychiatrique. Paris, Privat,
C1976. 295p.
Pamphlets
35. Association canadienne des protesseurs
d'Universit6. Guide des relations avec las pouvoirs
publics, par Jill McCalla Vickers. Ottawa, 1976. 1v.
(loose-leaf)
36. Association des Infirmidresdel'Ontario.Soyons
Vigilant Communique. Toronto, 1977. lip.
37. Canadian Medical Association. Statistics,
Systems and Economic Research (Unit)
Department of SS & R. Ouickbase. Ottawa, 1977.
1v. (various pagings. col.)
38. Canadian Nurses Association. Report of tiealtfi
promotion program for nurses. Pilot project No. RA3
compiled by Jean Everard, Project Officer,
Research and Advisory. Ottawa, 1977. 1v. (various
pagings)
39. Donaldson, R.J. Ttie new tiealtli service in
Britain; its organization outlined. London, Royal
Society of Health, c1977. 27p.
40. Mortensen, Charles. Association evaluation;
guidelines for measuring organization
performance. Washington, American Society of
Association Executives, 1975. 42p.
41 . Ontario Nurses' Association. Let us take care. A
report to the people of Ontario. Toronto, 1977. 16p.
42. Second liaison meeting with nursing /midwifery
associations on WHO'S European
nursing /midwifery programme, Copenhagen,
21-23 April 1976. Report. Copenhagen, World
Health Organization, Regional Office for Europe,
1976. 18p.
Government documents
Canada
43. Parlement. Chambre des Communes. Liste des
deputes avec indication respective de la
circonscription 6lectorale et de I'adresse. Ottawa,
Imprimeur de la Reine, 1977. 93p.
44. Parliament. House of Commons. List of
members with their respective constitutencies and
addresses. Ottawa, Queen's Printer, 1977. 93p.
United States
45. Public Health Service. Office of Nursing Home
Affairs. Assessing health care needs in skilled
nursing facilities: health professional perspectives.
Rockville, Md., 1976. SOp. (DHEW Publication
number (OS) 77-50049.)
Studies In CNA Repository Collection
46. Brailey, Lydia Joan. A study to identify specific
psychosocial needs of mothers of preschool
children with which community health nurses could
assist. Toronto, c1977. 93p. Thesis
(M.Sc.N.) — Toronto R
47. Cyr, Kathleen Ann . Some differences in the self
concept of first offenders and recidivists. Seattle,
Wash., 1974. 69p. Thesis (M.A.) - Washington. R
48. Hazlett, C. Employment opportunities for nurse
practitioners in Alberta. A report submitted to the
University of Alberta Ad Hoc Committee on
Employment Opportunities for Nurse Practitioners,
by... S. Stinson and J. Moore, Edmonton, 1977.
46p. R
Audio-visual aids
49. Picciano, Jacqueline L. The nursing library and
the literature. Buffalo, N.Y., Communications in
Learning Inc., 1976. 1 audio cassette. R ^
Classified
AdvtM'tiseiiienls
British Columbia
British Columbia
Ontario
Registered Nurses — Licensed Practicsl Nurses required im-
medateJy for new 300-bed extended care hospital in Vancouver area.
Must qualify for BC. registration. Wnte: Co-ordinator o( Patient Ser-
vices, Queens Park Hospital. 315 McBnde Boulevard. New West-
minster. Bntish Columbia, V3L 5E8.
Experienced Nurses (eligible for B.C regislralion) required for
409-bed acute care, teaching hosprtal located m Fraser Valley, 20
minutes by freeway from Vancouver, and within easy access of
vanous recreattonat faolities Excellent onentalion and continuing
education programmes. Salary Si 184 00 to Si 399.00 per month.
Clinical areas include Medicine, Surgery, Obstetrics. Pediatncs.
Coronary Care. Hemodialysis, Rehabilitation, Intensive Care,
Emergency. AppJy to. Nursing Personnel. Royal Columbian Hospital.
New Westminster, Bntish Cofumbia, V3L 3W7.
Registered Nurses — required Immediatety for a 340 -bed accredited
hospital in the Central Intenor of BC. Registered Nurses interested in
nursing positions at the Pnnce George Regional Hospital are invited to
make inqijries to: Director of Personnel Services, Prince George
Regional Hospital. 2000 - I5th Avenue, Pnnce George. Bntish Col-
umbia. V2M 1S2.
Graduate nurse requred immediately tor a modem. 1 0-bed genera!
hosprtal located tn picturesque Stewart. B C. Salary arxi corxJitions m
accordance wrth RNABC Contract. Accommodat)on is available in a
closely situated residence Apply to; Adminelrator. Pnnce Rupert
Regional Hospital. Pnnce Rupert, Bntsh Columbia, VSJ 2A6.
Positions Vacant — Registered Nurses reqijred for a i6-bed
Psychiatnc Unit located in Northwest BC. opening in June 1977
Psychiatnc training or expenence essential RNABC contract is m
effect. Apply tn wnting to Mrs. F Quackenbush. RN . Director of
Nursing. Mills Memonal Hospital. 4720 Haughland Ave.. Terrace.
Bntish Columbia. V8G 2W7,
Supervisor, Public HeaKh Nursin*; — Chaltengmg position for in-
rwvative nurse wrth leadership ability for community health program in
Metropolitan Toronto. Qualifications: Registration m Ontano and Mas-
ters or Bachelors degree in nursing, progressive expenence and
responsibility in public health nursing Forward resume to Director of
Nursing, Borough of york Department o( Health, 2700 Eglinton Av-
enue West. Toronto, Ontano, M6M 1V1.
Australia
Nova Scotia
We have many vacancies for Registered Nursing Sisters and other
para-medcal staff For details please wnte to Hospital Staff
Agency. 388 Bourse Street. Melbourne, Victona 3000. Australia
Community Mental Health Nurse — required to work with psychta-
tnsts. psychologists. arx3 Soaal Workers in active cSnicat programs
These include individual, group, and family therapy. Qualifications
Current registration as a registered nurse in the Province of Nova
Scotia Master s Degree m psychiatnc nursing preferred. At least two
years expenence m psychiatnc facility or community mental health
work. A Baccalaureate in Nursing, with additional educat)on courses
in psychiatnc field acceptable. Apply giving cumculum vitae, descnp-
tion of expenence. and names of three referees to: E C. McDonagh,
Medcal Director. Cape Breton Mental Health Centre. P.O. Box 515.
Sydney, N.S. B1P6H4.
United States
Registered Nurses — Dunhill. with 200 offices n the U.S.A.. has
exciting career opportunrties for both new grads and expenenced
R N s. Send your resume to: Dunhill Personnel Consultants, f*Jo 805
Empire Building, Edmonton. Alberta. T5J 1V9 Fees are paid tjy
employer.
EXPERIENCED REGISTERED NURSES
St. Anthony's General Hospital, The Pas, Manitoba
requires experienced registered nurses.
Positions available include Staff Development, General
Duty and Nursing Administration.
Salary and benefits in accordance with the current
M.O.N. A. agreement.
Apply to:
W. D. Larson
Personnel Director
St. Anthony's General Hospital
Box 240
The Pas, Manitoba
R9A 1 K4
Telephone: 204-623-6431
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.
Closing date for copy and cancellation is 6 weeks prior
to 1st day of publication month.
The Canadian Nurses Association does not review the
personnel policies of the hospitals and agencies
advertising in the Journal. For authentic information,
prospective applicants should apply to the Registered
Nurses' Association of the Province in which they are
interested in working.
Address correspondence to:
The Canadian Nurse
50 The Driveway
Ottawa, Ontario
K2P 1E2
4
The Canadian Nurse August 1977
United States
United States
Challenge Awaits You at our dynamic community medical center.
Huntington Memonal Hospital is a 565-bed general care hospital
located in a beautiful suburt)an area of Los Angeles. The emphasis ts
on excellence... in patient care and in maintaining the best possible
nursing staff through exceptional orientation and in-service training
programs, continuing education, and professional involvement with
innovators in many fields of medicine Were presently seeking ex-
perienced RN's as well as new grads for many of our outstanding
units. If you'd like to enjoy the rewards of more challenge from your
career, plus the many t>enefits our hospital and Southern California
offer, please contact: Linda Chavez, RN. (collect) at (213) 440-5400.
Huntington Memonal Hospital, 747 S. Fairmount, Pasadena. Califor-
nia, 91105.
Nurses — RNs — Immediate Openings in Florida — California —
Texas — If you are expenenced or a recent Graduate Nurse we can
offer you positions with excellent salanes of up to $1300 per
montn plus all benefits. Not only are there no fees to you whatsoever
tor placing you. but we also provide complete Visa and Licensure
assistance at also no cost to you. Write immediately for our application
evenif there are other areas of the U.S. that you are interested m. We
will call you upon receipt of your application in order to arrange for
hospital interviews. Windsor Nurse Placement Sen/ice, P O. Box
1133. Great Neck, New York 11023. (516-487-2818)
UNITED STATES
OPPORTUNITIES
FOR REGISTERED NURSES
AVAILABLE NOW
IN CALIFORNIA
FLORIDA
MISSISSIPPI
NEW ORLEANS
TEXAS
WE PLACE AND HELP YOU WITH:
STATE BOARD REGISTRATION
YOUR WORK VISA
TEMPORARY HOUSING - ETC.
A CANADIAN COUNSELLING SERVICE
Phone: (416) 449-5883 OR WRITE TO:
RECRUITING REGISTERED NURSES INC.
1200LAWRENCEAVENUE EAST, SUITE 301 ,
DON MILLS, ONTARIO M3A 1C1
JURIST
NO FEE IS CHARGED
TO APPLICANTS.
OPEN 7 DAYS A WEEK.
HEAD NURSE
INTENSIVE CARE
UNIT
Applications for the above position are
now being accepted by this 300 bed fully
accredited General Hospital. We offer an
active Staff Development Programme,
Competitive Salaries and Fringe Benefits
based on Educational background and
experience.
Apply sending complete resume to:
Director of Personnel
Stratford General Hospital
Stratford, Ontario
N5A 2Y6
R.N.'s — Pacific Northwest/Idaho, Openings in 229-bed. accredited
acute hospital serving as major regional center for orttiopedic.
ophttialmology, dialysis, mental tiealtti. neurosurgery, and trauma A
modern tiospital facility surrounded by uncongested recreational
areas with close skiing, sparkling lakes and rivers and clean air. Salary
range S900 to SI 21 2 p/mo, commensurate with expenence. Excellent
tjenefits. shift rotation, relocation assistance, and free parking Wnte
or call. Dennis Wedman. Personnel Office. (208) 376-1211. St. Al-
phonsus Hospital. 1055 N Curtis Road, Boise, Idaho, 83704 E.O.E.
Registered Nurses Needed — 1 1 4-bed Joint Commission approved
hospital located in Sardis, fylississippi. Ideal cHmate with large recrea-
tional area nearby and large metro area 72 km. away. Competitive
salary and benefits, with relocation loan available Contact: Jeanna
Hams, R.N., Assistant Director of Patient Care Services. North
Panola Regional Hospital, P.O. Drawer 160, Sardis. fulississippi.
38666
Registered Nurses — Flonda and Texas — Immediate hospital ope-
nings in Miami, Fort Lauderdale, Palm Beach and Stuart, Florida and
Houston, Texas. Nurses needed for Medical-Surgical, Critical Care.
Pediatncs. Operating Room and Orthopedics We will provide the
necessary work visa. No fee to applicant. Medical Recruiters of Ame-
rica, Inc.. 800 N.W. 62nd St., Fort Lauderdale. Florida 33309, USA,
(305) 772-3680
Director of Nursing
Applications are invited for the position of
Director of Nursing in a 22-bed active
treatment hospital. The town is located on a
major highway 85 miles northwest of
Edmonton.
This position carries responsibility for the
co-ordination direction and supervision of the
activities of all nursing service departments.
Applications should be in writing including
age, qualifications and experience, with
references and date of availability.
Salary commensurate with qualifications and
experience.
Please apply to:
Administrator
Mayerthorpe General Hospital
Mayerthorpe, Alberta
TOE 1 NO
Positions open for RN's with degree and
experience:
COORDINATOR, MEDICAL-SURGICAL
NURSING
COORDINATOR, PSYCHIATRIC-MENTAL
HEALTH NURSING
These positions involve curriculum development,
staff development for nursing faculty assigned to
these specific courses. Includes some teaching as
well as participation on faculty committees.
Qualifications:
Good experiential and educational background:
Master's degree and eligibility for licensure in
Michigan,
Salary dependent upon qualifications: excellent
fringe benefits. If interested, contact:
Oirector
Mercy Central School of Nursing
220 Cherry Street S.E.
Grand Rapids. Michigan 49503
Phone: 616-77 4-60B3
HEALTH SCIENCES CENTRE
WINNIPEG, MANITOBA
requires
NURSING SUPERVISOR:
EVENINGS AND NIGHTS
The Health Saences Centre, one of the continent's largest
health care facilities with 1 300 beds, is Manitotia s principal
referral institution for complex health problems and the
Province's major hospital for teaching and research. It is
centrally located in Winnipeg. Manitoba's largest city with a
population of 600,000 people, which is internationally known
for its cultural, sports and recreational activities.
Qualifications:
• Memtjer in good standing with the Provincial Nurses'
Association.
• Minimum of five years nursing expenence in
Medical-Surgical areas with one year Head Nurse or
comparable administrative responsibilities.
• University credits in Nursing Administration desirable.
Responsibilities;
• To be responsible and accountable for the nursing
administration, evenings/nights, for approximately 150
patients in an acute care teaching and research facility.
• To plan and implement nursing care and penodically
evaluate same.
• To support, direct, analyze and evaluate the
performance of nursing personnel.
• To participate in educational programs and utilization
studies in interdisaplinary team relationships.
Salary:
• Commensurate with expenence and credentials.
Interested applicants may apply in writing to:
Manager Employment & Training
Health Sciences Centre
700 William Avenue
Winnipeg, Manitotia
R3E0Z3
The Regional Municipality of Waterloo
requires a
DIRECTOR OF NURSING
at the Sunnyside IHome for the Aged
Duties:
Reporting to the Administrator, this position is
responsible for nursing services. To establish
methods and procedures and develop staff
training programmes in the maintenance of a
high level of care for residents.
Qualifications:
A graduate from an approved Schiool of
Nursing and currently registered in Ontario.
Several years previous experience in nursing
service administration.
Salary Range:
$18,146.00 to $22,681.00 per annum
We offer a comprehensive benefit
programme including a Dental Plan.
Please reply in writing to:
Mr. R. Dick
Regional Municipality of Waterloo
8th Floor, Marsland Centre
20 Ert> St., W.
Waterloo, Ontario
N2J 4G7
RN*s
$12,000 Annually
Minitnum Starting Salary After 90 Days
In Houston,'fexas
At the "New" Hermann Hospital
IMMEDIATE VACANCIES
Hermann Hospital, located in the famed Texas Medical
Center, is the primary teaching facilityforthe University of
Texas Medical School at Houston. We are growing from
500 to 1,000 beds — creating career opportunity in
PRIMARY NURSING at all levels and in all specialties.
Learning is a part of the job at Hermann with inservice
education programs and 6 months Internship for new
graduates, all designed to broaden the scope of medical
education.
Hermann offers many attractive comprehensive benefits;
plus:
• Relocation assistance available.
• One month free rent.
• Free shuttle bus service.
• Tuition reimbursement.
i
For more information about
Hermann Hospital, write or
call Ms. Beverly Preble,
Nurse Recruiter, 1203 Ross
Sterling Avenue, Houston,
Texas 77030. (713) 797-3000
Join the "LIFE FLIGHT" Hospital
Discover Houston ... a city with an unlimited future. A city
alive. We are now the 5th largest city in the U.S. and still
growing. Discover nonstop nightlife; culture; sports.
Discover year round recreational activities on nearby
beaches, inland lakes and rivers — all an easy drive away.
Discover lower cost of living and no local or state income
taxes that make it more than comfortable to pursue your
profession.
If you have a specialty,
Hermann Hospital has a
place for you: 19 operating
room suites. Renal Trans-
plantation. Psych, Neuro, a
Children's Center, Ortho-
pedics, Opthalmology ,
Pediatrics ICU, Neonatal
ICU, Bum Unit, and Oncology.
.•*F»
WlBSM Mk
Ffermann
Hospital
.cv^^c
^^^^o'^
AN EQUAL OPPORTUNITY EMPLOYER M/F.
The Canadian Nurse August 1977
+
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 community 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 Health
in the Home courses.
Volunteer now as a Red
Cross Instructor In your
Community
For further Information, contact:
National Coordinator
Department of Health
and Community Services.
The Canadian
Red Cross Society
95 Wellesley Street East
Toronto, Ontario, M4Y 1H6.
Associate
Executive Director
Applications are invited for the position of
Associate Executive Director, Canadian
Nurses Association, Ottawa.
Candidates must be members of the
Canadian Nurses Association, have a
master's degree or equivalent and have at
least five years' administrative
experience. Bilingualism an asset.
Interested applicants are asked to submit
their curriculum vitae, in confidence, to:
Executive Director
Canadian Nurses Association
50 The Driveway
Ottawa. Ontario
K2P 1E2
MANIT
CIVIL SERVICE COMMISSION
Director, Staff Development, Nursing
The DEPARTMENT OF HEALTH & SOCIAL DEVELOPMENT, Mental Health
Services, Brandon Mental Health Centre, requires a person to be responsible for
assessing and identifying staff education needs; developing, coordinating and
implementing programs in staff development programs in Mental Health under
general direction of Nursing Administrator.
Baccalaureate in Nursing with Psychiatric Nursing experience. Specialization in
Nursing or Adult Education desirable. Must hold valid Manitoba Licence.
Salary Range: Si 5,578 — $19,076 per annum (UNDER REVIEW)
Apply in writing referring to #519 immediately.
In-Service Educator
The DEPARTMENT OF HEALTH & SOCIAL DEVELOPMENT, Mental Health
Services. Brandon Mental Health Centre, requires a person to be involved in
in-service education programs for nursing staff. Emphasis will be on human
resource development in progressive Mental Health Delivery Services.
Bachelor of Nursing with Psychiatric Nursing specialization preferred. Valid
Manitoba licence. R.N. or R.P.N, with post basic nursing education and psychiatric
experience considered.
Salary Range: $13,543 — $16,330 per annum (UNDER REVIEW)
Apply in writing referring to #521 immediately to:
Civil Service Commission
340 — 9th Street
Brandon, Manitoba
R7A 6C2
Head Nurse
To be accountable for nursing care
and administration of a 40-bed
surgical unit in a progressive nursing
service. B.Sc.N. preferred, but willing
to consider applicants with
experience, educational
qualifications and personal qualities.
A full range of benefits together with
pleasant facilities and competitive
salary is also offered. Position
available November 1977.
Please write to:
Personnel Director
South Waterloo Memorial Hospital
Coronation Boulevard
Cambridge, Ontario
N1R3G2
Applications for the
position of
Supervisor
Operating Room and
Recovery Room
are now being accepted by this
300 bed fully accredited hospital.
We offer an active staff
development programme.
Salaries and fringe benefits are
competitive, based on
educational background and
experience. Temporary
accommodation available.
Apply sending complete
resume to:
The Director of Personnel
Stratford General Hospital
Stratford, Ontario
N5A 2y6
DIRECTOR OF NURSING
Mills Memorial Hospital
Terrace, B.C.
Applications are invited for the position of
Director of Nursing for a progress ive,recenfly
expanded 103 bed Regional Hospital.
The Hospital offers a full range of consultive
staff, acute facilities, intensive care and
psychiatry.
The hospital is located in the mountainous
Pacific Northwest and offers an impressive
range of outdoor and indoor recreational
facilities.
Qualifications
Applicants should have administrative
experience with preference given to a BSC or
masters degree in nursing.
Salary — negotiable
Please apply to:
The Administrator
Mills Memorial Hospital
4720 Haugland Avenue
Terrace, British Columbia V8G 2W7
The Canadian Nurs« August 1977
Assistant Director of Nursing Services
for the
Capital Regional District Community Health
Service
Victoria, B.C.
Salary: $2189 per month (single rate)
In ccxiperation with the Director of Nursing Services to plan, organize, and control a
diversified program of public health and home care nursing services provided to the
residents of the Capital Region. As a memtaer of a management team the Assistant
Director of Nursing Services will play a key role in planning and developing special
nursing programs, assisting supervisory nursing personnel with the implementation
of such programs and providing information regarding the nature of nursing services
to various community groups and other health and welfare agencies within the
community. The successful applicant will also be required to assist with the
day-to-day administration of a collective agreement covering approximately
one-hundred (100) public health and registered nurses, participate in contract
negotiations on a regular basis, assist with personnel selection, develop and foster
in-sen/ice and continuing education programs for nursing staff.
The successful applicant will be required to work with a good deal of independence,
be innovative and capable of making decisions with a high degree of objectivity while
developing and maintaining good working relationships with all health department
personnel and representatives of various community agencies.
Applicants should possess a Master s degree in Nursing with a major emphasis on
community health nursing and administration. Preference will tie grven to those
applicants with a minimum of six (6) years public health nursing expenence in more
than one area, and of which, at least four (4) years have tieen at a responsible
supervisory level. Applicants with a Bachelors degree in Nursing combined with
considerable previous supervisory experience will also be conskjered for
appointment to this position.
Candidates should be registered or eligible for registration in B.C. and possess or b>e
capable of acquiring a B.C. Driver's Licence.
Written applications giving details of education, training and work experience
together with appropriate character references will be received by the
Personnel Administrative Assistant, Capital Regional District, P. O. Drawer
1000, Victoria, B. C. V8W 286 at the earliest possible date.
Make yourself at home
in Philadelphia. . .
Art. History. Good restaurants and theatre.
Universities. An active social life. They're
all here in Philadelphia. And so are we.
Temple University Hospital serves a large
urban community in the midst of the city.
It's a teaching hospital where a nurse can
really get involved. At Temple, a nurse's
life is anything but routine. And your life
after hours? That's up to you.
So if you're looking for a place to call
home, consider Temple. We're now
offering a Nurse Internship Program for
those nurses with no more than six
months' clinical experience. It
enables you to meet your 6
month clinical requirement
transfertoSpecialCare _
Unitswhileyouareworking. ~
Get in touch with
Ms. Judy May. Temple
University Hospital, 3401 North
Broad Street, Philadelphia, Pa. 19140. (215)
221-3152. We're an equal opportunity employer.
Temple University Hospital
y
international nursing opportunities
If you have an adventurous spirit and have
ever thought of living and vi^orking in another
country, you may want to contact us.
A WORLD OF OPPORTUNITY
MAY BE AWAITING YOU!
At present there are \wo areas you may want
to consider — locations where Canadian RN's
are known and highly respected for their con-
tributions in Nursing.
SAUDI ARABIA: The King Faisal Specialist
Hospital and Research Centre in Riyadh,
Saudi Arabia — a modern 250 bed specialty
health center. Positions available (on 25
month contracts) for general and specialty
acute-care staff nurses.
UNITED STATES: Various locations in several
states are available — or will be in the near
future. Facilities may vary from small com-
munity hospitals to major metropolitan medi-
cal centers.
* An International Subsidiary of
Hospital Corporation of America
• Qualifications and requirements vary with
each location:
— Minimum for Saudi Arabia: R.N. License,
3 years current acute-care hospital ex-
perience
— Minimum for U.S. locations: R.N. License
and eligibility for U.S. state licensure, 1
year experience preferred.
• Salary and benefits are competitive and
dependent upon location, hospital, position,
and qualifications.
If you meet minimum requirements and think
you may be interested, why not write us for
more details?
Please forward professional resume (indicate
location preference i.e., Saudi Arabia or
U.S.A.) to:
Miss Marion L. Mullin, R.N.
International Representative
Hospital Corporation International*
One Park Plaza
Nashville, Tennessee 37203
^'3R"
The Canadian Nurse August 1977
STAFF DEVELOPMENT CO-ORDINATOR
Required for St. Anthony's General Hospital, The Pas, a health
complex consisting of a 1 1 2 bed hospital, a 72 bed personal care
home and 32 bed detoxification and rehabilitation unit.
Responsibilities include planning, organizing, co-ordinating and
directing all aspects of in service education and training for the
health complex.
Qualifications should include several years of experience in a
health facility, preferably as a nurse. Experience in organizing
and implementing training programs is desirable.
Please forward complete resume to:
Personnel Director
St. Anthony's General Hospital
Box 240
The Pas, Manitoba
R9A 1 K4
Telephone: 204-623-6431
ASSOCIATION OF REGISTERED NURSES OF
NEWFOUNDLAND
Nursing Practice Advisor
Applications are invited for the position of Nursing Practice Advisor.
Qualifications:
• Degree in Nursing, preferably at the Master's level
• Registered, or eligible for registration, with the Association of
Registered Nurses of Newfoundland
• Knowledgeable about the organization of the Nursing Profession
• Should be prepared and have experience in nursing practice,
especially in the development and implementation of standards
Salary:
Negotiable, depending on qualifications and experience
All replies confidential
Applications to be forwarded to:
Executive Secretary
Association of Registered Nurses
of Newfoundland
P.O. Box 4185
St. John's, Newfoundland
A1C6A1
The following positions are available now for a 450 bed active treatment hospital situated in a
year-round recreational area:
1.
PATIENT CARE CO-ORDINATOR
The Patient Care Co-Ordinator is responsible to the Director of Nursing Services for the daily administration of
selected patient care areas.
The successful applicant must be eligible for registration in the province of New Brunswick. Post Basic
Preparation preferred. Minimum of 5 years experience in a supervisory capacity.
Salary: $1,089.00 — $1,219.00 per month
(allowance for post basic preparation).
Excellent fringe benefits.
2.
RN— INSTRUCTOR— GN5
STAFF EDUCATION
Qualifications: Eligible for registration in New Brunswick with practical experience in hospital work. Bachelor of
Education or Baccalaureate degree in Nursing.
Salary: $1,089.00 — $1,219.00 per month
The purpose of the job is to plan or implement workshops, courses, and programs related to staff orientation and
education under the direction of the Director of Staff Education.
On any of the above positions — please apply in writing with a complete resume:
Employment Manager
Saint John General Hospital
P.O. Box 2100
Saint John, New Brunswick
E2L 4L2
The Canadian Nurse August 1977
63
Notice
WHO Fellowships
1978
The World Health Organization allocates each year a small
number of fellowships to Canadian Health Workers. Awards will
cover per diem maintenance and transportation. The fellowships
are used to provide short programs of study abroad of
approximately 2 to 3 months' duration.
Canadian citizens engaged in a professional capacity in
operational or educational aspects of health care are eligible to
apply. Ineligible are wort<ers in pure research, undergraduate and
graduate students and applicants more than 55 years of age.
Applicants will be rated and chosen by a selection committee on
the basis of their education and experience, the field of activity they
propose to study and the intended use of the knowledge gained
during their fellowship upon return to this country. Final
acceptance will remain the responsibility of WHO.
Projects should be submitted for Octotser 31, 1977.
Requests for Information should be directed to:
international Health Services
Brooke Claxton Building
Tunney's Pasture
OTTAWA, Canada
K1A 0K9
Director of
Nursing: $21,306 — $26,943
Duties: You will be required to direct and supervise nursing
service programs for a 51 0-bed facility of //hich 300 beds are in
the Oak Ridge Maximum Security Unit.
Qualifications: Nursing registration or proof of eligibility in the
Province of Ontario; post-graduate course in nursing
administration or Hospital Administration. B.Sc.N. preferred;
many years of responsible and varied nursing experience, with at
least 3 at the supervisory level. Ability to maintain high standards
of morale and nursing care. Ability to organize work and discipline
staff. Knowledge and experience in Maximum Security desirable.
Please submit application by Sept. 7, 1977 to the Personnel
Officer, Mental Health Centre, Penetanguishene, Ontario,
LOK 1P0.
This position is open equally to men and women.
Ontario
ontaro PubNc Sefvice
1
•••\
Children's Hospital of Eastern Ontario
■.A v*-'* ■•> -^i +•■ "^ •■xj^
Hopital pour enfants de Test de I'Ontario
THE CHILDREN'S HOSPITAL OF EASTERN ONTARIO
REQUIRES A
DIRECTOR OF NURSING
A new 300 bed paediatric teaching hospital in the Nation's Capital offers a challenging opportunity for a nurse with experience in paediatric nursing.
Preference will be given to iDtlingual applicants prepared at the Master's level who have a minimum of 5 years' experience in paediatric nursing
including a background in administration and teaching.
The successful applicant will assume responsibility for the management and operation of the Nursing Department as well eis the Education and Child
Study, Child Life and Volunteer Departments.
He/She will perform the activities of planning, organizing, directing and controlling the departments' physical, financtcti and human resources in
accordance with departmental and hospital objectives, policies and standards.
The Director of Nursing will be an active Member of the Hospital Management Team and will have the opportunity to contribute to and participate in the
formulation of recommendations affecting the development of hospital policies.
Interested applicants may submit a resume in confidence to:
The Executive Director
Children's Hospital of Eastern Ontario
401 Smyth Road
Ottawa, Ontario
K1H8L1
The Canadian Nurse August 1977
Wish
you were
here
...in Canada's
Health Service
Medical Services Branch
of the Department of
National Health and Welfare employs some 900
nurses and the demand grows every day.
Take the North for example. Community Health
Nursing is the major role of the nurse in bringing health
services to Canada's Indian and Eskimo peoples. If you
have the qualifications and can carry- more than the
normal load of responsibility. . . why not find out more?
Hospital Nurses are needed too in some areas and
again the North has a continuing demand.
Then there is Occupational Health Nursing which in-
cludes counselling and some treatment to federal public
servants.
You could work in one or all of these areas in the
course of your career, and it is possible to advance to
senior positions. In addition, there are educational
opportunities such as in-service training and some
hnancial support for educational leave.
For further information on any, or all, of these career
opportunities, please contact the Medical Services
office nearest vou or write to:
Medical Services Branch
Department of National Health and Welfare
Ottawa, Ontario K1A0L3
Name
Address
City
■ ♦
Health and Wellare
Canada
Prov.
Sanle el Bien-etre social
Canada
Index to ^^H
Advertisers ^^S^
August 1977 I^^^H
The Clinic Shoemakers
2
Connaught Laboratories Limited
Cover 4
Cutter Medical (Canada)
10, 11
Designer's Choice
Cover 3
Equity Medical Supply Company
4
Kendall Canada
56
J.B. Lippincott Company of Canada Ltd.
32, 33
McGraw-Hill Ryerson Limited
5
Posey Company
55
Procter & Gamble
53
Reeves Company
15
W.B. Saunders Company Canada Limited
13
White Sister Uniform Inc.
Cover 2
Advertising
Gerry Kavanaugh
The Canadian Nurse
50 The Driveway
Ottawa, Ontario K2P 1 E2
Advertising Representatives
Richard P. Wilson
219 East Lancaster Avenue
Ardmore, Penna. 19003
Telephone; (215) 649-1497
Gordon Tiffin
2 Tremont Crescent
Don Mills, Ontario M3B 2S1
Telephone: (416) 444-4731
Member of Canadian
Circulations Audit Board Inc.
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Continued health
protection for Canadians
from Connaught
New Fluval
Bivalent Influenza Vaccine
The National Advisory Committee on Immuniz-
ing Agents recommends that a bivalent (A/Victoria/
3/75-like and B/Hong Kong/5/72-like) inactivated
influenza vaccine be made available for use in
Canada for the 1977-1978 influenza season.
A/Victoria strain, in particular, has caused
many deaths worldwide since it was first identified in
1975. In anticipation of Canada's need, Connaught
will now provide Fluval, a high quality, bivalent
influenza vaccine.
Fluval is designed for those most vulnerable to
the complications of flu: the elderly, the debilitated,
the diabetic and those with chronic cardiac, pulmo-
nary- and renal disease. It can also be used for other
groups or individuals in essential services for whom
influenza vaccine may be desirable.
Last year the demand for a vaccine with an
antigenic content of A/Swine flu virus was especially
great. Connaught was the major Canadian company
that supplied the vaccine to every province in the
country. This year and in the years to come, Canada
can continue to depend on Connaught to fill its need
for protection against flu viruses.
With Fluval, Connaught expands its wide range
of immunizing agents to include a readily available
and competitively priced vaccine for today's most
prevalent influenza strains.
Supplies of Fluval will be available in time to
meet the expected demand for flu immunization.
New from Connaught
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In keeping with our tradition of
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a
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1755 Steeles Avenue West
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The " \^ " Signature on the garment is the symbol that you are wearing
the most exclusive designs in our White Sister collection.
A. Style No. 49320 - Skirt suit. Sizes: 5-15.
Royale W/S Impact - 100% textured Dacron"
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B. & C. Style No. 9872 - Pant suit. Sizes: 6-16
Royale Seersucker — 100 % woven polyester.
Whiite, Mint: about S39.00
White
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Available at leading department stores and specialty shops across Canada
tHo manndiaMB
numme
September, 1977
The official journal of the Canadian
Nurses Association published
monthly in French and English
editions.
Volume 73, Number 9
Input
News
6
Names
48
Calendar
51
Tri-Hospital DialDetes
Education Centre
£. Laughame,
G. Steiner M.D.
14
Books
55
ChNdhood Diabetes
Elizabeth F. Crosby
20
Library Update
56
The Juvenile Diabetic
Carol Polowich,
M. Ruth Elliott
24
God's Love and
a Jar of Honey
Dawn Moynihan
28
Nursing Education:
Another Tower of Babel
Mohamed H. RajabaJly
30
How do you Feel
about Working Nights?
Lynda Fitzpatrick
34
Listening Does Help
Mona Winberg,
Joan Hobson
40
Helping a Family and their
Premature Baby Grow Together
Norma J. Murphy
42
The two smiling faces on our
September cover belong to Jean
Bates (right), nurse coordinator of the
Tri-Hospital Diabetes Education
Centre in Toronto, and to Jean Smith,
a patient at the centre. For more on
Tridec and on other aspects of patient
care and education as they relate to
diabetics of all ages, see this month's
three-part feature that begins on
page 14.
Cover photo courtesy of Tom Burns,
Medical Photographer, Women's
College Hospital, Toronto.
The views expressed in the articles
are those of the authors and do not
necessarily represent the policies of
the Canadian Nurses Association.
ISSN 0008-4581
Indexed in International Nursing
Index. Cumulative Index to Nursing
Literature. Abstracts of Hospital
Management Studies. Hospital
Literature Index. Hospital Abstracts,
Index Medicus. The Canadian Nurse
Is available m microform from Xerox
University Microfilms. Ann Arbor,
Michigan, 48106.
The Canadian Nurse welcomes
suggestions for articles or unsolicited
manuscripts. Authors may submit
finished articles or a summary of the
proposed content. Manuscripts should
be typed double-space. Send onginal
and carbon. All articles must be
submitted for the exclusive use of The
Canadian Nurse. A biographical
statement and return address should
accompany all manuscripts.
Subscnplion Rates: Canada: one
year. S8.00: two years. SI 5.00.
Foreign: one year, S9.00: two years.
S17.00. Single copies: Si. 00 each.
Make cheques or money orders
payable to the Canadian Nurses
Association.
Change of Address: Notice should be
given in advance Include previous
address as well as new. along with
registration number, in a provincial/
territonal nurses association where
applicable. Not responsible for
journals lost in mail due to errors in
address.
Postage paid in cash at third class rate
Montreal, P.Q. Pemilt No. 10,001.
s Canadian Nurses Association
1977.
*
Canadian Nurses Association.
50 The Driveway, Ottawa, Canada,
K2P 1E2.
The Canadian Nurse September 1977
(America's
number! shoe
foryOting women
in white!
SOME STYLES ALSO AVAILABLE IN COLORS . . . SOME STYLES 3 2-12 AAAA-E, ABOUT 26.00 to 37.00
For a complimentary pair of white shoelaces, folder showing all the smart Clinic styles, and list of stores selling them, write:
THE CLINIC SHOEMAKERS • Deot. CN-g. 7912 Bonhomme Ave. . St. Louis. Mo. 63105
The Canadian Nurse September 197V
PereSpeetive
In this issue, CNJ reports on the
results of its recent mail-in survey on
how readers feel about working
nights. We think the results are
interesting — mostly because they
represent some very frank and
personal reactions to what is
obviously an important aspect of the
package that today is being called
"quality of care".
Obviously, the hours that you
work and the way that you feel during
those hours have a lot to do with the
way that you do your job. If you "walk a
metabolic tightrope" that makes
working nights a miserable part of your
nursing career, what can you do about
it? What can hospital administrators
do about it?
Round-the-clock nursing care
means exactly that. But what can we
do to make sure that the quality of that
care is as good at four o'clock in the
morning as it is at two o'clock in the
afternoon?
When we asked you to tell us how
you feel about working nights, we did
not do this in anticipation of making a
major scientific breakthrough in this
area. Our resources placed definite
limitations on the kind of data and
conclusions that we could come up
with.
Our major recommendation is
simply a plea for a more informed and
rational approach to the fundamental
question of "who shall watch and who
shall sleep."
This summer, a dispute in Nova
Scotia made it clear that the effects of
12 hour shift have not yet been
effectively evaluated. The dispute
arose when administrators at a Halifax
hospital decided to eliminate 12 hour
shifts on at least one unit of their
hospital on the grounds that they
caused fatigue and inferior patient
care.
But if administrators failed to
substantiate their arguments that 12
hours shifts were too hard on their
employees, the Nova Scotia nurses'
union was no further ahead. Tom
Patterson of the Nurses' Staff
Association of Nova Scotia said,
"Although hospital administrators had
no solid ground for ending 12 hour
shift, we had nothing to support our
position in favour of the 12 hour shift.
To my knowledge the effects of 12
hour shift simply haven't been studied
enough."
The dispute ended when the
hospital decided to continue the 12
hour shift with an important stipulation
— that committees be established to
evaluate the effectiveness of 12 hour
shift and its special problems.
In the light of today's economic
realities and the stress that every
nurse is under to perform at optimum
levels throughout each shift —
whether that shift is twelve or eight
hours, day, evening or night — isn't it
about time that nurses everywhere
supported a more informed and
analytical approach to this very
important question?
— M.A.H.
^o^^l-v:
.-v*'
Editor
M. Anne Hanna
Assistant Editors
Lynda FItzpatrick
Sandra LeFort
Editorial Assistant
Sharon Andrews
Production Assistant
Mary Lou Downes
Circulation Manager
Beryl Darling
Advertising
Gerry Kavanaugh
CNA Executive Director
Helen K. Mussallem
"Now tell me, just how long have you been feeling rejected?"
The Canadian Nurse September 1977
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USE A SEPARATE SHEET OF PAPER IP NECESSARY
Fetal Monitoring
As the author of the article
advocating fetal monitoring for all
women in labor (Fetal Monitoring,
Why Bother? March, 1977), I feel I
must reply to several of the statements
in Elaine Carty's letter (Input, July,
1977).
First of all, Carty cites a study
which compared the outcomes in
latxjrs which were monitored
electronically with those which were
monitored through auscultation of the
fetal heart every 1 5 minutes in the first
stage and every 5 minutes in the
second stage of labor (The Evaluation
of Continuous Fetal Heart Rate
Monitoring in High Risl< Pregnancy,
Haverkamp, A., et al., Am. J. Obstet.
Gynecol., June 1, 1976). It is true that
the authors found no
significant difference in perinatal
mortality or morbidity; however, they
admit to difficulties in deciding how to
evaluate morbidity. They followed the
hospital course of each infant for 72
hours after birth; morbidity was
determined according to the following
criteria: need for neonatal intensive
care, seizures, lethargy, diarrhea,
poor feeding, jaundice, and antibiotic
treatment for documented sepsis.
This was obviously not a longitudinal
study. What about long-term problems
(i.e. cerebral palsy, mental
retardation, visual, auditory, and
perceptual difficulties) which may not
become apparent until much later in
the child's ife? There are other
limitations to this study; these are cited
by the authors themselves and by the
distinguished experts who critique it in
the pages immediately following the
article.
Secondly, while I agree with Carty
that lying on one's back is a bad way to
labor (for both maternal and fetal
reasons), I must point out that:
• monitoring need not Interfere with
positioning (even if the patient is being
indirectly monitored, the nurse simply
adjusts the belts according to the
position the patient takes), and
• the woman in the photographs in
my article is lying with the head of her
bed elevated 30°.
Thirdly, although I have wori<ed in
three major metropolitan delivery
suites (each with over 2000 deliveries
per year), I have never seen nurses
auscultating fetal hearts every 15
minutes on a routine basis. To do so
would require a much higher
nurse-patient ratio than hospital
budgetswillpermit. Also, inorderfora
nurse to auscultate a fetal heart, the
patient must lie on her back; this can
produce fetal hypoxia and again, it is a
poor way to labor. I agree
wholeheartedly with the importance of
the nurse's physical and emotional
support through labor. The monitor
should never be used as an excuse to
decrease the amount and quality of
nursing care; it is meant to improve
care, not substitute for it.
Fourth, there is no basis for
stating that fetal monitoring increases
the level of maternal anxiety, let alone
the incidence of fetal distress.
Numerous authors, including Dr.
Morton Stanchever (who critiqued this
study) state that patients are
reassured by the presence of the fetal
monitor, probably because they
realize that the baby's progress is
being carefully watched. In my
experience, patients and their
husbands have been pleased to see
their baby's hearttjeat on the screen. It
is the patient's right to have all
unfamiliar procedures (including
shave preps and enemas, as well as
fetal monitoring) explained to her, so
that she understands what is being
done and the reasons for it.
Furthermore, there is no need for the
patient to have to listen to the sound of
the fetal heart — electronic monitors
have volume controls which can be
shut off without interfering with the
transmission of the fetal heart pattern
onto the recording paper.
Finally, I am concerned that the
fetal monitor is becoming a
scapegoat. There is a great deal
wrong with so-called "modern
obstetrical care." Consumers and
nurses alike are worried about
depersonalization of care, lack of
patient participation in
decision-making during the
childbearing cycle, overuse of
oxytocics and anesthetics, and other
interferences with the normal process
of latKDr. The fetal monitor is being
viewed as one more unnecessary,
interfering gadget. As an advocate of
the rights of the fetus to the best
possible start in life, I hope that we can
keep and improve upon what is good
about modern obstetrical care
(including fetal monitoring, prenatal
education, and husband participation
during labor and delivery) while
working to eliminate the bad.
— Ellen Hodnett, Lecturer, University
of Toronto, Faculty of Nursing.
She, Shis and shim
Language develops in i rational
pattern to express what the human
mind has to communicate. Language
is slippery and intractable because it
must not only serve man's expression
of ideas, but it must assure the
universal comprehensibility of the
means used. One cannot apply logic
to language and draw parallelisms.
For example, if the masculine
pronouns are he, his and him; one
cannot say the feminine pronouns are
she, shis and shim. Similarly, if the
plural of mouse is mice, the plural of
house is not hice. Words also have a
variety of meanings because they may
be used to express a variety of
actions, states or concepts. Raise and
raze are pronounced the same but
have oppx3site meanings.
There is also a tendency to
confuse sex with gender. They are nc
interchangeable terms. Many times
they coincide but not always. For
example, in Latin the word for sailor is <
nauta, feminine gender. In German,
neuter gender denotes a child, das
Kind, a girl, das Madchen, and a
horse, das Pferd! Similarly in English,
reference pronouns need not follow
sex. In French, the gender of the
pronoun is determined by the gender
of the noun, for example sa m6re
means his or her mother.
Of late there have been attempts
to impose on language violations and
falsifications of its linguistic patterns
and order. A case in point is the
neologism "Chairperson ' to
distinguish the sex of the presider.
This is an absolute misreading of the
term. Chairman is a combination of
two words: chair and man.
To use ctiair is not so much a
word as a figure of speech called
metonymy. This is where an
associated word is used to express an
attribute. For example, we say
"crown" to mean "state", the "bench"
to mean the law, and we use 'the
chair" to mean authority, because the
presider at a meeting sat on a platform
or dais. Similarly, the term man (in
chairman) does not mean a male, but
the wielder, from the old English verb
MANNIAN, to handle or wield. The
origin probably stems form the Latin
manus. Therefore, the term chairman
means "the wielder of authority". To
say chairperson is to indulge in
meaningless expression. Proof of the
matter is the term used to denote a
very able handling of a meeting, good
chairmanship. In like vein, oars are
manned, whether they are operated
by men or women. The wielders are
oarsmen, and agood performance is
good oarsmanship. Oarpersonship
would be both meaningless and
absurb.
It is disturtiing to attend national
or international meetings presided
over by educated women who call
themselves chairpersons. According
to Webster, among other meanings a
person is "a human being as
distinguished from an animal orthing'
or "an inferior human being".
Compared to that definition wouldn't
women wish to bie chairmen, wielders
of authority?
—Ella MacLeod, director. Public
Health Nursing Division, Department
of Health, PEL
The Canadian Nurse September 1977
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The Canadian Nurse September 1977
Nevi's
Better working
conditions for nurses
A new Convention aimed at creating
better working conditions for nurses
has been adopted by the International
Latwur Organisation.
The Convention calls for national
policies, within general health
programs, designed "to provide the
quantity and quality of nursing care
necessary for attaining the highest
possible level of health for the
population."
In particular, the Convention
states that ratifying countries must
fake measures to provide nursing
personnel "with education and
training appropriate to the exercise of
their functions and both employment
and working conditions which are
likely to attract people to the
profession and keep them in it."
The Convention was adopted by
government, employer and worker
delegates from 126 ILO member
countries. The delegates were
participating in the 63rd Session of the
International Labour Conference in
Geneva, Switzerland, last June.
Discussion at last year's session
concluded with agreement for a
Recommendation only. But a wori<ers'
proposal at this year's session got
enough support from government
delegates for the adoption of a
Convention — a legal agreement
designed to enable nurses "to enjoy a
status corresponding to their role in
the field of health."
Ratification of the international
agreement would enable nurses to
make a larger contribution to health
care in their countries.
Nurses, known traditionally for
their patience and sense of duty , have
recently gone on strike in several
countries in defence of their
occupational, moral and economic
interests.
Drafted in collaboration with the
World Health Organization, the ILO
Convention will try to ease the crisis in
the profession with guidelines for
better pay, shorter wori<ing hours and
job satisfaction.
The Convention calls for
participation of nursing personnel in
the planning of nursing services, and
for consultation with nurses on
decisions concerning them.
"Settlement of disputes concerning
terms and conditions of employment
should be sought through negotiation
between employers' and workers'
organizations. This can be
accomplished only through
independent and impartial machinery
such as mediation, conciliation and
voluntary arbitration."
The Convention states nursing
personnel should enjoy conditions
which are, atthe very least, equivalent
to those of other workers in their
country. This includes hours of work,
weekly rest, paid annual holiday,
educational leave, maternity leave,
sick leave and socisil security.
Delegates to this year's session
also adopted a Recommendation
concerning employment and
conditions of woric and life of nursing
personnel. The Recommendation
covers a wkJe range of problems that
confront nurses in our modern health
care system; education and training,
career development, remuneration,
working time and rest periods,
occupational health protection, social
security and international
co-operation. "Only through
co-ordinated action in each of these
areas can conditions of nursing
personnel be improved in a lasting
way."
Of special interest is the provision
in the Recommendation by which
nurses would be able "to claim
exemption from performing specific
duties, without being penalized, where
performance would conflict with their
religious, moral or ethical
convictions. " This is the fi rst time such
a "conscience clause " has appeared
in an ILO agreement.
The Recommendation also
states that:
e National legislation "shoukl
prescrit5e the basic requirements
regarding nursing education and
training" and provide for its
supervision.
e Continuing education and
training, both at the workplace and
outside, should be an integral part of
the training program.
• National legislation should "limit
the practice of the profession to duly
authorized persons."
e Nurses should be able to
participate in any decisions which
involve either their profession or
national health policy in general.
a Normal daily hours of work should
be continuous and not exceed eight
hours. In any case, the working day,
including overtime, should not exceed
12 hours.
a The weekly rest period should, in
no case, be less than 36 uninterrupted
hours.
A conference for
supervisors
Twenty-two evening and night
supervisors from eight hospitals in the
Sydney, N.S. area met recently forthe
first time to discuss their common
problems and share their ideas and
experiences.
Members at the Sydney
conference talked about several
problems that hold high priority for
them, including improvement of
communication among medical staff
administration and nursing so that
policies are clear and ensuring the
proper use of "Emergency " beds.
At the end of the one-day
meeting, a number of
recommendations were made by
those attending. Among these were:
e that supervisors continue to meet
as a group every four months to
continue discussions;
a that they elect an executive and
appoint a representative from each
hospital;
a that as a long-term goal they plan
to organize all evening and night
supervisors on a provincial basis;
a that they arrange annual or
semiannual conferences to include
supervisors, administrators and
directors of nursing;
a that they organize a
Medical-Nursing Liaison Committee;
e that the Coordinator prepare a
draft position paper (for review by
participants) which would emphasize
the need for concise written policies in
hospitals.
The meeting of supervisors was
attended by Gladys Smith, president
of the Registered Nurses Association
of Nova Scotia, and Jean MacLean,
Nursing Service Consultant, RNANS.
NBARNIioids61st
annuai meeting
This year's annual meeting of the New
Brunswick Association of Registered
Nurses attracted approximately 250
nurses and nursing students from
around the province. NBARN's
outgoing president SImone Cormier
addressed the opening session of the
two-and-one-half day meeting held in
eariy June.
Speaking about dissatisfactions
in nursing today, Cormier said that
more and more nurses are
questioning the future of health care.
"The madness of progress seems to
affect the profession, and nurses
worry about the quality of care
provided. Could the dissatisfactions
be a reaction to an inability to cope
with the accelerating growth and the
complexity of health services, or
maybe the multiprofessional power
structures in hospitals? "
Cormier told the delegates that
many nurses are still not aware and
underestimate the importance of
participating in the decision-making
process. The uneasiness in the
profession is a temporary growing
pain that is essential if the profession
is to keep growing, she said. "I also
believe that our nurses will become
more and more flexible and that they
will unite to speak with one voice."
During the business sessions,
reports were submitted by the
Executive Secretary, Registrar and
the Nursing and Legislation
Committees. The auditors' report was
presented, the 1 977 budget ratified
and a total of 35 resolutions were
presented and discussed by
delegates. Approval was given to 23
resolutions, some of which are:
a to conduct a review of nursing
home regulations
a to encourage nursing homes to
adhere to the defined role of the RN
and the RNA
a to establish a task force to
identify the role and the needs of RNs
employed in nursing homes, and
provide support in setting up
standards for those working in nursing
homes and In education
a to investigate ways of increasing
the number of nursing hours for each
level of care in nursing homes and
altering the criteria which determine
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The Canadian Nurse September 1977
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Th« Canadian Nurse September 1977
\C»\Y.S
■5
• to promote physical training and
health education programs for school
children
• to promote more community
health teaching programs on the CBC
network
• to place greater emphasis on
health maintenance and promotion
through increased monies available
e to complete reassessment of
NBARNs organizational structure
• to clarify the roles and functions
of the nurse in relation to other
members of the health team.
• to encourage employers to give
priority to hiring New Brunswick
graduates over new nursing
graduates from other provinces
• to promote a mandatory
reporting law in New Brunswick on
child abuse
• to promote the Code of Ethics
among nurses and students
• to support the right of part-time
nurses to the same privileges,
inservice programs, salary increases
and retroactive pay accorded full-time
nurses.
Keynote speaker for the program
dayof the meeting was LorlneBesel,
Director of Nursing at the Royal
Victoria Hospital in Montreal and
assistant professor at McGill
University School of Nursing.
Speaking on the theme, Day of
Concern forthe Future of Health Care,
she stressed the importance of
nurses' involvement in future health
care planning.
How nurses can be involved in
planning is the most basic and critical
question, according to Besel. Only
through involvement in future planning
will nursing find answers to where it
will fit if there are changes in health
care delivery services, she said. Then
nursing may be in a position to help
decide the most rational proportions of
hospital beds to ambulatory and home
care services, and be able to direct
educational programs to respond to
those new nursing roles.
Besel pointed out that if nursing is
not involved in the planning stages of
health care, it will endlessly be left to
ad hoc responses. She told the
delegates that in talking about a Day of
Concern, 'we are expressing
anxieties which we as a profession are
experiencing." These anxieties are
partly due to the lack of involvement in
health care planning, she said.
Besel focused on external forces
currently exerting pressures which are
shaping the practice of the profession.
She referred to three immediate
concerns of nursing — unionism,
consumerism and increasing
government intervention.
Although the future of nursing is
confusing and unpredictable, Besel
feels that it is also exciting. "At one
time our role was confined to hospital
nursing and fairiy uncomplicated.
Today the very scope of possible
activities to which a nurse's core skills
may be applied is one of our problems
in planning for education, practice and
research," she said.
Newly elected members of
NBARN executive are: President:
Judith Oulton of Fredericton; First
vice-president: Judy Mann of
Campbelton ; Second vice-president:
Bonnie Hoyt of Fredericton:
Secretary: Lucille Gaulton.
Personality profiles
reflect new maturity
Nurses studying to become medical
nurse practitioners in the U.S. show
striking changes in theii personality
when compared with those of similar
students a few years ago, according to
an assistant professor and clinical
chief of community health nursing at
the University of Rochester school of
nursing. Dr. Judith Sullivan studied
medical nurse practitioners at the
University of Rochester tietween 1 972
and 1 976. The nurses, all experienced
RN's, came from a wide variety of
positions in the western New York
region.
Dr. Sullivan tested personality in
terms of 15 personal needs. These
needs, as evidenced by the responses
to a large number of questions, were
then ranked in order of importance in
the makeup of the individual.
The needs measured were
achievement, deference, order,
exhibition, autonomy, affiliation (the
need to be loyal and to please),
intraception (the need to analyze
motives of oneself and others),
succorance (the need to help relieve
distress), dominance, abasement,
nurturance, change, endurance,
heterosexuality, and aggressbn.
In 1972, says Dr. Sullivan, the
predominant characteristics of the
nurses tested conformed to the profile
of nurses in general, as shown by
extensive eartier studies. That is, the
nurses tested showed the greatest
need for endurance, deference, and
order, with only one difference — they
showed a greater need for change. In
1973 and thereafter, the needs with
the highest overall scores were
heterosexuality, dominance,
intraception, change, and
achievement. The traits previously
ranked highest now ranked lowest.
Dr. Margaret D. Sovie, associate
dean for nursing practice at the
University's Medical Center,
commenting on the study, said, "The
change in characteristics, as identified
in Dr. Sullivan's research, reflects the
growing maturity of the profession of
nursing and its practitioners. These
results are undoubtedly correlated
with cultural as well as professional
changes."
Canada recently adopted national
standards for the application of CPR.
"First on the list of people who have to
be trained are those who work in
critical care areas," says Penny
Jessop, RA/.. coordinator of the
Ambulance Training Program for the
Ontario Ministry of Health,
Ambulance Services Branch. "From
now until 1980 target groups for CPR
instruction will include doctors,
nurses, respiratory technicians,
ambulance attendants and firemen. "
Jessop (pictured below) was
instructing and examining at a recent
CPR course held in Ottawa's
Algonquin College.
^JS^r;^^^
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Xt?\Y.S
NB RNAs set up
separate organization
New Brunswick's 2000 Registered
Nursing Assistants now have their
own Act of Incorporation. Following
study and amendments by the
Corporations Committee of the
Legislature, the Registered Nursing
Assistants Act was passed on June
16, 1977 and was expected to be
proclaimed law within 60 to 90 days.
The major amendment to Bill 36
revised the definition of the RNA. The
nursing assistant is now defined as "a
graduate of an approved school of
nursing assistants who, being neither
a registered nurse nor a person in
training to be a registered nurse,
undertakes the care of patients under
the direction of a registered nurse or
duly qualified medical practitioner, for
custodial, convalescent, sub-acutely
ill and chronically III patients, and who
assists registered nurses in the care of
acutely ill patients, rendering the
services for which he or she has been
trained. "
NBARN opposed the definition of
nursing assistant contained in the
original Bill on the grounds that it could
jeopardize the quality of health care in
the province by not assuring
accountability of RNAs to the
registered nurse, the person to whom
they are responsible in the work
situation. This objection, as well as
other concerns, were voiced by
NBARN representatives before a
Corporations Committee meeting on
May 26. The Association also
presented a reaction paper on the
proposed Act to memtiers of the
Committee.
Another source of concern to
members of the Corporations
Committee was the resolution
debated at NBARN's annual meeting
concerning the elimination of nursing
assistant training programs. This
resolution was subsequently defeated
by the delegates attending that
meeting.
A meeting held later in June
between representatives and legal
counsel from the groups concerned
revised the definition of the RNA to the
satisfaction of tXDth parties. The Act
approved by the Legislature contains
the amended definition which
stipulates that the RNA works under
the direction of an RN or a physicia
Another amendment provides for the
setting up of advisory committees on
education requirements and
standards of care.
NBARN has had legal authority
for registration, education and
discipline of nursing assistants since
1957. The new Act will transfer these
powers to the Association of New
Brunswick Registered Nursing
Assistants (ANBRNA). NBARN staff
members who have administered the '
legal responsibilities in the past will be
meeting with ANBRNA reresentatives
to arrange for the transition prior to
proclamation of the Act.
The incorporation of RNAs in
New Brunswickjas an independent
body leaves only the Saskatchewan
Registered Nurses' Association with
legal jurisdiction over nursing
assistants.
Nursing fellowships
offered
Nursing fellowships for 1 978 are being
offered by the American Lung
Association for graduate study in
respiratory disease. The fellowships
are offered to graduates of
baccalaureate schools of nursing
enrolled in an accredited graduate
program in nursing and are directed
towards those nurses seeking a
career as clinical specialist, teacher or
researcher in the care of patients with
respiratory conditions.
The fellowships are in the amount
of $6,000. per year with the possibility
of one renewal for a maximum of two
years of support. Awards are limited of
U.S. and Canadian citizens or holders
of bona fide permanent visas for study
in U.S. institutions.
Completed application form
must be received tjy April 1, 1978.
Address inquiries to: Marilyn Hansen,
Consultant in Nursing, American
Lung Association, 1 740 Broadway,
New York, N.Y. 10019.
ine uanaaian Nurse beptemDer 1977
QJyleet Skipper, our dashing young deck shoe with
skid-resistant deck sole and ship-shape fashion looks.
Soft white glove leather with a perfect fit built into
every lightweight pair. Skipper, the ^»r|rtm^ (^
most comfortable shoe in the fleet. ^^X ^
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For the individualist
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The Canadian Nurse September 1977
NBARN brief on
mental health services
The New Brunswick Association of
Registered Nurses has submitted a
brief to the sub-committee of the New
Brunswick Health Services Advisory
Council studying mental health
services in that province. A more
detailed submission on the subject will
be prepared by NBARN and
presented during a provincial tour by
the committee this fall.
The three-member
sub-committee, of which NBARN
member Marianne Schwarz is a
member, will present a preliminary
report to New Brunswick Health
Minister Brenda Robertson in
September. An indepth report on the
long-term aspects of mental health in
New Brunswick will be presented at a
later date It is expected that NBARN's
input into the Committees
investigation will be reflected in the
report dealing with the long-term
aspects of mental health services.
The Association's preliminary
submission to the sub-committee on
mental health supports the upgrading
of standards of care for the mentally ill
to equal the quality of care provided for
those who are physically ill. Mental
health services in New Brunswick
must change greatly if this ideal is to
be met, the submission states.
The submission makes six
recommendations, the major one
stressing the urgent need for hiring a
mental health and psychiatric nursing
consultant at the government level
The other recommendations support
the need for all forms of continuing
education programs, a post-basic
course in mental health and
psychiatric nursing in 1978,
coordination of mental health services
to provide continuous care from
hospital to community, establishment
of an "ideal unit" in each provincial
hospital staffed by qualified RNs
giving primary nursing care, and
examination of basic nursing
education programs with the goal of
better preparation of nursing students
The submission also suggests that
mental health services be
regionalized, with each region
responsible for the care of the
mentally ill of the area: recruiting
preparing and maintaining required
staff; and coordinating services that
provide a high standard of care.
One section of the submission
refers to the contribution of ideas and
comments from nurses. The
ovenwhelming response representing
the views of more than 275 nurses
from around the province indicates the
degree of concern about this aspect of
health services.
In responding to a question on
why more RNs aren't wori<ing in
psychiatric services, nurses spoke
about inadequate and undesirable
settings for clinical experience as
students, and nurses being employed
mainly for custodial care rather than
being able to use their skills to the
fullest potential. Other reasons cited
for the lack of nurses working in
psychiatric areas were listed as:
• lack of continuing education to
help nurses develop new attitudes
knowledge and skills in this field;
• lack of direction and leadership in
psychiatric nursing and mental health
services in general;
• a ratio of patients to professionals
and non -professionals which does not
permit the practice of quality nursinq
care; ^
• lack of receptiveness to new
ideas and approaches by persons in
positions of authority:
• nurses in positions of authority
not always qualified academically or in
experience for their leadership roles.
NBARN's preliminary submission
was prepared by Marilyn Brewer,
part-time staff member, in
consultation with NBARN's ad hoc
committee on mental health and
psychiatric nursing. Members of that
committee are Ryllys Cutler
(chainnan) and Roberta Nevers,
Fredericton; Jessie Baldwin,
Campbellton; and Betty Poley, Saint
John.
New primary care centre
opens in IMontreai
Did you know ...
More than 30 states and territories in
the USA now have legislation allowing
for the clinical practice of certified
nurse-midwives (CNM), according to
the American Journal of Nursing. The
two latest states to permit licensure of
nurse-midwives are Alabama and
Alaska. In addition, legislation is
pending in Colorado and
Massachusetts.
The Montreal General Hospital has
been awarded a $1.4 million grant in
order to establish a new
interdisciplinary Centre for Advanced
Studies in Primary Care.
The Centre is to be a faculty
development program in the
Department of Family Medicine of
McGill University. It will be
co-sponsored by all the family practice
units of McGill and several other
departments in the Faculty of
Medicine.
The grant was provided by the
W.K. Kellogg Foundation of Battle
Creek, Michigan.
The new Centre's primary
objective will be to provide an
advanced academic program for
family physicians and primary care
nurses who already hold or who will
soon hold a university faculty position.
Doctors and nurses will be
offered a two-year curriculum which
will emphasize four broad areas of
academic pursuit; investigative
principles and practice, new teaching
modalities, medical communications
and a program development for health
science institutions. Each student at
the Centre will also participate in
guided academic activities, which will
include teaching, academic clinical
practice and investigative projects
with scholarly presentations.
Graduates of the Centre will not
necessarily receive a degree or a
diploma. Anyone wishing to be a
degree candidate at McGill will have to
register with the University Faculty of
Medicine and comply with its
postgraduate residency
requirements.
The innovator, and designated
director, of the Faculty Development
Centre is Dr. Walter O. Spitzer. He is
presently the Director of the Family
Practice Teaching Unit at The
Montreal General Hospital and a
Professor of Epidemiology and Health
at McGill University.
Dr. Spitzer has taught family
medicine as well as epidemiology and
biostatistics for many years and he
bnngs considerable academic, as well
as research experience, to the Centre.
One of his foremost interests in the
field has been research into improved
primary health care services in
Dr. Spitzer emphasized the
Centre will act as the nucleus and
catalyst for satellite teaching centres
now being organized in remote rural
areas of northern Quebec and New
Brunswick.
These outlying teaching units will
include teaching teams made up of
both family physicians and family
practice nurses. Physicians and
nurses from such satellite units and
members of the McGill centre wHI
rotate regulariy to increase their
mutual awareness of the challenges
and demands of each area.
The Centre will accept its first
students in July, 1977. Once in full
operation, it will accommodate from
11 to 15 nurses and physicians.
Founded by the breakfast cereal
pioneer, W.K. Kellogg in 1930, the
Kellogg Foundation is among the five
largest private philanthropic
organizations in the United States.
The Foundation supports programs in
the areas of education, health and
agnculture in the United States,
Canada, Latin America, Europe and
Australia.
Health happenings
A technique first developed to uncover
flaws in the surfaces of industrial
materials has been adapted to help
uncover early scoliosis at low cost
and without the need for highly-skKled
medical help.
Essentially the technique is a way
of throwing a series of 'S-D' shadows
on the back of the child being
screened. If the spine is scoliotic
asymmetrical patterns are seen by the
examiner at a glance. It is thought that
this shadow technique is considerably
more sensitive as a screening method
than the bending test presently used in
school screening tests.
The percentage of Canadian
non-smol(ers has increased steadily
for 1 0 years to 53.9 percent from 47.2
percent except among teenagers. In
the last 10 years, teenagers have
smoked more each year but the trend
is now relatively stable.
Got questions on nursing care?
Let Saunders be your assurance company!
MARLOW:
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New 5th Edition
Marlow is the book nursing professionals
everywhere know and trust for the complete cover-
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color plates, and new topics such as Fetal Alcohol
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Hypertension, and Reyes Syndrome make this new
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EdD
By Dorothy R. Marlow. RN.
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ROBINSON:
Psychiatric
Nursing
as a Human
Experience,
New 2nd Edition
Well known and respected for its iiumane concerns.
Psychiatric Nursing as a Human Experience has
been substantially expanded, and now offers totally
new chapters on Human Sexuality. Psychosomatic
Illness, Antisocial Personalities. Family Therapy, and
Group Therapy. In addition, material on transac-
tional analysis has been added throughout, and the
excellent bibliographies have been thoroughly re-
vised.
By Lisa Robinson, RN. PhD, Univ. of Maryland School of
Nursing: and School of Medicine, Univ. of Maryland 459
pp $10 80, April 1977, Order #7621-9.
gJoc
I
I
Du GAS: Introduction to Patient Care,
iVeiv 3rd Edition
This brand new edition contains additional material
on the health care system, major health problems.
and f^e role of the nurse. Entirely new chapters on
Nursing Practice, Communication Skills, and Sen-
sory Disturbances, more than 70 new photographs,
and its considerably expanded glossary make this
revision an even better text to learn the fundamentals
of nursing. A Teacher's Manual is available.
By Beverly Witter Du Gas, RN, MN, EdD, formerly Nursing
Consultant. Dept of National Health and Welfare. Ottawa
686 pp, 218 ill, S14 00, June 1977 Order #3226-2.
ASPERHEIM &■ EISENHAUER: The
Pharmacologic Basis of Patient Care,
New 3rd Edition
In this comprehensive revision you'll find much new
data including expanded discussions of drug-drug
and drug-food interactions, hyperalimentation . con-
tent of the problem-oriented record and drug
therapy, steroid drug therapy, and drug administra-
tion to pediatric patients. It s thoroughly up-dated.
and A new Instructor's Guide is also available.
By Mary K. Asperheim, MD. Medical Univ of South
Carolina: and Laurel A. Eisenhauer, RN. MSN. Boston
College School of Nursing, 565 pp lllustd S11 60
April! 977 Order #1437-X.
WOOD & RAMBO: Nursing Skills for
Allied Health Services,
New 2nd Edition
Reorganized and thoroughly up-dated, this new 2nd
edition gives explicit instruction in problem-oriented
charting, patient rights, informed consent, care of
the dying patient, methods of calculating the drip
rate of intravenous infusion, and much more. For
example, the section on care of the colostomy pa-
tient now includes procedures used in changing
disposable colostomy bags, the use of permanent
stoma bags, and simplified irrigation procedures. A
Teacher s Guide is available.
Edited by Lucile A. Wood, RN. MS. Director of Nursing.
Bay Area Hospital. Coos Bay. Oregon: and Beverly J.
Rambo, RN. MN, Mount St Mary s College, LA.: with four
consultant writers 752 pp. 500 ill. June 1977.
Combined volume: S13.00. Order #9606-6.
Two-volume set: $16 20 Order #9603/4.
7o order lilies or^ 30-aay approval enler order number and autnor
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C Bill me—
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C My credit card or bank account reference l»:
send C.O.D.
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The Canadian Nurse September 1977
HOSPI^L
DMBETES EDUCMION
C^L \l 1 1 \ L : a cost effective,cooperative
venture
Tridec
Elizabeth Laugharne, R.N.
George Stelner, M.D.
Health care expenditures in Canada account
for a little more than seven (7.3) per cent of the
gross national product, compared to 6.8 per
cent in the United States and 4.8 per cent in the
United Kingdom.'
In Ontario — where the population
increased by almost one and a half million
people in the decade between 1 965 and 1 975^
— health insurance costs during the same
period skyrocketed from $350 million to close
to $3 billion.^
Even before the introduction of the current
austerity measures, intended to put a ceiling
on continued annual increases, concern was
being expressed by administrators and
practitioners alike over the need to find more
satisfactory long-term solutions to the twin
problems of rising costs and increasing
demands for services and facilities.
In 1 974, members of the Ontario Health
Planning Task Force" recommended that the
focus of health services be shifted from the
traditional hospital setting to community
settings more accessible to the public. They
suggested that there should be a built-in
capacity to encourage new methods of health
care delivery and to test new programs. Other
recommendations concerning regionalization
of health care, increasing the number of nurse
practitioners and improving utilization of the
primary health care sector have caused the
Ministry of Health in Ontario to give belated
recognition to preventive aspects of medicine.
Since then, more emphasis has been placed
on ambulatory as opposed to in-patient care,
and efforts have been made to amalgamate
services, to convert active treatment beds to
chronic beds, to share some services and to
close other facilities.
Tridec is an outgrowth of all these trends.
The center recognizes the need of the diabetic
and his family for adequate understanding of
the nature of diabetes mellitus.
• It reinforces the concept that, to achieve
such a goal the diabetic has to assume an
active and participating role ; the physician and
other health professionals are available to help
him assume this responsibility.
• Tridec provides a setting in which allied
health professionals can update their
knowledge of diabetes and improve their
teaching skills.
• Coupled with th is is the desire to create a
model for a shared physicians' service with the
primary objective of health education.
Staff and facilities
Tridec is a cooperative venture of Mount
Sinai, Toronto General and Women's College
Hospitals — three downtown Toronto
university teaching hospitals which serve a
mixed socio-economic population
representing many nationalities, most of
whom do not regard English as their first
language.
Host for the project is Women's College
Hospital and it is here that the classrooms,
offices, laboratory and lounge are located. In
addition to the 1800 square feet of space
needed to house the project. Women's
College also provides administrative and
back-up services such as purchasing,
personnel, housekeeping. X-ray, emergency
and laboratory facilities. Representatives of
the medical and administrative staffs of the
three hospitals sit on a committee which meets
bimonthly to advise on policy. The
paramedical staff — two nurses, two dietitians
and a social worker — are screened by this
committee and hired by the host hospital.
Medical staff is provided on a cooperative
basis by the three hospitals. Each of the ten
The Canadian Nurse September 1977
Six years ago, three teaching hospitais in Canada's fastest growing metropolitan area
decided to pool their resources, share facilities and staff to develop a patient education
program for the diabetic and his family that would emphasize preventive aspects of medicine
and ambulatory care. The venture has paid off handsomely in terms of well informed, highly
motivated patients and more effective utilization of costly hospital facilities. Here's how it
works...
1
Patient registrations and treatment
800 n
700-
600-
500-
400-
300-
200 - 160
100-
0
709
646
510
292
\38/A
33/
23 /
A*%
38%
22'A
37%
\30Z
277o
*Z%
25%
50%
N32%\
19°«
&4R>:
49%
1971 1972 1973 1974
I I insulin I I oral agents l\\i diet on
1975
1976
ly
Source of referrals
500-
400-
300-
200-
100-
62%
60%
^ 6256
72% rn
89%
92%
8%
9*
M^
27%
I
35%
I
36%
I
^3%
38%
I
1971
I ITRI-H
1972
OSPITAL
1973
1974
A METRO TORONTO
1975 1976
OUT OF TOWN
physicians cover for a week at a time on a
rotating basis.
Tridec physicians do not take an active
role in the treatment of registrants but are
involved in a teaching and consultant capacity.
Their main function is to teach the patients and
professionals at the center and to serve as a
back-up for unusual or emergency treatment
problems. The referring physician remains the
director of his patients treatment. Tridec
physicians will, however, at the request of the
referring physician, provide a medical
consultation during the patient's stay.
Day-to-day operations are handled by the
nurse-coordinator under the direction of the
medical director of Tridec and the medical
director of the host hospital.
Utilization
Since its inception in 1971, Tridec has
accommodated more than 2,000 patients for a
total of close to 8,000 visits. More than 1 0,000
meals have been served to registrants.
The daily patient census of 1 6 diabetics is
supplemented by relatives of these patients
and several allied health professionals. Most
of the patients are insulin dependent or
managed on diet alone. The majority of
diabetic registrants range in age from 20 to 50
years . There has been no significant change
in age or duration of diabetes in referred
patients since the program began. The
percentage of patients on oral hypoglycemics
has also remained constant since 1971 (see
Figure 1). The pattern of referrals has,
however, changed significantly. In 1971 when
the center opened, almost all referrals (92%
per cent) came from one of the three
participating hospitals. By 1976, referrals from
community physicians had increased to 38 per
cent of the total (see Figure 2).
The Canadian Nurae September 1977
Informal classroom teaching session.
The program
The center presents a comprehensive
four-day program which includes all medical
and dietary aspects of the management of
diabetes. Patients are grouped together or
segregated according to theirtreatment needs
— Monday through Wednesday for those
controlled by diet or by diet and oral
hypoglycemic agents and fVlonday through
Thursday for those dependent on exogeneous
insulin. Fridays are kept for staff to write
reports, develop audiovisual aids and attend
staff meetings.
Nutritional teaching and counseling is
done by teaching dietitians who emphasize
that balanced nutrition is the foundation of
effective diabetic management. The diabetic
diet is presented by the dietitians as simply a
healthy way of eating which can be used by the
whole family. A session on calorie control is
directed to those patients whose principal goal
is weight reduction. Breakfast and lunch are
served at the center under the supervision of
the dietitians and patients are responsible for
selecting portions of food appropriate to their
own diet. As well, each patient is seen
individually by a teaching dietitian who
prepares a meal plan which meets the
individual's needs and the physician's diet
prescription.
Nursing lectures provide information on:
• physiology of diabetes;
• complications of diabetes;
• the how and why of urine testing;
• insulin administration technique;
• pharmacology of insulin and oral
hypoglycemic agents;
• hypoglycemia, foot care, ketoacidosis;
• drug interaction.
Individual counseling of each patient by
nursing staff affords the opportunity to
\
evaluate and assess the patient's
understanding and acceptance of
responsibility to manage his diatjetes on a
day-to-day basis.
Tridec physician involvement at a round
table "Question and Answer " period for two
hours a week encourages patients to ask
questions about their concerns or perhaps
have further explanation of a topic previously
discussed in a more formal setting.
Each patient also participates in two
hours of group discussion led by a social
worker each week. These sessions are
divided into two groups — those who are
dependent on insulin and those who are not.
Many Tridec patients have commented on
how comfortable, supportive and enlightening
this process has proved for them. Group
discussions provide a climate for problem
solving and also serve to reinforce Tridec's
teaching program. Since diabetics are often
anxious and uncertain when they commence
the program — they do not know what to
expect or what is expected of them — a
conscientious effort is made to create an
atmosphere of relaxation, informality and
acceptance throughout the program.
Individual counseling by the social worker
is done at the request of the referring
physician, the patient or a member of the
teaching team.
Special one-day counseling sessions are
also arranged for pregnant diabetics, the
elderly, people who are not fluent in English or
who require a refresher course to assist them
in making diet adjustments.
Professional training program
One of the most important aspects of the
Tridec teaching program is its usefulness as
an educational resource for allied health
professions. For the health educator who
works in the community orteaches diabetics in
another hospital, this "Teaching the teacher"
program provides a chance to;
• observe individual diet assessment,
nursing evaluation and counseling;
• improve teaching skills aimed at diathetics
of various ages, ethnic, social and educational
backgrounds;
• develop interviewing and teaching
techniques.
As well, involvement in the group process
affords the health professional an opportunity
to interact with the inter-disciplinary health
team and to hear patients discuss as a group
their feelings about diat)etes and how they
cope with it.
More than 700 allied health professionals,
physicians-in-training and in practice have
attended Tridec since it opened six years ago
and the number is increasing rapidly each year
(see Figure 3).
Community outreach
Tridec staff, both individually and as a
team, travel widely, to give lecture
presentations and workshops to health care
workers in a variety of nursing schools and
community health agencies. Inservice
programs have been given in half a dozen
Ontario centers, including Sudbury, Timmins,
Goderich, Orillia and Sault Ste. Marie.
The Canadian NurM Septembw 1977
'Increasingly, insulin therapy is being initiated and
control monitored on an out-patient basis in
community health facilities such as Tridec.
Between 1973 and 1976 the number of Tridec
patients referred for initiation of insulin therapy
almost doubled (28 in 1973, 42 in 1974, 51 in 1975
and51 in 1976). Acutely inpatients arestill admitted
to hospital but earlier discharge to Tridec has
resulted in a substantial reduction of in-patient days.
Since Tridec began collecting data on these
patients, a total of 1,686 in-patient days have been
saved. In 1 976. this saving amounted to 500 hospital
days or $79,500.
Individual patient interview.
"Teaching The Teacher" registrations
— allied health personnel
400-
300-
200-
100-
I T 1 1 — r
^
^
m
Wi
1972 1973 1974
I I Nursing Y/A Dk
)ietary
1975
rmacyi I
1976
Pharmacy
Other
Operating costs-per diem per patient
$150 n
120
90 H
60
30
0
I
S30
35Yt
S34
I
I
343
■
S45
30*
1971 1972 1973 1974 1975 1976
^ In-hospital I I Tndec
Evaluation
1 . Cost benefits
As part of its ongoing assessment and
evaluation of the program, Tridec last year
sent out questionnaires to each of the 247
physicians who had referred patients to the
center during 1976. More than half, (54%) of
the referring physicians replied, representing a
total of four hundred and thirty-six patients
(436) or sixty -one percent (61%) of the total
1976 registration (709).=
Information provided by these referring
physicians (extrapolated to a 100 percent
return) indicates that a total of 1 ,652 in-patient
days were avoided by Tridec registrants in that
period. At an average per diem rate per patient
of $150,^ a total savings of $247,800 is
indicated in 1976. The total annual operating
budget for Tridec over the same period was
$102,000. Hence it is evident that the net
saving to participating hospitals was
substantial. In addition, use of Tridec facilities
by diabetic patients results in the freeing of
beds for other patients.
In assessing cost effectiveness, no
attempt has been made to assign a dollar
value to the educational aspects of the
professional training program. If, for example,
the center were to levy a charge of $100 per
registrant, this would generate approximately
$27,000 annually to offset operating costs.
In Ontario, the average length of stay in
hospital for primary diagnosis of diabetes
mellitusis 13.8 days.' Since Tridec's per diem
rate is approximately 30% of the provincial
average per diem cost of an in-patient day,* a
clearly defined area of savings and substantial
reduction in costs is achieved through the use
of Tridec facilities by growing numbers of
patients who are just beginning insulin
therapy.'' '° (See Figure 4)
The Canadian Nurae September 1977
*ln 1975, 138 referrals were made to public health
nurses. This represents 21% of Tridec's patient
registration.'*
Cafeteria-style meal hour at Tridec.
2. Patient assessment
In Tridec's experience the patient accepts his
diagnosis more easily as a result of support
from group Interaction. Follow-up In the
community by public health nurses who
evaluate the patient's understanding of and
compliance with their diabetic regimen and
report back to Tridec, has confirmed this
objectively and subjectively. Group interaction
has proven to be especially useful to those
who have had Insulin therapy initiated at
Tridec.
Tridec nursing staff can teach the patient
Insulin administration technique during the
four-day program in a setting that more
realistically relates to the activity of the
individual on a day-to-day basis.
Coincldentally, this approach provides a better
subsequent level of control than that achieved
when the patient is confined to the Inactivity of
an In-hospital stay.
No attempt has been made to estimate
the social benefits of the newly insulin
dependent diabetic by reason of his more
complete understanding of his condition and of
an early coming to terms with it. Tridec staff
suspects that these benefits are as
appreciable as they are difficult to measure."
3. Physician assessment
Control and compliance are difficult to
determine precisely In settings such as Tridec,
but referring physicians surveyed by
questionnaire indicate that they feel their
patients do benefit from the more structured
approach towards achieving understanding of
their condition.
At Tridec, the referring physician retains
as close supervision of the effects of
prescribed therapy as would be possible on an
in-patient basis. By reporting to the referring
The Canadian Nurse September 1977
What is diabetes?
Diabetes is one of the most common
diseases in Canada. It lias been
estimated that there are more than
100,000 undiagnosed diabetics in the
country right now. In spite of this large
numberof "hidden diabetics, "the disease
is fairly easy to detect and if found early
enough, can be controlled. If it is
overlooked or not well -treated, it can
quickly lead to complications.
What is diabetes? It is a chronic
metabolic disease of unknown origin
caused by a deficiency of the pancreatic
hormone insulin and, as recent evidence
indicates, an irregularity in the release of
glucagon. In either juvenile diabetes or
maturity-onset diabetes, the net result is:
1 . The body cannot make full use of
carbohydrate intake.
2. The pancreas produces insufficient
insulin to convert sugars to glycogen for
storage in the liver. Partial compensation
is achieved by increasing the blood sugar
in order to enhance glucose transfer into
the cell, hence hyperglycemia. Instead of
sugars, the body must use protein and
fats as energy. The use of fats causes
excessive amounts of ketone bodies
(products of incomplete fat metabolism)
to circulate in the body which can result in
acidosis. Attempts to compensate for the
acidosis result in hyperventilation and
loss of sodium, potassium, chloride and
water.
3. If the concentration of glucose in the
blood is sufficiently high, the kidney is not
able to reabsorb all of the filtered glucose
and glycosuria develops.
An undiagnosed diabetic may exh ibit
the following danger signs: polyphagia,
polydipsia, polyuria, loss of weight, easy
tiring, slow healing of cuts and bruises,
changes in vision, intense genital itching,
pain in fingers and toes, drowsiness.
physician daily, Tridec staff provide informed
feedback and work closely with him in
achieving control for his patient.
Although figures are not available on any
possible reduction in emergency visits or
housecalls, physicians have commented on
the reduced frequency of crisis calls
originating from Tridec graduates.
4. Community follow-up
From the beginning, Tridec patients have been
referred to community health agencies for
continuing evaluation of knowledge and
compliance with the prescribed diabetic
regimen. Most of these referrals have gone to
public health nurses who have become, in
effect, an extension of Tridec's program. The
cooperation of these agencies and their
interest in Tridec's program is increasingly
apparent'^ and it is expected that their
contribution to the continuing care of patients
with diabetes will be reflected in improved
patient acceptance of their diabetic regimen
and subsequent reduction in morbidity.
The future
The concept of patient education
programs such as Tridec has many
possibilities when applied to the preventive
approach to health care. Chronic health
problems such as obesity, hypertension,
diabetes, and epilepsy (to name only a few)
could be included in programs established
within patient education centers. Mobile
teaching units, educational materials in many
languages and methods of evaluation and
research are among the challenges that must
be met. Health professionals should be
concerned about effective utilization of costly
health facilities and also about cost control
measures.'" It would seem that the answer lies
in the pooling of resources, the sharing of
facilities, more emphasis on preventive
aspects of medicine and the handling on an
out-patient basis of those services which
should not require an in-patient stay . *
Elizabeth Laugharne, R.N. is the former
nurse coordinator of the Tri-hospital Diabetes
Education Centre In Toronto. Siie Is past
cliairman of ttie professional health workers'
section of the Canadian Diabetic Association
and Is a professional member of the American
Diabetes Association. Presently, she is on a
year's sabbatical and Is co-editing a
handbook for the pregnant diabetic which Is
slated for publication later this year.
George Steiner, /W.D., F.R.C.P.(C) is
associate professor at the University of
Toronto. He is the director of the Lipid
Research Clinic and director of the Diabetes
Clinic at the Toronto General Hospital,
Toronto. He Is also a member of Tridec's
executive committee.
References
1 Ontario.Ministryof Health. Data Development
and Evaluation Branch. Report. Toronto,
1975.
2 Ontario. Special Program Review. Report of
the special program review, appointed ... to inquire
Into ways and means of restraining the costs of
Government.. Toronto, 1975, p. 24.
3 Ontario. Special Program Review, op. cit.
p. 23.
4 Ontario. Health Planning Task Force. Report
Toronto, 1974.
5 Tri-Hospital Diabetes Education Centre.
Annual report. Toronto, 1 976.
6 Ontario. Ministry of Health. Budgets Branch.
Average per diem rate for teaching hospitals in
Ontario. Toronto, 1976.
7 Ontario. Ministry of Health. Ontario length of
stay tables 1974: Teaching hospitals. Toronto.
8 Tri-Hospital Diabetes Education Centre, op.
cit.
9 Ibid.
10 Spaulding, R.H. The diabetic day-care unit. II
Comparison of patients and costs of initiating insulin
therapy in the unit and a hospital, by ... and W.B.
Spaulding. Canad. IVIed. Assoc. J. 114:9:780-783,
May 8, 1976.
11 Miller, L.V. More efficient care of diabetic
patients in a country-hospital setting, by ... and J.
Goldstein. /VewEng. J. Med. 286:1388-91, Jun. 29,
1972.
12 Tri-Hospital Diabetes Education Centre,
op. cit.
13 Ibid.
14 Goldschmidt, P.G. A cost-effectiveness
model for evaluating health care programs:
Application to drug abuse treatment. Inquiry
13:1:29-47, Mar. 1976.
Bibliography
1 Etzwiler, Donnell D. Education and
management of the patient with diabetes mellitus,
by ... et al. Elkart, In., Ames Co., Div. Miles Lab.,
1973.
2 Etzwiler, Donnell D. Who's teaching the
diabetic? D/abefes 16:2:111-117, Feb. 1967.
3 Canada. Manpower and Immigration.
Program Data Division and Procedures Branch.
Immigration'74. 4th quarter. Ottawa,
1974.
4 Lalonde, Marc. A new perspective on the
health of Canadians; a working document, by ...
Minister of National Health and Welfare, Ottawa,
Information Canada, 1 974.
5 List of diabetic clinics, diabetes education
centres and in-patient teaching programs. Toronto,
Ames Co.. Div. Miles Lab. 1973.
6 Ontario. Ministry of Health. Annual report
1974/75. Toronto, 1975.
7 Report of the National Commission on
Diabetes to the Congress of the United States, Dec.
10, 1975. Diabetes Forecast, Special Edition, Dec.
1975, p. 33.
8 Watkins, Julia D. Observation of medication
errors made by diabetic patients in the home, by ... et
at. Diabetes 16:12:882-885, Dec. 1967.
The Canadian Nurse September 1977
DIKBETES: the emotional adjustment 4
of parents and child
Elizabeth F. Crosby
Diabetes is not in itself a barrier to a happy
childhood and adolescence, for the child with
diabetes can participate In all the normal
everyday activities of life. At the same time, no
one pretends that management is easy. For
the parents and the child there are many new
techniques to learn and new rules and routines
to develop and follow. In most cases, however,
this Is not too difficult, The hard part for the
family Is learning to live with a chronic
condition In a positive way.
The author of one nursing research
paper' on the concerns of diabetic children
and their parents had some very Interesting
observations to make about attitudes towards
the condition. Of 16 diabetic children
Interviewed aged 10 to 17 years all of them
indicated that having diabetes did not bother
hem particularly. They focused on the normal
aspect of their life situation stating that they did
not look different from their friends and that
they were as active as their friends. The
children stated that they could usually cope
with problems that arose due to their condition.
°arents of the diabetic children, on the other
land, tended to focus on the management
problems of the diabetic regime and
emphasized the condition rather than the
'normal life situation' of their child.
These are the two different points of view
that must somehow join forces in order for the
child to enjoy a healthy well-rounded life. Good
control is essential but overemphasis of the
diabetic regime can psychologically harm the
child. The child and his parents must work
together but the emphasis should be on the
child and the responsibility he must take in
controlling his condition.
Nurses who teach diabetic children and
their parents need not only a thorough
knowledge of the condition but also an
understanding of the emotional needs of the
child and the stages of adjustment of the
parents.
The parents: phases of
emotional adjustment
Stephen L. Fink In "Crisis and Motivation:
A Theoretical Model. "^ has proposed four
psychological phases which follow a
sequential pattern In the process of adaptation
to any stressful stimuli. The four phases are:
1. Shock
2. Defensive Retreat
3. Acknowledgement
4. Adaptation
Shock
When diabetes is first diagnosed in a
child. It Is the parents who experience the
negative feelings — feelings of guilt and
disbelief about the condition. In this stage, an
individual may be in a state of disorganization
so that he may not be able to think rationally.
Both parents will probably be at this stage
when they first learn that their child has
diabetes.
The initial meetings the parents have with
the nurse or other health personnel can help
change their negative outlook to a more
positive one. The nurse can be of help If she
encourages the parents to Identify and
express their feelings about their child's
condition. At this time, parents need to know
that although the condition is not curable, good
treatment and consistent management makes
It controllable.
Defensive retreat
This stage Is characterized by denial on
the part of the parents. "It cannot be our child
who has diabetes. There must have been a
The Canadian NurM September 1977
A child with diabetes is first and foremost a child — with
all the needs and desires of any child. Diabetes in itself
will not prevent him from living a normal life. But
learn ing to live with a chronic condition in a positive way
is the challenge that diabetes poses for the child and his
family.
mix-up with the blood." Reassurance to the
parents that no mistakes were made,
Indicating complete confidence in the doctors
and laboratory procedures, will help them
come to an acceptance of reality.
Acknowledgement
At this stage the parents give up the past
and start to face reality. This is when effective
teaching about diabetes can begin. Until they
reach this point, simple explanations of
procedures will help reduce fear and anxiety.
Education of the cfiild and parents should be
carried on together. An ideal situation is to
have teaching centers specifically for children
although this is not always possible.
At the Edmonton General Hospital
Diabetic and Metabolic Centre, a four-day
program has been developed for diabetics of
all ages. In discussing management of the
juvenile diabetic the program emphasizes that
diabetes mellitus is a life-long condition, that
each child and his environment is unique and
that success in controlling diabetes means
adherence to a pattern of routine. The aims of
management are: to control the diabetes, to
allow the child to lead a normal life and to teach
the diabetic and his parents as much as
possible about the condition.
During the four-day program, classes on
the basic concepts of diatDetes and its
management are provided by the physician.
The dietitian presents individual and group
sessions on diet instruction. Nurses give
individual and group instruction to diabetics
and their parents on: detailed aspects of
diagnosis and management with emphasis on
urine testing, insulin administration, oral
hypoglycemics; the importance of exercise;
complications such as diabetic ketoacidosis
and insulin reactions — etiology, causes and
treatment; when to increase and decrease
insulin dosage. The final class stresses the
importance of proper hygiene and good
control to the diabetic's general well-being.
Late complications such as gangrene or retinal
damage are not discussed with the parents at
this time unless they specifically ask for this
information. If the parents do ask about
complications the nurse should answer their
questions and also emphasize the importance
of good control in delaying onset of these
complications.
The child is expected to participate in his
diak)etic care. The young child can collect his
urine sample and choose the site for his
injection. The older child can carry out h is own
urine testing and prepare and inject his own
insulin.^ Including them in their own care
increases their confidence and pride and
facilitates their progress to independence.
However, before such independence is
encouraged, the child must be ready to handle
the responsibility. He must comprehend
certain fundamental concepts about diabetes
and its management which he will obtain
through experience and education before he is
ready for self-care. In 1959, Dr. D.D. Etzwiler
conducted a study on juvenile diabetics aged 6
to 17 at Camp Needlepoint, Minnesota. He
found that in the majority of juveniles, the
appropriate age for self -care was 12 to 13
years." However, there is always individual
variation and judgments must be made
accordingly.
As nurses, we often become too involved
in preparing the child and parents to handle the
more technical routines of diabetic
management. Inadequate emphasis may be
placed on the emotional adjustments and the
handling of psychological problems which may
arise when the child returns to school and the
community. Reaching the fourth step of
"adaptation " is probably the most difficult of all
the psychological phases of adjustment.
Adaptation
Adaptation and acceptance of the
modification in health requires complete
emotional adjustment. When diabetes occurs
in a family, all members are affected. This is
especially true when the condition appears in a
child because he depends on others for
supervision and management.^ Family
problems tend to surface ; there may be conflict
because of forced dependency on doctors.
One partner may blame the other
because the child is diabetic and refuses to
accept some responsibility for care. The nurse
can be most helpful at that time by establishing
an atmosphere in which the parents feel
comfortable and can express their feelings. An
effort must be made to understand their
feelings and to maintain a positive attitude
about theirability to manage this new situation.
Remember the Social Sen/ice Department in
the hospital and include them if family
counseling seems necessary.
Parents will often devote themselves to
their child's diabetes, being over-protective
and oversolicitous, with the result that the child
is convinced that he is handicapped. Johnny
should still be their son Johnny, NOT their
diabetic son Johnny. Parents who are
domineering will insist on perfect control
tjecause anything less is not acceptable to
them personally. Rejecting parents will want
the child less when they find he has diabetes.
Through patience, understanding, education
and continuing emotional support the health
team can help parents accept the diagnosis,
adjust to new routines and supervise the child
in an appropriate manner.
Tlw Canadian Nurse September 1977
Emotional needs of the child
with diabetes
The psychological reactions
demonstrated by the child with diabetes can
be better understood if we look at the basic
emotional needs of every child.^
• The chief need of the child is to be loved
by his parents and other important figures in
his life. This love is usually spontaneous but in
the presence of a chronic condition such as
diabetes, the relationship between the parent
and child can be strained.
• Security may be threatened because the
child realizes that he is different from his peer
group. Children want to be accepted by their
friends and be "just like everyone else."
Parents who tend to emphasize the disease
process over the child's normal life situation
can make the child feel "different." Tension
between the parent and child can be created
when the parent exaggerates the routines for
good control. For example, parents may insist
that Johnny be in the house at 1630 hours to
void so th at a second void can be taken before
supper. A more relaxed routine that would
allow Johnny to enjoy playtime with his friends
would help him to feel like the "other kids."
Parents need to learn early that flexibility in the
routine is alright.
• The child needs to be accepted as an
individual. If the parents do not accept the
diabetes and its limitations, they will fail to
accept their child.
• Actiievement can be impaired by the
limitations and frustrations of diabetes but it
need not be. The diat>etic child needs approval
from his parents. Striving for perfect control of
diabetes will frustrate the parents and make
the child feel like a failure. Diabetes should not
be a handicap. The child should be
encouraged to develop his interests and
competence in the activities for which he has
potential.
• The struggle for independence is one of
the chief characteristics of the child. This
independence is threatened when a child has
a chronic condition. Parents who demand that
their diabetic child maintain "perfect"
compliance to the "rules " of control or who
exaggerate the seriousness of the condition
jeopardize the child's ability to become
independent. Proper initial instruction of
parents and children with the child accepting
responsibilities for his own treatment as soon
as possible encourages development of a
normal sense of independence.
• Another basic emotional requirement for
children \s self-respect. Adolescents are often
preoccupied with their bodies and
appearance. An integral part of their
self-image is a sound body and any chronic
illness may make the child feel inferior and
inadequate. Children need help and guidance
in order to gain good control of their diabetes
without losing self-esteem.
Behavior problems
"... When theyfind they have diabetes it is
the unusual child who is not, in some way,
emotionally disturbed ...," says Dr. P.M.
Ehrlich, Director of the Diabetic Clinic at the
Hospital for Sick Children, Toronto.' Many
adjust quickly and carry on, others become
moody, depressed, angry and bitter.
Behavior problems that arise in the young
diabetic child are often due to fear of the
needle. He may not want to get up in the
morning, may take 5 or 1 0 minutes to inject the
insulin, may refuse to do it himself or may
demand to be alone. Sometimes he is so
resistant to the injection that he will have to be
held down. Parents can feel at a loss in trying
'^'^ '%... V
to deal with this situation. The nurse can tell
the parents to give the child positive support —
the injections do hurt but it will make him feel
better, stronger, and relieve his symptoms.
Urine testing may also present a problem.
At first, urine testing may be fun and novel but it
soon becomes monotonous and routine.
Because he may feel that he will get more
approval if his urine test is negative, the
diabetic child will sometimes test plain water
ratherthan urine. It is important that the child is
not made to feel that it is "his fault " if his tests
are positive for sugar. Explain to him that the
positive test means he needs more insulin. A
comment like "Oh, 2% sugar, that's not very
good." — can be interpreted by the child as a
failure on his part.
Diabetic camps
A diabetic child can feel that he is the only
one in the whole world who has diabetes. The
benefits of a camping experience for such
children are invaluable. It gives them a chance
to associate with other diabetic children, to
learn more about their diabetes and perhaps to
become a bit more independent. The child
sees that others are like him and that they can
lead normal lives.
Adolescents can also benefit from a
camping experience with other diabetic
teenagers. In the Edmonton area, a group of
teenagers organize a 'Teen Wilderness
Camp " each year. Ten to fifteen diabetics
along with a doctor, nurse, dietitian and boxes
of freeze-dried food spend a week on a canoe
trip. It is a great time to share experiences and
to learn about themselves and their diatjetes.
Adolescence
A diabetic child who has adjusted
emotionally to his condition will probably pass
Tha Canadian Nurse Septatnbar 1977
23
into adolescence smoothly.' If psychological
adjustments have been poor during childhood,
however, problems are apt to develop in the
teenage years. A child who has been
overprotected often fears the increased
independence which his parents are starting to
give him. Transferring too much responsibility
to him may be interpreted by the adolescent as
a lack of parental love and he may rebel in an
attempt to get more attention. For example,
there are many reports of rebellion manifested
by overeating, refusing to test urine and failure
to take insulin.
Adolescence is perhaps the most difficult
time to develop diatjetes. At a time of great
social, psychological and physical adjustment,
the addition of the self-discipline required to
handle the diabetic routine is often a problem
for the teenager.
Help for teenagers
Education that emphasizes the "normal"
can help the teenager accept his condition in a
more positive way. The health team must
strive to help him realize his potential as a
person. He will still tDe able to meet people,
make friends, plan for his future education and
explore job opportunities. The diabetic
teenager can still play sports, go camping,
wor1< part-time, babysit and carry on a normal
life. It may help encourage him to know that
many famous people have had diabetes and
have coped with it well (Bobby Clarke, Mary
Tyler l^oore, H.G. Wells).
A satisfying social life is important to a
teenager. He should be encouraged to
participate in the school activities which
interest him and should be independent
enough of his parents that he can manage on
school trips or stay overnight at a friend's. He
should be able to choose wisely from the menu
at a drive-in food outlet so that he can go there
with his friends. Hopefully, too, he will have
gained enough confidence to offer correct
responses to comments from classmates
about his diabetes.
Once adolescence is reached, the
teenager is encouraged to participate in a
refresher education program given at the
diabetic center. Up to this point he has
probably received most of his knowledge
atKDut his condition from his parents. Now he
should have individual teaching to review the
basics of control as well as to update his
information about diabetes.
Follow-up of the adolescent is important.
Now he can start to attend the center
independent of his parents. In between visits
he is encouraged to contact the doctor or the
nurse if problems arise. Knowing he can count
on the health team gives him a feeling of
security and confidence.
Summary
Diabetes is a condition that tests the
character of the patient as well as the family.
The two must share information, face the
challenges of each individual situation and
explore new ways of making diabetes easier to
live with. As nurses, we must use all our
knowledge and skyi to establish and maintain
supportive, interpersonal relationships with
both the diabetic patient and the family.*
Elizabeth F. Crosby is a graduate of the
Victoria General Hospital In Halifax, Nova
Scotia. Now registered m Alberta, slie has
been employed as a staff nurse in the Diabetic
and f/etabollc Centre at the Edmonton
General Hospital since 1975. During the past
two years she has been Involved with the
Canadian Diabetic Association as
camp-coordinator for the annual Charles Best
Camp for children with diabetes.
References
1 Olofinboba, Jola. Concems expressed by
diabetic children and parents of diabetic children.
Montreal, 1973. (Thesis (M.Sc. (App.) — McGill.
2 Beland, Irene L. Clinic^ nursing:
pathophysiological and psychosocial approaches.
by ... and Joyce Y. Passes. 3ed. New York,
Macmjilan, 1975.
3 Ehrlich, R.M. Diabetes mellitus in childhood.
Pediatr Clin. North Am. 21:4:871-884. Nov. 1974.
4 Etzwiler, D.D. What the juvenile diabetic
knows about his disease. Pediatrics. Jan. 1962.
5 Etzwiler, D.D. Juvenile diabetes and its
management: family, social and academic
implications, by ... and Lloyd K. Sens.J.A.M.A. July
28.1962.
6 Juvenile diabetes mellitus. In Report of the
51st Ross Conference on Pediatric Research,
October 1964.
7 Ehrlich, R.M. Psychological problems of
juvenile diabetics. Canad. Diabet. Ass. News. 2nd
quarter, 1974.
8 Tuthrie, Diana W. Diabetes in adolescence, by
... and Richard A. Guthrie. Amer J. Nurs.
75:10:1740-1744, Oct. 1975.
The Canadian Nurse September 1977
IHE JUVENILE
DIkBETIC: in or out of control ?
"Once I was at a sleepover. The next
morning at breakfast I was just goingto
put a little syrup on my pancake and my
girlfriend — she used to be my tyest
friend — said, 'No, don't let her have
any, she's diabetic' And the girl's
mother looked at me as if to say, 'What
have I got here'?" — a 13-year-old
diabetic girl.
"/ go off my diet every day — I eat
licorice every day. I tell my friends not
to offer me any candy but they always
do ... if I make something in Home Ec,
like cake, I save it and eat it for lunch ...
I'm always 5 (urine test)" — a
12-year-old girl, diagnosed diabetic for
about one year.
Carol Polowich
M. Ruth Elliott
Connments such as these by juvenile
diabetics are common and have
important implications for nurses and
others who will be involved in juvenile
diabetes and its control. Juvenile
diabetes, also known as "brittle"
diabetes, is much more difficult to control
than diabetes in adults, with a greater
likelihood of diabetic coma. Just how well
controlled are young diabetics after they
are on their own in the community?
I first became involved with diabetes
last summer when I worked with pediatric
and adult diabetics at Burnaby General
Hospital. At least two per cent of
Canada's population have diabetes' and,
therefore, contacts with diabetics either in
hospital or in the community are very
likely.
In preparing to write this paper I
completed an extensive literature search
and then visited diabetic facilities in
the Vancouver area. I discussed some
of my concerns with a variety of experts in
the field: dieticians, nurses and doctors. I
devised a survey questionnaire to find out
what was really going on with young
diabetics — those from the age of 1 1
to 17. My purpose was twofold:
1 . to determine diabetic-related problems
2. to learn from diabetics what they
thought they needed in their diabetic
education.
I sent survey questionnnaires out to
12 youths with diabetes; 10 responded.
All of these diabetics had been diagnosed
for at least 1 0 months and the longest for 9
years, 4 months. All had been taught about
diabetes and had been regular attenders
at a diabetic day care program. I also
formed a group of five diabetic girls in the
The Canadian Nurse September 1977
"Sometimes I pretend I'm having an
insulin reaction if I see a chocolate bar
on the counter (I'd like to eat) ...." — a
13-year-old girl with a six-year history of
diabetes.
pre-adolescent/adolescent years from 1 1
to 13 at Lions Gate Hospital, North
Vancouver. My purpose here was to
determine and work with these girls on
their diabetic-related problems. This
group was made up of diabetics who had
been diagnosed from six months to six
years.
The importance that is placed on
peer interaction in middle childhood and
adolescence suggested that a group
situation might help me complete my task.
But. I found that in such a group, members
tended to pair off and talk only to each
other. This added another dimension to
my work. I had to encourage total group
interaction, rather than several individual
dialogues.
Needless to say, I often became very
frustrated in my efforts to promote
Interaction with group members who were
unaccustomed to the group process.
However, by the end of the fourth group
session, the girls were listening to and
questioning each other, with little
assistance from me. I began to feel we
were getting somewhere.
The group situation and the
questionnaire responses indicated there
are five major diat)etic-related problems:
urine testing,
carrying an emergency sugar supply,
wearing diabetic identification,
adhering to the diabetic diet,
explaining diabetes to friends.
The responses to the questionnaires
I mailed out placed more emphasis on
urine testing while the group sessions
revealed considerably greater
preoccupation with diet and with peer
group concerns.
Clearly, there is no consistency in
advice given by doctors to their young
patients about the frequency of urine
testing for control (See table 1). The
literature recommends urine testing four
times a day,^ but, none of the young
people performed tests this frequently
even when it was advised. Only two
performed their testing as often as their
doctors' recommended and this was only
when they were required to perform the
minimally acceptable amount of two tests
a day (before breakfast and before
bedtime).^ Two of the subjects admitted
they did not meet even this requirement.
The double-void specimen (the
testing for sugar content of a second urine
specimen obtained 30 minutes after the
first voided urine specimen) is a more
accurate representation of the degree of
the body's insulin requirements in relation
to sugar utilization." Two of the 10
subjects indicated their ability to
consistently double-void. Of the rest,
three were sometimes able to
double-void, four indicated that it was
usually possible, though not done.
In order to treat an unforeseen insulin
reaction diathetics should carry some form
of sugar with them at all times^ Of the 1 0
subjects surveyed by mail, one always
carried some form of sugar, three
occasionally carried it, and the remaining
six, rarely or never.
The diabetic who wears appropriate
identification can be given emergency
treatment if he needs it much more
quickly.^ A majority, (eight out of ten
surveyed by mail) constantly wore
diabetic identification in the form of a
bracelet or a neckchain. The two others
wore identification only occasionally.
Data from the questionnaires shows
there is a need to reassess the teaching of
the young diabetic about the importance
of urine testing for diabetic control.
Through their behavior the young
diabetics also indicated they need
instruction on how they can achieve the
double-void urine specimens for more
accurate test results. One way to help
them is to encourage their fluid intake
immediately after the first void specimen
is obtained. The importance of having an
acceptable emergency sugar supply
readily available should remain a prime
teaching focus for the majority of young
diabetics. Some reinforcement teaching
is also indicated for the two diabetics who
only occasionally wear identification
pointing out their health problem.
Group Discussion
Diet was identified as a major
problem with young diabetics in the group
discussion sessions.
Member No. 1 (a diabetic for
approximately one year): 'I go off my diet
every day — I eat licorice every day. I tell
my friends not to offer me any candy but
they always do ..."
Member No. 2 (a diabetic for
approximately six years): 'If I have an
insulin reaction in the middle of the night
I 'm j ust so ravenous — 1 1 1 eat about seven
Oreo" cookies, a piece of bread with gobs
of peanut butter, about three glasses of
juice and suck some candy ... the first few
years you re a diabetic you're really
scared what might happen to you if you go
' Oreo is a registered trademark of Nabisco Inc.
The Canadian Nurse September 1977
V
Table 1
^"^"""
URINE TESTING
Recommended Actual tests
Double-
Subject
Sex
M
tests per day
per day
voiding
1
3
2
sometimes
2
M
4
3
yes
3
M
4
3
no
4
M
2
0
yes
5
M
4
3
no
6
M
4
3
yes
7
F
2-3
1-2
yes, sometimes
8
F
2
2
sometimes
9
F
4
2-3
usually
10
F
2
2
no
This table shows the urine testing behaviors of the group surveyed by mail.
off your diet, but then you just get so tired
of not being able to have anything (that
you like) that you go off (your diet) and
nothing really happens."
Thoughtful discussion of potential
complications can assist the young
diabetic to realize the necessity of
adherence to an appropriate dietary
regime. In a setting, such as a Diabetic
Day Centre, It Is possible to provide
realistic dietary reinforcement teaching.
Group and individual discussion about
dietary problems can work to achieve the
desired result of helping the young
diabetic maintain a healthy balance
between diet, insulin and energy
requirements.
These are some of the ways I found
of discussing dietary concerns with young
people:
1. There may be times when you go off
your diet. Remember that some foods are
not as high In sugar as others. For
example, an extra fruit would be better to
eat than cookies, chips or a candy bar. If
you do overeat or eat chips or candy, you
should do some exercise to balance this
off. The exercise should be done the
same day and as close to the time of
eating the "extras" as possible. Pick
some activity you enjoy, invite a friend
along and fit it in at lunchtlme or after
school. In other words, make a social
event out of it.
2. If you are ravenously hungry between
snacks or meals It is time to see the
dietician and doctor about a new diet plan
and possibly an insulin change. As you
grow, your body puts In new requests for
energy supplies, so adjustments continue
to be necessary to meet these new
demands.
3. If you are ravenously hungry when an
Insulin reaction occurs, take appropriate
food or drink in moderation, for example,
a cookie or small can of juice. It will take a
few minutes for the food to reach your
stomach (and your blood stream) to turn
off the hunger sign In your brain. Stuffing
yourself with too much food all at once can
lead your body to suddenly demand more
insulin than you have available.
Peer reactions
Explaining diabetes to their friends
emerged as another important Issue in
the group discussions. I asked the group
members to discuss what they could say
to their peers whenever they were offered
food ordrink that is forbidden on their diet.
The group members unanimously agreed
that kids at school and the public in
general should be educated about
diabetes. But, some of the diabetics said,
"... it's too hard to explain," or "... they
wouldn't understand. "
The kids said their friends were
confused because some diabetics tell
them "diabetes means you can't have any
sugar or candy, "and yet they do see them
go off their diet, or take some sugar in an
emergency.
I found it best to encourage each
diabetic to feel comfortable In explaining
and interpreting diabetes to friends.
Role-playing can be a useful technique In
this situation. A discussion based on the
following four questions can help the
young diabetic with some of his
uncertainties:
1. How do you feel when you are having
an insulin reaction?
2. Why are you having the reaction?
3. How do you tell someone about what Is
happening to you?
4. What do you do whenever you have a
reaction?
I tried to tell the patients that
explaining, on the spot, plus a more
consistent diet pattern, Is a good way for
them to enhance their friends'
understanding of diabetes. In other
words, by example, rather than by words
alone.
Areas for education
The young diabetics surveyed by
mail provided suggestions for what they
believe a new diabetic should be taught
and told:
• "It is Important for a new diabetic not
to feel he Is different from other people...
(Education should not be) limited to th Ings
he can't do ... (Stress) importance of diet
and exercise ... what insulin is and how it
controls diabetes."
• "How to Inject a needle and how to
take care of It and carry some sugar and
stick to a proper diet ..."
• "lV/7y you should test your urine, w/7y
you should always stay on your diet, what
insulin does In your system ..."
• "A new diabetic should be taught to
do their own needle because If they don't,
they probably would want their mother to
do it all the time, like I do, but I've learned
to do it. They should be told that it Is
Important to have the needle because if
you don't you become very ill."
• "Not to feel sorry for yourself, their
(sic) is other people an awful lot worse
than you. Not to stop doing things your
The Canadian Nurse September 1977
(sic) use to doing just JDecause you have
diabetes. "
These comments indicate some of
the emotional needs and
teaching-learning requirements of
pre-adolescent and adolescent
diabetics. Are diatsetic educators, hospital
and community health care personnel
sufficiently aware of these needs?*
References
1 Luckmann, Joan. Medical-surgical nursing: a
psychophysiological approach, by ... and Karen C.
Sorensen. Toronto. Saunders, 1974. p. 1314.
2 Hunt, J. ed. Diabetes: a manual for
Canadians. 6ed. Toronto, Canadian Diabetic
Association, 1973. p. 58.
3 Tyson, J., North Vancouver, B.C., Lions
Gate Hospital Diabetic Clinic. Personal interview.
4 Hunt, op. cit. p. 53.
5 Ibid. p. 41-2.
6 Ibid. p. 43.
Carol Polowlch conducted this study as a
requirement for the fourth year other degree
program at the University of British Columbia.
She graduated with her Bachelor of Science
in Nursing in June of 1977. Polowich has
worked asan R.N. inboth Vancouver General
Hospital and Burnaby General Hospital. Her
future work interests include community
mental health and public health nursing.
Polowich is currently traveling in Europe.
M. Ruth Elliott was the faculty advisor to
this study. She graduated with a Bachelor of
Science from the University of Alberta,
Edmonton in 1956 and from the University of
California, San Francisco in 1965 with a
/blaster of Science in maternal and child
nursing.
Elliott has worked in public health
nursing, mental health nursing, V.O.N, and
pediatric nursing (staff nurse, assistant head
nurse and head nurse. Children's Hospital,
Calgary, Alberta). She has taught in schools
of nursing at the University of Alberta,
University of California, and the University of
British Columbia. Right now, Elliott is on the
Executive of the Vancouver Chapter of the
Registered Nurses Association of British
Columbia and is a member of the Association
for the Care of Children in Hospitals. She has
published several other articles in various
nursing journals.
Acknowledgment: The authors wish to
thank J. Tyson and I. Byers of Diabetic Day
Care, at Lions Gate Hospital, North Vancouver
and E. Mallory of the Juvenile Diabetic Clinic,
Children's Hospital, Vancouver, for their
assistance in tf7/s study.
The Canadian Nurse September 1977
The Canadian Nurse September 1977
29
Dawn Moynihan
The first time I saw Angie I was too busy
ducking a flying supper tray to worry about
formal introductions. A dish of applesauce just
missed my students cap as I cautiously
entered the ward. A classmate and a graduate
nurse were trying unsuccessfully to calm an
elderly, enraged patient. As I drew nearer, part
of her ammunition splashed against my ear
and a wet, soggy teabag dropped at my feet. A
pair of enormous, bright blue eyes glared at
me. I realized that a strange face would only
add to her uneasiness and decided it was time
to leave. What I hoped was the last of her
weapons, a flying bedpan, preceded me out
the door. Later, I heard that none of the nurses
had been able to control her and that sedation
had little calming effect on this
ninety-five-year-old lady.
Not long afterwards, I came on duty to find
that Miss Angie Mclntyrehad been assigned to
me. Understandably enough, she was to be
my only patient. Doubts about my nursing
abilities came flooding over me as I made my
way to the ward. I decided that it was time to
consideracareeras a secretary, a nun, a lady
wrestler, or any other less hazardous
profession. A skinny nineteen yearold, I hardly
felt a match for the eccentric ancient.
By this time, I was near her bed. As I
gazed down at her sleeping form, peaceful and
childlike, I couldn't help but think that she
reminded me of a sleeping volcano, waiting to
glorify itself in a new eruption. As I turned to
leave, the sound of my black oxfords
awakened her. Turning again, I saw trembling
hands searching for the bed railings to raise
her frail body. The same angry eyes. Did I see
fear there also?
"Who are you?" she roared. 'What do you
want? Get out."
All my remaining confidence left me. Even
today I don't know how I managed to whisper,
"Dawn Herrington. I'm a student nurse." And
then it happened.
'Well, Donna McLennan. It's about time you
showed up. I was beginning to think there were
■r\o more "Scotties" left in this world. Would you
get me my apple, please? "
I hurried away to get an apple, stunned at
the change in her. At least there was no
applesauce in orbit! Apparently, Angie did not
consider me a threat and that was something.
When I returned, she asked me all kinds of
questions about myself, and I answered them
tnjthfully. But I didn't evertell her that my name
wasn't Donna McLennan.
Apparently Angie decided that I could be
trusted because in the days that followed, she
allowed me to nurse her, feed her and tease
her. We had so much fun that sometimes I
wondered which of us was nineteen.
Periodically I would see an Angie that I
could not get through to. At these times she did
not know me. Sometimes she would sit up in
her bed and re-arrange all the bedding,
winding the sheets in and out between the bed
railings which she often referred to as her
monkey-cage tsars. She would do this for
hours and then fall, exhausted, into a deep
sleep. At other times she spoke to God, telling
Him off for this and that, or thanking Him for all
His gifts to her. Somehow I had the impression
that they were old friends.
Angie had broken both her legs in a fall
while she was living in a nursing home. Her
legs were in two casts joined at the waist. For
long periods of time she would work at the
stockinette in the newly changed casts and
then put her "treasures " inside them. These
consisted of a bell, a set of very loose
dentures, her glasses, sometimes even some
crusts of bread.
Often when she talked to me. her
dentures would fall out. I suppose it sounds
absurd, but I loved to watch her try to master
them . Sometimes also her shaky fingers would
ease her thin white hair upwards until she had
it all collected into some form of a knot ending
in a curl. It would take at least half an hour for
her to accomplish this. Then she would call out
"Donna," and I would have to run and locate
her blue hair net which she had often stuffed in
the "safety deposit box " formed by her casts.
Then she would ease it over her hairdo and
settle down for a sleep.
I grew to love this old lady. Sometimes
when we talked she would ask me about my
"men-friends." As a girl, she told me, she had
loved a young man named John. Her family
had considered him a nobody, she recalled
tearfully while searching her casts for her
hanky. But she had loved John and, she
maintained, still did. She wondered if he ever
thought of her. I hadn't the heart to tell herthat I
was almost certain John must have died years
ago. Angie never married and many, many
times she warned me neverto lose my love as
she had.
We often spoke of important things. Our
biggest argument was over the relative merits
of an apple and a jar of honey. I maintained
that with God's love and a jar of honey, I could
do anything. She thought the benefits of a daily
apple outweighed the honey. As soon as she
was better we would go bowling and she would
prove her apple's worth.
Then came the day Angie left our hospital
to return to her nursing home. Probably she
would never walk again since by picking at the
casts she had loosened them and lessened
any chance of normal healing. She left
tearfully, making me promise to visit her. I
promised to come to see her as often as
possible although I would be moving shortly to
another town. There was a chill in the air as
they wheeled her to the waiting ambulance.
I wrote often, hoping she would realize
who the little notes were from. The day I vi sited
her at the home a nurse warned me that she
would not know me. But the moment I entered
the door, I heard her whisper "Donna." Tears
came to my eyes: she had failed so much.
Nevertheless, she munched away on the
candy I had brought, the loose dentures
interrupting her flow of conversation. She ate
so much candy that I was frightened she'd be ill
but she informed me that "people often came
into her room at night to steal. " So — the more
she ate, the less they could steal. From under
her pillow she brought out one of my notes
which she had managed to hide from the night
robbers. Apparently, the nurses had read them
to her and she wanted to know more about
how I was. It was hard to leave, knowing our
visits were dwindling.
I saw Angie several times after that. Each
time, she was bright, excited to see her Donna.
Once, she tried to remove a gold ring from her
fingerto give to me. It was all she had, and she
wanted me to have it. It would not come off and
I was relieved, really, because I would have
been reluctant to take it knowing that her
relatives might think that I had taken
advantage of her. It was a funny old ring , more
like a tiny belt with a locket. I often think of it
now and wish I had it .... because it was hers.
I finished my affiliation at the out-of-town
hospital and returned to find Angie had been
re-admitted with pneumonia. I visited her
every day until once more I was off to another
town and another affiliation.
Angie recovered amazingly fast and by
the time I returned was in another home. When
I visited her, the nurses once more warned me
she was very ill and recognized no one. This
time when she whispered "Donna " my heart
ached for her. She had failed considerably, but
clung to my hand with amazing strength.
Gently she told me that if I really thought the jar
of honey was better, to go ahead and eat it. I
knew from the way she said it, that it was her
way of saying how much she cared for me.
Once more she tried to remove her ring from
her long, bony finger. But it would not come off.
It had been part of her for so long that it could
not leave her now. When I left, she seemed
stronger and I was sure I'd see her again.
Two weeks later, however a friend broke
the news that Angie had died in her sleep. I am
sure now, as I was then, that before she died
Angie whispered "Say goodbye to Donna for
me and tell her not to forget about that apple ."*
The author of "God's Love and a Jar of
Honey, " Dawn Moynihan, is a graduate of the
class of '6 1 of the Cornwall General Hospital in
Cornwall, Ontario. In the past few years she
has developed her talents as a writer and is
now a free-lance writer specializing in
children's literature.
30
The Canadian Nurse September 1977
IMNKLY SPMKING
NURSING
EDUCATION: ANOTHER
TOWER
OF bab:
H
.?
Mohamed H. Rajabally
Professional beliefs — these are the
meaningful answers to the basic questions
that all thinking professionals ask. The past
few years have seen the nursing profession
caught up in a search for beliefs that are suited
to its changing role. The winds of change that
have swept nursing along in the last decade
have been both refreshing and rewarding, but
we need to take precautions so that these
winds do not simply blow us away.
The academic landscape of North
America is littered with the wreckage of
long-range educational plans; if the term
"wreckage" is too strong, I suggest that
"damaged prows" is no exaggeration. Plans
fail for a variety of reasons; most of the time
they are either too inflexible or too visionary.'
Blueprinting for the future of the nursing
profession is no exception.
Academic disciplines in transition tend to
become philosophical and speculative about
their status, function and future. Likewise, a
profession tends to cast about for a suitable
self-image while it is changing. Sometimes,
however, the transition process creates
puzzling answers to the questions posed by
change.
A look at the nursing process
It is an exaggeration, if not sheer
dishonesty, to dress-up the problem-solving
approach (which a man uses daily from the
moment he awakens) and call it "the nursing
process" in an attempt to make it unique to
nursing. I find it amazing that so many nurses
are seduced by such deception .... Educators
scramble to integrate nursing process into
their curriculum; text-books are revised and
rewritten, consuming time and money; and
perhaps worst of all, students lose valuable
time trying to learn something that they ought
to know and use simply because they are
rational creatures.
What seems to be indisputably unique to
nursing is the tendency to complicate nursing
practice under the guise of professionalism
and accountability. If we are honest with
ourselves, we realize that one group within the
nursing profession that ought to be
accountable directly to the consumer is the
group of nurse educators. We must ask
ourselves — what is it that the consumer
demands? Like concerned parents who want a
return to the basics in education, consumers of
health sen/ices cry out for better nursing care,
not more elaborate theories to add many more
pieces to an already complicated puzzle. And
instead of better nursing care, we add theories
to theories, accomplishing perhaps confusion
instead of accountability, and catching the
bedside nurse in the cross-fire.
All those little arrows ...
Only a few years ago, general system
theory was "in vogue," just as rock and roll
claimed the fifties and theories on death and
dying consume the seventies.
The fashion in nursing today is the
"conceptual framework," so that it has
become virtually illegal to teach nursing
without it. But an editorial by Edith P. Lewis
aptly describes the confusion introduced by
the use of the conceptual framework and its
attending models. "All those little arrows
pointing both ways and going off in all
directions at the same time; the circles within
the circles overlapping circles; the boxes
spawning more boxes and sometimes
three-dimensional cubes in cross-section —
all of these sometimes do more to confuse
than to enlighten."^
Can we document the fact that better
learning and understanding occur when a
model is used or that using a model improves
retention of knowledge and provides better
nursing care? Or on the other hand, can we
show that nursing taught without a model
results in inferior learning, retention, and
practice?
The common defence for the use of a
conceptual framework is that it provides a
series of reference points. If I may put it in
colloquial terms: a man needs a place to hang
his hat. This defence is based on one of three
assumptions: (1) that one wears a hat, (2) that
one has a head, and (3) that even if one has a
The Canadian Nurse September 1977
In their eagerness to bring nursing into the realm of scientific status, the academics within
our profession have, sometimes unknowingly, created an enormous puzzle, one that a bionic
woman would find difficult to assemble, let alone the average practicing nurse. The number of
parts to the puzzle are growing: the nursing process, conceptual framework, standard care
plan, quality assurance, voluntary continuing versus mandatory continuing education and a
host of new categories of nu rsing personnel, are some of these parts. Granted, we are looking
for a professional self-image suitable to our emerging role. But let's take a closer look at the
puzzle we are creating ...
head, he still needs something to hang his hat
on.
In an attempt to discover why the use of a
conceptual framework is so important, I began
a search of nursing literature. I was drawn by
the title of an article by Barbara Redman, "Why
Develop a Conceptual Framework?"^ but
unfortunately, it didn't seem to answer the
question it posed. I fail to understand why
anyone would want to use a device that alters
perceived reality. (Johnsons contention is that
a model is drawn from reality and pertains to
reality, but does not constitute reality").
Digging deeper, I found that according to
Levine's theory of holistic nursing, four
principles are useful in planning and
implementing care: the individuals needs for
energy, and for structural, personal and social
integrity. These are termed conservation
principles because care is centered around
the preservation of personal well-being.^
Levine says that when planning and
providing care, the student must consider the
sources of a persons energy and how he is
using it.
This is patently absurd. Don't nurses
(doesn't anyone?) know that the sources of a
persons energy lie in the consumption,
digestion, and utilization of food and
nourishment, especially carbohydrates, not to
mention oxygen intake and the elimination of
wastes? In any event, how can the student
concentrate on what she is doing if she must
constantly think of the model?
The adaptation models descrit»ed by
Helson^ and Roy ^ are thought-provoking. The
adaptation model regards each person as a
unique individual (is this new?) who constantly
responds to internal and external stimuli by
means of adaptive responses. The model
believes that people are not satisfied merely
by reaching a state of equilibrium, but rather
strive constantly for the greater satisfaction
associated with activities and goals requiring
an even higher level of adaptation.
So far so good. Now comes the
application of this theory to nursing practice.
When students are planning patient care, they
must not only identify the patients' problems
but must attempt, often in a state of frustration,
to classify them as focal, contextual or
residual. I wonder why we encourage these
classifications. I would expect students to deal
with problems identified in order of priority,
regardless of their classification.
More Towers of Babel
Despite recurring challenges to the
direction the nursing profession will take,
nursing educators, like little engineers, keep
erecting Towers of Babel. Margretta Style
writes of our response to these challenges: "In
the interim ... task forces the world over
labored to identify and elaborate processes,
concepts, strands and themes which would be
sufficiently comprehensive, yet sufficiently
specific to the practice of nursing .... The result
is a few major patterns with myriad variations
— for example, nursing process, human
development, adaptation, interaction, or
health-illness continuum — all spelled out on
diagrams, called models or systems, often
resembling very complex electrical circuits or
realistic arts."'
I wonder too at our apparent desire to
eradicate the influence the medical profession
has had upon us — doesn't this also indicate
some degree of irrationality in nursing? It
seems to me that any such trend is
unfortunate, because, medicine and nursing
seem to go together like shirt and trousers (or
skirt and blouse) — remove one part, and
embarrassment follows.
Perhaps if we are in fact so antagonistic
towards all things medical, we shouldn't really
be heading for doctoral degrees in nursing.
After all the first people to be called doctors
were not nurses.
It was interesting to read that eleven
nursing experts from certain European
countries recently gathered in England to take
a look at this magnificent thing called the
nursing process, available only in North
America.' (Pity). Our European counterparts
will hold other meetings, meetings scheduled
to spread over an eight-year period, before
they decide to integrate the nursing process
into European nursing.
Maybe there is a lesson in this for all of us.
The nursing profession is moving ahead all the
time. Time isn't running out. Why can't we
assess bei'ore we implement? *
References
1 Jeffels, R.R. Untitled internal document.
Kelowna, B.C. Okanagan College, 1976.
2 Lewis. Edith P. A matter of models. Nurs.
Outlook. 25:5:307, May 1977.
3 Redman, Barbara K. Why develop a
conceptual framework? J. Nurs. Educ. 13:3:2-10,
Aug. 1974.
4 Johnson, D.E. Conceptual models: functions
and uses. Los Angeles, 1969. Unpublished.
5 Lindstrom, Myrna. Holistic nursing: a basis for
curriculum. Nurs. Pap. 7:3:6-12, Fall 1975.
6 Helson, Harry. Adaptation — level theory: an
experimental and systematic approach to behavior.
N.Y., Harper and Row. 1964.
7 Roy. Callista. Sister. Adaptation : a conceptual
framework for nursing, Wurs. Outlook. 18:3:42-45,
Mar. 1970.
8 Styles, Margretta M. In the name of
integration. Nurs. Outlook. 24:12:738-744, Dec.
1976.
9 The Nursing Process, Nurs. Times. 73:1:11,
Jan. 6, 1977.
Mohamed H. Rajabally (R.N.. Ed.M.,) is a
lecturer at the School of Nursing, Okanagan
College, Kelowna. B.C.
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The Canadian Nurse September 1977
HOW DO YOU
FEEL ABOUT...
nights ^
liil
itiiii
liiiiii
iiiii
iijiii
When it comes to patient care, nothing could be more obvious than the fact that it is a 24-hour
affair. Shift worit may well be the bane of existence for the administrator juggling time sheets
and for the staff nu rse working a stretch of graveyards. But we all realize that it is a necessity.
If we don't like it, we still have to live with it, because, "Some must watch while some must
sleep".
Perhaps because night shift turns us upside-down, because it makes most of us feel
physically uncomfortable, the problems inherent in working nights are of great concern to us.
Last fall, CNJ published a questionnaire to see how you, our readers, feel about working
nights. In all, 1,175 questionnaires were returned to us, many of them with your comments
and concerns attached. Of the questionnaires analyzed, 64 per cent of our respondents
indicated that they only worked nights because they had to — responses to other questions
seem to indicate why ...
liiiiil
iiiil
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The Canadian Nurse September 1977
35
Lynda Fitzpatrick
How do nurses feel about working nights? We
are all familiar with the complaints of our
colleagues caught up in the night shift blues,
familiar too perhaps with our own nagging
discomforts and general lack of energy when
it's our turn to work nights. The majority of
responses to our questionnaire showed some
degree of dissatisfaction related to night duty.
Although responses could generally be
grouped positive or negative in nature, they
j also made one thing very clear, that each
came from a unique individual, with his/her
own reaction to the problems attending night
work.
There are nurses (a puzzle to some of us)
who find night work rewarding — greater
independence was only one of many reasons
cited for enjoying the night shift. We found that
1 2.7 per cent of our respondents said that they
worked nights simply because they wanted to.
One nurse signed herself "A very happy nurse
who loves to work nights."
Not surprisingly perhaps, this small group
indicated few physical or psychological
disturbances attending those periods when
they wori<ed night duty. Adding up the number
of negative responses or complaints about
night shift, we found that those who work
permanent nights have in general, few
complaints about the shift.
About our respondents
The majority of our respondents are, as
you would expect, those nurses who are now
involved in working night duty. Most said that
they presently work night duty on a ward, are
full-time employees, and work either three
eight-hour shifts, permanent nights or night
and day shifts (See Table 1). 84.4% of our
respondents work short periods (up to seven
days) as opposed to long stretches of night
duty.
In cross tabulating the data, we found
significantly different responses from those
who work n ights out of choice and, on the other
hand, those who work nights because they
have to (i.e. hospital policy). We also found
that those nurses who prefer to wori< nights
rather than evenings or work nights for
personal reasons tended to express moderate
views.
What made the answers to our
questionnaire most interesting were the letters
accompanying them — typewritten pages,
notes printed around the margins of the
questionnaire, or admittedly scrawled after a
particularly exhausting night. Many of these
letters expressed the feeling that more
attention should be paid to such a fundamental
aspect of nursing. "It's high time, " said one
respondent, "that concrete efforts were made
to assess nurses' individual and collective
reactions to working shift. The topic needs
illumination, and some good hard thinking.
After all, our profession is a health profession."
Rest
The majority of our respondents (64.1%)
complained that they had some difficulty
sleeping after wori<ing night shift. Further
analysis indicated where this complaint
originated — the majority (73.5%) of those
who work nights on a voluntary basis deny any
problems sleeping, whereas 76.2% of those
who work nights because of 'hospital policy'
indicate that they do have problems sleeping.
Many nurses expressed their feelings on
returning home from night shift in negative
ways. "I feel too keyed up to sleep, and I'm
already dreading the night to come." 'I'm so
physically and mentally exhausted, yet I'm
unable to relax." "I feel awful, depressed, and
sick, like I've forgotten to do something very
important."
Other respondents, who just termed
themselves "very tired " when they arrived
home, complained that noise, and other
distractions kept them from sleeping
restf ully . They complained that they could only
sleep for a short period of time, that their sleep
was light, inadequate. 'Working any other
shift, I don't think about sleep, I just do it, and
I'm never tired ... wori<ing nights, I have this
compulsion to store up sleep in case I have a
busy night ahead, so I'm always restless and
sleep poorly."
These feelings are reflected to a certain
degree in the use of medication to induce
sleep — of those working nights out of
preference, only 10.8% take medication to
sleep either occasionally or regularly ; close to
1 /3 of those working nights because they have
to, occasionally or regularly find medication
necessary for sleep.
Those who prefer nights are also more
consistent in calling themselves 'well-rested'
while working nights (60.2% consider
themselves well-rested). Only 11.7% of those
working nights because of hospital policy
describe themselves as well-rested; 38.1%
respond that they do not feel well-rested
during a term of night duty.
It appears then that voluntary night
workers on the whole feel content or cheerful
after night shift, have less difficulty sleeping
after shift, need medication less often to
induce sleep, and generally feel well-rested
after night duty, it is interesting to note
however, that a minority of those preferring to
worknightsdo have difficulty sleeping, do find
medication necessary for sleep, and that 2.4%
do not feel well-rested after night duty.
Eating Habits
Cross analysis also proved interesting as
far as the eating habits of night nurses are
concerned. A majority (69.1%) of voluntary
night nurses said that they experienced no
change in appetite when they wori<ed nights;
73.0% of those wori<ing nights because of
hospital policy said they experienced change
in appetite. Almost half of this group describe
their eating habits as poor, compared with
7.2% of voluntary night workers.
Weight fluctuation, perhaps a more
reliable indicator of change in eating habits,
also shows a marked increase in those who do
not wori< nights out of choice.
Poor eating habits seem to derive from a
constant nausea, or a feeling of
imbalance: "My stomach works day shift when
I am on night shift."
Those who prefer nights aim their
complaints more consistently at the way in
which their hospital is run at night: "Hospital
cafeterias should be open at night so that staff
can leave the wards for a relaxed supper
break and proper meal. Hot meals at night are
a necessity. Buying a cold, stale sandwich
from a vending machine and bringing it back to
the ward is pretty revolting. "
~
About our respondents
,
T-
83.6%
presently work nights
43.0%
work three 8-hour shifts
0)
16.4%
have worked nights in the past
4.7%
work only evenings and days
OS
14.2%
wori< only nights and days
1-
9.5%
work 12-hour shifts
61.3%
work on a ward
10.1%
wori< permanent days
28.1%
work in a specialty care unit
1.1%
work permanent evenings
(ICU, PAR, Emergency)
17.5%
work permanent nights
10.5%
other — small hospital,
supen/isory position, etc.
77.8%
13.7%
work full time
wori< regular part-time
84.4%
work short periods of
night duty (up to seven days)
8.5%
work casual part-time
1
15.6%
wori< blocks of nights
(two weeks or more)
12.7%
14.2%
work nights because they
want to
work nights in preference
to working evenings
40.3%
prefer to work short periods
of night duty
64.3%
wori< nights because of
hospital policy
12.4%
prefer to work blocks of
night duty
8.9%
work nights for other reasons
(especially family reasons)
47.3%
prefer never to wori< nights
The Canadian Nurse September 1977
Relating to Others at Work
Working with others on night duty, do you
find yourself as communicative as usual, do
you find communication productive; are you as
open to the emotional needs of your patients?
Again, the responses of voluntary night
workers are more positive in nature. Only 2.4%
of this group found themselves less
responsive than usual to their patients'
emotional needs, and comments from this
group seemed to express the feeling that
communication with patients was often
enhanced during the midnight hours:
"I feel more empathetic towards patients at
night — they need so much more during the
dark hours ... when their pain and their fears
are more pronounced, they need my
reassurance."
"Nights provide me with the time and
opportunity to talk to patients, they let their
worries surface more easily and I can sit and
listen and really do bedside nursing. "
In contrast, 41% of the nurses working
nights due to hospital policy described
themselves as less empathetic than usual, a
description that is not surprising when it is
considered in conjunction with the degree of
discomfort that this group tends to associate
with night duty. These discomforts grow into
quite a lengthy list, but the most common are
tiredness, nausea, indigestion, headache,
cold, constipation, restlessness, eyestrain,
weakness, heaviness, bloating, nervousness,
and dizziness. Any combination of these
complaints could impede relationships with
patients. "Physically and emotionally I was so
low. After a long period of night duty I felt so
bad I couldn't detach myself ... I was feeling so
much for patients that I couldn't help them."
Communication with other workers
followed a similar pattern; those who prefer
night duty enjoy positive relationships with
other staff more consistently than those who
have to work nights. The latter find themselves
quiet, annoyed or withdrawn.
"As yet (after five years) I have been
unable to take pride in my care at night."
"I'm restless and irritable with everyone, staff
and patients. I find it hard to be understanding,
and that bothers me."
Alertness at work
Anyone who has worked nights knows
that they are not always as quiet as subdued
lighting in the corridors might seem to indicate.
There are still emergencies, still patients in
need of alert and skilled nurses. How do we
react on night duty to those times when we
really need our wits about us, when we need to
be sensitive to those sometimes subtle clues
that tell us something is wrong, when as at any
other time, we need to be clear thinking and
quick in our actions?
Fortunately, most of those nurses
answering our questionnaire seem to respond
nSome
of your responses
In relation to your patients'
emotional needs, how would
you describe your reactions
on night shift?
Do you find it difficult
to carry on such functions
as shopping, banking,
keeping appointments, etc.
while working nights?
How do you feel that you
interact with friends and
family while working
night duty?
Do you feel physically
comfortable while working
nights?
Do you feel that your
reflexes are
Working nights, do you
generally feet
When you return home
after a night shift do
vou aenerallv feel
more caring than usual
unchanged
less caring than usual
uncaring
yes, very difficult
moderately difficult
no problem
as well as usual
not as well as usual
yes
no
quick
jumpy
slowed somewhat
slowed considerably
bored
lethargic
content
anxious
cheerful
content
letdown
:&
/
^%^
34.9%
62.7%
2.4%
16.7%
58.9%
24.4%
6.0%
42.2%
51.8%
28.0%
52.7%
19.4%
67.9%
32.1%
40.2%
59.8%
96.4%
3.6%
69.2%
30.8%
78.5%
10.1%
11.4%
46.7%
20.7%
30.4%
2.2%
■c o
Do you have difficulty
sleeping after night shift?
no
yes
73.5%
26.5%
47.3%
52.7%
23.6%
76.2%
Do you feel generally
well-rested while
working nights?
yes
somewhat tired
no, very tired
60.2%
37.3%
2.4%
26.1%
57.6%
16.3%
11.7%
50.2%
38.1%
Would you describe your
eating habits while working
nights as comparatively
good
poor
92.8%
7.2%
66.7%
33.3%
54.0%
46.0%
12.0%
45.6%
41.0%
1.4%
45.2%
41.4%
13.3%
16.8%
83.0%
52.9%
47.1%
28.9%
29.2%
40.0%
1.9%
2.5%
7.0%
13.4%
4.9%
36.0%
43.6%
87.7%
47.7%
21.8%
4.9%
9.3%
20.0%
25.6%
18.0%
8.5%
72.0%
57.3%
46.5%
2.4%
24.7%
44.5%
The Canadian Nurse September 1977
well to the demands made upon them during
the night shift, regardless of whether or not
they feel physically comfortable working atth is
time.
The majority of nurses responding say
that they feel alert most of the time during the
night, although 1/3 of those nurses working
nights out of necessity feel alert only some of
the time and 3.8% do not feel alert at all (a
small percentage, but a sobering thought).
"I am not alert; only tense and nervous."
"I worry about the patients in my care, even
though I know it's silly. When I sleep, I dream
about them, and about being at wori<. "
Most nurses describe their thinking
processes as at least adequate, regardless of
their motivation for wori<ing nights. Again, it
may be important to consider the minority of
nurses who feel that their thinking is impaired
when they work nights — only 1.2% of
voluntary night workers, but 13.4% of the
greater percentage of those working nights,
the involuntary night wori<ers.
"At night, I always want to ask another nurse
for an opinion for simple things — on days, I
can rely on myself."
"I do dumb things at night — I'm always losing
things. I feel incompetent. "
"I have to fight being over-excited or the
feeling takes over, and I'm not thinking
straight."
Everyday activities
Aside from the physiological problems
arising from living upside-down', regulating
living around night duty can be very fmstrating
to many nurses. Working, only part of the
whole of any person's experience, sometimes
seems to dominate and frustrate other
activities during a term of night shift.
Even those nurses who prefer nights
seem to have problems with making time for
shopping, banking and related activities, with
50.2% of this group complaining of some
degree of difficulty in fulfilling these tasks. In
other groups, the difficulties seem even more
pronounced.
"My chores all get done ... but it's because I
just can't sleep. "
"I find it hard to get anything done in my home
when I work nights, and my days after nights
are a complete loss until my system swings
around again (sometimes a whole week)."
"It takes me three to five days to feel normal
and rested again, and once I'm readjusted, I
feel like I have to catch up on so many things."
There are nurses who feel that night duty
does not interfere with their everyday
relationships with others.
"It's the best of two worids — I can do what I
want in the daytime, and I'm available to my
children when they need me most."
"I can sleep all day, have a pleasant evening
with my friends and then go to wori<."
But generally interaction with family and
friends seems to suffer from the demands
imposed by worthing nights — 32.1% of those
who prefer n ight shift complain that they do not
interact as well as usual with friends and family
while they are wori<ing nights. This percentage
grows to an ovenwhelming 83% for
those who work nights because of hospital
policy.
"The family always suffers ..."
"A lot of nurses seem to have family problems
— shift wori< with all its demands could be at
the t)ottom of it."
"When I work nights, I never get in touch with
my friends... I feel that no time is my time... I'm
just so irritable."
"Getting on the bus to go to work at night, I feel
really cut of touch with the rest of society.""
"Night duty is like hibernating — l"m so out of
touch with everybody!""
Depending on how important we consider
these relationships, this evidence seems to be
a strong point in favor of keeping night shift
rotations short. How important are these
relationships in our lives? How important is our
work ... Need the two conflict?
Mood
"Night shift that winter was a low point in
my life. My biggest problem was depression in
my off duty hours and inability to relate to those
I care for most — my husband and two
school-age sons. Ive never had so little
confidence in myself, so little self-esteem."'
For some nurses, night shift rolls around
once every three weeks. If it is accompanied
by physiological discomfort and a feeling of
alienation from the rest of the world, it can be a
miserable experience.
Working nights, how do you generally
feel? Of those preferring nights, 87.7% said
that they felt content through the night, and
only 12.3% termed themselves bored,
lethargic, or anxious. Again, those working
nights because of hospital policy had markedly
different answers — 21.8% called themselves
content; 13.4%, bored; 43.6%, lethargic;
20.0%. anxious.
52.6% of these wori<ers also called
themselves either slightly depressed or
miserable in answer to another 'mood"
question. And 68.3% said that they felt" slightly
low" or depressed" in their off duty
hours. All of these answers contrast sharply
with answers given by those who prefer night
duty. Those wori<ing nights because of
hospital policy indicated that they had rapid
mood swings, felt alienated, or just tired and
irritable.
Although the majority of night wori<ers in
both groups indicated that they felt that their
night functions were necessary and
worthwhile, job satisfaction does not seem to
have tipped the balance or led those
nurses who must wori< nights to feel really
good about it. So let"s look at what
voluntary night workers find rewarding about
night duty, and what makes night duty
impossible for others.
The pros and cons
Most nurses who said they prefer night
duty mentioned independence and enhanced
nurse-patient communicaton as the greatest
advantages to night wori<.
"I wori< better alone, away from the rat race of
day shift.' 'Night shift brings both challenge
and responsibility, more time for patient care
and the emotional support that no one has time
to give on other shifts. "
"It gives you a different perspective on patient
problems." "I have a great sense of
responsibility and well-being when I work
nights. " "On nights there is less hustle and
bustle, no housekeeping staff, technicians or
doctors to trip over. Generally the atmosphere
is relaxed with other nurses, supervisors and
doctors, and there is a kind of esprit de corps'
not found on other shifts. "
"Night duty provides me with a time to take
stock of myself as a nurse, and as a person.
If night shift wori< is, as one nurse put it
"not to be looked upon as an imposition, but as
part of our role as nurses," then these nurses
are fortunate in viewing their night shift
experience in a positive light. Another nurse
says. "If we eat and sleep well, we should
function as well as day workers...," but there
are indications that some nurses find it
impossible to eat or sleep well. They walk "a
metabolic tightrope " and therefore find it
impossible to describe night shift in anything
but grim terms.
"I can't comprehend that there are nurses who
prefer night shift — I start dreading nights for
three or four days tDefore I start my tour of night
work."
"It takes me a full week to recover my balance
after wori<ing nights ... and that means eating,
sleeping, and emotional balance. It's worse
than jet lag. "
"Normally I feel very alive, very buoyant. I'm a
different person when I have to wori< nights. "
"Normally I love to work and I enjoy my free
time too. On nights I only wori<, sleep (or try to)
and I can't eat."
"The older I get, the harder it gets — not the
wori< itself, but acclimatizing my body to night
living and day sleeping."
"I have actually cried before going on night
duty — once I get to work it's not quite so bad,
but I don't function well. "
"Learning and meeting people is essential to
me. On nights I am restless, depressed and
think atx)ut leaving a job I love — nursing. "
"It's hard on my health. No matter how I try to
call it mind over matter, my body, my mind, my
emotional well-being, all of me feels in limbo. I
feel less than a whole person. Night shift
literally makes me ill. "
It seems that here we have our stumbling
block. Is it mind over matter that makes some
nurses see the positive and make the best of a
'necessary evil, " while others lack the moral
fibre to fulfill an obligation cheerfully? It doesn't
really seem so — there is current evidence that
individuals adapt very differently to changes in
their daily physiological patterns, that for
The Canadian Nurse September 1977
some, the shift from days to nights poses
genuine and serious problems in biological
response, well-being, and efficiency (see
Circadian Rhythms).
So many times, the time-sheet or Master
Rotation Plan reflects little consideration for
individuals, individuals who are so much more
than just workers. Granted, making out
time-sh'eets is no easy proposition. So
perhaps our first step in overcoming the
problem of shift work is to look at what is going
on, evaluate it, and explore other possibilities.
Night work, as evening shift, day work, and
weekend duty, is part of nursing. But, as one
nurse put it, the problem needs some "good
hard thinking."
On Circadian Rhythms
As one very understanding (and
enthusiastic) night nurse put it, "For
people who have problems changing their
sleeping patterns, the night shift is misery
— it shows on their faces, in their
temperaments, and in their ability to react
to any kind of stressful situation."
Studies on circadian (24-hour)
rhythms may lend "morning types" a little
insight into how night owls manage to
view night shift in a positive light. These
studies have shown that certain
individuals can adapt more readily to
radical changes in their sleeping-waking
patterns than others. Many of our bodily
functions — sleep/wakefulness,
hunger, hormonal balance, renal flow,
temperature, mental and physical ability
— move in a daily cycle,' as surely as light
and dark. The 'chilly' feeling that
many of our respondents noted at about
four A.M. coincides with evidence from
studies that show that a typical oral
temperature peaks at about 20:00 hours
and ebbs in the vicinity of 04:00 hours.^
Ostberg has reported a significant
difference between the maximum
temperature of those individuals who are
"morning types ' and those who call
themselves "evening types." He found
that those individuals whose oral
temperature peaks the soonest (the
"morning types ") tend to have the
greatest difficulty adjusting to radical
changes in hours.^ Not surprisingly then,
those nurses who cited a specific time
when they had difficulty just staying
awake on night duty, specified the time
period t)etween four and six A.M.
Studies have also indicated that
performance tests done in the middle of
the night yield consistently poorer scores
than those done at midday (regardless of
how well-rested the individual tested may
be)." One author suggests that perhaps it
is because of our rhythms that we sleep at
night, when we are least efficient, during
the depressed phase of our circadian
cycle.^
Exploring the Possibilities
On permanent shifts
Permanent shift tends to evoke strong
reactions from many nurses, both positive and
negative. On the negative side, nurses will
argue that it cuts a nurse off from a 24-hour
view of patient care, that permanent shift
workers become inflexible slaves to their own
little routines, that they are difficult for head
nurses to evaluate.
On the other hand, many nurses
expressed the following feelings:
"If a nurse prefers to work permanent nights,
she gets the argument that it would be just too
difficult to work out, that it's favoritism, or
contrary to hospital policy. Why? Perhaps this
nurse functions better at night, perhaps she
would be a better nurse if she were allowed to
adjust her working and home life into a stable
pattern. "
In 1970, l-1elen Saunders wrote a
convincing argument in favor of permanent
shifts,* outlining administrative advantages,
advantages to the nurse, and most important,
to the patient. Her opinions are something to
think about:
"Permanent shift can have social, educational,
psychological and health advantages for the
nurse.
"To begin, the nurse would be able to
choose the shift that best fits her personal and
family life. She would be able to take part in
sports groups or teams, hobby groups,
community organizations, church activities,
professional association wori< — in fact in all
social activities ... It is impossible to keep up
many social activities while on a continually
rotating shift."
She goes on to mention the advantages of
family stability, educational possibilities, and
adds "One basic rule of health is to maintain
regular hours for sleeping and eating ...
studies show we can adapt to other patterns ...
provided we are given the time needed to
adapt and provided the patterns are constant."
Administration, she says, can gain from
the experience of a permanent shift worker,
and the patient is assured of an alert nurse and
continuity of care.
Saunders adds that permanency of shift
must be tempered with common sense, that
thorough orientation, and short periods on
alternate shifts are necessary to keep the
nurse in tune with what goes on on a 24-hour
basis.
Permanent shift is certainly not
everyone's answer. Is there room in our
organizations for allowing some nurses to
work a shift of preference while others rotate
shifts? Is permanent shift, opinions aside,
measurably beneficial to those concerned with
patient care? Permanent shift work is nothing
new. Has its effectiveness — for the nurse, for
the patient, for the hospital, — ever been fully
evaluated?
Two shifts — better than three?
"Working three shifts amounts to
exploitation — it is both unhealthy and
unnecessarily hard on everyone."
"I really don't understand why it should be
compulsory to work all three shifts. Days
should be compulsory — just to keep up with
what's going on — but there is no reason there
can't be a choice between evenings and
nights."
"Why are two-shift rotations denied at our
hospital? I know it wori<s for some hospitals, so
why not here? Adjustment to the rotation of
hours takes time, and rapid rotation on three
shifts certainly makes me wonder about my
efficiency as a nurse."
A number of respondents to our
questionnaire suggested that the two shift
rotation would be a vast improvement overthe
three shift system. Many mentioned that it
would be most acceptable to the greater
numberof nurses because itwould cause less
disturbance to them and to their families and
would allow them to function better at work and
at home.
It appears from the responses that there
are hospitals that use the two shift system, so
that the argument that it is impossible doesn't
really seem to hold water. Perhaps it is another
possibility for us to consider.
The Canadian Nurse September 1977
The long and short of it
There are other approaches to consider
when looking at shift work. One has to do with
the length of time that a nurse should work a
particular shift. Is seven days of night duty in
one period too long or too short? Are
twelve-hour shifts a viable alternative to longer
stretches of duty on three shifts?
"Only once have I enjoyed nights — and that
was on a four-week rotation of nights. This
allowed me to adjust to shift hours — a
workable eating, sleeping and recreation
pattern was easy to establish before another
change.
We were a warm, congenial group,
because staff were well-rested and alert. Care
was more patient-oriented. After those nights,
I realized that seven-day adjustments (the
rotation plan used in so many settings) were
the worst for me. My personality and
decision-making ability were really affected by
all the changing around."
"I have worked rapid rotation shift for 1 0 years,
and still have problems adjusting, fvlaybe
longer periods on one shift would be tsetter. "
Studies done in industry where shift work
is also necessary have not yet established
whether or not longer stretches of a particular
shift are generally advantageous. It has t)een
proposed that two or three-day stretches of
shift may interfere less with adaptation to shift
work.^ The important recommendation that
such studies make is that there is scope for
further research, that shift work in industry,
though widespread, has not been evaluated,
and needs further study.
"Seven nights is taxing, too long. By the sixth
or seventh night, I'm exhausted, impatient,
uncaring, and despondent. Fatigue for me
means emotional and physical imbalance.
Five nights is enough at one stretch for me to
be able to cope with any complexities or
emergencies at a time when hospital staffing is
at its minimum."
The past few years have seen some
experimentaton with a return to the use of the
12-hour shift; reactions to this system are
mixed.
"Twelve-hour shifts help tremendously. You
know your patients before the lights go out and
they know you. '
"Twelve-hour nights — such a long time to
work without becoming tired, fnjstrated and
angry."
Permanent shift, two shift rotations,
blocks of shift, rapid rotation, and twelve-hour
shifts — by now you may have begun to
recognize some of the problems faced by
those who wrestle with time sheets. Some
would argue that no arrangement is going to
please every nurse, that compulsory three
rotation shift is the only expedient way to
ensure patient care on a 24-hour basis.
Our questionnaire does not pretend
scientific status; we have instead tried to focus
on your feelings about an area of concern to all
of us. How much weight can we give to all your
opinions? Strong arguments seem to come
from all sides. But if we return to our "good
hard thinking," we recognize that more
acceptable solutions to the problems of shift
work require knowledge, planning, trial and
evaluation rather than a habitual or haphazard
approach.
Nursing literature doesn't seem to have a
great deal to offer in an area so fundamental to
nursing. Perhaps it's time all of us took a good
long look at shift work, at how it affects us, and
weighed the pros and cons of alternatives to
whatever systems we now use.
As one of our respondents writes:
"Why should we break down our health simply
to hold down a job. Nursing means something
to me — it's much more than just a job — but I
drag through night shift, and the rewards of
nursing disappear.
'What nursing needs is more flexibility.
Why is shift handled in such a dictatorial way?
Is there a better way? I feel that we need some
freedom to choose our working hours, those
hours when we can function well, realize our
value and recognize all the potential of our
personal lives. " *
References
1 Rhodes, Carol E. Circadian rhythms. Occup.
Health. 23:2:45-50, Feb. 1971.
2 Ostberg, O. Inter-individual differences in
circadian fatigue patterns of shift workers. Br. J.lnd.
Med. 30:341-351, 1973.
3 Ibid.
4 Dement, William C. Some must watch while
some must sleep. San Francisco, Freeman, 1972.
p. 18.
5 Ibid p. 19.
6 Saunders, Helen. Let's have permanent shifts.
Can. Nurse 66:6:21-22, Jun. 1970.
7 Maurice, Marc. Shift work: economic
advantages and social costs. Geneva, International
Labour Office, 1975. p. 45.
40
The Canadian Nurse September 1977
Listening
does
help:
ONE PATIENT'S EXPERIENCE
Mona Winberg is disabled by cerebral palsy. In spite other handicap, Mona lives
alone. Cerebral palsy is crippling (both physically and emotionally) but many
afflicted people can manage on their own and do want to be independent. In this
article Mona shares with us her fears and apprehensions during her first visit to
hospital and she tells us how patient and understanding nurses, both at home
and in the hospital, helped her along the road to recovery.
Talking is one of Mona's favorite
pastimes (by her own admission >
She is seen here chatting with a
former board member of the Adi.
Cerebral Palsy Institute of
Metropolitan Toronto at Bellwoods
Park House annual garden party
Bellwoods is Canada's first reside
for disabled adults.
Mona Winberg
Joan Hobson
Not long ago I entered North York General
Hospital in Toronto for a Dilatation and
Curettage. Unfortunately, the "D & C" showed
that a hysterectomy was necessary and the
three days that I was originally scheduled to
spend in hospital stretched into a seemingly
endless six and a half weeks, including a stay
in a convalescent hospital.
As is usual, with any new experience,
both fear and apprehension overwhelmed me.
How would the nurses and other staff react to
having a cerebral palsied person as a patient?
What would my roommate be like? Would I be
able to cope as independently in the hospital
as I do at home?
I am disabled by cerebral palsy. It affects
mainly my hands, which are not able to
function in a coordinated manner; and my
speech, which although comprehensible is
accompanied by involuntary jerkiness.
Happily all of my fears about entering the
hospital proved groundless. The nurses were
friendly, compassionate people and I was
soon on a greeting and smiling basis with all of
the hospital staff.
My roommate's name was Edith. She
entered the hospital a couple of days after me
for the same operation. She knew all about
cerebral palsy as she has a niece who is
similarly disabled. Edith was remarkably
helpful and understanding. But let's go back a
little, for all of that is the end of my story.
Pre-op
The fun began as soon as I was admitted.
The nurses needed a blood sample. They tried
three times (once when I was mildly sedated)
and three times I tensed up and no blood
would flow!
Finally, the night before the operation,
three nurses marched into my room and
announced with determination: 'We're not
leaving without your blood. " Two nurses
distracted me with conversation (which is
always a good device to use with me) while the
other plunged a needle into my already black
and blue arm. Hallelujah I At last they were able
to get the blood they needed.
My last medical interview, before the
operation, was with the anesthetist who
said:"Usually I try to fit the intravenous
needle into my patient's arm before the
operation. But, in your case, I think 1 had better
wait until you are under anesthetic. "
After my experience with the blood
sample, I most heartily agreed with him.
The last thing I remember before the
operation is drowsily asking the anesthetist
why they made operating room tables so
narrow. He replied laughingly: 'To allow fat
doctors to get around them."
Post-op
The following week is still a rather hazy
memory for me. I developed a temperature
and a cough and so I was kept on intravenous
therapy for a few days longer than usual. But
that was the least of my worries for as the
sedation gradually wore off, I was faced with a
far more dismal problem. My coordination, or
whatever I had of it, seemed to have
completely deserted me.
In vain the doctors, nurses and my family
tried to reassure me. They told me this was just
a temporary state of affairs due to after-effects
of the operation. They told me not to worry —
but I was desolate and could not be consoled.
The nights found me thinking thoughts as
black as the sky outside for where could I go
and what would I do if I could no longer take
care of myself? Which institutions, even the
ones who were geared for it, would want to
accept somebody who could do so little for
herself?
I remember lying in bed one night, unab
to sleep. The night nurse came in and we
talked together for awhile. We didn't talk fc
long — it was just fifteen minutes or so. Wh
we talked about does not matter; what is
important is that this nurse, through her
understanding interest and sincere solicitude
relaxed me and made me feel more
courageous than I'd felt in weeks.
This episode marked a real turning point
in my recovery. My coordination gradually
returned. No conqueror of Mount Everest
could have felt more jubilant than I when I
discovered I could once again feed myself.
One day, two student nurses came in and
said they'd help me take a tub bath if I wanted
to have one. I was more than willing to go with
them and the bath felt great. Aftenwards
however we all agreed on one thing: hospital
bathrooms are not designed to accommodat^
three people.
The day soon came when my
gynecologist told me he thought I was ready tc
be moved to St. John's Convalescent Hospital
I was glad my recovery had progressed that fa '
but I was still worried. St. John's would be ye
another new place with new faces and new
situations to cope with.
I was very sad when the time came to say
good-bye to Edith — we had travelled the
same difficult road together. As for the nurses
I shall always think of them with affection an
gratitude. Their understanding and
encouragement helped pull me through one c
the most demanding periods of my life.
The Canadian Nurse September 1977
Convalescence
I was made to feel most welcome at St.
John's. My admitting nurse was the
mother-in-law of an active Board Member of
the Ontario Federation for the Cerebral
Palsied so she understood my situation very
well. My new roommate, Ruth, greeted me
cheerfully; she was a friendly and outgoing
person.
If the treatment I received at St. Johns
had to be summed up in three words they
would have to be: tender, loving care. The
atmosphere there was so relaxed and restful
that both my sleep and my appetite improved
greatly. After two weeks, my family physician
told me I was ready to go home. As I was
wheeled down the corridors to the door, the
nurses and other patients either called or
waved their good-byes.
So, at long last, there I was, ... home — a
little shaky and a few pounds lighter — but
back in my own little apartment. Nothing has
ever looked so good to me.
Despite all of the physical discomfort and
mental anguish, I feel the time I spent in the
hospital was a most worthwhile learning
experience. It taught me that even though
disabled people may have to work a little
harder at gaining acceptance, the
understanding and warmth that one receives
in return makes any effort well rewarded.
CNJ asked author Mona Winberg to tell us a
little about herself. This is what she had to say.
"When I was young I attended a special
public school for handicapped children in
Toronto. Later I enrolled at the High School of
Commerce and upon graduation completed
one year at the University of Toronto.
After leaving university I v/orked in the
bookkeeping department of Corbrook
Sheltered Workshop for six years. I was editor
of "Contact," the national publication of the
Canadian Cerebral Palsy Association, for the
next five years.
Right now, I am second vice-president
of the Adult Cerebral Palsy Institute of
Metropolitan Toronto. The Institute is the
operating body of Bellwoods Park House,
Canada's first residence for disabled adults.
Bellwoods is celebrating its lOth Anniversary
this year. I am also Chairman of Bellwoods'
New Directions Committee. The purpose of
our committee Is to establish and define new
priorities for Bellwoods and its residents.
As a past president of the Ontario
Federation for the Cerebral Palsied I have
worked for some time now in an effort to
establish apartment accommodation, with
special support services, for disabled adults. I
believe it is essential that we be able to
provide handicapped people with their own
choice of living accommodation, whether it be
residence, group home or apartment.
But what is most important is that I have
been blessed with a wonderful family and
friends: through their special confidence in
me these people have given me the courage
to try new ventures without fear of being
alone. "
Joan Hobson, VON
Thanks to supportive hospital staff
Mona found her hospital experience most
agreeable. She is now feeling very well and
living Independently in her "own little
apartment."
As Mona's visiting nurse I resumed my
weekly visits to her as soon as she
returned home. What can I, as a nurse in the
community, do to help those with cerebral
palsy manage on their own? Together,
Mona and I drew up this guide:
► It is important for the community nurse
to realize that she is not just
dispensing medical treatment or
counseling in health concerns. During
her visits to the home, the nurse
should listen, encourage, support and
share — both in the laughter and the
disappointments.
► The nurse can assist by discussing the
available community services. But she
should always remember that the
cerebral palsied person is as much an
individual with her own preferred
lifestyle as any other person; she must
allow her patient the dignity and
freedom of choosing her own way of
life.
'p Since the community nu rse may be the
only person her cerebral palsied client
sees all day, it is of inestimable value if
the nurse patiently takes the time to
make herself aware of any other
service that she could perform. This
could be just little things that the
cerebral palsied person, because of
her disability, cannot do for herself. A
nurse has to be realistic and
understand that many persons with
cerebral palsy, no matter how much
they may wish to t>e independent,
cannot manage without some
supportive care or service.
In conclusion, perhaps my entire
philosophy when dealing with a
handicapped client can be summed up this
way:
I have learned it is essential that the
community nurse look upon the person
with cerebral palsy not as a helpless
individual, but as a human being of worth
and dignity. This person is struggling to
make a life for herself in the community.
The visiting nurse is in a unique position
because she has the potential to make this
road a great deal easier and freer of
obstacles. 4
Joan Hobson Is a graduate of the Wellesley
Hospital school of nursing in Toronto. Shehas
received diplomas in Teaching and
Supervision from the University of Western
Ontario and Public Health Nursing from the
University of Toronto. Right now she is on the
nursing staff of the Victorian Order of Nurses,
t^etro Toronto Branch.
The Canadian Nurse September 1977
HELPING
A FAMILY AND
THEIR
PREMATURE BABY
GROW
TOGETHER
Interaction between a mother and her premature infant is all too often
discouraged by the glass barrier of the premature nursery, a barrier that
protects the baby when he is most vulnerable, but may signify to his mother
that he is fragile, untouchable. Studies have shown us that communication
between a mother and her child is vital during the first few days of a baby's life,
that it shapes responses between mother and child for years to come. A
sensitive and knowledgeable nurse can play an important role in bringing a
mother, father and their premature infant together, helping them to discover
one another, and easing the development of a bond between them in spite of
the glass barrier.
"Bizabeth was bom six weeks prematurely in
an unfamiliar hospital. My husband was out of
town. At first, the whole experience was very
frightening for me.
"It was a nurse that helped me to get over
my fear and get to know my new baby. Her
help allowed me to come to terms with the
grieving I felt as I anticipated the possible loss
of the baby. When Elizabeth was born, the
nurse explained to me with sensitivity the
need for special nursing care and the
equipment involved in the treatment of my
premature child. I learned to trust this nurse.
She encouraged me to touch Elizabeth in her
incubator just a few hours after she was born,
and to change her diaper on the following
day.
"When my husband arrived, we talked to
the nurse together, expressing all our fears
about Elizabeth's tiny size, her treatment and
expected development. As the days passed
and our baby's health improved, we were
encouraged to spend more time with her,
feeding her and holding her. Because of our
involvement with Elizabeth, we came to
realize how normal she was.
"I breast-fed Elizabeth twice a day before
she came home. I learned to be patient. . . not
to panic at my daughter's immature sucking
reflex. The nurse helped me to realize that the
problems I had feeding Elizabeth were not a
reflection on my ability to mother, and that with
patience on my part, the baby would drink
adequately. Because of her interest,
knowledge and empathy, this nurse became
a link that drew us closer to our daughter
during an emotional period. "
The Canadian Nursa Saptembar 1977
Norma J. Murphy
^^
It was the story of my friend that helped
me to realize just how helpful a nurse can be in
bringing a new mother and father and their
premature infant together.
A number of factors influence the depth
and intensity of the attachment that eventually
develops between parents and their newborn
child. People who are about to become
parents take on roles that command new
responsibilities and behavior patterns; their
response is determined in part by their
upbringing and their backgrounds, and, in turn,
influences the degree to which they can
become close to their child.
A mother's attitude towards her baby is
shaped by the way she accepts her pregnancy
and by her perception of the unborn child as an
individual. The birth of the baby and the
mother's first experience seeing and caring for
the child also have an important effect on her
initial response to him. Recently it has been
acknowledged that the contact of mother and
child in the first few hours and days of the
child's life have an extremely important
influence on the quality and lasting effect of the
bond between them.
In the case of a premature birth, the
immediate nature of mother-child bonding can
meet with interference. When a child is born
prematurely, the mother may be separated
I from him shortly after his birth, and so she has
! little opportunity to interact with him or provide
i his basic care at this time. This imposed
alienation affects both mother and child and,
, as a result, the mother of a premature child
: may have a distorted perception of her
; infant that can have serious results for the
I bond between them. Understanding what is
; known about mother-child bonding, in order
I that we may facilitate its development when a
I premature birth makes separation inevitable,
is a step in the direction of helping these
families.
Understanding Maternal-Child
Bonding
The first minutes and days after the birth
of a baby constitute a maternal sensitive
period. During this time mother and child
become actively involved in behaviors that
complement and reward. Bonding at the
sensory level draws the mother and child
together with great interest, dependence and
commitment.
The observations of a number of authors
allow us to see what happens in the bonding
process, how interactions between the mother
and child begin. The mother will begin to
recognize her infant as an individual apart from
herself as she initially explores the baby and
notices his reactions to his new environment.
The mother and child begin bonding through
the sense of touch. Initially, the mother
examines her child with her fingertips, then
with her palms, while making eye-to-eye
contact with the baby.
Immediately after he is born, the infant is
in a q uiet , alert state , with h is eyes open for 45
to 60 minutes.' The infant can see and has
visual preferences. It is not long before he
focuses on the most interesting visual stimulus
— the human eye.
At t)irth, the infant moves his head when
he is spoken to; because of a sensitive
auditory perception he will respond to a
high-pitched female voice in preference to a
male voice. The neonate also moves to the
rhythm of human speech — as the speaker
pauses for a breath, he almost imperceptibly
raises his eyebrow or lowers his foot.
In utero, the actions and rhythms of the
fetus are strongly influenced by his mother.
Birth interferes with these actions and rhythms
and the infant must adapt to a new
environment. The mother helps her infant to
reestablish biorhythmicity. Progressively, the
infant grows more alert during those times
when he is being held by his mother. His cry
produces physiological changes in the mother
that encourage herto feed him. On the fifth day
of life, it has been noted that breast-feedin^
infants are able to discriminate the smell of
their mother from that of another mother with
significant reliability.- Many mothers observe
that their baby has a particular scent.
It can be seen from the observations
recorded about the bonding process that the
first few days of life elicit mother-child
closeness. What are the effects on this
closeness when a premature infant is
immediately hurried to an intensive care unit or
to another hospital where he is cared for
exclusively by skilled nurses, and the mother
doesn't have a chance to be with him?
( -
4A-
^'
The Effects of Separation
The mother of a premature infant often
experiences the child's birth as an emotional
crisis involving strong guilt feelings.
Resolution of her conflicting feelings is
essential so that she and her baby may
develop closeness to one another. According
to Kaplan and Mason, there are four tasks that
must be mastered by the mother of a
premature infant in order to promote a close
relationship between her and her child. ^
The first task confronts her at the time of
the baby's birth. At this time, the mother
prepares for the possible loss of her baby by
withdrawing from the relationship; she hopes
for her child's survival but simultaneously
prepares herself for his death. Secondly, when
the child is born, she must face the fact that her
baby is not full term — she must give up her
dream baby and face the reality that her child is
premature. The third task involves changing
her attitude as improvement in her baby
becomes apparent. Finally, she must learn the
differences between a normal infant and her
premature child in order to respond
appropriately as she learns to care for him.
Failure to cope with any of these four tasks is
seen as detrimental to the mother-child
attachment.
The parents of a sick premature baby may
feel that the child is not really theirs, even when
he is discharged from the hospital to tjecome
part of the family. Although the baby's
problems are entirely resolved prior to his
dischargefrom hospital, his mother's behavior
may often t>e disturbed during the first year or
more of her infant's life. An increase in the
Incidence of failure to thrive without organic
cause and in cases of battered child syndrome
has also been shown among premature
infants and those hospitalized in the newborn
period (that is, in comparison with those who
were not separated from their mother during
this period of time).^
The Canadian Nurse September 1977
The Role of the Neonatal Nurse
The nurse in a neonatal unit can assume a
great deal of responsibility for preventing the
development of physical, emotional and social
problems for the parents and their child. By
encouraging parents to explore together and
eventually accept their feelings about the
baby, she can help them to become closer to
their child. She can help to reduce the number
and intensity of parental concerns by teaching
parents about the behavior of their premature
baby and about basic care of the child.
Emphasis should be placed on teaching the
parents about immature behavior which could
seem threatening to a mother and add to her
feelings of inadequacy, for example, the
child's poorsucking reflex orspecial problems
such as heat control or apneic spells.
The nurse can assess the parents'
emotional response to their infant by
observing their efforts to touch the baby, to
learn about him, or take part in his care. She
can also observe the way in which the couple
share their positive and negative feelings, and
discuss their preparations and plans for caring
for the baby at home. In this way she can do a
great deal to facilitate the mother-child
bonding process and the development of a
healthy relationship between them.
In order to be an effective link between the
mother and child, the nurse must be aware of
her own feelings and ideas about her role as a
neonatal nurse. Self-awareness and
communication skills are important for they
enable herto be sensitive to the needs of each
individual family. Sometimes a group
approach that includes a social worker or
chaplain along with the nurse can be most
helpful to the family of a premature infant.
The Glass Barrier
There are a number of problems apparent
for the nurse concerned with quality care in
neonatal nursing, problems associated
particularly with the care of premature
newborns. Some of these barriers need to be
overcome in order to promote helpful
relationships between the nurse and families
of premature infants.
• Inadequate staffing
Neonatal nurses are often discouraged
because of the problems arising from
inadequate staffing. So often there is little time
to give the comprehensive and understanding
care necessary to encourage a mother to get
to know her baby. A new mother may be
frightened, for example, to hold her infant while
he is receiving oxygen unless a nurse is
present. But it is almost impossible for a nurse
who is caring for five sick infants to spend time
with each individual mother. A one-to-one
nurse/patient ratio would allow the nurse to be
fully responsible for the infant throughout
his hospitalization and consequently deliver
better nursing care to the infant and continual
support to the child's parents.
• Unit structure
Very often, the physical structure of the
neonatal unit is not conducive to the
development of a close mother-child
relationship. A mother needs the privacy of a
parents' room for examining, holding and
breast-feeding her baby. Ideally, the parents'
room would be furnished to allow the
involvement of the baby's father and other
family members. Such a unit should be as
relaxing a setting as possible, with dimmed
lights, a rocking chair, colors and music to
counteract the hospital atmosphere and
stimulate the infant. Facilities should tDe
available for a motherto remain in the hospital
with her child, especially if the family lives in an
area outside of the hospital center.
• 'Don't touch'
Often the parents' fear and anxiety is
exaggerated in the neonatal unit by the
busyness of skilled nurses, noisy machinery
and emergencies. Sometimes a nurse may
forget that a setting so familiar to her may
cause parents considerable anxiety, and she
may make little effort to allay their fears.
If a neonatal nurse examines her behavior
carefully, she may have to admit to the attitude
that the nursery is her domain, that she resents
the involvement of parents because it
threatens to down-play her own importance.
The 'don't touch' attitude of many nurses tends
to add to the parents' sense of uneasiness.
How do we change our attitude? Perhaps
if nurses are given the time and are
encouraged to share in teaching parents about
their premature infant, they would find the
rewards of involvement the motivating force
necessary for change of attitude.
• Education
The neonatal nurse requires formal training in
the specific physical needs of the premature
baby, and in the emotional needs of the
parents. Such education should emphasize
communication skills and the need for
self-awareness. Knowledge of communicatior
skills can help the nurse to relate her interest in
the family without seeming to intrude on the
integrity of the family members involved,
without seeming to interfere with their ways of
coping. By learning to listen to a mother talk
about preparations for the baby's
homecoming, for example, she will be able to
understand whether or not the mother feels
confident. By helping a mother to recognize
and accept her feelings, she is in a position to
help her work out a solution.
• Family Involvement
If nursing care is to be family centered,
consideration must be given to family
members at home who may know very little
about the baby's hospitalization. The child left
at home needs to know why his parents are
spending so much time at the hospital. Unless
parents take the time to talk to the child at
home, he may arrive at his own conclusions
about the baby's stay in hospital, conclusions
that could be inaccurate and troublesome to
him. Parents should be made alert to changes
in a child's playing, eating and sleeping habits
that might indicate his need to express himself
openly. If the child is shown pictures of the
baby and assurance that the baby will "grow
up" it helps him prepare for a new family
member.
The Canadian Nurse September 1977
k
^mi^^ wmif
• Involvement of Others
Parents of premature infants need the
involvement of their friends as well as
professionals. Talking to other parents or
friends often helps the parents of a premature
baby see their situation in perspective. Nurses
are in a key position to help bring parents
together with others to share their
experiences.
The initial phase of mother-child bonding
significantly affects the development of a child.
What could be more important to the
well-being of family life than our efforts to
promote this early attachment? As nurses, we
are in a key position to provide vital
opportunities for mother-child bonding. When
parents are separated from their newborn
infant, as in a premature birth, it is important
that we take initiative in helping mother and
father become acquainted with the baby.*
Norma J. Murphy (R.N., Halifax Infirmary
School of Nursing, B.N., Dalhousie University,
Halifax, Nova Scotia) has had most of her
nursing experience in the field of pediatrics,
including neonatal intensive care. In August of
this year, she joined the College of Nursing of
the University of Saskatchewan, Saskatoon,
as a teacher of psychiatric nursing.
References
1 Desmond, M.M. The transitional care nursery.
A mechanism of preventive medicine in ttie newborn
by . . . et al . Pediatr. Qin. North Am. 1 3 :65 1 -668, Aug .
1966. p. 66.
2 Symposium on the Parent-Infant Relationship,
London, 1974. Parent-infant interaction.
Amsterdam. New York. Elseveir, 1975. (Ciba
Foundation Symposium. 33) p. 76.
3 Kaplan, D.N. Maternal reactions to premature
birtti viewed as an acute emotional disorder, by ...
and E.A. Mason. Amer J. Orthopsychiat.
30:539-552, Jul. 1960. p. 102.
4 Klaus, M.H. Maternal-infant bonding: the
impact of early separation or loss on family
development, by ... and John H. Kennell. St. Louis,
Mosby, 1976. p.2.
Bibliography
1 Brazelton, T.B. Visual responses in the
newborn, by ... et al. Pediatrics 37:284-290. Feb.
1966.
2 Collinge, Judith Mary. The concerns of
mothers during the first week following discharge of
their new baby from an intensive care nursery.
Montreal, 1973. Thesis (M.Sc. (App.)) — McGill.
3 Condon, W.S. Neonate movement is
synchronized with adult speech: interactional
participation and language acquisition, by... and
LW. Sander. Sc/ence 183:99-101. Jan. 11, 1974.
4 Desmond, MM. The transitional care nursery.
A mechanism of preventive medicine in the
newborn, by ... et al. Pediatr Clin. North Am.
13:651-668, Aug. 1966.
5 Eaton. Shamo. A family study. San Francisco,
1969. A study in partial fulfillment of MN course
requirements. University of California.
6 Kaplan, D.N. Maternal reactions to premature
birth viewed as an acute emotional disorder, by ...
and E.A. Mason. Amer J. Orthopsychiat.
30:539-552, Jul. 1960.
7 Klaus. M.H. Maternal-infant bonding: the
impact of early separation or loss on family
development, by ... and John H. Kennell. St. Louis,
Mosby, 1976.
8 Kennell, John H. Discussing problems in
newborn tsabies with their parents, by ... and R.A.
Rolnick. Pediatrics 26:832-838, Nov. 1960.
9 International Congress of Psychosomatic
Medicine in Obstetrics & Gynecology, London,
1971, 3rd. Psychosomatic medicine in obstetrics
and gynecology: proceedings. Morris, Norman ed.
White Plains. N.Y.. S. Karger. 1972.
10 Symposium on the Parent-Infant
Relationship, London, 1974. Parent-infant
interaction. Amsterdam. New Yori<, Elseveir, 1975.
(Ciba Foundation Symposium, 33).
1 1 Robson, K.S. The role of eye-to-eye contact
in maternal-infant attachment. J. Child Psychol.
Psychiat. 8:13-25. May 1967.
1 2 Sander. L. W. Early mother-infant interaction
and 24-hour patterns of activity and sleep, by . . . et al.
J. Amer Acad. Child Psychiat. 9:103-123, Jan.
1970.
s?
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• good for 4 weeks'
continuous use
icreasing"
^erst LaboratoT!^5Wtook after tl..
needs. Every product Mto Ayerst an
lives up to a weli-earnec^K|g||gon for
is backed by Ayerst's tecnmcal servl.
would like further information on any c
these products, contact your Ayerst reprei
pr complete and return this coupon.
iL^^m-
r
TO
AYERST LABORATORIES
1025, Laurentian Blvd., Montreal, Quebec, H4R 1J6
I would like to receive information on:
□ Hibitane* Skin Cleanser
□ Hibitane* Gluconate 20% Solution
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HIBITANE and SAVLON made in Canada by arrangement with IMPERIAL CHEMICAL INDUSTRIES LIMITED.
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AYERST LABORATORIES
Division of Ayerst, McKenna & Harrison Limited
Montreal, Canada
Ayerst
Quality has
no substitute
48
The Canadian Nurse September 1977
Names and Faces
Canadian Nurses
Foundation Scholars
Thirteen Canadian nurses have been
granted scholarships from the
Canadian Nurses Foundation for the
academic year 1977-1978. This year,
a total of $9,000 was awarded for
doctoral studies related to nursing and
$24,500 for study at the Master's level.
The Canadian Nurses
Foundation was established in 1962
by the Canadian Nurses Association
to receive funds and administer
fellowships for the preparation of
nurses for leadership positions. A total
of 1 44 nurses have been awarded
scholarships under the program to
date. CNF funding is voluntary and
dependent on gifts, donations and
bequests from individuals and
organizations.
Jenniece Beryl Larsen, a former
nursing instructor at Grant MacEwan
Community College in Edmonton, has
been awarded the Katherine E.
MacLaggan Fellowship of $4,500 to
continue her doctoral studies in
educational administration at the
University of Alberta. Upon
completion of her degree, Larsen
plans to teach nursing at either the
university or community college level
and/or obtain a government position
involving organization and planning in
the field of health and welfare in
Canada.
Heather Marion Ogilvte,
presently the co-ordinator of
education and research at the
Children's Hospital of Eastern Ontario
in Ottawa, has been awarded $4,500
to begin doctoral studies in child
health at Texas Woman's University in
Houston. Texas. Followina
completion of her doctoral studies,
Ogilvie plans to continue in the area of
research in child health.
Jane Buchan of Vancouver has
been named winner of the White
Sister's Uniforms Incorporated
Scholarship Award of $1,000 and a
CNF award of $2,000. She will enter
her final year at the University of
British Columbia where she has been
studying community nursing at the
Master's level. This is the second year
that Buchan has been awarded a CNF
scholarship.
Marilyn Darlene Botterill of
Edmonton, Alberta will receive $3,000
to begin Master's study in nursing at
the University of Alberta with special
emphasis on critical care in nursing
practice. Formerly, she held a postiion
with the Department of Health and
Social Development for the province
of Manitoba and has nursed in a
newborn intensive care unit in
Winnipeg. Botterill iskeenly interested
in research and hopes to complete
doctoral requirements following her
Master's degree.
Dawn Marie Hanson of St.
John's, Nevirfoundland will receive a
$3,000 scholarship and plans to begin
Master's study in counseling in mental
health at the University of Oregon in
Eugene, Oregon. Hanson's particular
interest is in the area of community
mental health and upon completion of
her degree, she plans to practice
counseling in mental health in
Newfoundland and to teach at the
university level.
Sheryl Ann Lapp of Winnipeg,
Manitoba has been awarded the
Helen McArthur Canadian Red Cross
Fellowship for Graduate Studies in the
amount of $3,500. She will begin study
towards a Master's degree in
community health nursing at the
University of Minnesota, in
Minneapolis, Minnesota. Lapp plans
to return to the University of Manitoba
School of Nursing following
completion of her degree.
of psychiatric nursing when she
completes her studies.
Wendy Lynn McKnight, of
Ottawa will receive $2,000 to
complete her second and final year in
a Master's program at McGill
University in Montreal where she has
been examining family involvement in
emergency room care nursing. This is
the second year she has received a
CNF scholarship. Following
completion of her Master's degree,
McKnight plans to find a position as a
clinical specialist in an emergency
department of a hospital.
.'■v^
Kiyoko Matsuno of Montreal will
receive a $3,000 scholarship and
plans to complete Master's study in
clinical nursing at McGill University,
Montreal. Her background includes
nursing of children, psychiatric
nursing and neuro-psychiatry.
Previously, she spent a year as a
nurse consultant in Osaka, Japan.
Matsuno plans to continue in the field
Isabel Caroline Milton of
Beaconsfield, Quebec will receive
$3,000 scholarship and plans to
complete a Master's degree in
community nursing at McGill
University. Upon completion of he'
degree, Milton plans to practice in
community health center in the
Montreal area and hopes eventually 1 1
teach nursing at the community
college or university level.
Eleanor Grace Pask of Tore:
will receive a $1,100 scholarship '.
study at the University of Toronto
towards a Master's degree in materr
and child health. Pask's nursing
experience includes nursing childreri
in various hospital settings in both the
U.S. and Canada.
Laurie Dawn Reid of Edmonton
Alberta will receive a $3,000
scholarship and plans to enter the
Master's program at the University ol
Toronto to study community health
nursing. Reid plans to teach
community health nursing in a
Canadian university following
completion of her studies.
NOW FULL LAST NAME or
Initials FREE on Many Itemsl^^
nme 7^ 'k 7lcHa^...^0i Xik
IT'S EASY TO ORDER REEVES NAME PINS FOR YOURSELF OR FRIENDS !
Chocse style you want, shown nght Print name (and 3nd
line it desired) on dotted lines below. Check other info m
boies on chart, clip this section and attach to coupon
bottom right. Attach e<tr3 sheet tc- additional pms
NOTE SAVINGS ON 2 IDENTICAL PINS . . . more convenient,
spare in case ot lo».
LETTERINGS-
CHOOSE;
DESCRIPTION
ALL METAL rich. trim, tailored, Lightwe-ghl.
smooth edges, rounded corners, Choose
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METAL FRAMED . Smooth plastic back-
|T|K ground with classic, distinctive polished metal
- *■ ^ frame Beveled and rounded edges and corners
Smart professional appearance
PLASTIC LAMINATE Slim, broad, yet I
weight Engraved througti surface into
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matches lettering. Ejcel'ent value.
ght-
MOLOEO PLASTIC . . , Simple is smart. Smooth
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2nd LINE;
BACKGROUND imERlNG
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PRICES^
1 Line
Lette'ing
2 Lines
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1 Line
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(available 559
lfi»
D2M
0 4.29
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04.49
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Umk^i SCISSORS and FORCEPS
. E\c=A.i'.G--^r>;j^ DOB.-MtsTEB ^ Finest Forged
^^\ ^^--^^ 5-*==zr^ — — ^^ Steel. Guaran-
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I V:— a^^^^^^*^^^ LISTER BANDAGE SCISSORS
3Vi" 3V2" Mini-scissor. Tiny, handy, slip into
AVj" uniform pocket or purse Choose jewelers
iVi" gold or gleamrng chrome plate finish
''''''" No. 3500 V/2" Mini 2.75
No. 4500 4V2". Chrome only . . 2.95
For last name or No. 5500 SVi", Chrome only . . 3.25
initials engraved, No. 702 JVa", Ctirome only . . 3.75
r ;, add 60. ^ ^g^LY FORCEPS
~*^'— — — "^^^-^"^ So handy for every nurse! Ideal for clamping
-^'^^^ off tubing, etc Stainless steel. SVi"
^ -^ No. 25-72 Straight. Box Lock 4.69
Qi^3^ No. 725 Curved, Box Lock 4.69
No. 741 Thumb Dressing Forcep,
Serrated, Straight, S'^i" . . 3.75
CAP TOTE keeps your caps clean
Flexible clear plastic, whde turn, zipper, carrying
strap, hang loop. Stores flat. Also for wiglets, ' ■s^ . ::*.)!
curlers, etc, 8''z" dia,, 6" high. ^*^»fc— --^rj
No. 333 Tote . . . 2.95 ea. Gold init. add 50<.
y^J^ MEDI-CARD SET
^^^^^^\ Six sTiooth plastic cards
1 \ 3'''b" X i^'j" crammed
., \ with info on ApothMetcic Household meas.i
,^JH\ ""-'''-i ^ '° F. liver, body, blood, urine, bone dis-
\ /MU-^' V\ ease incub. weights etc. , . . m vinyl holder,
■ '■ " - - -" You're a walking encyclopedia!
No. 289 Card Set . . . 1.75 ea.
Initials gold-stamped, add 60(.
MOLDED
CAP TAGS
Replace cap band instantly. Tiny plastic tac. dainty ^^^^
caduceus Choose Black. Blue. White or Crystal with ^^^
Gold Caduceus. The neater way to fasten bands "^^Tj
No.200-Setof 6Tacs... 1.49 per set ^ ''^'-tT'^'
RXHl . ^t/ METAL CAP TAGS Pair or dainty
>^j'^J| " ^^ii^\ lewelry-quality lacs witti gfippers, holtjs cap
n I — -T'llfc^^'^ ^^^<^^ securely Sculptured metal, gold (in.sti.
iMLU I ■'^^ appro W wide Choose RN, IPN, LVN, RN
I J I^Uj - -JyjSf Caduceus or Plain Cadoceus Gift boied
nV^'rii -^^^igT No.CT-l (Specify Init.) . . . No. CT-2 (Plain
\i\lg \ I ^ Cad.) ... No. CT-3 (RN Cad.) . . . 2.95 pr.
POCKET PAL KIT
Handiest for busy nurses. Includes white Deluxe
Pocket Saver, with 5^2" Lister Scissors. Tri
Color ballpoint pen, plus handsome little pen
light , , . all silver finished. Change compart-
ment, key Cham Keeps pockets Oean and neat V
No. 291 Pal Kit , .6.95 ea. \ «
Initials engraved on shears, add 50c-
No. 791 Pocket Saver only ... 6 for 2.98
fi[\i , ENAMELED PINS Beautifully sculptured status
\llV / jifsaa^ insignia. 2-color keved, hard-fired enamel on go!d
^Zy #nr\% ^'^'^ Dime-sized pm back Specify RN. LPN LVN, Of
fW HI NA on coupon fjp 205 Enam. Pin 2-49 ea.
BZZZ MEMO-TIMER Time tiot packs
heat lamps park meters Remember to check vital "^ i^ (['
signs, give medication, etc. Lightweight, compact * ,*
dVi" dia.), sets to buz: b to 60 mm Key ring ^ ^^}<- ••f^s^
Swiss made No. M-22 Timer ... 6.95 ea. ^ "^ gJ
PIN GUARD XiiX
i.-iT\_J Sculptured caduceus. chained to your protes
^— ^=^**^ sional letters, or replace eittier iKitti class pin
Gold tinisli gift boied Ctioose RN, LPN, or IVN
No. 3420 Pin Guard . . . 2.95 ea.
CROSS PEN ,^^^^-5i^^.»^-~ ^
'- rid lamous ballpoint, wilti ^^^^^^ftft^^^^.,^^'----^*'^
-Iptured caduceus embleii Full name FREE ^^^^^Sfe*-fc.^.-^^>^
"," on barrel 'include name with couocn: Lite',^" ^..■^.."■-l ^^^"^s^*
No. 3502 Clirome 11.95 ea. No. 6602 12kt. G.F. 16.95 ea
^53> — ' '^.EXAMINING PENLIGHT
^^,^--'' Wtlite barrel with caduceus imprint, lli;
-^^— ^"^^ minufti band and clip 5" long batteries mciudei
^^- No. NL 10 Penlight 3.95 ea. Initials engraved, add 60i
WHITE BOBBIE PINS Hold cap firmly m place Si. 2" and
■I I I I l|
Mrs. R. F. JOHNSON
SUPERVISOR
CHARLENE HAYNES
Famous Brand
Stethoscopes
. . with FREE Engraved
Name or Initials
and Scope Sack!
^^ ^'"^^^^BBP^^ precision stethoscope made to
Reeves exacting standards, witti
our 1 year guarantee. I's" chest-
piece slips easily under B.P. cuff.
Weighs only 2 oz. A fine, dependable, sensitive scope in Blue.
Green, Red, Gold or Silver, adjustable binaurals, chestpiece and
tubing to match. Chrome spring. FREE last name !up to 15
letters) or initials engraved on chestpiece, and protective plastic
Scope Sack Reevescope No. 5150 12.95 ea.
Liftman'' NURSESCOPE Famous scope advertised in
nursing magazines' High sensitivity. 28" overall, 2 oz.. non-
chilling diaphragm, patented internal spring. Choose Gold, Sil-
ver, Blue, Green or Pink, with Grey" tubing. 1 year guarantee.
Includes FREE engraved name or initials, and Scope Sack
No. 2160 16.95 'Matching tubing No. 2160M 17.95
Littmann' COMBINATION STETHOSCOPE
Similar to above, 22" overall. 3'/2 oz. Stainless chestpiece with
1%" diaphragm. I'/a" bell. Nonchill sleeve. I year guarantee.
Includes FREE engraved 2 initials only, and Scope Sack. ^
Liftman No. 2100 ... 32.50 ea.
Lum/scope DUAL SCOPE
Highest sensitivity at a budget price!
Non-chill rubber ring on beli side
Only3'/2 0z., lii"bell. 1 '/a "chest-
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or Blue, Green or Red (matching tub-
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itials (no name) and Scope Sack included.
Dual Scope No. 800 . . . 17.95 ea.
CLAYTON ECONOMY SCOPES Our lowest cost pre
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No. 414 Clay . . . 9.95 No. 412 Clay Dual . . . 14.95
$ MONEY COUPON! $ ■
Include this coupon with your order and . . . |
Deduct .10 it your order totals 1.49— 2.49 _
.20 " 2.50— 4.99 I
.40 " " •• •• 5.00- 9.99 _
— " 10.00 — 24.99 ■
25.00-49.99
50.00 — 74.99
7<; nn
All pinbachs with saftty catch
BLOOD PRESSURE SETS &
SPHYGS For Every Budget!
REEVES DELUXE
Outstanding professional
aneroid sphyg. made
especially for Reeves'
Meets US Gov, specs.
^3mm accuracy, cal, to
300mm. 10-year Reeves
Guaranteed, Black and
Chrome, Black tubing.
Grey Velcro" cuff. Zip-
pered leatherette
case. Set includes
No. 5150 Reevescope
(left). FREE last name
(up to 15 letters)
or initials on mano
and scope,
FREE Scope Sack.
Set No. 51100. .35.95 Sphyg. only No. 108. 27.95
SPECIAL DELUXE REISTER UmifM*
One of the finest professional sphygs in the world . . , with no
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guaranteed to -3mm, Velcro* cuff, zipper case. Choose Black
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Set No. 06 . . . 47.95 Sphyg. only No. 106 .. . 39.95
ECONOMY B.P. SET
A low cost yet highly dependable unit. Cal to 300mm. guaran-
teed by Reeves to :r3mm for 1 year Smart Grey 'Chrome styling.
Vetcro" cuff, zipper case. Set includes slim, sensitive stetho-
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Includes FREE last name or initials on sphyg and steth.
Set No. 14 . . . 27.95 Sphyg. only No. 10 . . . 20.95
TIMEX' Pulsometer WATCH
Movable outer ring computes pulse rate for
you! Dependable Pulsometer Calendar
Watch with date. White luminous numerals
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No. 237 Watch 19.95 ea.
■ ■ ■ ■
■ ■ ■ ■ g
TO: REEVES CO., Box 719-C, Atlleboro, Mass. 02703
COLOR QUANT.
Use extra sheet for adctitional items or orders
INITIALS as desired:
TO ORDER NAME PINS, fill out all information in t»«,top
left, clip out and attach to this coupon
1 enclose $_
No COD'S ptease Mass. res add 5
Master Cliarge, BanhAmericarit or Visa welome on
orders of SS 00 or more Submit complete Card No
Expiration Date and your Signature
t Please add 50< handling postage
'l on orders totaling under 5,00
ST
Send to .
Street
The CanacHan Nurse September 1977
\aiiie.s and Faces
Ingeburg Ursula Schamborzki
of the Town of Mount Royal, Quebec
will receive a $1,000 sctioiarship and
plans to enter the Master's program in
nursing at McGill University to
specialize in research in nursing and
health care. Recently she was the
co-ordinator of inservice education at
the Montreal General Hospital. Her
future goals include pursuing a career
in administration or as a nurse
clinican.
Joan Irene Wearing of Montreal
has been awarded a $3,000
scholarship to enter the Master's
program in nursing at the University of
British Columbia where she will
examine primary health care as it
relates to the elderly. Upon completion
of her degree, Wearing plans to
resume work in a primary care setting.
Olive E. Anstey, of Australia was
elected president of the International
Council of Nurses at the 16th
Quadrennial Congress held recently
in Japan. She will head the world-wide
organization of more than one million
nurses from 88 countries until the next
Congress in 1981. She succeeds
Dorothy Cornelius from the United
States.
Anstey is a former president and
senior vice-president of the Royal
Australian Nursing Federation and
has (seen a member of the ICN Board
since 1973. She is well-known
throughout Australia for her
contributions to nursing.
The new ICN president has had a
varied nursing career encompassing
public health, acute care, and
operating room nursing as well as
administration. At present, she is
matron of Sir Charles Gairdner
HosDital in Perth. Western Australia.
Also elected to the ICN Board of
Directors, 1977-1981 are: First
vice-president: Rebecca Bergman,
professor of Nursing Department, Tel
Aviv University, Israel.
Second vice-president: Verna
Huffman Splane, faculty of the
Schoolof Nursing, University of British
Columtiia, Canada.
Ttiird vice-president: Hildegard E.
Peplau, former director, Graduate
Program, College of Nursing, Rutgers
University, U.S.A.
Members-at-large: Ang Mun Moi
nursing officer and head, Nursing Unit,
Singapore General Hospital and
Faculty of Dentistry, Singapore.
Ingrid Hamelin, nursing officer,
Helsinki City Hospital and Social
Services Planning Bureau, Finland.
Eunice Muringo Klereini, chief
nursing officer. Ministry of Health,
Kenya.
Sheila M. Quinn, area nursing officer,
Hampshire Area Health Authority
(Teaching), United Kingdom.
Area Members
Africa: Eloise C. Duncan,
administrator, Nursing Services,
John F. Kennedy Medical Center,
Liberia.
Eastern Mediterranean: Hend
Abdel-AI, lecturer. Psychiatric
Nursing, High Institute of Nursing,
Cairo University, Egypt.
Europe: Marle-Loulse Badouallle,
National Association of Continuing
Education of Public Hospital
Personnel, France.
North America: Eileen M. Jacob,
professor and dean. School of
Nursing, The University of Texas at El
Paso, U.S.A.
South and Central America: Syringa
Marshall-Burnett, lecturer.
Advanced Nursing Education,
University of the West Indies,
Jamaica.
Southeast Asia: Annamma P.
Cherlan, principal. College of
Nursing, Post Graduate Institute,
Chandigarh, India.
Western Pacific: Fe M. Valdez,
chairman. Board of Nursing,
Professional Regulation Commission,
Phillipines.
Norah O'Leary, Nursing Consultant
has been transferred from the Health
Consultants Directorate to the Health
Standards Directorate of the Health
Programs Branch, Health and Welfare
Canada.
O'Leary obtained her M.Sc.N.
from the University of Toronto and is a
clinical nurse specialist in
cardiovascular nursing. She was an
assistant professor in the Faculty of
Nursing at Lakehead University
before joining Health and Welfare in
1 976. She is a memlDer of the Board of
Management and the Executive
Committee of the Board of the
Registered Nurses Association of
Ontario and is past president of the
Nurses' Section, Ontario Lung
Association.
O'Leary's responsibilities with the
Health Standards Directorate will
involve the establishment of
guidelines and standards for nursing
practice. To do this, she will be
working closely with the Canadian
Nurses Association, the provincial
associations and government
agencies. She pointed out that many
specialized nursing groups and
provincial associations across the
country have already set up their own
standards of practice and that, as a
result, there are a vast number of
resource people to draw on in setting
up national standards of nursing
practice. In her work, she plans to
travel to the provinces to meet with
these various groups.
In describing her position, she
stressed that "this is not the federal
government imposing their standards
on the nursing profession. It is up to
nursing to define nursing practice. My
job is to coordinate and facilitate the
wori< of expert practitioners in setting
up national standards."
O'Leary sees that the
establishmentof standards is an acute
need in nursing. One of the priorities of
CNA since 1975 has been to develop
a definition of nursing practice and to
establish national standards. "At
present, there is no objective criteria to
judge the quality of care that is being
given. Standards are one way of
measuring the quality of our care. "
H. Rose Imai will leave her position as
acting Principal Nursing Officer,
Health and Welfare Canada to join the
staff of the Canadian Nurses
Association as director of professional
services in early September. She will
also assume the role of deputy
director of CNA in the absence of Dr
Mussallem.
Imai received her diploma in
nursing at the Moose Jaw Union
Hospital in Saskatchewan and then
went on to obtain her bachelor's
degree in nursing at McGill University
and her master's degree in public
health at Johns Hopkins University.
She has nursed in a variety of settings
including work in Japan and Okinawa
and public health nursing in Toronto.
She has also taught at McGill's school
of nursing.
Imai was previously on the staff
of CNA from 1 970-1 972 as a research
officer preparing submissions to
government and drafting position
papers.
Robert Gourdeau, M.D., F.R.C.P.(C
was recently elected president of the
Canadian Medical Assocation for
1 977-78. At present, he is a consultant
in pediatrics and hematology at the
Centre Hospitaller de I'universit^
I Q\/al in Qto Fnu Oiiphflr
The Canadian Nurse September 1977
51
Calendar
October
Interim Council on Health Sciences
Education of Canada (ICHSEC)
First Annual Meeting. To be held at
the Hotel Meridien, Montreal on
Oct. 2-4. Theme: Accreditation and
Health Sciences Education.
Contact: C.A. Casterton, Executive
Secretary. Association of Canadian
Medical Colleges, 151 Slater St.,
Ottawa, K1P5H3.
Workshop on Diagnosis of Venous
Thrombosis: Theoretical and
Practical Approaches, to be held at
McMaster University Medical Centre,
Hamilton, Ontario, on Wednesday,
Oct. 26. Contact: Dr. J. Hirsh,
Professor, Department of Pathology,
Mcl^aster University Medical Centre,
1200 Main Street West, Room 3N18,
Hamilton, Ontario, L8S 4J9.
Annual Meeting and Workshop of
the Association of Remotivation
Therapists of Canada Inc. to be held
at the Douglas Hospital in Montreal,
Quebec on Oct. 3-5, 1977. Fee: $30.
Contact: Mr. P. Steibelt, Director of
Remotivation Therapy, Douglas
Hospital, 6875 LaSalle Blvd.,
Montreal, Quebec, H4H 1R3.
(514) 761-6131.
Therapeutic Touch as it Relates to
Nursing Practice. A one-day
symposium given by Dr. Dolores
Krieger designed to expose nurses to
new scientitic findings on "touch." To
be held Oct. 27 at the University of
Calgary, Calgary, Alta. Fee: $18.
Contact: Mary Hammond, R.N.,
Administrative Officer, Division of
Continuing Education, The University
of Calgary, 2920 24th Avenue N. W.,
Calgary, Alberta, T2N 1N4.
Association of Registered Nurses
of Newfoundland 23rd Annual
Meeting. To be held on Oct. 3-5. atthe
Hotel Gander, Gander, Nfld.
Guest speaker: Lorine Besel.
Contact: /4flA//V, 67 Le Marchant Rd.,
St John's, Nfld., A1C2G9.
November
Order of Nurses of Quebec Annual
Meetingtotieheldon Nov. 9-10, 1977
at the Queen Elizabeth Hotel.
Montreal. Contact: Order of Nurses of
Quebec, 4200 Dorchester Blvd. West,
Montreal, Quebec.
Good nursing practice calls for the
removal of necrotic tissue as a first step
in the treatment of decubitus ulcers.
Think of Travase" as
(Sutilains Ointment, N.F)
I
Iravase
(Sutilains Ointment, N.F.)
INDICATIONS: For wound debridement, Iravase
Ointment Is indicated as an adjunct to established
methods of wound care for biochemical debridement of
the following lesions: Second and third degree bums:
Decubitus ulcers: Incisional, traumatic, and pyogenic
wounds: Ulcers secondary to peripheral vascular dis-
ease CONTRAINDICATIONS: Application of Travase
Ointment is contraindicated in the following conditions
Wounds communicating with maior body cavities:
Wounds containing exposed major nerves or nervous
tissue: Fungating neoplastic ulcers WARNING; Do not
permit Travase Ointment to come into contact with the
eyes In treatment of burns or lesions about the head or
neck, should the ointment inadvertently come into
contact with the eyes, the eyes should be immediately
rinsed with copious amounts of water, preferably sterile
PRECAUTIONS A moist environment is essential to
optimal
activity of the en- _ ^^
zyme Enzyme activity may be im-
paired by certain agents (see package insert). Al-
though there have been no reports of systemic allergic
reaction to Travase Ointment in humans, studies of
other enzymes have shown that there may be an
antibody response in humans to absort)ed enzyme
material. ADVERSE REACTIONS; Consist of mild,
transient pain, paresthesias, bleeding, and transient
dermatitis. Pain usually can oe controlled by adminis-
tration of mild analgesics Side effects severe enough to
warrant discontinuation of therapy occasionally have
occurred If dermatitis or unusual bleeding occurs as a
result of the application of Travase Ointment, therapy
should be discontinued No systemic toxicity has been
observed as a result of the topical application of Travase
, Ointment DOSAGE AND ADMINISTRATION
■,'^\ Strict adherence to the following is required
»->^ for effective results of treatment: 1 Thor-
■f^i^ oughly cleanse and irrigate wound area with
sodium chloride or water solutions Wound must
be cleansed of antiseptics or heavy-metal antibactenals
which may denature enzyme or alter substrate charac
teristics (eg. Hexachlorophene, Silver Nitrate. Benzal-
konium Chloride, Nitrofurazone. etc.) 2. Thoroughly
moisten wound area either through tubbing, showering
or wet soaks (eg, sodium chloride or water solutions)
3. Apply Travase Ointment in a thin layer assuring
Intimate contact with necrotic tissue and complete
wound coverage extending to '.» to ''2 inch beyond the
area to be debrided 4. Apply loose wet dressings 5
"pXabI Repeat entire procedure 3 to 4 times per day
C CPP I for best results, c Flint 1977
■ IJ FUNT LABOR/\TORtES OF OMMADA
ft405Ncy1tiamDnv« Mallor>.On(anoL4V1J3
52
The Canadian Nurse September 1977
L
%I%
king for nevr texts
to enrich
your curriculum?
A New Book!
MATERNITY CARE:
The Nurse and the Family
Emphasizing the human dimensions of childbirth, this dynamic new text helps
you prepare your students to function as competent, sensitive maternity nurses
in today's changing society. Discussions integrate psychosocial factors with
current clinical information and show how to apply this to actual patient care.
Throughout, the authors provide detailed plans for nursing intervention based
on diagnostic, therapeutic, and educational objectives. They stress the
importance of setting care goals before planning care or attempting to
assess results. All information is logically arranged to follow the chronologic
order of conception, pregnancy, labor and complications, birth, post delivery
and parenthood. More than 650 superb drawings and photographs augment
this significant addition to maternity literature.
By Margaret Duncan Jensen, R.N., M.S.; Ralph C. Benson, M.D., Irene M. Bobak, R.N.. M.S.:
with 2 contributors April, 1977. 764 pages plus FM l-XX, 8'/2" x 11", 684 illustrations. Price,
$18.40.
Medical/Surgical
CARE or THE
OSTOMY WkTIENT
■ lb-'. ^'>A^
New 2nd Edition!
CARE OF THE OSTOMY PATIENT. By
Virginia C. Vukovich, R.N., E.T. and Reba
Douglass Grubb, B.S.; with 12 contributors.
The new edition of this widely used book
continues to show nurses how to meet
the special physical and emotional
needs of ostomy patients. Its valuable
"how-to" approach focuses on both pre- and
post-surgical care, as well as social and
vocational rehabilitation. The authors in-
clude new discussions on patient assess-
ment and patient education. April, 1977. 164
pp , 23 illus. Price, $6.85.
New 2nd Editioni THE SURGICAL PA-
TIENT: Behaviorial Concepts for the
Operating Room Nurse. By Barbara J.
Gruendemann, R.N.. B.S., M.S.; et al. This
new edition presents behavioral concepts
that can be applied to patient care in a
variety of surgical settings. Totally updated,
this revision incorporates the Standards of
Practice developed since the first edition,
and includes valuable new suggestions to
help students effectively implement the
nursing process. April, 1977 206 pp., 72
illus. Price. $7.30,
New 4th Edition! NURSING CARE OF
PATIENTS WITH UROLOGIC DISEASES.
By Chester C. Winter. M.D., F ACS, and
Alice Morel, R.N. The updated edition of this
popular text presents current concepts of
urologic diseases and their management.
Chapters new to this edition discuss such
topics as: urologic examination and diag-
nostic tests; equipment; urinary ostomy care
and appliances; and the cystoscopy suite.
The Canadian Nurse September 1977
Fundamentals
New 9th Edition!
Mosbys COMPRE-
HENSIVE REVIEW OF
NURSING. Edited by Dolores F.
Saxton.RN ,B,S in Ed, , MA.. Ed D.: Patricia
M. Nugent, R.N.,A.A.S..B.S.,M,S.;and Phyllis
KPelikan.R.N.A.A.S.B.S MA ;with10con-
tributing authors. Revised, reorganized, and
field-tested tor accuracy, the new edition of
thiswidelyacclaimed review bookexamines
current practices in professional nursing. It
features new material on motivation and the
teaching process, psychosomatic disorders,
Canadian nursing history, physics and
chemistry. The revised medical-surgical
section emphasizes common or recurring
diseases. January, 1977. 624 pp.. 17 illus.
Price. $13.15,
A New Book! INTRODUCTION TO NURS-
ING ESSENTIALS: A Handbook. By Helen
Readey. R.N.. M.A.; Mary Teague, R.N.,
M.S.N ; and William Readey III. B.S This
handy resource provides basic information
essential to all beginning nursing students.
Discussions range from study skills, com-
munication and terminology to legal aspects
of nursing. P.O.M.R., and mathematical
problem-solving, March. 1977. 207 pp.,
illustrated. Price, $6 25
Nutrition
Nutrition
and diet therapy
jpsaDiiwEU-
C3
WBXMMS
A New Book! NUTRITION IN INFANCY AND
CHILDHOOD. By Peggy L Pipes, R D ,
MP H This new text helps students gain the
knowledge they need to counsel parents
and others about nutrition concerns and
goals for children Discussions present
principles of nutrition and development
(including recommended dietary intakes for
children), along with current strategies for
dealing with specific clinical problems.
April, 1977. 218 pp., illustrated Price,
$685.
A New Booki NUTRITION IN PREGNANCY
AND LACTATION. By Bonnie S Worth-
ington, PhD, Joyce Vermeersch. DrP H .
and Sue Rodwell Williams, M.P.H., M.R.Ed.,
PhD : with 3 contributors. This unique new
book integrates scientific rationale with
specific techniques essential to maternal
and child health nutritional assessment and
education. It offers pertinent suggestions for
improved client learning and motivation,
along with comprehensive discussions on
such topics as the pregnant adolescent and
nutrition and family planning July. 1977,
234 pp , 34 illus. Price. $7,30,
Critical Care
RESPIRATORY
NURSING
CAKE
New 2nd Edition!
RESPIRATORY NURSING CARE: Physio-
logy and Technique. By Jacqueline F
Wade, R.N., S.C.M , B.TA, The new
2nd edition of this book provides
exhaustive information on physiology as it
relates to nursing care. You'll find increased
emphasis on the application of physiology
and nursing therapies to prevent respiratory
complications, and more material on spe-
cific clinical problems. New chapters dis-
cuss bedside monitoring and hypoxia,
hypoxemia, and oxygen therapy. April,
1977 244 pp,, 51 illus. Price, $7,90.
Education and
Administration
Power
and influence
in health care
JL NEM A( PROACH TO LCAOfcHSHtP
New 3rd Edition!
NUTRITION AND DIET THERAPY, By
Sue Rodwell Williams, M.P.H., M.R.Ed.,
Ph.D. The new 3rd edition of this
popular text focuses on nutrition within
a context of human needs. Updated
discussions examine nutrition's role in pub-
lic health, basic health care specialties, and
clinical management of disease. You'll find
more information on minerals in the body, as
well as new behavioral and problem-
oriented approaches to weight control.
March, 1977, 741 pp , 134 illus. Price.
$1340
New 3rd Edition! NUTRITION AND DIET
THERAPY: A Learning Guide for Students. *!,
By Sue Rodwell Williams, R,D,, MR, Ed.. ^
M.P.H., Ph.D. March, 1977, 186 pages plus
New 8th Edition!
HISTORY ANDTRENDSOFPROFESSIONAL
NURSING. By Grace L Deloughery, R N ,
MPH , PhD, The new edition of this
well-established text surveys the history
of nursing from its ancient beginnings
to the present. Throughout, the author
stresses the parallel evolution of
professional nursing and the women's
movement The book incorporates much
new information on recent nursing history
(since 1945) and on trends that are still
developing. New discussions explore
minoritynurseeducation, continuing educa-
tion for rel icensure, new nurse practice acts,
and legal aspects of nursing, June, 1977,
286 pp , 37 illus Price, $8 95
A New Book! POWER AND INFLUENCE IN
HEALTH CARE : A New Approach to Lead-
ership. By Karen E. Glaus, PhD and June T,
Bailey, R,N,, Ed,D,; with 2 contributors. The
authors of this innovative book believe that
power can be a positive force — the core of
effective leadership. Their book clearly
demonstrates how nurses can develop and
use power to effect changes in health care,
April, 1977. 204 pp.. 27 illus Price, $6.85.
Behavioral Science
A New Book! ALCOHOLISM: Development,
Consequences, and Interventions. By
Nada J, Estes, R.N,, MS, and M, Edith
Heinemann, R N,, M A, with29contributors
A valuable resource for all members of the
health care team, this important new book
examines the care, treatment, a_nd diagnosis
of alcoholism from both physiologic and
psychologic perspectives. Leading au-
thorities from many disciplines explore the
effects of alcoholism on the primary victim
and on family members, friends, and soci-
ety. September, 1977. Approx. 352 pp., 6
illus. About $9.75.
i^i
Look to Mosby*
MOSBV
TIMES MIRROR
THE C. V MOSBY COMPANY, LTD.
86 NORTHLINE ROAD
TORONTO, ONTARIO
M4B 3E5
54
The Canadian Nurse September 1977
Salt,Sugar
and Heinz Baby FDods.
Since the late 1960's, the
HJ. Heinz Company of
Canada Ltd. have undertaken
a significant number of
reformulations that have
included in many varieties,
the reduction or elimination
of added salt and sugar.
Currently, Heinz
markets 123 varieties of
Strained and Junior Baby
Foods and Cereals of which 84 now contain no added sugar and 82 no
added salt. During the balance of 1977 Heinz will be offering further
varieties to which no sugar will be added and will be removing all added
salt from those varieties in which it is currently used.
Heinz Baby Foods do not contain any artificial colours, flavours or
preservatives. Monosodium glutamate (MSG) was removed in 1969 and
Hydrolized Vegetable Protein (HVP) is currently being removed from those
17 varieties in which it was previously used.
Heinz Baby Foods will reflect product formulation changes by label
flashing those varieties that no longer contain added salt or sugar
The reduction or elimination of added salt and sugar in Heinz Baby
Food varieties has been undertaken following an extensive review of
Research literature, published papers, and has covered a wide range of
scientific and medical opinion. As further external research is reviewed, and
original internal research undertaken, Heinz nutritionists will evaluate all
results, to ensure that product formulations reflect a consensus opinion
and the best interests of infant feeding in Canada.
For further information write to: Heinz Baby Foods,
250 Bloor Street East, Toronto, Ontario, M4W IGl.
Good Nutrition Starts with Heinz.
Oiemz^
M I l-loin7 Primnanu nf Panada I tri
The Canadian Nurse Saptembar 1977
Books
Cancer Care Nursing by Maureen I vers
Donovan and Sandra Girton Pierce, New York,
Appleton-Cenfury-Crofts, 1976.
Approximate price $9. 75.
Reviewed by June M. Davidsort, Head Nurse,
Oncology Unit, Ottawa Civic Hospital, Ottawa.
Ontario.
This book has been written by nurses and for
nurses. Its authors, Donovan and Pierce, have
provided a comprehensive approach to the cancer
nursing problem. In the preface, they state, "one of
the main goals of this work is to influence the
philosophy of nurses who work with cancer
patients."
There is a recognized need for nurses in the
field of oncology. In order for patients to receive
optimum care, we have to change our negative
attitudes about cancer. Each person needs hope,
something to look forward to, and this book attempts
to help us fulfill that need. It is above all a practical
book, guiding the nurse towards a systematic and
positive approach to cancer nursing.
The t)ook deals first of all with the meaning of
cancer. It explores the effect that this meaning has
for the patient. In The Family and Cancer', the
authors deal with the special needs of the patient's
family, and their feelings related to the disease and
death. The Nurse and Cancer' explores the impact
of cancer on nurses, and its implications tor
participation in cancer care.
One chapter deals with dying, exploring current
material available on death and offering ways of
dealing with dying. The following chapters relate to
the patient, the family and the nurse; how each deals
with death and dying.
A chapter concerning pain is a comprehensive
review of many theories regarding pain and the
implications of pain. The chapter offers practical
ways of dealing with the patient who has pain or
fears pain, along with methods of control.
Infection, an ever present problem and threat to
cancer patients, is well handled by this text. The
book goes into the causes of infection, and outlines
ways of dealing with and controlling infections.
Nutrition and elimination problems of cancer
patients are also covered.
The last chapter of the book deals with the
patient's body image, the devastating effect of
cancer on the human body, and offers practical
suggestions towards dealing with the patient's
feelings about his body.
The book has a thorough titbliography at the
end of each chapter. It is a concise and worthwhile
handbook; students and graduates alike will benefit
from reading it and applying its direction.
The EKG — Basic Techniques for
Interpretation by Jerome Passman and
Constance D. Drummond. 306 pages. New
Yori<, McGraw Hill. Inc. 1976.
Reviewed by Lorna Rankin, Instructor, General
Hospital School of Nursing, St Jot}n's,
Newfoundland.
This book, designed for anyone interested in
EKG interpretation, would be found useful by
many nurses, particularly those wori<ing in critical
care areas.
The authors, two American cardiologists,
pioneered the concept of having the technicians
report on, as well as actually produce, the EKG
tracings, on the principle that the technicians would
find their work more satisfying and reporting would
tjecome more efficient.
Readers with some prior knowledge of
electrocardiography can skim through the first three
chapters which outline the anatomy and physiology
of the heart, describe the various waves, complexes
and intervals of the EKG, and how to measure them.
The remainder of the book describes the cardiac
axis, specific abnormalities of rhythm and
waveforms and ttie changes that can occur in a wide
variety of clinical conditions.
The book, written as a programmed learning
text, is valuable, both as a practical guide and as a
reference when specific abnormalities are
encountered. It deliberately gives no details of the
theory behind heart diseasesor the treatment (these
may tie found in other texts), but can tie highly
recommended for nurses wishing to enlarge their
knowledge of electrocardiography.
At 300 pages, it is neither too brief nor too
long-winded and so can be read and understood in a
few evenings' study.
i^etelast
The first and last word
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and can easily be tailored to
the needs of every hospital.
Technical training
• Training and group demonstrations by our representatives
• Full-colour demonstration folders and posters
• Audio-visual projector available for training programmes
• Continuous research and development in cooperation with
hospital nursing staff
For full details and training supplies, contact your Nordic representative or
write directly to us.
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PHARMACEUTIQUES LTEE
ARMACeUTlCALS LTD
2775 Bovet St., Laval, Queljec
Tel: (514) 331-9220
Telex: 05-27208
56
The Canadian Nurse September 1977
KGRLIX
Disposable Lap Sponges
Designed to reduce
lint and debris problems.
^^^^.^^
I
Kail»7'U
Innovators In Patient Care
KENDALL CANADA/6 CURITY AVENUE
TOROK-rn ONTARIO M4B 1X2
Librarij Update
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 f/me,
should be made on a standard Interlibrary Loan form
or by letter giving author, title and item number in this
list.
If you wish to purchase a book, contact your
local bookstore or the publisher.
Books and documents
1 . Barber, Janet MWter. Adult and child care; a client
approach to nursing, by... Lillian Gatlin Stokes and
Diane McGovern Billings. 2ed. St. Louis, Mosby.
1977. 1036p.
2. Behavioral approaches to children with
developmental delays, by Sally M. O'Neil, Barbara
Newcomer McLaughlin and Mary Beth Knapp. St.
Louis, Mosby, 1977. 210p.
3. Canadian Teachers Federation. Bibliographies in
education, no. 59. Evaluation of student teachers
Ottawa, 1977. 76p.
4. Canadian Tuberculosis and Respiratory Disease-
Association. Standards Committee. Reports.
Ottawa, 1972. 65p.
5. Carter, Joan Haselman. Standards of nursing
care: a guide for evaluation, by... et al. 2ed. New
York, Springer, 1976. 292p.
6. Fraiberg, Selma H. The magic years;
understanding and handling the problems of early
childhood. New York, Scribner's, c1959. 305p.
7. Gannik, Dorte. The national health system in
Denmark: a descriptive analysis, by... Erik Hoist and
Marsden Wagner. Washington, U.S. Public Health
Services, 1976, 86p. (U.S. DHEW Publication no
(NIH) 77-673)
8. Hughes, Harold Kenneth. Dictionary of
abbreviations in medicine and the health sciences
Lexington, Mass., Lexington Books, 1977. 31 3p. R
9. Jacobs, Charles M. The PEP primer: the JCAH
performance evaluation procedure for auditing ana
improving patient care. by... and Nancy D. Jacobs.
2ed. Quality Review Center, Joint Commission on
Accreditation of Hospitals, c1974. 1v. (various
pagings)
10. Leahy, Kathleen M. Community health nursing,
by... et al. 3ed. Toronto, McGraw-Hill, 1977. 432p.
11. Leifer, Gloria. Principles and techniques in
pediatric nursing. 3ed. Toronto, Saunders, 1977.
321 p.
12. Marshall, T. David. Patients' rights: what you
should know before seeing a doctor. Vancouver.
International Self-Counsel Press, c1976. 70p.
1 3. Nursing in Japan. Tokyo, Japanese Nursing
Association, 1977. 71 p.
1 4. Stoutt, Glenn R. The first month of life; a parent's
guide to care of the newborn. Oradell, N.J., Medical
Economics Co., c1977. 161p.
15. Symposium on Labor Relations, Lake Bluff, III
1 975. Taft-Hartley amendments; implications for the
health care field: report of a symposium sponsored
by the American Hospital Association June 27-29,
1975 at the Harrison House, Lake Bluff, Illinois.
Chicago, American Hospital Association, 1976.
The Canadian Nurse September 1977
57
Index of Canadian Nursing Studies: 1976 Addendum
The 1 976 Addendum to the Index of
Canadian Nursing Studies is now
available. This Addendum lists all
research studies by Canadian nurses
or atwut nursing in Canada on which
information was retrieved in 1976. It is
not limited to studies completed in that
calendar year. This Addendum is
available at Si. 00 per copy from the
Pubication Order Department,
Canadian Nurses Association,
50 The Driveway, Ottawa,
K2P 1E2.
The 1976 Addendum is the
second Addendum to the last
cumulated index which was published
in 1974. The cumulated index with the
Addenda for T975 and 1976 may be
purchased lor $7.00 per copy.
Ovol 80
Tablets
Ovol 40
Tablets
Ovol
Drops
Antlflatulent
Simethicone
INDICATIONS
OVOL is indicated to relieve bloating,
flatulence and other symptoms
caused by gas retention including
aerophagia and infant colic.
CONTRAINDICATIONS
None reported.
PRECAUTIONS
Protect OVOL DROPS from freezing.
ADVERSE REACTIONS
None reported.
DOSAGE AND ADMINISTRATION
OVOL 80 TABLETS
Simethicone 80 mg
OVOL 40 TABLETS
Simethicone 40 mg
Adults: One chewable tablet between
meals as required.
OVOL DROPS
Simethicone (in a peppermint
flavoured base) 40 mg/ml
Infants: One-quarter to one-half ml as
required. May be added to formula or
given directly from dropper.
0 HORRER
\F Montreal Canada
iometimes, baby gets
more air than formula.
i
That's why we make soothing,
peppermint-flavoured Ovol
Drops.
Ovol is simethicone, an
effective but gentle antif latu-
lent that relieves trapped air
bubbles in baby's stomach and
bowel without irritating gastric
mucosa.
Ovol works fast. And that's a
relief for baby. And for mother.
Also available in adult-strength
chewable tablets.
A HORHER
58
The Canadian Nurse September 1977
Request Form for "Accession List"
Canadian Nurses Association Library
Send this coupon or facsimile to:
Librarian, Canadian Nuraas Asaoclatlon
50 The Driveway, Ottawa K2P 1E2, Ontario.
Please lend me the following publications, listed in the
or add my name to the waiting list to receive them when available.
'••™ Author Short title (for identification)
No.
. issue of The Canadian Nurse,
Request for loans will be filled in order of receipt.
Reference and restricted material must be used In the CNA library,
Bon-ower
Registration No
Position
Address
Date of request
Two careers in one.
Have you ever thought of combining two
careers in one' As a Canadian Forces nurse
you could, because you would also be an ofticer,
eligible for regular promotion, enjoying a mini-
mum of four weeks vacation your very first year,
free transportation privileges to many parts of
the world, early retirement mcluding a generous
lifetime pension and a number of other bene-
fits. The Canadian Forces will give you every
opportunity to continue your nurse's training,
while using the skills you already have in one
of the many military medical installations in
Canada or overseas. You might qualify for flight
nurse's trainmg or even for a complete doctorate
study course
If you're a graduate (female or malel of a
school of nursing accredited by a provincial
nursing association and a registered member
of a provincial registered nurses' association,
a Canadian citizen under 35 with two years' post-
graduate experience in nursing, you owe it to
yourself to en|oy two careers in one
Contact your nearest Canadian Forces
Recruiting Centre or write to:
Director of Recruiting and Selection
National Defence Headquarters
P.O, Box 8989
Ottawa, Ontario
K1AGK2
GET
INVOLVED.
WITH THE
CANADIAN
ARMED
FORCES.
16. Wade, Jacqueline F. Respiratory nursing care:
physiology and techniques. 2ed. St. Louis, Mosby
1977. 231 p.
17. Western Interstate Commission for Higher
Education. Communicating nursing research vol. 8:
nursing research priorities: choice or chance.
Edited by Marjorie V. Batey. Boulder, Colorado
1977. 379p.
18. World Health Organization/International
Collaboration Study of IVIedical Care Utilization.
Health care. Edited by Robert Kohn and Kerr L.
White. Toronto, Oxford University Press, 1976
557p.
19. Zilliox, Henry. On les appelait gardiens de fous:
la profession d'infirmierpsychiatrique. Paris, Privat.
C1976. 295p.
Pamphlets
20. Airline Users Committee. Care in the air; advice
for handicapped passengers. London, Civil
Aviation Authority, 1 977. 20p.
21. Canadian Council on Hospital Accreditation.
Report 1976. Toronto, 1977. 5p. R
22. Canadian Medical Association. Council on
Medical Services. Sub-Committee on Primary
Medical Care. Primary medical care: Resource
document Calgary, 1973. 39p.
23. Canadian Medical Association. Council on
Medical Services. Review of primary care studies:
Resource document. Ottawa, 1976. 36p.
To The Nurse
Whose Professional
Standards Are As
High As Ours
If your skills are current, you are invited to
become part of MPP Nursing Services. The
advantages to you will be many, including top
pay plus continuing inservice education
programs. We respect you both as a
professional and as an individual; we'll make
every effort to provide the satisfactions and
rewards of your career the way you want
them.
208 Bloor St. W.
Suite 204
Toronto, Ontario
(416) 964-0328
NURSING SERVICES
24. Conseil canadien d'agr6ment des hdpitaux.
Rapport annuel 1976. Toronto, 1977. 5p. R
25. Commonwealth Nurses Federation. Gu/de to aid
agencies. London, 1976. 19p.
26. Kruglet, Jo Ann, comp. Bibliography: Nursing
literature on cancer 1965-1975. Texas, University of
Texas System Cancer Center. 1 976? 23p.
27. Manitoba Nurse Practitioners Interest Group.
Brief: Nurse practitioners, Manitoba. Winnipeg,
1977. 15p.
28. New York State Nurses Association. Council on
Nursing Education. Task Force on Behavorial
Outcomes of Nursing Education Programs. Project
tool. New York, 1977. 3p.
29. Organisation mondiale de la Sant6. f/lesures
legislatives d'action anti-tabac dans le monde;
apergu des lois et r^glements en vigueur Gen6ve,
1976. 29p.
30. Pan American Health Organization.
Epidemiology and nursing. Washington, 1976. 10p.
(Pan American Sanitary Bureau. Scientific pub. no.
Tha Canadian Nurae Saptambar 1977
59
31. Romeder, J.-M. The development of potential
years of life lost as an indicator of premature
mortality, by... and J.R. McWhinnie. Ottawa, Long
Range Health Planning Branch, Health and Welfare
Canada, 1977. 24p. (Canada, Health and Welfare
Canada. Staff papers. Long range health planning
77-2)
32. Registered Nurses Association of Ontario.
Statement on cardio-pulmonary resuscitation.
Toronto, 1977. 1p.
33. — , Statement on patient advocacy. Toronto,
1977. 1p.
34. Saskatchewan Registered Nurses' Association.
Consumer participation. Regina, 1977. 1p.
35. Schulfe, Eugene J. You mean I can't do this? A
guide for health care facility supervisors when
faced with a union organizational campaign. St.
Louis, Mo., Catholic Hospital Association, 1976.
32p.
36. World Health Organization. Legislative action to
combat smoking around the world; a survey of
existing legislation. Geneva, World Health
Organization, 1976. 27p.
Government documents
Canada
37. Bureau de Recherches sur les traitements.
Commission des relations de travail dans la
fonction publique. Analyse des conventions
collectives dans la fonction publique du Canada.
Ottawa, 1976. 1v. (various pagings)
38. — .Le bureau de recherches sur les traitements:
une retrospective. Ottawa, 1975. 23p.
39. Dept. of Communications. fleport?976. Ottawa,
Minister of Supply and Services, 1976. 26p.
40. Department of Manpower and Immigration.
Occupational and Career Analysis and
Development Branch. Task inventory: Nursing
occupations. Ottawa, 1977. 1v. (unpaged)
41. Dept. of the Solicitor General. Report 1974-75.
Ottawa, Information Canada, 1976. 50p.
42. Health and Welfare Canada. Social Services
Division. The proposed federal social services
legislation; an outline. Ottawa, 1 977. 5p.
43. Minist6re du Solliciteur g6n6ral. Rapport
1974-75. Ottawa, Information Canada, 1976. 58p.
44. Pay Research Bureau. Public Service Staff
Relations Board. Analysis of Canadian public
sen/ice collective agreements. Ottawa, 1976. 1v.
(various pagings)
45. — . The pay research bureau: an overview.
Ottawa, 1975. 23p.
46. Statistics Canada. Hospital indicators 1976.
Ottawa, 1977. (various pagings)
47. — . Indicateurs des hdpitaux 1976. Ottawa,
1977. (various pagings)
Studies in GNA Repository Coiiection
48. College of Nurses of Ontario. /Cursing education
and registration. Statistical report. 1975. Toronto,
1976. 46p. R
49. Kariinsky, Norma. Environmental and
interpersonal factors which influence the
satisfaction of clients of a psychiatric aftercare
service. Ann Arbor, University of Michigan, 1977.
20p. Thesis (M.S.) - U. of Michigan. R
50. Jones, Phyllis E. An investigation of the
definition of nursing diagnoses: Report of Phase 1,
by... Principal investigator and Dorothea Fox Jakob,
Research Assistant. Toronto, University of Toronto,
C1977. 88p. R
Audio-visuai aids
51. About aging: a catalog of films 1977. 3ed.
compiled by Mildred Allyn. Los Angeles, Ca., Ethel
Percy Andrus Gerontology Center, University of
Southern California, 1977. 148p.
52. Association des m6decins de langue frangaise
du Canada. Sonomed, s4rie 4, no. 1. Montreal,
1973.*
MEDICATION GUIDE FOR
PATIENT COUNSELLING
Dorothy L. Smith, Pharm. D.
An authoritative and much needed reference guide to be used
during the education of the patient regarding his medications, so
that he will become a more active and reliable partner in drug
therapy. Flexible in design, the book leaves ample scope for the
exercise of judgement by the practitioner.
July 1977 425 pages $13.95
PSYCHOLOGICAL PROBLEMS OF
THE CHILD AND HIS FAMILY
Paul D. Steinhauer, M.D., & Qumtin Rae-Grant, M.D.
Edited by two eminent child psychiatrists, this outstanding col-
lection of 24 original articles cfiscusses the principles of child and
adolescent psychiatry in a language that is easily understood by
all; includes a glossary of terms.
1977 459 pages $12.95
Please send me copies of Medication Guide For Patient Counselling.
copies of Psychological Problems of the Child and His Family.
D I enclose my cheque or money order.
Bill my Chargex/Visa No.
Expiry Date Signature
Name Address
City Prov
.Master Charge No.
Postal Code
M
MaCmillan of Canada ZO Bond street, Toronto. Ontario MiB 1X3 1416) 362-7651
Students & Graduates
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To receive a free sample of our "needs no starch" cloth, and more
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The Canadian Nurse September 1977
ilassiriod
Ad vcM't i.sement.s
British Columbia
Registered and Graduate Nurses required for new 41 -bed acute
care hospital, 200 miles north of Vancouver, 60 miles from Kamloops
Limited furnished accommodation available Apply Director of Nurs-
ing, Ashcrofi & District General Hospital, Ashcrott, British Columbia.
Registered Nurses — The Bntish Columbia Public Service has vac-
ancies in the Greater Vartcouver arKl Other Areas for Nurses who
are currently registered or eligible for registration m British Columbia.
Positions are in mental health, mental retardation, and psycho-
?9riatnc institutions Salaries and fringe benefits are competitive —
1 . 184 to Si .399 for Nurse 1 . Canadian citizens are given preference.
Interested applicants may contact the: Pubic Service Commission,
Valleyview Lodge, Essondale, British Columbia VOM 1J0. Quote
competition no. 77:449A.
Experienced Nurses (eligible for B.C. registration) required for
409-bed acute care, teaching hosprtal located in Fraser Valley, 20
minutes by freeway from Vancouver, and withm easy access of
various recreational facilities. Excellent onentation and continuing
education programmes. Salary $1184.00 to S1399.00 per month
Chnical areas include Medicme, Surgery, Obstetrics, Pediatncs,
Coronary Care, Hemodialysis. Rehabilitation. Intensive Care,
Emergency. Apply to: Nursing Personnel, Royal Columbian Hospital.
New Westminster. Bntish Columbia. V3L 3W7.
Positions Vacant — Registered Nurses required for a l6-bed
Psychiatric Unit located in Northwest B.C., opening in June 1977.
Psychiatnc training or expenence essential RNABC contract is m
effect. Apply in wnting to: Mrs. F Quackenbush, R N., Director of
Nursing, Mills Memonal Hospital, 4720 Haughland Ave., Terrace,
Bntish Columbia. V8G 2W7.
General Duty Nurses for modern 41 -bed hospital located on the
Alaska Highway, Salary and personnel poliaes m accordance witti
RNABC Accommodation available m residence Apply: Director oi
Nursing, Fort Nelson General Hospital. P.O. Box 60. Fort Nelson,
British Columbia, VOC 1R0.
General Duty Nurses for modem 35-bed hospital located in south-
ern B C s Boundary Area with excellenl recreation faalities. Salary
ar>d personnel polfctes in accoraance with RNABC. comfortable
Nurse s home. Apply Director of Nursing, Boundary Hospital, Grand
Forks. Bntish CoJumbia, VOH 1H0
DO YOU HAVE GRADUATE LEVEL CLINICAL EXPERIENCES
AND/OR NURSING RESEARCH TO SHARE WITH YOUR
PROFESSIONAL COLLEAGUES?
The Colorado Nurses' Association Chautauqua '78 will be held in Vail
July 29 - August 5, 1978. Abstracts are currently being solicited from
RNs interested in presenting pertinent nursing seminars at the next
symposium. Only one presenter per seminar, must be an RN, travel,
lodging and per diem paid, no honoriums. Application deadline: Novem-
ber 1, 1977. For application form and more information, contact:
Colorado Nurses' Association, 5453 East Evans Place, Denver, CO.
80222, 303-757-7483.
United States
Ontario
Nurses ~ RNs — Immediate Openings in California — Florida —
Texas — Arkansas — If you are experienced or a recent Graduate
Nurse we can offer you positions with excellent salaries of up to $ 1 300
per month plus all benefits. Not only are there no fees to you whatsoe-
ver for placing you. but we also provide complete Visa and Licensure
assistance at also no cost to you. Wnte immediately for our application
even if there are other areas of the U.S. that you are interested in. We
will call you upon receipt of you application m order to arrange for
hospital interviews. Windsor Nurse Placement Service, P.O. Box
1133, Great Neck, New York 11023. {516-487-2818)
"Our 20th Year of World Wide Service"
R.N.'s — Pacific Northwest/Idaho; Openings in 229-t)ed. accredited
acute hospital serving as major regional center for orthopedic,
ophthalmology, dialysis, mental health, neurosurgery, and trauma. A
modern hospital facility surrounded by uncongested recreational
areas with close skiing, sparkling lakes and rivers and clean air. Salary
range $900 to$1 21 2 p/mo. commensurate with expenence. Excellent
benefits, shift rotation, relocafion assistance, and free partting. Write
or call, Dennis Wedman, Personnel Office, (208) 376-1211. St. Al-
phonsus Hospital, 1055 N. Curtis Road, Boise, Idaho, 83704. E.O.E.
United States
Registered Nurses — New Critical Care Areas — Wishard Memor
iai Hospital, Burn Center-lCU-CCU. Rotation-Permanent evenings -
Permanent nights. Call: Madeline DeTalvo, Nursing Service
(630-7032). or apply to; Wishard Memorial Hospital. Nursing Service
Office. Indiana University Medical Center, 1001 West 10th Stre-
Indianapolis. Indiana, 46202. The Health and Hospital Corporati
AN EQUAL OPPORTUNITY EMPLOYER
The best location in the nation — The wo rid -renowned Cleveland
Cinic Hospital, a progressive, 1020-bed acute care teaching facility ,
committed to excellence in patient care currently has staff nurse i
positions available m several of our 6 ICUs and 30 departmentalized i
med/surg and specialty divisions. Starling salary range is $1 2,454 to '
$14,300, plus premium shift and unit differential, progressive benefit
package and a comprehensive 7 week onentation. For further infor
mation contact: Director — Nurse Recruitment. The Cleveland Climc
Foundation. 9500 Eucid Avenue, Cleveland, Ohio 44106; or call
collect 216-444-5865.
Nursing Opportunities — Progressive 500-bed Medical Cente'
West Texas City of Abilene with population nearly 100,000 is look
for new graduates and experienced R.N.'s for positions in 0 6 .
Pediatncs. Surgery. E,R.. ICU, CCU. plus surgical and medical floors
Good competitive salary and generous benefits are provided
Contact: Personnel Office, Hendrick Medical Center, 19th and
Hickory. Abilene, Texas 79601.
RN or RNA. 5 7 or over and strong, without dependents, to care for
160 pound handicapped executive with stroke. Live-in, '/z yr, in To-
ronto and '/? yr in K^ami, Preferably a non-smoker. Wage: $20000 to
$220.00 weekly NET. depending on expenence plus Miami bonus.
Send resume to: M.D.C, 3532 Eqlinlon Avenue West, Toronto. On-
tario, M6M 1V6.
Supervisor of Public Health Nursing required for an expanding
Health Unit, OualilScations: B Sc.N, or equivalent with demonstrated
competence m Pubic Health Nursing and management functions. For
further particulars, apply: Miss Joan OLeary, Director of Nursing.
Algoma Health Unit Sixth Floor. Civic Centre, Sault Ste. Marie. On-
tano, P6A 5X6,
United States
Registered Nurses — Dunhill. with 200 offices in the USA. has
exciting career opportunities for both new grads and experienced
R N.'s, Send your resume to: Dunhill Personnel Consultants, No, 805
Empire Building. Edmonton. Alberta. T5J 1V9. Fees are paid by
employer.
Registered Nurses — Flonda and Texas — Immediate hospital ope-
nings in Miami. Fort Lauderdale, Palm Beach and Stuart, Florida and
Houston. Texas. Nurses needed for Medical-Surgical, Critical Care,
Pediatrics. Operating Room and Orthopedics. We will provide the
necessary work visa. No fee to applicant. Medical Recruiters of Ame-
nca. Inc., 800 N.W. 62nd St., Fort Lauderdale, Florida 33309, U.S.A.
(305) 772-3680.
PUBLIC HEALTH
NURSE
Required for service in Blind River,
Ontario and surrounding
District. Preferrably bilingual.
Qualifications: B.Sc.N. with Public
Health Content or recognized
certificate in Public Health Nursing.
Please apply:
Miss Joan O'Leary
Algoma Health Unit
6th Floor
Civic Centre
Sault ste. Marie, Ontario
P6A 5X6
Operating Room
Post-Basic Six Month
Course
A clinical and academic program offered
to Registered Nurses.
Beginning:
October 3, 1977 (next course March 13,
1978) Applications now being accepted.
For further information, write:
M. Whitney
Director of Staff Education
St. Paul's Hospital
1081 Burrard Street
Vancouver, British Columbia
V6Z 1Y6
Tne Canadian Nurse September 1977
61
Applications for the
position of
Supervisor
Operating Room and
Recovery Room
are now being accepted by this
300 bed fully accredited hospital.
We offer an active staff
development programme.
Salaries and fringe benefits are
competitive, based on
educational background and
experience. Temporary
accommodation available.
Apply sending complete
resume to:
The Director of Personnel
Stratford General Hospital
Stratford, Ontario
N5A 2Y6
Head Nurse
With preparation and demonstrative
competence in Psychiatric Nursing and
Management required for a 20 bed unit.
Applicant must be eligible for registration
in the Province of British Columbia. Salary
and benefits in accord with R.N.A.B.C.
contract.
Please apply forwarding complete
resume to:
Director of Nursing
St. Joseph's General Hospital
2137 Comox Avenue
Comox, British Columbia
V9N 481
HEAD NURSE
INTENSIVE CARE
UNIT
Applications for the above position are
now being accepted by this 300 bed fully
accredited General Hospital. We offer an
active Staff Development Programme,
Competitive Salaries and Fringe Benefits
based on Educational background and
experience.
Apply sending complete resume to:
Director of Personnel
Stratford General Hospital
Stratford, Ontario
N5A 2Y6
Director of Nursing
Applications are Invited for the
position of Director of Nursing, St.
Joseph's Hospital, Chatham,
Ontario.
St. Joseph's is a 170 bed general
acute hospital. Applicants nnust have
had previous nursing administrative
experience; B.Sc.N. or Masters'
degree preferred. Appointee will be
responsible for complete
management of the Nursing
Department.
Applications in writing to:
Director of Personnel
St. Joseph's Hospital
Chatham, Ontario
N7M 1G8
PROVINCE OF
BRITISH COLUMBIA
PUBLIC HEALTH
NURSE
Community Mental
Health Centre
NELSON & OTHER AREAS
The Mental Health Programs,
Ministry of Health, urgently requires
persons to function as members of
multi-discipline mental health team in
providing diagnostic, assessment,
treatment, consultation and
education services to the community
concerned; to conduct individual,
marital and group therapy, and liaise
with the community and allied
agencies. Registration or eligible for
registration as a Nurse in B. C. and,
preferably, a Master's Degree in
Nursing, with emphasis in
behavioural sciences and/or
community mental health; extensive
experience and skill in family and
marriage therapy.
Salary — $1 ,502 — $1 ,769/month,
depending upon qualifications.
Obtain applications from the Public
Service Commission, Valleyview
Lodge, ESSONDALE, BRITISH
COLUMBIA. VOM 1J0 and return
immediately.
COMPETITION NO. 77:451 B.
UNITED STATES
OPPORTUNITIES
FOR REGISTERED NURSES
AVAILABLE NOW
IN CALIFORNIA
FLORIDA
MISSISSIPPI
NEW ORLEANS
TEXAS
WISCONSIN
WE PLACE AND HELP YOU WITH:
STATE BOARD REGISTRATION
YOUR WORK VISA
TEMPORARY HOUSING - ETC.
A CANADIAN COUNSELLING SERVICE
Phone: (416) 449-5883 OR WRITE TO:
RECRUITING REGISTERED NURSES INC.
1200 LAWRENCE AVENUE EAST, SUITE 301,
DON MILLS, ONTARIO M3A 1C1
J^RIV
NO FEE IS CHARGED
TO APPLICANTS.
OPEN 7 DAYS A WEEK
Director of Nursing
Applications are invited for the position of
Director of Nursing in a 22-bed active
treatment hospital. The town is located on a
major highway 85 miles northwest of
Edmonton.
This position carries responsibility for the
co-ordination direction and supervision of the
activities of all nursing service departments.
Applications should be in writing including
age, qualifications and experience, with
references and date of availability.
Salary commensurate with qualifications and
experience.
Please apply to:
Administrator
Mayerthorpe General Hospital
Mayerthorpe, Alberta
TOE 1N0
Foothills Hospital, Calgary,
Alberta
Advanced Neuroiogical-
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, September
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 Canadian Nurse September 1977
"*" TitTTTTrifc
Assistant Director of
Public Health Nursing
The City of Toronto's Department of Public Health requires an
Assistant Director to aid the Director in the organization,
direction and administration of the Division of Public Health
Nursing. In addition to aiding in the administration of district
nursing services and Divisional programs, the successful
candidate will be expected to devote considerable time to
analyzing and evaluating the quality and effectiveness of the
activities and programs in the Division and recommending
changes.
Registered Nurse in the Province of Ontario, Baccalaureate
Degree from a University School of Nursing which has
included Public Health Nursing and a Master's Degree from a
University School of Nursing or School of Public Health
including administration and supervision. Salary Range
$20,207 — $25,852 per annum with full fringe benefits.
Apply in writing giving full resume of qualifications and
experience to the Personnel Department, 17th Floor,
West Tower, City Hall, Toronto, Ontario M5H 2N2.
All applications will be treated in confidence.
This position open to both women and men applicants.
OTTAWA CIVIC HOSPITAL
NURSING VACANCIES
Teaching Position: Degree required. Surgical/medical,
clinical or teaching background. Experience in a School of
Nursing or Hospital Staff Education required.
Assistant Director of Nursing Service: Evening and night
schedule. Degree required.
Nursing Care Co-ordinator: Degree required.
Medical/surgical, clinical background. Three-four years
experience.
Head Nurse: Case Room. Degree preferred, with experience
in specified area.
Please send curriculum vitae to:
Miss M. Mills, Reg. N., B. Sc. N.
Assistant Director of Nursing Service
Ottawa Civic Hospital
1053 Carling Avenue
Ottawa, Ontario
K1Y4E9
Director of Nursing
Applications are invited for this position in a modern
10-bed general hospital located in picturesque
Stewart, B. C.
The successful applicant will be responsible for the
day to day management of the hospital and prefer-
ence 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 qualifica-
tions, will be offered and accommodation is also av-
ailable.
The position is currently available and written
applications should be submitted to:
The Administrator
c/o Prince Rupert Regional Hospital
1305 Summit Avenue
Prince Rupert, British Columbia
V8J 2A6
VERNON JUBILEE HOSPITAL
Vernon, B.C.
a 258 bed acute and extended care hospital in
Okanagan Valley invites applications for the
following positions —
DAY NURSING CO-ORDINATOR
An excellent career opportunity for a qualified, innovative
individual involving responsibility for a specific Nursing
division. The applicant must have the ability to plan,
implement and assess new projects and programmes.
Must be eligible for B.C. registration. Preference to the
applicant with advanced educational, clinical and
management preparations.
IN-SERVICE EDUCATION CO-ORDINATOR
Responsibilities in this newly established position include
planning, organizing, co-ordinating and fully directing all
aspects of in-service education in the hospital.
The successful applicant should possess qualifications and
experience in education and/or hospital management.
Apply sending complete resume to:
Director of Personnel
Vernon Jubilee Hospital
Vernon, B.C.
V1T 5L2
The Canadian Nurse September 1977
S3
Make yourself at home
in Philadelphia. . .
Art. History. Good restaurants and theatre.
Universities. An active social life. They're
all here in Philadelphia. And so are we.
Temple University Hospital serves a large
urban community in the midst of the city.
It's a teaching hospital where a nurse can
really get involved. At Temple, a nurse's
life is anything but routine. And your life_
after hours? That's up to you.
So if you're looking for a place to call
home, consider Temple. We're now
offering a Nurse Internship Program for
those nurses with no more than six
months' clinical experience. It
enables you to meet your 6
month clinical requirement for
transfertoSpecialCare
Unitswhileyouareworking. ~
Get in touch with
Ms. Judy May, Temple
University Hospital, 3401 North
Broad Street, Philadelphia, Pa. 19140. (215)
221-3152. We're an equal opportunity employer.
Temple University Hospital
OPPORTUNITY Ahcjtn
Associate Director of Nursing Services
The Alberta Hospital, located 2 1/2 miles norttieast of the city of
Edmonton, seeks an experienced Individual to assume a leadership
role involving assessment, planning, organization, directing,
evaluating and making revisions to improve patient care.
Qualifications: Graduate of an approved School of Nursing and
eligibility for registration In Alberta. Baccaluareate Degree with
demonstrated leadership and administrative skills also required.
Note; Transportation from downtown Edmonton is available.
Salary up to $22,320 dependant upon qualifications presented
(Currently Under Review)
Competition #M341-15
This competition will remain
open until a suitable
candidate has been
selected.
Application forms may be obtained and should be returned to the
Personnel Director, Alberta Hospital, Box 307, Edmonton,
Alberta, T5J 2J7 or phone 973-2212.
can go a long way
...to the Canadian North in fact!
Canada's Indian and Eskimo peoples in the North
need your help. Particularly if you are a Community
Health Nurse (with public health preparation) who
can carry more than the usual burden of responsi-
bility. Hospital Nurses are needed too... there are
never enough to go around.
And challenge isn't all you'll get either — because
there are educational opportunities such as in-
service training and some financial support for
educational studies.
For further information on Nursing opportunities in
Canada's Northern Health Service, please write to:
Medical Services Branch
Department of National Health and Welfare
Ottawa. Ontario K1A0L3
Name .
Address
City
\
l«
Prov.
Health and Wellaie Sante el Bien-etre social
Canada Canada
#
The Canadian Nurse Seotember 1977
Assistant Director — Nursing Service —
Administration
An opportunity for a challenging position in nursing administration in a Teaching
Hospital, where on going efforts are made to incorporate the most effective methods
of patient care.
Applications are invited from Registered Nurses with the following qualifications;
• Masters Degree
• 5 years successful management experience
• eligible for registration with Manitotja Association of Registered Nurses
Clinical Nursing Head for Intensive Care Services
Clinical Areas include:
1) Intensive Care Medicine
2) Coronary Care
3) Cardio Vascular Thoracic Surgical Area
(Cardiac Surgery)
4) Intensive Care Surgery
The Successful Applicant will have the opportunity of providing nursing leadership
and functioning clinically in:
• Cardiac Surgery team
• Neuro-Surgery team
• Renal team
• Respiratory team
• Cardiology team
Qualifications:
1) Advanced academic preparation
2) 5 years clinical experience preferred
3) Management experience
Apply to:
Mrs. Phyllis McGrath
Director of Nursing
St. Boniface General Hospital
409 Tache Avenue
Winnipeg, Manitoba
R2H 2A6
Advertising Rates
For Ail Classified Advertising
$15.00 for 6 lines or less
$2.50 for each additional line
Rates for display advertisements on request.
Closing date for copy and cancellation is 6 weeks prior
to 1st day of publication month.
The Canadian Nurses Association does not review the
personnel policies of the hospitals and agencies
advertising in the Journal. For authentic information,
prospective applicants should apply to the Registered
Nurses' Association of the Province in which they are
interested in working.
Address correspondence to:
The Canadian Nurse
50 The Driveway
Ottawa, Ontario
K2P 1E2
4
Index to
Advertisers
September 1977
Abbott Laboratories
Cover 4
Ayerst Laboratories
46,47
The Canadian Nurse's Cap Reg'd
59
The Clinic Shoemakers
2
Connaught Laboratories Limited
32,33
Cutter (fvledical) Canada
5
Department of National Defence
58
Designer's Choice
Cover 3
Equity Medical Supply Company
4
Encyclopaedia Britannica Publications Limited 8
Flint Laboratories of Canada
51
H. J. Heinz Company of Canada Limited
54
Hoi lister Limited
10
Frank W. Homer Limited
57
Kendall Canada
56
Lowell Shoe Inc.
11
Macmillan of Canada
59
The C.V. Mosby Company Limited
52, 53
MPP Nursing Services
58
Nordic Pharmaceuticals Limited
55
Reeves Company
49
W. B. Saunders Company Canada Limited
13
Uniform Specialty
7
White Sister Uniform Inc.
Cover 2
Advertising
Gerry Kavanaugh
The Canadian Nurse
50 The Driveway
Ottawa, Ontario K2P 1 E2
Advertising Representatives
Richard P. Wilson
219 East Lancaster Avenue
Ardmore, Penna. 19003
Telephone; (215) 649-1 -^97
Gordon Tiffin
2 Tremont Crescent
Don Mills, Ontario M3B 2S1
Telephone; (416) 444-4731
Member of Canadian
Circulations Audit Board Inc.
fffnn
designer's
Designer's Choice
Uniforms as individual as you are
A. Style No. 49207 - Culotte dress. Sizes; 3-15. White, Blue: about $30.00
B. Style No. 49241 - Culotte suit. Sizes; 3-15. White, Yellow; about $33.00
Fabric; "DESIGNER'S RIB" — 100% textured Dacron" polyester warp knit
tHo e€BMBMdi€BMB
MBMmso
October 1977
ES 760 7615
58 HAKWE
OTTAW^/
White Sister...
because good clothing is an investment
A. Style No. 49588 - Pant suit.
Sizes: 3-15. "Pristine Royale"
— 100% textured polyester warp knit.
White. Cream: about $33.00.
B. Style No. 9
Sizes: 6-16. "Pi
— 100% textured polyester warp knit.
White about: $26.00.
e No. 49505 - Skirt suit.
3-15. "Pristine Royale"
— 100% textured polyester warp knit.
White, Cream: about $30.00.
White
Sister
SENIOR
HEALTH SERVICE EXECUTIVES;
CONTINUE YOUR STUDIES WHILE YOU WORK,
WITH THESE OPPORTUNITIES FOR
baGGiiidureiite
programs in
heanh services
administration
As admission criteria, degree requirements, Professor J. Nicholson
and courses vary at each educational institu- Department of Administrative Studies
tion, interested executives should write directly Atl<inson College. Yorl< University
to the following: 4700 Keele Street
Downsview. Ontario. M3J 2R7
Dr. D.Gyallay
Canadian School of Management
L-76. Learning Resources Building
50 Gould Street
Toronto, Ontario. MSB 1 E8
Professor Frank Silversides
College of Commerce
University of Saskatchewan
Saskatoon, Saskatchewan. S7N OWO
Dr. J-Y. Rivard
Directeur
Department d'Administration de la sante
Universite de Montreal
C. P. 6128 Montreal, Quebec
General information is available from: Canadian College of Health Service Executives
410 Laurier Avenue West
Ottawa, Ontario. K1R7T3
Pampes
you both
abieak
<ee|)8
Vim 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 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.
FROCTER « GAMBLE
tHo eanntMiatB
MBMmmo
October 1977
The official journal of tfie Canadian
Nurses Association publislied
monthly in French and English
editions.
Volume 73, Number 1 0
[^■BHHHI^H^HI
Input
6
Calendar
8
Things That Go Bump
in the Night
Laura Worthington
18
News
10
Glaucoma:
Awareness Prevents Blindness
Eileen French
20
Names and Faces
16
Four Score and Ten
Maude Wilkinson
26
Research
50
Anatomy of a Death
Carole Estabrooks
30
Books
51
From A to Z with
Adolescent Sexuality
Benjamin Schlesinger
34
Library Update
55
The Nursing Process:
A Tool to Individualized Care
Lorraine Hagar
38
Secondary School Nursing
May Brown
42
A Canadian Grad Goes
to the States
Katherine Zin
46
Electronic wizardry. It's part and
parcel of living in the seventies. We
have learned to co-exist with
intercoms and transistors,
microwaves and even Instabank. But
what about the life-supporting
machines that we work with every
day? Author Laura Worthington,
whose article, "Things that go bump in
the night, " begins on page 18, says a
whole new world awaits the nurse who
takes it upon herself to develop a more
informed and responsible attitude
towards the medical devices that
surround her. The electronic wizard
cum nurse on our cover is CNJ
assistant editor, Sandra LeFort.
Photoart by Studio Impact of Ottawa.
The views expressed in the articles
are those of the authors and do not
necessarily represent the policies of
the Canadian Nurses Association.
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* Canadian Nurses Association
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The Canadian Nurse October 1977
IVr.speetivc*
The basic contribution of industrial
democracy has been to reduce the
disparity between the rights of the
individual as a worker and his rights
as a citizen. (Report of the Task Force
on Industrial Relations, Ottawa, 1969,
page 97).
In Canada, the collective
bargaining process, like our legal
system, is based on the adversary
system. Differences betvi/een
management and workers are
resolved through conflict or the threat
of conflict.
In the case of organized
professional workers, the issues at
stake are far more complex than the
bare essentials of wage and fringe
benefits. Conflict, in these instances,
is more likely to center on issues
related to the protection of the
"professional role" and assurance of
conditions and standards of
"professional performance."
When these demands can be
translated into monetary terms —
such as provision for continuing
education days, for example — they
pose relatively little threat to the
relationship. It is when "professional
prerogatives ' threaten to impinge on
"management rights" that trouble
arises. When, for example, teachers
demand the right to have a voice in
determining curriculum content, how
many students will be in their
classrooms and how they will
discipline these pupils, their demands
are seen as limiting the discretionary
power of management and school
boards react accordingly.
When nurses insist on their right
to express an opinion on the number
of patients they can care for safely, or
who is qualified to perform a task such
as dispensing medications, they
encounter similarly strong employer
resistance.
IVIany professionals consider that
participation in policy decisions such
as patient workload constitutes one of
the hallmarks of professional status.
Management, on the other hand, is apt
to feel that the employer who
recognizes the right of workers to help
determine the rules that prevail in the
workplace, is giving up a little of the
prerogative that is traditionally his "to
assign the work as he sees fit."
That is why nurses in Ontario are
hailing announcement of the details of
an arbitration award affecting nurses
at IVIount Sinai HQspital in Toronto as
"a major breakthrough." At the heart
of the matter is a "professional
responsibility clause" in the
agreement that provides for the
establishment of an outside forum to
make recommendations concerning
conflicts over workload and patient
care.
The forum, or "independent
assessment committee" as it is
described in the award will consist of
three registered nurses — one chosen
by the Ontario Nurses Association,
one by the hospital and one from a
panel of four independent registered
nurses "well respected within the
profession." When a nurse feels that
she has been asked to perform more
work than is consistent with proper
patient care she is to complain in
writing to the union-management
committee.
Complaints that are not resolved
to the satisfaction of both parties by
this committee within a specified time
will be forwarded to the panel. The
expectation is that most complaints
will be settled quickly without resort to
the outside panel.
Officials of the Ontario Nurses
Association will assess the
effectiveness of the professional
responsibility clause over the next two
or three years.
In the meantime, we must agree
with them in their description of the
award as a significant step in the
direction of "recognizing the right and
responsibility of the nursing
profession at large to be involved in
assessing quality and quantity of
nursing care within a health agency."
— M.A.H.
Editor
M. Anne l-ianna
Assistant Editors
Lynda Fitzpatrick
Sandra LeFort
Editorial Assistant
Sharon Andrews
Production Assistant
Mary Lou Downes
Circulation Manager
Beryl Darling
Advertising
Gerry Kavanaugh
CNA Executive Director
Helen K. Mussallem
lllM-lMIl
The nursing process, is it all pie in
the sky? Not according to author
Lorraine Hagar. In her article startinc
on page 38, she explains the
"common sense" element of the
nursing process and demonstrates iti
application in the nursing care of
Brian, one of her young patients.
World statistics on Infant and
maternal mortality rates indicate thai
hospitals may not necessarily be th(
best or safest places to have babies
Holland, where seven out of ten
babies are born at home with
midwives in attendance, has one of'
the world's lowest infant mortality
rates. Rates in the U.S. and Canad*
are comparatively high.
Using these and other
arguments. North American
childbearing women and their
partners are questioning the
traditional hospital birth. They say the
are seeking a childbirth experience
that is both physiologically safe and!
psychologically satisfying — in sho-
a family-centered experience.
Next month, authors Alison Ric i i
and Elaine Carty of Vancouver shanj I
their observations about how four
alternative childbirth centers (ABC
in the United States are providing
safe, family-centered environment
■.r
in gynecology
for both
vaginal candidiasis
and
trichomoniasis
Vaginal Tablets
The broad spectrum approach to vaginitis
due to Candida, trichomonas or mixed infections.
fungicidal and trichomonacidal action
convenient once-a-day, 6 day therapy
for pregnant and non-pregnant women j^ dermatology
low relapse rate
no cross-resistance with other agents
no known contraindications
well tolerated
excellent patient acceptance:
non-staining, non-greasy, odourless,
rapid and complete disintegration
of vaginal tablets.
Cream/Solution
instant therapy
% for the topical treatment of
both tinea and candidiasis
% when your patient cant wait
for time-consuming culture
identification.
Canesten
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The Canadian Nurse October 1977
The Canadian Nurse invites your
letters. All correspondence is subject
to editing and must be signed,
alttiough the authors name may be
withheld on request.
Input
At home with exotic diseases
With the rising interest in Canada,
with regard to "imported" and "exotic"
diseases, some points may be useful
to Canadian nurses who might
encounter such new conditions.
Always ask a patient, "Where
have you been?' Even a few minutes
in a foreign airport is sufficient time for
a malaria- or dengue-infected
mosquito, to transmit disease to a
traveller. Pinpointing the travel area
can help to save life, in the case of the
often fatal P. falciparum, for instance,
where speed in diagnosis and
treatment is vital.
In the case of possible viral
infections, for personal safety, as well
as that of others, adequate knowledge
and practice of the "barrier"
techniques are essential. Such
techniques and practice may have to
become post-basic courses for nurses
likely to be involved in caring for such
cases. "Nursing Mirror," (G.B.), May
26, 1977, vol. 144, No. 21, pp. 13-18,
has a most informative article on the
nursing care of Marburg virus, with
first priority on "barrier" techniques,
rather than on the Trexler
negative-pressure plastic isolator with
air filtration, Tyvec suits for the health
team staff, etc.
Nurses should be aware of their
provincial "tropical disease" clinic
centers, and nursing libraries should
have available the standard textbooks
for referral. An excellent handbook for
nurses' personal libraries, is "Control
of Communicable Diseases in Man"
WHEN YOU'RE
IN OTTAWA
BE SURE TO SEE ONE OF CANADA'S FINEST
SELECTIONS OF WHITE AND COLORED
UNIFORMS
at
« KOSfbV WKifes
(THE COMPLETE UNIFORM SHOP)
Ltd.
WE ALSO CARRY:
White Shoes Slips
Hosiery Panties
Nurses Caps
Bras
BELL MEWS PLAZA, BELLS CORNERS, ONTARIO
Mrs. Catherine Buck, R.T.R. (Mgr.)
P.S. OH YES, WE ARE OPEN EVENINGS
Abram S. Berenson, M.C., Amencan
Public Health Association.
In English-speaking Canada, the
"International Health Program, "
post-basic, in Parasitology and
Infectious Diseases, will tje available
again at Seneca College of Applied
Arts and Technology. Willowdale,
Ontario, starting in September.
National Health and Welfare has
"Canada Diseases Weekly Report,"
and the U.S. Department of Health,
Education, and Welfare Center for
Disease Control "Morbidity and
Mortality Weekly Report," with both
carrying interesting accounts of
diseases abroad as well as at home. In
the global world of today, not just
public health nurses, but most nurses
may ultimately be involved with some
of the exotic diseases during their
professional careers.
P.S. Interested nurses are welcome
as members of the Division of Tropical
Medicine and International Health,
soon to be known as the "Society " of
the Canadian Public Health
Association.
— G.C. Pope, R.N., P.H.N., Toronto,
Ont.
A role for PHNs
In relation to your interview with
Shiriey Post of the Canadian Institute
of Child Health, July 1 977, 1 am deeply
concerned that she seems unaware of
the fact that public health nurses have
been and are presently directing the
major portion of their professional time
to the health needs of children. At no
point in the interview does she indicate
that she interviewed or consulted with
these valuable community wori<ers.
Was this an oversight in reporting
or an oversight in research?
— Reta McBean, Public Health
Nurse, Pembroke, Ont.
The author replies:
Thank you for giving me an
opportunity to reply to Ms.
McBean's letter. Please assure her
that in preparing the feasibility study
for the Canadian Institute of Child
Health — a numtier of public health
nurses, some medical officers of
health and the Canadian Public Health
Association were consulted.
I am aware of the important role
that public health nurses play in child
care. However I also believe that in
many communities they are
underutilized. Public health nurses
have the skills necessary to play an
even greater role in preventive healtl
care for children if given the
oppiortunity to do so.
The Institute would like to heat
from public health nurses regarding
theirrole. We'd like to knowif they feel
they are being fully utilized and if no'
what factors might be preventing then
from playing an expanded role in chil
health.
— Shirley Post. Canadian Institute o
Child Health, Ottawa, Ontario.
More funds for C. Ed.
The dilemma of mandatory
continuing education vs. voluntary
continuing education is one which
concerns every nurse and nurse
administrator, I am against
regimentation and legally forcing
people to do what they do not, really
want to do. I must therefore, presen
as being against mandatory C.E. foi
renewal of registration as is practice^
in some states. I must, though,
express my firm belief that unless
nurses remain abreast of the
continuing changes in the health care
spectrum they may not be giving '^'
client the care that he deserves.
I would like to commend Nora j
Briant for her article "What every
reasonable prudent nurse should
know" (May, 1977); and add that qui
provincial nurses' associations mu *
indicate their support for
continuing education by budgeting
larger sums of money for this area anc
generating more activity than is nr-
evidenced in some provinces. Ou-
associations must also bring press
to bear upon our provincial
governments (through our nursinc
representatives) to recognize the
need for continuing education for c.r.
health care workers, and insist on
government increasing budget
allocations for staff development
will then be incumbent on directors
nursing to make sure that nurses ge
their fair share of the budget and
participate in programs internally am
externally.
— G. Hollingsworth, director of
nursing. Provincial Hospital, Saint
John, N.B.
New family association
This letter is to introduce your
readers to the Canadian Cleft Lip and
Palate Family Association. Our
association, now one and a half years
old, is the first of its kind in Canada,
although in the U.S. there are 50
groups of this nature. Our sponsor is
the Hospital for Sick Children in
Toronto.
The initial aim of the association
is to set up a newborn program
through which parents of infants with
cleft palates will receive assistance
and information. Another aim is to
develop a resource center with
information about the cleft lip and
palate condition. It will be the
members themselves, as they assist
and learn from one another, who will
determine the ultimate form the
association will take.
We are fortunate in having
competent professional advisors for
the association who will be available
for general educational purposes.
For further information:
Elise Bossin (Mrs.), Coordinator,
Cartadian Qeft Lip and Palate Family
Association, 4981 Bathurst Street,
Apt. 215, Wiliowdale, Ont. M2R IY5.
Lost and found
The 1941 graduating class of
Newartc Beth Israel hospital in the
United States included at least one
Canadian nurse. Now that I am in
Canada, I would appreciate renewing
contact with some of these
classmates who are probably readers
of this journal.
— Pearl (Koweek) Newton, associate
professor, Dalhousie University
school of nursing, Halifax, N.S.
Moving, being married?
Be sure to notify us in advance.
^
Attach label from
\. your last issue or
•''^ copy address and
code number from it here
New (Name)/Address
Street
City
Prov./State
Postal Code/Zip
Please complete appropriate category
2 I hold active membership in provincial nurses assoc.
reg. no. /perm. cert. /lie. no.
" I am a personal subscriber
tVlail to: The Canadian Nurse, 50 The Driveway. Ottawa K2P 1E2
you
hate to
change
dressings,
change to . . .
Effective wound care without the bother
of absorbent dressings.
The Hollister Draining-Wound Management Sys-
tem lets you:
Examine the wound in seconds by looking right
through the odor-barrier, fluid-barrier transparent
film.
Treat the wound by removing just the Access Cap.
Assess and measure exudate without removing
anything from the patient.
This unique alternative to absorbent dressings is
ideal for any wound where drainage is expected.
For a welcome change from dressing changes, try
the Hollister Draining-Wound Management System.
Write today for free evaluation samples. You ve got
to see through it to believe it!
HolllSTGR
Hollister Incorporated. 21 1 East Chicago Ave Chicago. Illinois 6061 1
Distributed in Canada by Hollister Limited. Wiliowdale. Ontario M2J 1 P8
: Copynght 1977 Hollister Incorporated All Rights Reserved
The Canadian Nurse October 1977
Correction
Calendar
Order of Nurses of Quebec Annual I
Meeting will be held on Nov. 9-10,
1977 at the Quebec Municipal
Convention Centre. Quebec City not
in Montreal as previously printed.
Contact: Order of Nurses of Quebec,
4200 Dorchester Blvd. West,
Montreal, Quebec.
November
Canadian Intravenous Nurses
Association 2nd Annual
Convention to be held in Toronto,
Ontario at Inn on the Park Hotel —
November 23-24th, 1977. Contact:
C.I.N. A. - Box 481, Station Z, Toronto,
Ontario, /W5A/ 226.
Parent to Infant Attachment:
Strengthening the Family in the
Perinatal Period. A four-day
conference to be held on Nov. 6-9,
1977 at the Bond Court Hotel in
Cleveland, Ohio. Sponsored by the
Rainbow Babies' and Children's
Hospital. Contact: Marilyn Griffitti,
Assistant Director, Public Relations
Dept., Rainbow Babies' and
Children's Hospital, 2101 Adelbert
Rd., Cleveland, Ohio, 44106.
Conducting Performance Reviews
— a two-day program for health care
professionals who are expected to
review the performance of others.
Techniques to use in conducting the
actual interviews will be presented
with concrete examples. To be held in
Toronto on Nov. 14-15, 1977. Tuition:
$120. (Tax deductible). Contact:fl.M.
Brown Consultants, 1115-1701
Kilborn Ave., Ottawa, Ontario,
K1H 6M8.
One-day seminars for helping
professionals to be held at
Ashtonbee Conference Centre,
Scarborough, Ontario. Speaker:
Jackie Barber, R.N., B.Sc.N., MEd.
Power and conflict in the professional
work setting on Oct. 20; Group
dynamics and leadership on Oct. 27
Supervision and discipline on Nov. 3
The helping relationship on Nov. 10
Evaluating staff on Nov. 17: Working
with families on Nov. 24.
Contact: Roy Del Bianco,
Co-ordinator, Conferences and
Seminars. Centennial College,
Continuing Education Division,
Ashtonbee Conference Centre, 651
Warden Ave., Scarborough, Ont,
MIL 3Z6.
Ontario Nurses Association Annual I
Meeting to be held Nov. 16-18, 1977
at the Constellation Hotel In Toronto.
Contact: Rita Kohan, Administrative
Assistant, Ontario Nurses
Association, Suite 1401, 415 Yonge
Street, Toronto, Ontario, MSB 2E7.
Conjoint Meeting on Infectious
Diseases to be held at the Chateau
Laurier Hotel, Ottawa, Ontario on Nov.
23-25. Sponsored by the Tropical
Medicine and International Health
Laboratory Divisions of the Canadian i
Public Health Association. Contact:
Dr. P. F. Stuart, Dept of Microbiology,
Toronto General Hospital, Room 215,
100 College Street, Toronto, M5G IL5.
WHEREAS the Canadian Nurses Association will hold
its biennial convention in Toronto in 1978
WHEREAS the Registered Nurses' Association of
Ontario is preparing to roll out the red carpet;
WHEREAS Toronto offers a wealth of professional and
social opportunities;
THEREFORE BE IT RESOLVED to attend the CNA
Convention in Toronto from June 25 to 28, 1978.
8o;-
o « ^
S 2 c
A good move for cholesteiol
concerned patients.^
•••
is to Fleischmann's Margarine and Egg Beaters.
Egg Beaters, the anti-cholesterol
eggs.
The average large egg contains 275 mg
of cholesterol. It's the single highest source
of cholesterol in man's diet. By replacing
egg yolks with corn oil and a vitamin/
mineral fortified nutrient, we've reduced
the cholesterol content of eggs by 98%. Yet
Egg Beaters look, cook and taste like fresh
farm eggs. They're versatile and delicious.
Egg Beaters. Even cholesterol patients
can eat them every day. . ..^^^
In your grocer's freezer ^T^Z^^"^
Special give-aways to help
your patients.
Please send me at no extra charge:
4/y
. Eng. copies .
Tell your patients about
polyunsaturates.
Because Fleischmann's Margarine is made
from 100% corn oil, it has a very high poly-
unsaturate level— 40%, and only 18% saturates.
A very sensible choice for patients writh
cholesterol problems. Incidentally, when you
recommend Fleischmann's for its health
benefits, they'll thank you for the
taste! Fleischmann's. We make all
our margarine with 100% corn oil.
Name:
"Cooking with Egg Beaters"
copies
Eng. copies .
Fr.
Address:
City:
Postal
. Code: .
"Cholesterol, Calorie,
Sodium Calculator"
copies
Province:
CN-77-10
Fleischmann's, Consumer Service Division, The Business Center, Toronto Eaton Center,
P.O. Box 504, Suite 104, 220 Yonge Street, Toronto, Ontario, MSB 2H1
The Canadian Nurse October 1 977
News
World Federation for Mental Health
draws 2100 concerned professionals
The stigma attached to mental illness should be a first priority tor those
working with the mentally ill. for it is negative public attitudes that are holding
back progress in the field, says Rosalynn Carter, wife of United States'
President Jimmy Carter.
"This self-feeding cycle of fear, discrimination and lack of understanding
about mental illness is more than a vague uneasiness we detect from time to
time. It is a very real and troubling fact," she told delegates to the 1977
Congress of the World Federation for Mental Health in Vancouver in
mid-August.
Carter was speaking during a special
session for the more than 2,100
registrants, including 350 nurses,
from 44 nations. Her message
summed up much of the five days of
sessions, lectures, debate and
workshops that were to determine as
the Congress theme put it, "Today's
Priorities in Mental Health "
"The data our Commission has
gathered show that the public
continues to be repelled by the notion
of mental illness — although it is
becoming less socially acceptable to
say so, " Carter said. Even when
patients manage to overcome their
fears and shame and finally seek
professional help, there are still
attitudes that need to be scrutinized;
patients often run into as much fear
and prejudice from professional
workers as from the general public.
"We need to try to create a national
commitment, a national attitude, a
national climate for the proper care
and treatment of the mentally ill," she
said.
Another highlight of the
week-long convention that drew
together psychiatrists, social workers,
psychologists, teachers, mental
health volunteers and nurses was a
debate between Ivan lllich, author of
"Limits to Medicine: Medical
Nemesis, and Morris Carstairs,
vice-chancellor of the University of
York, England, on the role of
professionals in today's society.
lllich repeated his thesis that
professionals have become too strong
through their organizations and now
completely dominate individuals who
have had to surrender all
responsibility for their own health.
He accused the professions of
being "disabling" rather than
"enabling." or helping, because they
create dependence. The professions
jealously guard their body of
knowledge, shrouding it in almost
religious trappings so individuals
cannot understand the facts on which
care is based.
Carstairs replied that many of
lllich "s ideas were so "safely Utopian
there is little possibility of their being
put into effect." He denied that the
medical establishment is trying to take
over, but agreed that individuals ought
to assume more responsibility for their
care when it is within their power to do
so.
Also drawing a large crowd at a
main session was
anthropologist/author, Margaret
Mead, who questioned Western
attitudes towards leisure and
retirement. Westerners seem to
believe that leisure exists merely to
refresh people so they can work
harder the next day or the next week,
she said disdainfully. She also
scorned the idea of mandatory
retirement, saying retirement can kill.
"All the evidence we have at
present is that stopping abruptly what
we"re doing and, equally, imposing
non-participation on children and
adolescents and keeping people out
of the working world, is one of the most
disastrous things we can do to them."
Chairman Dr. Milton Miller (left) and president Dr. Tsung-yi Lin of the WFMH,
are pictured during recent Congress. Both are from Vancouver.
(Photos by Kent)
Fitness Minister lona Campagnolo
addresses participants in "Health by
the People'" meeting.
Opening speaker at the Congress
was lona Campagnolo, Canada's
Secretary of State responsible for
fitness and amateur sport. She spoke
of the value of physical exercise to
comtiat stress and anxiety, referring to
activity as "natures tranquilizer," and
adding that Hans Selye, the father of
the theories related to stress, advises
physical activity as one of the most
effective ways of channeling and
balancing stress.
Campagnolo noted that a
sub-theme of the Congress was
"Health by the People," with its
attendant emphasis on prevention
and individual responsibility for ones
own well-being. She urged Canadians
to be their own fitness planners and
"achieve an extra measure of pride
and satisfaction in addition to those
physical and mental benefits. "
Many of the papers presented at I
the wori<shop sessions were given by
nurses, including some of the
research papers. Joan Anderson of
the faculty of nursing at the University
of British Columbia reported on her
recent study that showed nursing
students are more negative than
professionals in their predictions
about the futures of psychiatric
patients. She said students depend on
and are influenced by diagnostic
labels. However, if the diagnosis is
concealed, the students are more
positive and tend to use their
observations more wisely. If the
diagnostic label is present, the
students rely less on observation.
However, they are more positive
toward the prognosis than if no
diagnosis is given for the patient.
Anderson sees the study as having
implications for education of nursing
students, saying, ""There needs to be
emphasis on observation of behavior
and on arriving at conclusions from
direct obsen/ations rather than from
the diagnostic label alone "
—Glennis Ziirr
Special isolation unit
A two-day meeting of federal and
provincial Health Ministers in Ottaw;
was told of a plan for a three-level
approach to handling persons who
enter Canada with dangerous
communicable diseases. The
national plan would consist of three
lines of defence:
a) stretcher-type plastic isolators to b€
maintained in selected international
airports in Canada
b) bed-type isolators to be stationed ir
strategic hospitals under provincial |
auspices at major centers in Canada'
c) a central facility to provide a fully I
secure environment. j
Health Minister Marc Lalonde said the
the special isolation unit, costing
approximately $3 million will be built ir
Ottawa. The unit, comprising six beds
would be as impenetrable "as the
Bank of Canada and would ensure the
disease would not spread. "
The three lines of defence are t
be linked by highly skilled medical
evacuation Canadian armed forces
personnel using a transit isolator anc
armed forces aircraft.
uciouer iv/f
VON appoints
financial adviser
The Victorian Order of Nurses for
Canada Is well on its way to
Implementing the nine
recommendations made by Edward A.
Picl<erlng In his study of the future role
of the VON. In his 1976 report 'ACase
for the VON In Home Care,"
Pickerings suggestions included,
among others, that organizational
changes were needed, such as
adding a business executive to the
national office staff and making a
professional study of budgeting and
cost accounting.
In light of these
recommendations, the VON are
making changes at the national,
provincial and local levels, says
Lorette Sutton, assistant director at
VON National Office. "Since more and
more of our funding now comes from
government agencies, the VON is
working towards Improving Its
methods of budgeting, to correspond
with government expectations." A
professional study on budgeting and
cost accounting has already been
completed In the province of Ontario,
she said.
In August, VON president R.G.
Smethurst of Winnipeg announced
the appointment of Bruce Daubney of
Ottawa as an advisor In the field of
financifel administration and liaison
with governments concerning
'nanclal arrangements for services
provided by the VON.
Daubney is a past president of
Computing Devices Company and
also has had an extensive career with
the Ford Motor Company of Canada.
Health happenings
in the news
Dr. Blair Fearon of The Sick Children's
Hospital in Toronto has removed the
tonsils of four patients using a burst of
light from a laser rather than scissors
and knife. The procedure which
destroys tissue by burning and
vaporization takes about twice as long
as conventional surgery — one
reason why the laser tonsillectomy will
be limited to cases where blood loss Is
a problem. The lasers accuracy
makes it possible to treat other
conditions such as narrowing of the
windpipe.
Dr. Fearon said that the four
tonsillectomy patients suffered much
less and nurses were amazed at the
speed of recovery.
The major findings of the Nutrition
Canada Dental Report of Health and
Welfare Canada show that:
• Dental caries is the leading cause
of tooth loss in persons under 35 years
of age. Ninety-six per cent of adults
over 1 9 years of age had dental caries.
• The percentage of children aged
12-14 years with good teeth, i.e. zero
DMF teeth (DMF Is the number of
decayed, missing and filled
permanent teeth) appeared to be
unrelated to Income.
• Periodontal disease ( a disease of
the tissues which support the teeth
firmly In the jaws) Is the main cause of
tooth loss in persons over 30 years of
age. About 15 per cent of the adult
population had obvious "pockets" of
periodontal disease, a condition which
was generally worse in men than
women.
• Approximately 40 percent of
adults aged 1 9 years and over had no
teeth in one or both dental arches.
• A consistent beneficial effect of
fluoridation in reducing the prevalence
of dental caries was observed in
children under 1 1 years of age.
• Thirty-nine per cent of children
aged 12-14 were observed to have a
malocclusion (a deviation from the
normal, accepted manner in which the
teeth of the upper jaw fit with those of
the lower jaw). Thirteen per cent
showed a serious need for treatment
and one per cent an urgent need.
Respiratory nurses
seek CNA affiliation
The Canadian Nurses Association
could have its second affiliate member
within a matter of months. The
Canadian Nurses' Respiratory
Society has announced that It will seek
affiliation with the national
organization that now represents
117,206 nurses in this country.
Last Spring, CNA directors
approved an application from the
Canadian Association of Neurological
and Neurosurgical Nurses for affiliate
membership In CNA.
Announcement of the CNRS
decision was made following the
annual meeting of the Canadian Lung
Association (formeriy the Canadian
Tuberculosis and Respiratory
Disease Association) In Moncton,
N.B.
At the same meeting, the nurses
section of the association announced
that it was changing its name from tfie
Nurses Section of the Canadian
Tutierculosis and Respiratory
Disease Association to the Canadian
Nurses' Respiratory Society. A
committee has t)een formed to select
a suitable French equivalent.
U. of Victoria
focuses on elderly
The newly established school of
nursing at the University of Victoria in
Victoria, B.C. is pksneering a health
ph llosophy to ease the problems of old
age.
In an interview with the Canadian
Press, the director of the school,
Isatiel McRae stated that by the year
2000. one-quarter of the population
will be older than 55 and the old
nursing philosophy which emphasized
care of the acutely sick will no longer
be adequate.
"Our program is based on the klea
that nurses are not junior doctors, but
personnel trained: to help people
maintain good health; to help patients
tolerate the experience of ill health;
and to hel p them live as satisfying lives
as possible within the constraints of
their dysfunction," she said.
McRae said that one reason that
the university nursing school is able to
focus on gerontology is that it is a
post-graduate institution and not tied
down to preparing nurses to write
registration exams. Opened in 1976, it
offers a two-year program leading to a
bachelor of science degree In nursing.
AARN allocates $36,000
to continuing education
The Alberta Association of Registered
Nurses has announced the award of
two educational scholarships as part
of the association s S36,000 annual
allocation for continuing education.
The Atie Miller Memorial and the
Helen M. Sabin Scholarships are each
awarded annually In the amount of
S2.000 to assist members to continue
graduate study of not less than one
academic year.
This year, the Abe Miller
Memorial Scholarship was won by
Rhea Arcand. section head of the Post
R.N. Nursing Program at Grant
MacEwan Community College.
Arcand has enrolled in the Master's in
Nursing Program at the University of
Alberta.
Karen Mills, assistant director of
nursing, Edmonton Local Board of
Health, was the winner ofthe Helen M.
Sabin Scholarship. She will enter the
Master's In Health Services
Administration Program at the
University of Alberta.
The A. A. R.N. also has an
Educational Loan Fund available to
assist members enrolled in graduate
programs. This year 21 members of
the A.A.R.N. have been allocated
loans totalling $20,000 to assist them
in pursuing baccalaureate and
master's programs.
To complete the budgetary
allocation In support of continuing
education, the A.A.R.N. contributes
annually In excess of Si 2.000 to the
Canadian Nurses Foundation which
exists to assist nurses in educational
endeavors by providing scholarships
bursaries and fellowships.
mo
Nature gives it. "^iw^ll^^Jl
Zincof ax* keeps it that way.
After every bath, every diaper change and in between,
soothing Zincofax protects baby's nature-smooth skin.
Protects against chafing and diaper rash, against irritation
and soap-and-water overdry.
But Zincofax isn't just for delicate baby skin. It's for
you and your entire family — to soothe, smooth and
moisturize hands, legs and bodies all over.
What's more, Zincofax is economical, even more
important now with a new baby at home.
keeps a family's
smooth skin smooth
2inco¥
Contains Anhydrous Lanolin and 15% Zinc Oxide.
Available in 10 and 50 g tubes and 1 15 g and 450 g jars.
fe
Burroughs Wellcome Ltd.
LaSalle, Que.
Xcws
CNA supports Bottle holders banned
special Interest groups by federal officials
In March 1 977, CNA directors adopted
preliminary guidelines for the support
of "emerging" special interest groups
in nursing. The board of directors was
acting in response to a resolution
passed at the 1976 biennial
convention, that called for the national
association to actively encourage the
establishment and development of
additional special interest groups in
nursing and to be prepared to offer
financial assistance to such groups for
organizational purposes and up to two
years of operation.
In the past, CNA has provided
support in various ways to emerging
nursing groups of a national nature.
Now, however, they have established
I specific guidelines that will provide
special interest groups with moral and
financial assistance. These
preliminary guidelines are:
1. Advice from CNA will still be
available, as CNA resources permit,
but no financial assistance will be
given to "established" organizations.
2. "Emerging" nursing special interest
groups must meet the following criteria:
a) their organizers and potential
members must be members of CNA
b) there must be a tentative statement
of the proposed purpose and
objectives of the interest group and
these must be compatible with CNA
purposes and objectives before
funding assistance is considered
0) there should t)e at least one contact
person designated in each
province/territory before any funding
assistance is considered
d) normally, not more than $500. will
be given to any one group in their first
year of operation; and normally any
further financial assistance would be
limited to a $500 allotment in their
second year of operation
e) any financial assistance beyondfhe
first $500 would be contingent upon
the groups' having been incorporated.
3. Any group receiving financial
assistance must provide a yearly
report to CNA.
Nurses involved in forming
national special interest groups are
irtvlted to apply for assistance by
contacting: Executive Director,
! Ttie Canadian Nurses Association,
50 The Driveway,
Ottawa, Canada, K2P 1E2.
A federal ban on mechanical devices
for propping infant feeding bottles
went into effect late this Summer.
Consumer and Corporate Affairs
Minister Tony Abbott, who issued the
warning, explained:
"While no deaths have been reported
from the use of these devices, we are
issuing the ban as a purely preventive
measure based on suggestions of
possible dangers to Canadian infants
by representatives of the medical and
nursing professions."
Directors of the Canadian Nurses
Association, in response to a
complaint from a member of the
Manitoba Association of Registered
Nurses, passed a motion in April 1 975
recommending that the threat posed
by these devices be brought to the
attention of the appropriate
authorities. The correspondence that
followed involved the Consumers
Association of Canada,
manufacturers, retailers and federal
officials.
In their letters, CNA directors
pointed out that "If a child is being
prop-fed' without supervision,
regurgitated food may be drawn into
the lungs and pneumonia could result.
In an extreme situation, the infant's
breathing could be cut off, resulting in
death."
Did you l(now ...
Dr. Bruce Bistrian of Boston told the
Canadian Medical Association annual
meeting in Quebec that one-tliird to
one-half of the patients in acute care
hospitals will be malnourished. He
stated that acutely ill people need
double the usual amount of protein
and 25% more calories than usual. He
suggested that patients should have a
"beefed up" version of the instant
breakfast kind of food to sip at all day.
Did you Imow ...
Pediatric dentists say that children up
to the age of 4 or 5 years do not have
the necessary hand skills to clean their
teeth thoroughly. Dentists suggested
that an adult help the child brush his
teeth at least once a day. Dentists
were meeting at a conference on
dental health in Toronto in April.
Hemophiliacs studied
A comprehensive study of the
Canadian hemophiliac is currently
being directed by Dr. Martin Inwood, a
clinical hematologist and chairman of
the Medical and Scientific Advisory
Committee for the Canadian
Hemophilia Society. With $90,000 in
grants from federal, provincial and
private sources, Dr. Inwood, assistant
professor at the University of Western
Ontario, tjegan working on a census of
the estimated 2,400 hemophiliacs in
Canada in the early summer.
The survey of hemophiliacs is
only one of several projects of the
Advisory Committee of the Canadian
Hemophilia Society. Plans are now
underway for a central data bank.
Anonymous data will be compiled at a
central registry to provide up-to-date
social, economic and medical
information on hemophilia to be used
by researchers.
Plans are also being made forthe
establishment of comprehensive
hemophilia assessment centers at all
Canadian medical schools. Dr.
Inwood descritjes the proposed
facilities as "centers of excellence "
which would provide complete
information atwut the rare blood
concStion and would offer assessment
and treatment on a comprehensive
basis.
Each of the centers across
Canada would offer a multidisdplinary
approach to assessment and
treatment and would employ the
services of a nurse, physiotherapist,
physician, surgeon, social worker and
psychiatrist. Once a patient's
problems have been identified, he
could then be treated by the
appropriate health care professional.
Dr. Inwood said the development
of new treatments, wider use of
genetic counseling and creation of the
"centers of excellence" will shift the
emphasis to a more preventive
approach. He also stated that a
comprehensive social survey of
hemophiliacs will be undertciken by his
committee in the future so that "we
can come up with a definite profile of
what the Canadian hemophiliac is
like."
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STETHOSCOPES
DUAL HEAD (LITTMANN TYPE)
in 6 oretiii coiou's Eiceptioftai
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iiflht*e'oni omau'ais Has 001"
cjiao'i'agm and Po'd i»pe ^^
With non-Chill ring Cc-^ f- ,
wnn spare dtaphragm afic ea- j
pieces Cnoose reo. Diue i-ee- J
Silver (with Dfack tubing), goic "
gray No 110 S17.t5 MCh.
SINGLE HEAD TYPE As aPOve
but wiithoul Dell Same large
diaphragm for high serfsiliv ~
No 100 tlt.»« -
PHYGMOMANOMETERS
5,sre^
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NOTE; WE SERVICE AND
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ABOVE ITEMS
OTOSCOPE SET One of
Germany s t>nest instruments
iceptiOAai (Hum.nat'on power-
'u. magnifying lers 3 sianaaia
s:;e specula Sae C Datteries
.rxiuOea Metal carrying case
iirie<] wiin so*t ctoih No 309
S69.«SMch
STER BANDAGE SCISSORS
m.js; for every Nurse V^
ciurea ot tinesi sieei ano
Tished in sanitary chrome
ENAMELLED PINS Beaulifun,
Oesigned to sho* you' pro'es
ii status Jewei'y quality ii-
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ciasp No 101 RN *i;r
LiL-cewSOfNo 129 Nurses
A.de Si1.49each
NURSES EARRINGS For pierced
ears Dair^iy CaduceuS m gold
plate wnn gold Mied posts
Beaui-'ui', gift Ooied No 325
Sn 49 . pt
NURSES CAP TACS Gca
tea H&;a5 your cap si'ipe
f.rmly in place Non-twiSt
edture No 30i RN" wilfi
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Caduceus $3.95 ' pf.
DELUXE CAP TOTE Auh
shoulder sfap 'or easy carrying
of caps etc Beautifully and
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:;ens scissors etc plus
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*e can Piastahide No 505
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NURSES WHITE CAP CLIPS. Made if. Canada tor
Canadian Nurses St'ono steel Booty Pms with Nylon
lips 3 s>2e t1.2S/ card ol 15. 2 sm S1.M/ can) ot 12
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NURSES 4 COLOUR PEN for reco'dmg temperature,
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The Canadian Nurse October 1977
Nmv.s
CNA rep attends
world food symposium
A recent symposium on Canada and
World Food was told that there are
tragic effects on infant mortality
because of the move away from
breast feeding in developing
countries.
N.S. Scrimshaw of the
Department of Nutrition and Food
Science, Massachusetts Institute of
Technology, was speaking to 170
agrologists, economists and others
interested in the problem of world food
at a three-day meeting in Ottawa. The
Canadian Nurses Association was
represented at the meeting by
research officer Marion Kerr.
Symposium participants presented
papers on population, health, food
production and processing, research,
engineering, economics, the political
and the social sciences.
Scrimshaw also stated that an
often neglected aspect of the world
hunger problem is the large
post-harvest losses of food to rodents,
insects, molds, simple spoilage and
inefficient processing procedures.
"Yet most food-deficit countries
could be self-sufficient or even food
exporters if proper storage of grains
were assured, if processing were
more efficient and if spoilage of fruits
and vegetables and fish were
reduced," he said.
Another speaker, Helen Abell,
consultant in socioeconomic
development, said in her paper "The
Forgotten Familiars and World
Health" that the grass roots expressed
needs of people in the Carribean,
Africa and Indo-China are, in order of
importance: drinkable water; basic
tools; cooking fuel; midwives from
their own district: and eradication of
communicable diseases.
Other speakers at the conference
pointed out that;
• Canada has very high food
production costs and that there is a
serious deterioration in Canada's
agriculture-food industry;
• Canada should encourage third
world countries to give agricultural
development a high priority in their
own domestic spending;
• there are no local agricultural
training programs and no training
abroad programs for women in third
world countries.
Central registry for
community nursing
Acentral registry forthose applying for
community health nursing positions in
Alberta has recently been established
by the Nursing Branch of the Division
of Local Health, Alberta. Individual
nurses enquiring about positions will
be asked to complete an application
form that includes geographical
preference and availability status.
Local health authorities with vacant
positions will be sent completed
applications and will remain
responsible for screening,
interviewing and selecting nurses.
Enquiries may be made to:
Registry for Community Health,
Nursing Applicants,
Office of the Senior Nurse Consultant,
Local Health Sen/ices,
4th Floor Administration Building,
109 St and 98 Ave..
Edmonton, Alberta, T5K 0C8.
Health happenings
A Health Day, with free checkups and
demonstrations, attracted a sellout
crowd of 200 senior citizens in
downtown Toronto last month. The
all-day clinic marked the conclusion of
an "Aging Successfully" program
conducted by St. Christopher House
Older Adult Centre for residents of the
community, including many
Portuguese and Chinese-speaking
people.
Program director Marcelle Abou
Assaly said that planners emphasized
the need for preventive care. She
pointed out that many residents of the
area are immigrants who have never
become Canadian citizens and may
not be eligible for financial assistance
available to others. "Proper dental
care and care of the feet," she said,
"are the great needs of the elderly."
Twenty-four of those who
attended the clinic had a podiatrist do
their feet. Twenty-five of 29 who had
dental checkups were found to have
dental problems. Fifteen persons with
defective vision were found among the
67 who came for eye tests; six of the
77 who had their lungs checked had
lung trouble; 20 of 55 checked for
arthritis were found to be affected by it ;
1 7 of the 54 checked for diabetes were
found to have the disease.
A Yale psychologist warns that once a
person becomes overweight he is
likely to become "highly, sometimes
uncontrollably responsive to external
food-relevant stimuli."
Dr. Judith Rodin told members of
the American Psychological
Association attending their annual
meeting recently that ovenweight
people have an increased tendency to
secrete insulin when they are
stimulated by the sights and smells of
food. Insulin, a hormone produced in
the pancreas, leads to increased
hunger and eating and promotes the
storage of fat in the body. Obesity, she
said, makes one less active and more
unhappy because society
discriminates against the overweight,
and more likely to overeat in response
to situations that produce
anxiousness or arousal.
Moreover, said Dr. Rodin, the
overweight person tends to try diet
afterdiet, but once his self-discipline is
momentarily weakened, the diet
collapses in an overeating spree. She
cast doubt on the theory that fat
people are genetically destined to be
fat, and said the research shows that
overweight is primarily a result of
lifestyle, helped along by what she
called a national preoccupation with
eating.
Dr. Rodin said the fight against
obesity has become a
$10-billion-a-year industry in the
United States, "and yet the record of
success in losing and keeping off
weight is abysmally poor. '
In the search for the secrets of long
life, the Soviet Institute of Gerontology
found that "work is an invaluable
remedy against premature old age." A
Pravda article which cited the effects
of "pension illness" — the quick
deterioration suffered by old people
when they retire — stated that "Old
age is not a time to be sedentary, but
to be active." Soviet gerontologists
also recommended getting married,
having children, living in high places,
eating moderately, drinking well water
and talking a lot."
The Soviet Union claims to have
19,304 centenarians as of the 1970
census or 8 per 100,000 population
compared to 1.5 per 100,000 in the
United States.
The U.S. Bureau of the Census has
identified some of the changing
patterns of marriage and family
living in our neighbor to the South,
among them:
• The number of unmarried
persons living with someone of the
opposite sex doubled between 1970
and 1976.
• In the same period, the proportion
of the population aged 25 to 29 who
had never married increased
substantially from 19.1 percent to 24.9
percent among men and from 10.5
percent to 14.8 percent among
women.
• The divorce rate more than
doubled between 1963 and 1975,
from 2.3 percent per 1 ,999 population
to 4.8.
• Of every 1 ,000 married persons
in 1976, 75 had been previously
married and divorced ; in 1 960 the ratio
was 35 in 1,000.
Did you know ...
The originator of "Anstie's Alcohol
Limit" was a physician-
scientist-reformer named Francis
E. Anstie who died more than 100
years ago in London, England.
His dictum concerning the daily
amount of alcohol that an individual
can consume without risk of
deterioration of health is still cited in
Dorland's 25th Medical Dictionary as a
rule used in connection with life
insurance examinations: "the
maximum amount of absolute alcohol
taken daily without injury is 1 1/2
ounces, equivalent to about 3 ounces
of hard liquor, a pint of light wine, or 24
ounces of bottled beer or ale.
Although Anstie's name is best
remembered for his pronouncement
on moderation, he was recognized
during his lifetime as a tireless leader
in the public health field who was
responsible for many progressive
measures connected with medical
and nursing care in workhouse
infirmaries and urban renewal.
When he died of septicemia at the
age of 41, Florence Nightingale
predicted; "Many will fall victims to the
want of (pursuing) the public health
measures of which he was such a
devoted supporter."
mETamuciL
Comfortable relief. Naturally
FOR
-lemDRRHDID
PRone pariEnrs
Many hemorrhoid-prone patients
require a laxative to encourage
relief from constipation. Trust
Metamucil to provide just thiot for
some very good reasons:
• Metamucil is made from grain,
not chiemical stimulants, oils or
salines to provide soft, fully
formed stools
• Metamucil promotes regular
Powel function, ptiysiologically,
wittiout straining, cramping
or irritation
• Metamucil W\\\ not cause
laxative dependency or loss of
bowel tone
• Metamucil provides thie bulk
lacking in many diets
Available as Metamucil powder,
low in sodium for your geriatric and
cardiac patients; and lemon-lime
flavoured Metamucil Instant Mix,
low in calories for diabetics or
ttiose patients wtiose carbohiydrate
intake is restricted.
The dosage can be
individually regulated.
For short or long term
treatment and successful
bowel management,
trust Metamucil for all
kinds of patients.
The laxative most
recommended by
physicians.
SEARLE
Searle Ptiarmaceuticals
Oakvllle, Ontario
Il6H1M5
16
The Canadian Nurse October 1977
Raines and Faces
CNJ talks to
Suzanne M. Gouthreau
"Nurses must decipher which
problems concern nursing and which
do not; then they must learn to say
"no." So says Suzanne M. Gouthreau
of R.M. Brown Consultants, Ottawa.
Along with her associate Ron Brown,
Sue develops and presents a series of
seminars to health care personnel in
management positions covering such
topics as management functions, time
management, leadership style,
motivation, and inter-personal
relationships. The lively conferences
are presented all across Canada at
various times during the year in both
English and French.
Sue completed her basic nursing
education at the University of Ottawa
School of Nursing, Ottawa General
Hospital. She then went on to obtain
her B.Sc.N.Ed. at the University of
Ottawa in 1 967. She has also
engaged in graduate work in the
Department of Business
Administration at the University of
Minnesota. During her experience as
a head nurse in pediatrics and as an
inservice education coordinator in a
600-bed acute care hospital, she saw
the need for management courses for
nurses.
"The role of the nursing manager
has changed tremendously in the last
ten years. Today they are given much
greater responsibilities and they
require more knowledge in such areas
as finances, systems engineering,
staffing, personnel selection and
performance review. Traditionally,
most professionals selected to fill
management positions are the best
practitioners in their field but may not
necessarily be adequately prepared to
deal with the growing complexities of
health care organizations. The
nursing manager of the present must
have a strong and a positive
self-image. She must be aggressive
when necessary (yes, it is
permissible) even if this role runs
counter to earlier cultural and
professional training. She must be a
risk-taker and must know how to deal
with conflict tactfully and from a
position of strength. Being aware of
the power bases within the
organization and knowing the "jargon"
of the business world can be a great
asset to her in competing with others
for the limited resources available."
Sue explained that almost all
managers who attend the seminars
are already practising their own set of
management strategies. The
seminars strive to provide the
language of management, to reinforce
present management practices and to
provide alternative strategies that may
be used in handling various
management situations. She stressed
that there is no such thing as the
"cookbook" approach to
management: there are no easy
answers. Decisions must be made
and there is never 100% gain. There
are always some negative
consequences. The critical factor in
solving problems is in the climate of
the organization — if relationships are
open and if people talk to each other,
they are half-way there.
Margery Furnell, (R.N., University of
Alberta Hospital; B.Sc.N., University
of Alberta; M.S.N. , University of British
Columbia) has joined Alberta Social
Services and Community Health,
Division of Local Health Services as a
provincial nurse consultant. She will
be located in Calgary as the first
nursing consultant to be decentralized
from the provincial office in Edmonton.
Furnell also holds a joint appointment
with the University of Calgary as an
assistant professor.
Furnell most recently was an
assistant professor at the University of
British Columbia. She has had
experience in teaching and
community health in Alberta as well as
working with the V.O.N, and in Home
Care in Ontario.
Marilyn L. Carmack has been
appointed assistant executive director
of the Registered Nurses Association
of British Columbia effective January
1 , 1 978. She will serve in this position
until the following September when
she becomes executive director.
Before joining the RNABC staff as
employment referral director in 1974,
Carmack was director of nursing at
River view Hospital, Coquitlam. Her
background includes inservice
nursing education and psychiatric,
surgical and general duty nursing. She
is a graduate of the Calgary General
Hospital School of Nursing, holds
certificates in psychiatric and public
health nursing, and earned a B.Sc.
degree in nursing from the University
of Washington at Seattle.
Carmack will succeed Nan
Kennedy of Vancouver who retires
next fall after eight years as RNABC
executive director.
Michael Samuel Phillips has been
appointed deputy director-
administration of the newly formed
Metropolitan Toronto Forensic
Service, a pilot project of the
government of Ontario. The service
was established to provide psychiatric
assessment services for those
appearing in court who may be
identified as having serious
psychiatric and emotional problems.
Phillips received his nursing
diploma at the University of the West
Indies, Port of Spain General Hospital,
a B.Sc.N. at the University of Toronto,
and a diploma in hospital and health
care administration from the
University of Saskatchewan.
Previously, Phillips was administrative
nursing supervisor at the Clarke
Institute of Psychiatry in Toronto.
New Appointments
The School of Nursing of Queen's
University, Kingston, Ontario has
announced the following faculty
appointments:
Lynn Ashworth, (B.Sc.N., University
of Western Ontario) as lecturer;
Faye Brooks (B.Sc.N., M.Sc.N.,
University of Toronto) as assistant
professor returning to the faculty after
a two-year absence;
Leta Burnfield (B.Sc.N.. Queen's
University; M.Sc.N., State University
of New York at Buffalo) as assistant
professor;
Ruth McKenzie (B.Sc.N., Roberts
Wesleyan College, Rochester, New
'yori<) as lecturer; |
Shirley Smale (B.Sc.N., Western ]
Reserve University; M.P.H.,
University of Michigan) as assistant
professor returning after one year's I
absence. I
The Faculty of Nursing, University of
Alberta has made the following faculty
appointments;
Kathleen A. Dier (M.Sc, McGill
University) as associate dean
effective Sept. 1. For the past year,
Dier has been on a one-year posting
as a World Health Organization
consultant. She worked with the
Faculty of Public Health, Mahidol
University, Bangkok, Thailand
concerning the planning and
implementation of a one-year Nurse
Practitioner Diploma Program and a
two-year Master's in Public Health
Nursing program;
Patricia Lynne Brown (B.Sc.N.,
University of Western Ontario; Dip.
Clinical Behavioral Sciences,
McMaster University) as course
leader in the fundamentals of nursing;
Donna Elaine Crozier (B.Sc.N.,
University of Alberta) as lecturer in
community health nursing;
Roberta L. Koziey (R.N., St. Boniface
School of Nursing; B.Ed, and M.A.,
University of Wyoming; Ph.D.
University of Alberta) as associate
professor;
Winnifred Claire Mills (B.Sc.N.,
University of Alberta) as lecturer;
Olive June Young (B.Sc, University
of Alberta) as assistant professor.
updated and revised
CPS'78
Compendium of Phamiaceuticals
and Specialties Thirteenth Edition
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factually describes pharmaceutical products generally available
for human use in comprehensive monographs
D Updated Products Monographs
both Brands and Generics
D New Product Recognition Charts
revised, expanded, colour-keyed
D Comparative Vitamin Charts
D Therapeutic Index
D Brand/Generic Name Index
D Manufacturers' Index
D Metric Conversion Tables
D Poison Control Centres (Canada)
D Federal Drug Schedules (Canada)
Available: English - late December, 1977
French - late February, 1978
Canadian Pharmaceutical Association
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McMaster University School of
Nursing in Hamilton, Ontario is
pleased to announce the appointment
of the following nurses to the faculty
for the 1977-78 academic year:
Jo-Ann Tippett Fox, (R.N.,
Montreal General Hospital, B.N., U. of
New Brunswick, M.Sc, Ph.D.
(Physiology) Queen's University). In
January, 1977, Fox received the first
annual award for Student Research
from the Canadian Foundation for
Ileitis and Colitis. During her Ph.D.
program. Fox was supported by an
M.R.C. Studentship. She has also
received a Fellowship from the
Medical Research Council and is
carrying out post-doctoral training in
the Department of Neurosciences,
Faculty of Health Sciences under Dr.
E.E.Daniel.
Regjna Bohn-Browne (B.Sc.N.,
Catharine Spaulding College,
Louisville, Ky.: M.S., Boston; M.Ed.,
Ph.D. (Educational Theory .Toronto).
Browne has received a NHRDP
Scholar award under the supervision
of Dr. Dorothy Kergin, the associate
dean of health sciences (nursing) at
McMaster. Browne's research
interests relate to the roles and
utilization of nurses in primary care
settings.
The following nurses have also
been appointed to the McMaster
faculty:
John English,(M.H.Sc., McMaster)
Esther Green,(B.Sc.N., Windsor)
Jo Anne E. Haynes,(B.Sc.N.,
Toronto)
Michael J. Lawrance,(B.S.N.,
U.B.C.: M.S.N., U. of Penn.)
Maureen Montemuro, (B.Sc.N., U. of
Toronto)
Barbara Pine, (B.Sc.N., Queen's
University)
Ann Schmitt, (B.S.N., Marquette;
M.S.N. Indiana)
Catherine Tompkins, (B.Sc.N, U. of
Western Ontario)
Helen M. Evans (R.N., Toronto
General Hospital School of Nursing;
B.Sc.N., University of Western
Ontario; M.S., Boston University) has
been appointed president of the
Council of the College of Nurses of
Ontario. Evans is director of nursing at
the North Yorl< General Hospital in
Toronto. Prior to joining the hospiteil
she was assistant director,
professional standards, at the College
of Nurses of Ontario. She succeeds
Una Ridley who will now devote her
time to duties as Acting Principal of the
Kingston campus of St.
LawrenceCollege of Applied Arts and
Technology in Kingston.
In the treatment of decubitus ulcers
provi
Iravase
(Sutilains Ointment, N.F.)
INDICATIONS For wound debridement. Travase
Ointment is indicated as an adjunct to established
methods of wound care for biochemical debridement of
the following lesions: Second and third degree burns:
Decubitus ulcers: Incisional, traumatic, and pyogenic
wounds: Ulcers secondary to peripheral vascular dis-
ease CONTRAINDICATIONS Application of Travase
Ointment is contraindicated in the following conditions:
Wounds communicating with major body cavities:
Wounds containing exposed major nerves oi nen/ous
tissue: Fungating neoplastic ulcers. WARNING: Do not
permit Travase Ointment to come into contact with the
eyes In treatment of burns or lesions about the head or
neck, should the ointment inadvertently come into
contact with the eyes, the eyes should be immediately
rinsed with copious amounts of water, preferably sterile
PRECAUTIONS: A moist environment is essential to
optimal - _
activity of the en-
zyme Enzyme activity may be im-
paired by certain agents (see package insert). Al-
though there have been no reports of systemic allergic
reaction to Travase Ointment in humans, studies of
other enzymes have shown that there may be an
antibody response in humans to absorbed enzyme
material ADVERSE REACTIONS Consist of mild,
transient pain, paresthesias, bleeding, and transient
dermatitis Pain usually can be controlled by adminis-
tration of mild analgesics Side effects severe enough to
warrant discontinuation of therapy occasionally have
occurred If dermatitis or unusual bleeding occurs as a
result of the application of Travase Ointment, therapy
should be discontinued No systemic toxicity has been
observed as a result of the topical application of Travase
. « Ointment DOSAGE AND ADIullNISTRATION
'''- Strict adherence to ttie following is required
.^ for effective results of treatment: 1 Thor
oughly cleanse and irrigate wound area with
sodium chloride or water solutions Wound must
be cleansed of antiseptics or heavy-metal anlibaclenals
which may denature enzyme or alter substrate charac
teristics (e g . Hexachlorophene. Silver Nitrate. Benzal
konium Chloride. Nitrofurazone. etc ) 2 Thoroughly
moisten wound area either through tubbing, showering
or wet soaks (eg . sodium chloride or water solutions)
3 Apply Travase Ointment in a thin layer assuring
intimate contact with necrotic tissue and complete
wound coverage extending to ' a to ' ? inch t)eyond the
area to be debrided 4 Apply loose wet dressings 5
p.API Repeat entire procedure 3 to 4 times per day ■
( C pp I for best results • Fiinii977
^^y FUNT LABORATORIES OF CAfMADA
AAA M06NtythwnOr'v«.UMOo OUnoL4V1J3
The Canadian Nurse October 1977
Things that
• •
in the night
"From ghoulies and ghosues and long-leggety beasties
And things that go bump in the night,
Good Lord, deliver us!"
— Scottish prayer
If you've ever found yourself all alone at two o'clock In the
morning, acting as troubleshooter for a mechanical device
that spells the difference between life and death for a patient,
then,this story is for you.
Organized nursing in Canada took its first
shaky step in the direction of official
partnership in the realm of electronic
wizardry within the hospital environment in
June of this year. I know because I was
there. This is my report to the nurses I
represented on that historic occasion.
Laura Worthington, CNA representative at
the International Conference on Medical De-
vices, Ottawa, June 14-16, 1977.
Why were Canadian nurses represented at
this type of seminar? I certainly wondered
myself until I began mentally to tick off all the
medical devices we depend on.
As an acute care nurse there Is no end to
the electrical gadgetry I cope with every day ...
pacemakers, intra-aortic balloons, l-Vacs,
transducers, monitors and respirators. These
are just a few of the tools In our "trade." Would
I like to have a say In how they are made, what
safeguards are built Into them and to
understand a little better how they work? You
bet I would ! If you've ever found yourself in the
situation I described above, you'll agree It Is
critical for nurses to acquire a working
knowledge of these devices. Yes, we really
needed to be at that convention ...
But what could I as a nurse contribute?
Was my experience unique or valuable? Over
and over I kept thinking, "well, the buck stops
here. Who is better qualified to tell the people
that conceptualize, construct and distribute
equipment how It works than the nurse?" We
know all the Idiosyncracies of our machines,
from a monitor that does an electrical
fandango when you lean over the leads to a
temperature probe that doesn't work unless It
points due north. Yes, there were some points
that nursing should make.
But when I approached the podium, the
200 expectant faces blurred and I suffered my
usual pre-speech panic. What could I tell these
doctors, bio-medlcal engineers, journalists,
company presidents and sales
representatives that they didn't already know
about medical devices? How could I get the
needs and concerns of our profession across
to them without sounding maudlin or
completely Idiotic? I glanced at my few, brief
notes, took a deep breath and began.
My talk was simple, direct and to the point.
I stressed that the number of mechanical
devices within hospitals had skyrocketed over
the last few years. They have become so
intimately connected with direct care of the
patient that a mechanical device often
indicates when a change in therapy Is needed
while another one may be the therapy
indicated i.e. a monitor alerting the health care
team to the patient's need for a temporary
pacemaker.
Have nursing currlculums reflected their
awareness of the profession's responsibility to
know more about electrical devices? No, only
on the Master's level am I aware of universities
which offer courses in bio-instrumentation. I'm
sure this will change but as yet It has not. And
we need to understand now.
When an R.N. experiences a power
failure (or similar calamity) on her unit she
needs to know:
1 . which machines are life-saving to the
patient, and
2. how can she substitute for them until the
problem Is solved.
We need to have these answers from the
people who bring mechanical Instruments into
the hospital environment — preferably before
we are faced with a malfunction or similar
"calamity." Also, it is only natural that each
machine should have Its limitations; we should
be aware of these before the patient is
Involved.
Which brought me to my second point. As
a nurse, as someone who teaches nurses, I
would like to see companies distribute
modular teaching packages with their more
complex equipment. Something like an
audiovisual tape and slide show would be
ideal. Every nurse on any shift could then learn
or reinforce her skills by previewing It.
And, as an afterthought, I stressed that there is
no reason these teaching aids couldn't be
made by nurses who have worked with a new
piece of equipment in a controlled
environment, and know its nuances.
Finally, I emphasized the need for more
and better safety devices on existing
equipment. Can you imagine a temporary
pacemaker with a green light showing when
the battery is new, an amber light showing half
its life has been used and a red light coming on
before it actually fails? This makes Infinitely
more sense than noting loss of capture on the
monitor! This Is only one of many Ideas I
believe the nursing profession could come up
with if they were allowed to have a say in the
type of machines they use.
Judging from the response, my audience
was just as anxious to hear what I had to report
as I was eager to tell them. I wondered why we
hadn't made ourselves heard sooner. All
nurses are involved with medical devices
whether they are disposable syringes or
intra-aortic balloons. We just don't realize how
much a part of the whole picture we are.
I would like to share some of the things I
learned at the conference with you. Did you
know, for example, that:
• There is an emergency care research
institute In the U.S. which checks out
equipment before it is released to the
consumer? This institute also
— Issues hazard bulletins
— organizes educational seminars
— provides telephone and letter consults
for on-the-spot answers to problems.
The address Is 5200 Butler Pike, Plymouth
Meeting, Pennsylvania.
• Health Devices, a monthly publication of
the Institute, constantly reviews and Issues
impartial reports on the quality of new
equipment?
• R.N. representation on every hospital's
standards committee is imperative as this is
usually where new equipment is cleared?
• Health and Welfare Canada is in the
process of establishing a central Information
and evaluation service for mechanical
devices?
• Biomedical engineers in Vancouver have
asked officials at U.B.C. School of Nursing to
Introduce a class on Instrumentation?
• An education seminar on medical devices
may be held in Montreal next year?
After th ree days in Ottawa I left with many
positive impressions about the role of nursing
in the future of medical device regulation. I
believe that we must be in the forefront of
future research and Implementation. If we
don't wake up and assume that position, we
have no right to complain when "something
goes bump in the night " and. In the wee hours
of the morning, we can't figure out how to fix,
operate or interpret that "dumb machine."*
Author Laura Worthington's experience in
the intensive care setting is far-ranging. She
has worked in units in Los Angeles, San
Francisco, Vancouver and is presently a
nurse clinician in the recovery room and ICU
of the Royal Victoria Hospital in fvlontreal. She
received her Bachelor of Science from the
University of San Francisco in 1971 and her
t^/laster of Science in cardio-pulmonary
medicine from the University of California in
San Francisco in 1976.
References
1 Yura, H. The nursing process, by ... and M.
Walsh 2ed. New York, Meredith, 1973, p. 35.
2 Leininger, M.M. Nursing and anthropology:
fwo worlds to blend. New York, Wiley, 1 970, p. 31 .
3 Yura, op.cit. p. 72.
4 Sutterley, D.C. Perspectives in human
development, by ... and G.F. Donnelly. Toronto,
Lippincott, 1973. p. 81.
5 Yura, op. cit. p. 93.
6 Ibid. p. 121.
The Canadian Nurse October 1977
CO
AWARENESS PREVENTS BLINDNESS
Glaucoma is the cause of blindness in one in ten of those who eventually go
blind. In Canada, 100,000 people over the age of 35 have glaucoma; half of
them are unaware of their condition. Many of them will find out about it only
when it is too late. Like the "thief in the night," glaucoma works quietly, and
often the victim remains unaware of the condition until the damage is done,
until he is almost blind. Knowing about glaucoma is important — for nurses,
and for the public — because it is common, because it causes blindness, and
because early detection and treatment can prevent loss of eyesight.
Eileen French
Glaucoma is a condition in which the pressure
inside the eye increases above the normal
limit, an increase that may result in either
temporary or permanent loss of vision.
Originally the word glaucoma' referred to
the color change that characterizes acute or
congestive glaucoma (a gray-green color, like
"a stormy sea"). Now the term applies to all
conditions in which there is increased
Intraocular pressure, so that the chronic form,
which displays no color change, is also
referred to as glaucoma'.
A normal intraocular pressure lies in the
range of 16 to 21 mmHg, and any reading
above 21 mmHg is considered pathological.
When intraocular pressure increases atjove
the normal, fluid (aqueous humor) is forced
into the cornea, where it collects in tiny
droplets. The person with glaucoma may
notice blurring of vision because this build-up
in fluid interferes with light rays passing
through the cornea.
As intraocular pressure builds, blood
supply to the retina is impaired. Unless
measures are taken to prevent further
increase, the retina and optic nerve are
gradually destroyed. Undetected glaucoma
can result in permanent atrophy of the optic
nerve, and irreversible blindness. Early
detection of the condition and medical
intervention can prevent blindness.
For nurses, understanding what happens
In glaucoma is an important step towards
teaching others effectively about the disease.
In order to understand the pathophysiology
underlying glaucoma, we need first of all to
review the structure and function of the parts of
the normal eye. (See Table 1 and Figure 1).
Figure 1 : Anatomy of the eye
Pupil
Canal of Schlemm
Zonules
Ora serrata
Medial rectus.
Choroid -
-Cornea
-Anterior chamber
— Iris
Ciliary body
Lateral
-rectus
-Retina
Sclera
Optic
Table 1 Structure and function of the eye: a review
Structure
Function
1 Outer or fibrous coat includes:
• the sclera — a tough fibrous tissue, the
"white of the eye"
• the transparent cornea (in front)
• preserves the shape of the eyeball
• protects delicate inner layers
• allows the passage of light rays to the retina
• the extrinsic muscles (attached to the sclera)
• permit and limit the movement of the eyeball within the orbit
2 Middle or vascular pigmented coat includes:
• main arteries and veins of the eyeball
• nourish tissues of the eye
• the pupil
• the opening at the center of t; ' s for the transmission of light
• the iris — the colored muscular ring surrounding the pupil
• controls the size of the punil ,- ■ he amount of light entering the eye
• the ciliary body
• produces aqueous humo
• the ciliary muscle
• contracts and moves forwa: i to aid in the adjustment of the eye for vision of
near objects
• the suspensory ligament
• relaxes to allow curvature o< lens to alter for accommodation for near vision
• the crystalline lens
• brings light rays to focus on light-sensitive retina
• the choroid
"forms the posterior 5/6 of the vascular coat
3 Inner or nervous coat includes:
• the retina which lines the back of the eye
and contains nerve receptors for vision
• a light sensitive layer
• highly specialized to respond to stimulation by light
• converts light energy into nerve impulses which travel along the optic
nerve to the visual center in the occipital lobe of the brain
22
The Canadian Nurse October 1977
Figure 2: Normal flow of aqueous
fiumor is forward between tfie iris and
ttie lens into tfie anterior cfiamber,
through the trabecular meshwork into
the Canal of Schlemm and info the
venous system.
Aqueous vein
Iris
Trabecular ^!^^^
meshworkj;*^^\ ^^---^
Posterior
Lens
Cornea
Anterbr chamber
Canal of Schlemm
^^^^^
===5^
f^'^^^^l
chamber ^^^^
<^^ff///l'// Ciliary body ^v;;\^
Normal intraocular pressure
Intraocular pressure is determined by the rate
of production of aqueous humor by the ciliary
body, and the resistance to outflow of aqueous
humor from the eye. In the normal eye, there is
a constant balance between the rate of
formation of aqueous humor and the rate of its
absorption from the eye.
Aqueous humor, a crystal clear fluid, is
formed by the ciliary body and fills the anterior
and posterior chambers of the eye,
permeating the vitreous humor. It serves as a
refractive medium, provides nutritional
support to the avascular lens and cornea, and
contributes to the maintenance of intraocular
pressure.
From the posterior chamber, the aqueous
humor passes between the iris and lens to the
pupil and the anterior chamber. A portion of
aqueous humor then passes through the
trabecular meshwork by diffusion into the
Canal of Schlemm and out through the
aqueous veins into the anterior ciliary veins. It
is also absorbed by the vessels and the iris;
some diffuses into the vitreous humor and
leaves the eye by posterior drainage routes.
What happens in glaucoma
Most cases of glaucoma are caused by a block
in the trabecular meshwork. The cause of this
block is the feature that identifies the various
types of glaucoma.
Secondary glaucoma is caused by a
clogging up of the meshwork by blood, fibrin,
inflammatory cells and debris, pigment etc.,
and is secondary to such causes as injury or
infection. Other forms of the condition are
known as primary glaucoma.
Chronic simple glaucoma or open
angle glaucoma is the most common type of
the disease. It is caused by a thickening of the
meshwork itself as an eye with a hereditary
predisposition to glaucoma becomes older. In
chronic simple glaucoma, the trabecular
meshwork is just not working. It may be
compared to the blocked drain of a sink — the
water goes through the sink but is blocked
further down the drain; it may drain a little at a
time, but eventually, it becomes completely
blocked.
Congestive glaucoma occurs only In
those uncommon eyes in which the iris is
displaced abnormally far antehorly. Because
of this displacement, the iris presses against
and covers the filtration meshwork.
Congestive glaucoma may be chronic or
acute; the angle between the iris and
trabecular meshwork may be narrowed or
closed.
Acute or closed angle glaucoma is a
medical emergency. If it is not treated
immediately, blindness may occur in three to
five days. Using the blocked drain analogy,
this type of glaucoma is like a sink that is full of
garbage — the tap is open, but water cannot
get to the drain.
f^ost often attacks are unilateral, and are
characterized by a sudden rise in intraocular
pressure, causing edema and congestion of
the iris and ciliary process. The patient's eye is
usually red in appearance, the cornea steamy,
clouded and insensitive; the pupil dilated and
sluggishly reactive. The patient may complain
of blurred vision, see halos around lights, or
have rapid loss of vision. He may also have
excruciating throbbing pain accompanied by
nausea and vomiting.
Diagnosis of glaucoma
How does a person discover that he has
glaucoma? Unfortunately, many people do not
realize that they have the disease until they
cannot see. By this time, no treatment can
restore their sight. Routine eye examinations,
however, detect the disease early, and
adherence to the prescribed treatment regime
will maintain good vision. Chronic simple
glaucoma is never discovered spontaneously
by the patient himself until he is partially blind,
Figure 3: Closed angle glaucoma
because its influence on vision is very gradual.
Symptoms are insidious and develop slowly.
He may feel mild discomfort associated with
the development of glaucoma, a feeling of
tiredness in the affected eye. Impairment of
peripheral vision occurs long before any
effects are noticed on the patient's central
vision, so that he may have problems bumping
into things, or difficulty driving a car.
Late symptoms occur only after severe
and irreversible eye damage takes place.
Unless the patient develops acute angle
glaucoma, the disease process is not
accompanied by pain, redness of the eye or
any alarming appearance. It is only through a
few simple diagnostic tests that the disease
can be discovered early enough to prevent
blindness.
Intraocular pressure may be measured
painlessly, easily and safely by tonometry.
Although there are a number of different
tonometers in use, the most common are the
Schiotz Tonometer and the Applanation
Tonometer.
The Schiotz Tonometer
The Schiotz Tonometer indents the cornea by
slight pressure. If the patient's intraocular
pressure is high, the cornea will resist
indentation more than if the pressure is low.
The test itself is simple. The patient is
placed on a table or tilted back on an
adjustable chair, and instructed to look straight
up. A single drop of anesthetic (ophthaine
0.5%) is instilled into both eyes to produce
corneal anesthesia within a minute. The sterile
tonometer is then placed gently upon the
center of the cornea for several seconds,
during which the scale reading is determined.
The Applanation Tonometer
The Applanation Tonometer measures the
force required to flatten rather than indent a
small area of the central cornea. This
tonometer fits on a slit lamp. The patient is
seated in front of the slit lamp and the
tonometer is placed in front of the right or left
eye. Both eyes are anesthetized and stained
with fluorescein. The patient's chin is placed
on a chin rest with his forehead pressed firmly
against the supporting bar. This tonometer
gives the most accurate measure of
intraocular pressure obtainable clinically.
After examination by tonometry, the
patient is cautioned against rubbing his eyes
for about fifteen minutes, because the corneas
are still anesthetized and could be painlessly
abraded.
Other tests
• Gonioscopy is another diagnostic test
used in the diagnosis of glaucoma. It consists
of a biomicroscopic examination of the angle
of the anterior ch amber. Th is test is necessary
for diagnosing the type of glaucoma the patient
has. Preoperatively, this examination helps to
determine which eye is in danger of angle
closure and which is safe from closure, and
defines the cause of secondary glaucoma. In
the case of angle closure glaucoma,
Measuring intraocular pressure using the Schiotz Tonometer.
gonioscopy is used postoperatively to
evaluate the success of an iridectomy in
opening the angle.
• Perimetry is used to measure the
peripheral fields and will delineate any loss of
vision from glaucoma.
• Tonography is the recording of the
intraocular pressure on a graph (similar to the
electrocardiogram) over a period of four
minutes. This is a valuable test for the
ophthalmologist to use in determining the
adequacy of the trabecular drainage systems.
Treatment
The treatment of glaucoma varies with the type
and severity of the disease. Fortunately, the
great majority of early diagnosed cases
respond well to medical therapy; advanced
cases often fail to be controlled by either
medical or surgical means. Once the
diagnosis is confirmed, treatment must begin
at once.
The ultimate goal of treatment for any type
of glaucoma is to reduce intraocular pressure.
In most cases, the instillation of miotic drops
several times daily will control the pressure
adequately. Miotic drops, the most commonly
used being pilocarpine, constrict the pupil to
facilitate the outflow of aqueous humor by
increasing the efficiency of the outflow
channels. The concentration and frequency of
the dosage to be used by the patient is
gradually regulated by clinical trial.
Miotic drops do not cure glaucoma: the
patient must use these drops daily for the rest
of his life, just as a diabetic must remain on
*-v
The Canadian Nurse October 1977
insulin therapy. He must not neglect to use
them.
Another medical method used to control
intraocular pressure is through the use of an
oral medication, a carbonic anhydrase
inhibitor, most commonly, diamox. This drug
acts to reduce the rate of formation of aqueous
humor by the ciliary body.
In the case of acute angle closure,
surgery is imperative, once the patient's
intraocular pressure is lowered to a safe level.
(^peripheral iridectomy , usually done under a
local anesthetic, is one method of surgical
correction. This procedure creates a hole in
the iris, a new channel to enable aqueous
humor to flow from the posterior to the anterior
chamber.
An iridencleisis is the surgical procedure
used to create an opening between the
anterior chamber and the space between the
conjunctiva. This opening bypasses the
blocked meshwork and enatjies aqueous fluid
to be absorbed into the conjunctival tissues.
For chronic open angle glaucoma,
a corneoscleral trephining is the usual surgery
performed. A permanent opening is made at
the junction of the cornea and sclera through
which aqueous humor may drain.
Whether the treatment of glaucoma is
medical or surgical, the nurse has a
responsibility to create a climate of awareness
about the disease, and to teach the patient
what he should know atxiut glaucoma and its
treatment.
The role of the nurse
The nurse's responsibility begins with
knowledge. With a thorough understanding of
the pathophysiology of glaucoma, she is in a
good position to help educate individuals
about the disease and its potential to cause
blindness. It is especially important for her to
help educate those whose age (over 40) or
family history might indicate a need for
screening. Her knowledge of the location of
glaucoma screening clinics and le necessity
for frequent checkups can be a elp to those
needing guidance.
Optometrist, Optician, or Opthamologist?
Many individuals simply do not understand the
functions of those who call themselves eye
specialists. Recognizing this fact, the nurse
ought to clarify the roles of different eye
specialists and direct people intelligently for
proper care.
It is important for people to know that the
opthamologist (also referred to as an oculist)
is a medical doctor, skilled in the treatment of
all conditions and diseases of the eye.
Because of his specialized training, his
experience, and the availability of specialized
equipment, he makes a thorough and
complete eye examination. In addition, he
prescribes medication and does eye surgery.
On the other hand, the optician is not a
physician. His specialty is in grinding,
mounting and dispensing lenses. Again, the
optometrist is not a physician, but is licensed
to examine the eyes for refractive errors by
Author Eileen French has her intraocular pressure mee ired by the Applanation Tonometer.
mechanical means, and to provide appropriate
corrective lenses. The optometrist does not
use eye drops in his examinations.
The nurse can recommend that an
individual have a thorough eye examination by
an opthamologist to screen for glaucoma.
An informed nurse can also help to
explain to individuals the types of tests that
they need tc undergo in order to rule out or
confirm a diagnosis of glaucoma, emphasizing
that these tests are painless and simple.
Glaucoma cannot be cured, but it can be
controlled to a large degree whether the
patient has surgery or not. The great majority
of early glaucoma cases respond well to
medical therapy. The nurse can play an
important teaching role in helping the patient to
understand this therapy.
The patient with glaucoma must know just
how important it is to use miotic drops in his
eyes (as prescribed by a physician) every day,
for the rest of his life, even after surgery. The
nurse needs to emphasize that he must never
neglect to instill the drops, that intraocular
pressure is controlled only as long as therapy
is maintained.
It is also important for a nurse to be aware
of the action and adverse effects of the drugs,
so that she can properly instruct the patient,
answer any of his questions, and reinforce the
physician's instructions.
Pilocarpine, the most commonly used
miotic, has a relatively short duration of effect
and must therefore be instilled several times a
day. The patient should be instructed to store
the drug in a light resistant container. It is a
help to the patient to be made aware that he
may experience some dimness of vision for a
short time after instilling the drops.
Although adverse reactions to pilocarpine
are rare, prolonged use of the drug may
increase their incidence. Symptoms such as
darkened vision, blurred distant vision, aching
in the eyebrows or head, excessive salivation
or sweating, or nausea and abdominal
cramps, should be reported to the patients
doctor as they may signify the onset of
systemic toxicity.
The instillation of eye drops is a simple
task, but a patient or members of his family
may appreciate a demonstration of the correct
method.
If the patient is prescribed a cartwnic
anhydrase inhibitor such as diamox, he should
also be aware of the action of this drug.
Diamox inhibits the action of an enzyme
necessary for the production of aqueous
humor. Because it slows the production of
aqueous humor, intraocular pressure is
reduced. The medication is taken by mouth
and is well absorbed from the gastrointestinal
tract. As a side effect, diamox increases
urinary flow.
Normally, su rgery is used only to alleviate
acute angle glaucoma or cases of glaucoma
that cannot be controlled by medical means.
Immediate pre and postoperative care of the
patient undergoing eye surgery is determined
by the type of operation done, the anesthetic
used, and the patient's age and state of health.
The prospect of any type of eye surgery
can be a threatening experience for a patient
because he faces the fear of blindness. The
patient's fears can be alleviated to a certain
extent by a nurse's explanation of what is
going to happen to him and what is expected of
him, as well as her answers to questions and
concerns that he may have.
Most patients have some type of
trephining procedure done: they will return to
their room with both eyes bandaged and will
usually be kept flat and relatively quiet for the
first 24 hours post-op. Patients are usually
encouraged to turn towards the unoperative
side, and to restrain from straining, coughing,
squeezing their eyelids or any other activity
that could cause an increase in intraocular
pressure.
Whether a patient is treated medically,
surgically, or both, a good teaching plan is
essential if he is to understand his disease and
its treatment. There are also many common
misconceptions that a nurse can help to clear
up. So often the patient with glaucoma will
restrict himself unnecessarily because his
source of information is an overcautious friend
or relative who lacks knowledge about the
condition.
The patient should understand that It
does not harm him to use his eyes as usual,
although he may feel fatigued more quickly
than a normally sighted person simply
because his vision is impaired to some degree.
This is due to muscle fatigue, and rest helps.
But he needs to know that he cannot
"save" his eyesight by using his eyes less: in
fact, it has been shown that aqueous outflow is
slightly improved during reading.
Another common misconception that
needs clearing up has to do with fluid intake.
There is no logical reason for a person with
glaucoma to restrict his fluids: drinking under
normal circumstances does not increase
intraocular pressure. Rarely, a person will
show an elevation of intraocular pressure
when he drinks coffee. A test can be done
using a tonometer before and after drinking
coffee to determine its effect on each
individual patient: if it doesn't affect his
intraocular pressure, then there is no reason
for him to stop drinking coffee. It has also been
shown that eye pressure is not signifteantly
changed by smoking or drinking alcoholic
beverages.
General physical exercise is not harmful
to the patient with glaucoma: in fact, it is
necessary to promote good circulation and
elimination, fvlaintenance of regular bowel
habits prevents straining and a resulting
increase in intraocular pressure.
Use of medications taken for other
diseases, with the single exception of the
atropine-like drugs will not interfere with the
treatment of glaucoma. Patients should carry a
card stating they are being treated for
glaucoma because the use of a mydriatic such
as atropine could be very serious to them,
especially for the patient who has shallow
angle closure.
Tight clothing, tight belts, collars or
girdles, do not increase intraocular pressure.
Heavy lifting, with the possible exception of
weight lifting does not increase intraocular
pressure.
It is a common belief that there is a
relationship between vascular hypertension
and ocular hypertension (glaucoma), but such
is not the case.
A person who has been diagnosed as
having glaucoma should be aware of the
absolute necessity of using prescribed eye
drops and the need for frequent checkups for
the rest of his life. He should also know that he
does not have to become crippled. Although
he may have some limitations, he can also
expect to live a normal, productive life. The key
is early detection, proper treatment and
continued follow-up. A nurse who is aware of
glaucoma and what it means, who knows how
to apply her knowledge and is willing to do so
at every opportunity, is the nurse who holds
this key. ♦
References
1 Abrams, J.D. The nature of glaucoma. Nurs.
Times, 68:25:767-770, Jun. 22. 1972
2 Govoni, Laura E. Drugs and nursing
implications by ... and J.E. Hayes. New York.
Appleton-Century-Crofts, 1965. p. 349.
3 Fernsebner, Wilhelmina. Etiology, treatment
of glaucoma. y»Ofl/V J. 20:6:996-1001. Dec. 1974.
4 Havener, William. Nursing care in eye, ear,
nose and throat disorders. 3ed. by ... et al. Saint
Louis, Mosby. 1974. p. 459.
5 McNaught. Anne B. Nurses' illustrated
physiology, by ... and Callander, R. Glasgow,
Churchill, Livingstone, 1965. p. 156.
Eileen (Clapin) French (R.N., University of
Ottawa School of Nursing. B.Sc, P.H.N., and
f^.Ed., University of Ottawa) Is presently an
assistant professor in medical-surgical
nursing at the University of Ottawa School of
Nursing, Ottawa, Ontario.
a;
his is the first in a three-part series of excerpts from the unpublished
memoirs of l^^aude Wilkinson, a Canadian nurse for 47 years. Maude is
now ninety-five years old and living in Sunnybrook Medical Centre's
Extended Care Facility, Toronto. This first part describes Maude's entry
into nursing. Next month she looks at her experiences as a Nursing
Sister in World War 1 and finally she remembers the time she spent with
the Red Cross Outpost Service and as a superintendent of a nursing
home.
Maude worked in various facets of nursing from 1912 to 1959. We
believe that in many ways her unique history captures the flavor of those
early years of nursing and serves as a personal account of the evolution
of our profession in Canada.
In the early afternoon of November 28, 1882, Emma Elizabeth Wilkinson gave birth to a frail little girl.
The baby breathed with difficulty, was properly spanked, wrapped in a blanket and placed in the
oven of the kitchen stove.
John Wilkinson, husband, "doctor" and "midwife" watched the new mother very anxiously — it
had been a long, hard labor and a difficult delivery. His wife was exhausted.
Later the baby was taken out of the 'improvised incubator, ' washed and placed in her mother's
arms. This is the story of that baby, hAaude Wilkinson.
Maude Wilkinson
/^/^ %' any of my early years were spent
moving around North America. My father was
a minister and this meant a great deal of
travelling for my family. But Toronto was still
home and it was to Toronto that we kept
returning.
My mother, sister and I made two trips
overseas visiting large European centers in
the early 1 900 s. It was after one of these trips
that I began to consider entering the wori<
force.
I was 27 years old in 1909 and still
completely dependent upon my mother for
support. A financial discussion with my father
made me realize just how unfair this was. My
health was good and I was certainly physically
capable of taking care of myself.
I decided something had to be done, but
what? How could I begin to support myself?
Nursing had appealed to me for a long
time. I had read a lot about the life of Florence
Nightingale and of what she had accomplished
in the Crimea. These accounts intrigued me
and to a great extent influenced my decision to
enter the profession.
Actually, nursing had been in the back of
my mind for quite a while. While we were
visiting London, England in 1907 I went to St.
Thomas's Hospital and asked to see the
Matron. When I asked her about their nurse
training program she was curious to know why
I was considering St. Thomas's. She said that
she knew we had several good schools of
nursing in Canada. I had to confess,
sentimentally, that it was because Florence
Nightingale had been so closely connected
with her hospital.
The Matron explained to me that her
school accepted two types of students —
those who were able to pay for theirtraining (I
don't recall the amount) and those who did not
pay. Although both of these groups were given
the same course, the latter had to do a good
deal of the menial work, such as cleaning and
scrubbing. Matron said she could see that
physically I would not be able to do the work
required of the non-paying group and asked if I
would consider paying. I thanked her and said
that I would think the whole situation over.
Upon our return to Toronto I had an
interview with Miss Lash, the superintendent
of the Cottage Hospital on Wellesley Street.
Much to my embarrassment Miss Lash asked
me the same question. "Why are you thinking
of entering my training school?" She pointed
out the fact that although her school offered a
good practical course, graduates were not
eligible for provincial registration.
Once again I had to confess to sentiment.
The Cottage Hospital occupied the house my
grandfather had owned, the house where my
mother was married.
Miss Lash was very understanding, but
she told me that in the long run it would be to
my advantage to enter a training school
connected with a large general hospital. Later I
realized just how important her advice was and
I have always been very grateful for it.
At first Mothers sisters were quite disturbed
by my decisbn to be independent and support
myself. No female member of the family had
ever thought of such a thing, let alone
attempted it. The fact that Florence
Nightingale had been from such a prominent
English family and was so highly respected for
her wori< finally won them over.
Many Toronto women were taking their
training at Roosevelt Hospital in New York
City, so I applied there. I knew I would miss
being with my family, but Mother and my aunt
were planning to be together so they didn't
need me.
My application was accepted and I was
included in the class of 1 909.
Training
I left for New York in November of 1909.
The girl I sat beside while on the train was also
entering the fall class. This trip together
sparked a warm friendship that lasted until my
friend's death a few years ago.
Our first three months of training were
very difficu It . We were probationers and had to
earn our caps. Those not qualifying had to .
leave.
We worked very hard; twelve hours a day
with only two hours off for breaks. Our time off
Included one half day a week from 2:00 to
10:00 p.m. and every other Sunday afternoon
beginning at 2 o'clock.
As students we would gather together at
night, very tired, but happy. We would chat and
relate to each other the events of the day.
There were some funny experiences to
laugh about. I remember the story of the girl
who was told to clean the dentures of some
thirty patients on the ward. Feeling very
honored to be selected for this task, she
collected all of the patients' teeth in a basin and
proceeded to the utility room to wash them!
Needless to say, nobody was very
impressed and this probationer did not earn
her cap, she had to go home. Even up to the
day they left the hospital some of her patients
swore their own teeth had never been returned
to them.
My roommate at Roosevelt was a Toronto
girl. She was my senior' and her authority had
to be recognized. For example, if we were both
leaving the room at the same time I was
expected to open the door and step aside until
she passed through.
As I look back on those years I rememtjer
one particularly special night. A girl in the
graduating class learned the Superintendent's
birthday was the next day. She also knew the
chef had baked a special cake and where he
had put It for safekeeping.
To the chef's surprise that cake somehow
disappeared through the night. We students
had a grand party with all thoughts of seniority
forgotten — we were all in this together. Poor
Miss Samuel, our dignified superintendent,
was wished many, many happy returns the
next day, but the chef never found her cake. (It
was delicious!)
We received our obstetrical training at the
Sloane Maternity Hospital across the street
from Roosevelt — 59th Street and Madison
Avenue. The hospitals were located in a
predominantly black district of New 'Vork. All of
the students loved those little babies; they
were so sweet.
During my three years of training I was
never once able to go home, there just wasn't
enough time. I was never ill, except to have my
appendix out. I had been having a lot of trouble
with indigestion. My appendix was blamed and
therefore removed.
Oddly enough, after my operatkjn the
chief surgeon was heard to remark to his
students, "The appendix was normal you
know, but the ten days rest will be good for
her. " The first night I was allowed one
hypodermic 1 /4 grain of Ckxieine. No other
sedative was administered at any other time
during my recovery period. The ten days I lost
recuperating had to be made up before
graduation.
Upon commencement I was offered a
nurse-in-charge position at txjth Roosevelt
and Sloane, but I wanted to go home. During
my last year I had written to Dr. Herbert Bruce
in Toronto, he and Sir William Mulock had
founded a hospital on Wellesley Street. I
reminded Dr. Bruce that he had met me at my
uncle's wedding and asked if there would be a
position for me at his hospital when I
graduated.
I received a reply almost immediately. I
was to report to the superintendent of nurses
as soon as I arrived home!
Wellesley Hospital: my first job
Wellesley kjegan in a large house on
Homewood Avenue off Wellesley Street. The
rooms on the ground floor were large. The
doctors had kept enough of the original
drawing room furniture to furnish one room.
This room was shown to prospective patients
along with assurances that when they were
admitted all of the proper' hospital furniture
would replace what was there.
When a patient decided to enter our
hospital for treatment the unsuitable' furniture
was moved out into another room which would
then be set up for the next prospective clien"
Needless to say, Wellesley catered to
wealthy private patients and soon becanne
very popular among that elite class. Some of
the larger public hospitals were indignant
because they didn't think Toronto needed
another hospital, especially one such as ours.
I wonder if Elisabeth Flaws, the first
superintendent at Wellesley is ever
rememt)ered? She was an energetic woman
who worthed ceaselessly from early in the
morning to late at night. Her assistant, Miss
Ferguson, and I often stayed on to help her
with the extra wori<. Wellesley owes a great
deal to Miss Flaws' organizatbn.
At first I was put in charge of the ground
floor but when the rooms there were filled, I
was moved to the second floor. We had more
rooms on the second but they were smaller
than the ones downstairs. The staff lived on
the third floor of the house until the nurses'
reskjence was built years later.
Preparing for War Duty
The Canadian Government sent the first
medical unit overseas in 1 91 4. Miss Ferguson \
and I discussed enlisting for army service
should a second unit be required. Our
opportunity came in 1915 when Numtjer 4,
Canadian General Military Hospital was
organized in Toronto. We decided to enrol for
service. Miss Flaws was very annoyed, but Dr.
Bruce was pleased that "his hospital" would
be represented overseas.
Miss Gunn*, the superintendent of nurses
at Toronto General Hospital had been
appointed to enrol graduate nurses for
enlistment. We filled in our applicaton forms
and presented them to her.
Miss Gunn took note of the fact that both i
of us had been trained in the United States;
Miss Ferguson in Battle Creek, Michigan and I
at Roosevelt. We both told her we were bom in
Canada and had been employed in a
Canadian hospital ever since we'd received
our provincial registration. In spite of this our
applications were not accepted.
On our return to Wellesley we told Sir
William Mulock, the President of the Hospital
Board, and Dr. Bruce, the Chief Surgeon, all
about our experience. They were infuriated to
have members of their hospital staff not
considered eligible. Dr. Bruce wrote a letter to
his friend. General Sir Sam Hughes in Lindsay,
right away.
Word was received for us to apply again.
We did, and our names were added to the list
at once.
It is quite possible both Military
Headquarters and the University of Toronto
were not aware of this practice. Toronto
hospitals disi iked n urses not trained in Toronto
hospitals and, therefore, discriminated against
them. We heard from other nurses who had
experienced the same kind of treatment. For a
long time, even overseas, we were considered
"outsiders. " As a result we too became
clannish and called ourselves "The Odds and
Ends."
Time passed very quickly. There were so
many things to be done. There were fittings for
our long navy dress uniforms and for our blue
cotton service uniforms. The service uniforms
were worn with voluminous white aprons,
muslin veils, ankle length navy cloth coats and
unbecoming navy blue hats. Looking at the
group photo taken before we left makes it
clear, no anxious father had to warn his
daughter to beware of the men overseas. In
those uniforms even the most adventurous
male would hesitate before casting an
amorous glance in our direction.
We also had to attend military drill. A
senior sergeant yelled the commands at us as
we ined up, stepped out, marched and stood
at ease.
^i^^^k^fi.^ / k'l
I remember one morning in particular, it
was raining and we all arrived with umbrellas.
You can imagine the strictly military
Sergeant's reaction to this display of
femininity. "Put down the umbrellas, roll them
and use them as canes," he barked with
annoyance.
There were many social events planned
for us which we were required to attend,
punctually. Sir Henry and Lady Pellatt
entertained all of us for tea at their new home,
"Casa Loma. " There was plenty of room for 73
nursing sisters in the 'Great Hall' where tea
was served.
Dr. and Mrs. Bruce entertained Miss
Ferguson and I for dinner with senior
Wellesley graduates.
Altogether there was not much time left for
family gatherings or going-away parties. May
1 5th came all too soon and we had to report to
Exhibition Park for our departure.
I expect there have been gatherings on
the Canadian Natbnal Exhibition grounds far
more important than ours, but surely none
could have been more unusual. There were
officers, with their wives and families, nurses
and their families and friends, administration
people and many, many other personnel with
their friends, wives and children.
Irrespective of rank, officers and men
carried their babies in their arms. The little tots
hanging onto them couldn't have known what
was going on but they could sense something
was wrong. Daddy was going away, they didn't
know why or where, but they weren't going to
let go of his hand.
Arrangements had been made for
mother, my sister, several aunts and myself to'
be driven out to the grounds. We all stood
together, not knowing what to do or what to
say. There were promises to write often, to
take care of myself, to come back soon — and
endless admonitions. Poor old George; he had
been grandfather's coachman for years and
when it was time for me to leave he wrung my
hand and cried, "Good-bye Miss Maudie;
come back soon!"
I shall never forget my dear mother's face,
anxious and bewildered, controlling the tears
which I knew she would shed as soon as I left.
Then the call went up, "All aboard!" There
were whistles shrieking, bells ringing and
porters slamming doors; in the midst of all of
this chaos, we were off.
The University of Toronto Unit, No. 4
Canadian General Military hospital left the
Canadian National Exhibition grounds in
Toronto very early on the morning of May 1 5,
1915. Destination ... unknown.*
T79.
• Jean Gunn, was president of the Canadian
Nurses Association from 1917 to 1920 and
was convenor of the CNA Committee charged
with erecting a memorial to the Nursing Sisters
of Canada. The memorial, which is located in
he Canadian Parliament Buildings, was
unveiled in 1926.
'a-tiitif^^a „;?<!«>
n
^^^^
The Canadian NurM October 1977
Anatomy of a
Death
Tonight
a man was dying
I felt his life
as it slid away
I watched
the fear
in your faces,
coupled
with the drama.
You were very
well versed
in pathology
you taught me
very well,
but I couldn't
take away my eyes
from his door.
I heard you
recite
the stages of his
death
and I listened
as he must have —
in anger,
for just as he must
have feared you
so I did.
I hated you
as he must have,
because the death
you felt was yours
not his
Then because
I wanted
to feel
I went inside his door
and all he was.
was real.
As a rule, CNJ does not publish poetry. We made an
exception in this case because we feel the author
expressed some of the feelings that we all have at
least once in our working life. In a letter to us, Carole
Estabrooks made her own case for publication:
"I wrote this poem on February 1 , 1 977 while I
was a senior nursing student at the University of
New Brunswick in Fredericton. I was working in a
Coronary Care Unit at that time. This was my first
exposure to the unit, it was also my first exposure to
death. I wrote the poem to help me resolve my own
personal conflicts.
I had not originally intended to submit the piece
for publication but one of my professors encouraged
me to share it in the hope that it would get across a
point we, as nurses, can far too often ignore in a
clinical hospital setting."
Since Feltruary, author Carole Esta brooks has
graduated from the University of New Brunswick,
written her registration exams and assumed a
full-time position on a Coronary Care and Intensive
Care Unit
I touched him
it didn't hurt
I didn't cry
there was only
sadness
so deep
I cannot understand.
It's funny
you know,
we left him
alone —
a man became our failure
we turned away
and watched
his life as it
bleeped
across the screen.
You never touched
this man
You weren't there
to hold his wife
instead you
asked
the learned man
to diagnose
your grief
I walked away
in shame.
and it was worse than
I had thought,
because
I too
could see
my death
and still
I couldn't share.
I sat inside
a tiny room,
my hatred
surely showed
except now you
could never see
the reasons
for my words.
I do not understand
these tears,
I hardly knew
this man
except inside
a part has changed —
to watch a man
die alone.
his family grieve
alone,
to run away
because I feared
I'd never fill
the space.
My life goes on
as it always has
except there'll
be one change
I'll never run away again.
You see —
he squeezed
my hand.
— Carole Estabrooks
®
t(h()c.lrcli(>^r,1phic
DiagnusJN
or
C()nj;t'nitjl
Hcdrl
Disodso
®
HYPERTENSION:
The Nurse's Role in Ambulatory Care
How does the nurse become a hypertension specialist? Who is going
to educate the nurse? This volume evolved from a recent intensive
workshop held at Cornell University Medical College. The workshop
was designed to supply the nurse with the physiologic and path-
ologic background necessary for understanding basic vascular
diseases: to supplement physical examination skills to permit more
detailed evaluation not only of the severity of the disease but also
of the patient as a whole; to provide the pharmacologic background
for use of antihypertensive agents; and perhaps most important,
to emphasize the value of the team approach in long-term therapy
and patient compliance. In sum, its goal was to prepare the nurse
to be a pioneer in preventive medicine. It is hoped that this book
will help promote the process.
By M.H. Alderman, /W.D.
Springer 174 Pages Illustrated 1977 $12.00
ECHOCARDIOGRAPHIC DIAGNOSIS
OF CONGENITAL HEART DISEASE
An introduction to the field of pediatric echocardiography, this
book provides a standardization of echocardiographic examination
technique and interpretation. Each chapter includes an introduction
to the anatomy of a lesion, followed by discussion of the relevant
examination techniques, diagnostic features, pitfalls of diagnosis,
differential diagnosis, case examples, and references.
By R. G. Williams, M.O.,- and C. R. Tucker, /M.D.
Little, Brown 352 Pages Illustrated 1977 $21.00
From Lippincott . . .
QUICK REFERENCE TO
CARDIOVASCULAR DISEASES
Here is authoritative, easy-to-find, clinically relevant data, presented
in a special, time-saving format. Each entry is numbered and step-
by-step instructions are given in outline form.
Dr. Chung and his many eminent contributors summarize their years
of experience in this manual, covering all kinds of cardiovascular
disease: vascular, valvular, endocardial, myocardial, and pericardial
diseases, arrhythmias, drug-related disorders, cardiovascular dis-
orders in systemic diseases, etc.; all aspects of each disease: general
considerations, definition, etiology, pathophysiology, classification,
signs and symptoms, complications and prognosis; all phases of
medical care: history taking, laborotory findings, diagnosis, differ-
ential diagnosis, and management.
By E. K. Chung, M.D., F.A.C.P., f^.A.C.C. With 33 Contributors.
Lippincott 469 Pages Illustrated 1976 $21.75
®
®
CARDIOSURGICAL NURSING CARE:
Understandings, Concepts, and Principles
for Practice
The widely published author on technology in health care, recipient
of numerous professional honors, answers the two-fold question:
What is good nursing?; in particular what is good postoperative
nursing care of the cardiac patient? Cardiovascular surgical nursing
is presented in terms of 1) the "why" for nursing intervention;
2) the "what to do"— i.e., nursing actions to solve the patient's
physiologic problems: and 3) the "how"— suggested nursing pro-
cedures.
By R. K. Chow, R.N., Ed.D., F. A.A.N. : and E. C. Lambertsen,
R.N. , Ph.D.
Springer 386 Pages. Illustrated 1976 $20.50
SELF-ASSESSMENT
IN ELECTROCARDIOGRAPHY
Here is a fully illustrated review of simple and complex electrocar-
diographic studies which will provide the reader with a practical tool
for assessing and improving his knowledge of electrocardiography.
The one hundred actual full-sized electrocardiograms included
cover a wide range of rhythm and pattern abnormalities frequently
encountered in the adult patient. Each electrocardiogram is
followed by a brief history of the patient and a number of pertinent
multiple-choice and true-false questions designed to stimulate the
reader's thinking and containing clues for the correct interpretation
of the tracing.
On the reverse side of each page the same electrocardiogram appears
again, this time with the addition of appropriate labeling and
superimposed Lewis ladder diagrams. This format allows for rapid
identification of the ECG waves and the time intervals between
waves as well as for a clear picture of the site of impulse information
and of the electrophysiological mechanisms involved. The answers
to the multiple-choice and true-false questions are then given so
that they may be reviewed in conjuction with the annotated cardio-
graphic tracing. In this way the reader can quickly compare his
interpretation with the correct diagnosis of the condition.
By S. Mangiola,/W.D., F.A.C.C.
Lippincott About 210 Pages Illustrated 1977 About $20.00
/jN CARDIOVASCULAR NURSING:
^^ Prevention, Intervention, and Rehabilitation
This book describes the means of assessing heart function, current
methods of treatment, and rehabilitation of patients with chronic
heart disease.
By J. Holland, R.N., M.S.
Little, Brown 233 Pages Illustrated 1977 $7.75
lO)
INTENSIVE CARE
AM members of the health team who assume responsibility for
patient care in and out of the intensive care setting will applaud the
practical approach and explicit discussions that Intensive Care
provides.
"This IS the most complete compendium on intensive care of the
surgical patient to come to this reviewer's attention. While the
book is clearly slanted toward the problems in care of the critically
ill 'surgical' patient, the majority of its chapters apply equally
to the problems of intensive care of patients from any specialty
group ..." — Annals of Surgery
By J. J. Skillman.M.D.
Little, Brown 609 Pages Illustrated 1976. S27.50
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THE PATIENT IN
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for detecting critical changes in the patient's condition. By the same
token, coronary care nurses everywhere will welcome the many
electrocardiographic illustrations of possible cardiac abnormalities.
The physiologic basis of the discussions affords clear understanding
of the causes of coronary complications and of the effect of drugs
and other forms of therapy.
By H.Sweetwood, R.N.
Springer 465 Pages Illustrated 1976 $17.00
HANDBOOK OF CRITICAL CARE
A concise presentation of how to cope with problems commonly
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book is geared to the step-by-step solution of practical problems
in respiratory and hemodynamic monitoring, cardiac and renal
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Edited by J. L. Berk, M.D., et al.
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MANUAL OF CORONARY CARE
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them. Practical and current topics include management of unstable
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Little, Brown 150 Pages 1977 $9.95
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PATIENT CARE IN CARDIAC SURGERY,
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"... a masterpiece of exposition and teaching, and deserves very
wide circulation at all levels of the profession concerned with
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Blackwell 240 Pages Illustrated 1976 S9.50
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The Canadian Nui
<r 1977
Almost 60 million women in the world became mothers in 1975. Thirteen
million of those women were still in their adolescent years. In Canada in 1973,
39,852 babies were born to mothers who were not yet 19 years old. Among
these teenage mothers 14,013 gave birth to illegitimate children. These figures
illustrate trends which have assumed great importance in the 1970's— trends
that require awareness, consideration and community cooperation.
The adolescent is neither child nor
adult. He is a complex between-ager
presenting us with intricate and often
perplexing problems. Adolescent
sexuality is not something that we as
nurses can ignore, rather it is
something we must face daily, both at
work and at home. What are our
responsibilities to our adolescents?
FROM
AtoZ
WITH
ADOLESCENT
SEXUALITY
Benjamin Schlesinger
A
.CTION especially community action.
Talking, slogans, conferences and reports all
serve their own purpose but it is time for
communities to take positive action insofar as
adolescent sexuality is concerned.
B
ASIC ISSUES underlie the complex
topic of adolescent sexuality. We cannot
discuss or examine adolescent sexuality in a
community without examining these factors.
They include the political system, religious
beliefs, culture and economy. A thoughtful
examination of these basic issues will clarify
our view of the sexual politics in our
communities.
c
ONTROL What type of control should
our communities have over sexual behavior?
There exists in the world today a wide range of
methods of control; from China where there is
political, almost total control over the sexuality
of adolescents, to the American laissez-faire
attitude. Do what you want, when you want,
just don't bother me."
D
OUBLE STANDARD This double
standard makes adolescent women
responsible for their actions while adolescent
men are not — after all, boys will be boys. If our
communities let this double standard continue
then, quite frankly, were not going to get
anywhere. Instead of the time-worn double
standard, we must establish a new standard
which should be "equality for all human
beings."
E
DUCATION and in this context. I mean
primarily sex education. I do not believe we
have really considered many of the practical
questions that surround the introduction of sex
education into our communities. How should
we start? Who should teach sex education?
What approaches are best for each individual
community? What information should we
transmit, to whom? One of the mo.st important
things we have to remember is that each
community has different values — different
norms. A textbook or training material
appropriate for one community may be wholly
inappropriate for another.
F
ATHER Let s not leave him out of any
discussion that concerns adolescent fertility.
We traditionally ignore the father —
discussions of his conduct are usually
negative and often jocular. I consider
adolescent fertility a family affair: babies born
out of wedlock are born to two people, a
mother and a father. Social work tends to leave
out that essential third party. The shacow of
this family is the unmarried father. It is tin-'e we
included him; not in a punitive way but in a
positive vein. We must remember he too has
feelings and emotions, he too is an
adolescent. The experience of fatherhocd
has. without a doubt, affected him and he may
need help.
G
ROWNUPS or adults. I see grownups
as models, not as judges: as examples, not as
hypocrites. The old saying. Do as I say. not as
I do' seems to express the situation prevalent
in many parts of the world. We should not be
surprised that through their actions youngsters
reply. You do not act as you advise, why
should I act as you tell me to? It is time that
we, as adults who represent the community,
look within ourselves and examine what kind
of examples we are setting.
H
EALTH No one would argue the fact
that we need good physical and mental health
services but sometimes I feel we re so busy
building clinics and hospitals that we neglect
some of the novel approaches to health care.
There is. for example, a whole paramedical
approach to working with adolescents that has
yet to be explored in many places. Let's face it.
there are not enough trained doctors in the
world to do all of the work that is necessary —
we cant leave it all up to them. Nor do doctors
want to provide some of the health and
quasi-medical services which adolescents
need: our communities must be ready to
provide them.
I
NVOLVEMENT especially community
involvement with adolescents. Professionals,
volunteers, institutions, doctors, teachers,
social workers, religious groups, social groups
and cultural groups should integrate their work
rather than follow a piecemeal approach to
health care. Right now. one person is
interested in the adolescent s head, another is
interested in his mouth and his diet. There is no
one person who sits down and talks with a
young man or young woman as a complete
person — a wtiole being.
^ USTICE Not punitive, but therapeutic
justice. Many laws, regulations of social
agencies and community policies are punitive
and very often they are entirely unenforceable.
We need to reexamine them considering both
community values and justice for the affected
adolescent.
K
INDNESS It is time tor us to begin
treating all adolescents with kindness. They
are worthwhile human beings who need love.
We should stop rejecting them just because
their behavior sometimes clashes with our
ideal. They need understanding, not
accusations: they need warmth, not coldness:
they need to be included, not isolated from our
communities.
L
IMITS Are there no limits to the
acceptable sexual behavior of adolescents
within a community? We have to reintroduce
one small word into our communal
vocabularies: that word is NO. Sometimes we.
as adults in the community, appear to want to
leave all decisions about sex up to
adolescents themselves. Our attitude says,
"do as you choose, but there are times when
we should say NO. ' Most of us who have
worked with children know that even the most
independent adolescent does want some kind
of limits set on his behavior. In many places we
are moving towards a situation where
adolescents do not know what the limits on
their behavior are or if any limits exist at all.
M,
• EDI A In spite of the fact that there are
universal complaints concerning the misuse of
television, radio and newspapers there are
positive ways we could use the media for
adolescent education. Im not saying that we
should produce ads proclaiming. A pill a day
keeps the babies away or Technicolor
Condoms will save you from V.D.' I am talking
about a positive approach to fertility and
sexuality using all of the knowledge we now
have. One of the most effective, positive
efforts we could make would be to educate, not
only adolescents, but also their parents
through our media.
The Canadian Nurse October 1977
N,
ATIONAL GOALS Does our national
government support communities who are
trying to help adolescents or are we working in
a vacuum? For example, a government may
announce a sex education policy, but if there is
no implementation procedure included with
this policy then what is its use? What is the use
of a beautiful document 220 pages long if it is
not implemented by a national program. A
document alone cannot stop my teenager, or
yours, from getting pregnant.
o
PENNESS We must open our minds to
new ideas. We need not blindly accept every
new idea, but let's examine them each for their
own value. For example, I have found that I,
who live in an 'industrialized country" can
learn a lot from the work being done with
adolescents in the so-called
"non-industrialized countries." There is much
to learn from other countries and from the
efforts of other communities in our own
country
P
ARENTS We must get parents involved
in our work with adolescents, this is absolutely
essential but how should we go about doing
this? What's the purpose of getting them
involved? We need to help parents for their
own sake, as well as for the sake of their
adolescent children. Adolescent sexuality and
adolescent pregnancy (even the prospect of it)
is a major source of anxiety, depression,
frustration and general social and
psychological maladjustment for parents
Often they need help as much as (or more
than) their own teen-age child.
\^ UALITY OF LIFE What is the "quality
of life" in our communities? Is there respect for
human beings? Do people care for each
other? Is the individual adolescent considered
and respected as a human being? Is there
affection and love?
R
■ ESEARCH Certainly no one would
deny that research is a vital part of our health
care system. There are many areas we should
study that deal with adolescent sexuality. Let's
look at the different adolescents in our
communities. What makes them different?
What are their individual and collective
beliefs? What do they think about the quality of
life in their community? What do they believe
the quality of life should be? What are the
criteria for their decisions?
We have to remember that research
should not be conducted for the sake of
research alone. Our goal must be to help
communities fulfill their responsibilities to their
adolescent citizens.
s
ERVICES It is possible for us to
overservice a community. Opening service
areas is fairly easy, the problem is closing
down once there are vested interests
opposing any change. As a result, we now
have many service units which overlap and
duplicate each other. Yes, we do need
services, but let's examine the type, our needs
and the costs.
T
RUTH Can we have a true dialogue
between adults and adolescents without lies
sham and hypocrisy? What is the "truth" m
human sexuality?
u,
NDERLYING CAUSES OF
PREGNANCY This can include boredom,
poverty, unemployment, a difficult home life,
misinformation about sexuality and the effectj
of the community's morality on the lives of its
adolescents.
V,
ALUES Whose values? Should I
impose my generation s values on the
adolescent? What values do adolescents
have? It's all very nice to talk about throwing
out old values, but what worries me is that we
have no substitute new values. It's almost as if
we propose to throw old values in the garbage
can and then throw out the garbage can as
well. Suddenly, we have no place to put the
garbage.
It's too easy to reject this or that basic
community value without substituting anything
in its place. We cannot live in a valueless
society. Yes, adolescents are proposing a fev^
v^armed-over old values — what they call new
values are really nothing more than old value;
with a new accent. We now have to consider
at the community level, whether we (or the
adolescents themselves, when they become
older) would want these "new values' to be a
permanent part of our community culture.
Sexual values do not exist in a vacuum, they
must be consistent with other moral, religious,
psychological and social values.
Y
W
OMEN and in this case, especially
adolescent women. It's time we began to
recognize their rights: their sexual rights and
their expectations. We must recognize that
they have within them, the entire spectrum of
adult needs, that they want to, and must be
encouraged to participate with us as equals.
X
-PERIMENTAL We need experimental
programs. We need innovative programs that
do not cost a lot of money but which are
imaginative. There are some very beautiful
program ideas that should be tried. We could,
for example, utilize the arts, theatre, literature
— the whole creative realm is open to us.
Outreach work is another important area for
experimentation. We have done a little
outreach work here and there, but not nearly
enough.
Our global society might honor a country
for the construction of a special building for
adolescents and adolescent research but this
project may accomplish less than small
experimental programs which are completed
without fanfare, without trumpets. We do not
have to build monuments for the youngsters
which they do not need. We have to ask
ourselves if the real goal behind the
construction of these monuments is the
improvement of the quality of life for our
adolescents or our picture in the newspaper
and headlines in the world press.
OUTH Do we want to dominate our
adolescents? Do we want to work against
them, for them, or with them? Obviously
working with them can be our only fruitful
alternative. It is very likely that this is the first
time in history where adults and adolescents
have had the opportunity to work together as
two generations, rather than continuing the
intergenerational conflicts of the past. Both
generations should seek cooperation, not
authoritarianism: dialogue, not monologue:
self-help, not external aid: and understanding,
not deaf ears and unresponsiveness.
z
IP is North American slang suggesting
zest, a high morale and readiness. We must
become front-line soliders in our communities
in the fight to liberate adolescents and this fight
Includes their sexual liberation. It takes great
energy, fortitude and courage to take this
stand. Right now there are a few pioneers who
are fighting an almost lone battle on the
national level. We need more people and we
need this kind of energy and spirit at the
community level.
When the words sex . adolescence' and
■fertility' are mentioned together in local
discussion, there should be leaders who will
stand up and speak their mind. It is very
difficult to stand on a podium and shout aloud
to your neighbors. "We need change." Such
people are often accused of all kinds of subtle
and not-so-subtle motives, nevertheless this is
the kind of involvement and community action
that we need and we must work towards it.*
Benjamin Schlesingerfe./A.. M.S.W., PhD.)
presented his paper "The Pregnant
Alphabet" during the first inter-l-lemisphehc
Conference on adolescent fertility held in
Virginia in the Fall of 1976. He was Canada's
only representative at the conference where
39 nations met to discuss the increasing
phenomenon of adolescent fertility.
At present. Schlesinger is a professor in
the Faculty of Social Work at the University of
Toronto. He is the author of many books and
articles concerning family planning, family life
and sexuality.
38
The Canadian Nurse October 1977
In many ways, the nursing process is 'common sense'. It incorporates an approach that most
of us use every day when we try to solve the problems we face. But each of us, from time to
time, is guilty of sloppy thinking. We make assumptions about the problems we f/}/n/( a patient
has; we think we know the solutions but never stop to evaluate their effectiveness; we fall into
routine patterns of behavior — the old familiar 'rut.' Individualized nursing care, however,
demands more than good intentions. It takes 'common sense' to look at a patient's needs and
problems in an organized and perceptive way and to use the time we have with a patient, no
matter how limited, in the best way possible.
S^^^
^
<^%<^
\c^^^"
^
6
d^
/e
Lorraine Hagar
The use of the nursing process as a standard
tool in all activities related to nursing has
become a primary concern in our professior
today. As a method that uses assessment,
planning, Implementation and evaluation as it:!
formula, the nursing process is flexible and
adaptable, applicable in any setting. It
provides a deliberate, systematic and
organized approach to nursing practice that'
accomplishes the main purposes of nursing —
to promote wellness, to contribute to the
quality of life and to maximize all resources.'
The nursing process requires the
development of a therapeutic relationship
between ourselves and our patients. We arc
past the day when nurses work with only one!
part of the patient — the part that is sick. Now
we are challenged to utilize all our knowledge
to assess the patient's strengths as well as his
weaknesses so that he can share in the
assessment, planning and evaluation of his
care. Familiarity with theories and disease
entities is no longer enough. We need to knowi
our patients as individuals. For example, to
know that Mr. Smith in Room 401 has
hypertension is to know only a small part of
what is happening to Mr. Smith. If we plan our
nursing care solely on that "classification ", w(,
will do a poor job of meeting Mr. Smith's needs ,
The nursing process provides a framework — '
a tool of the trade — that we can use to find out
more about Mr. Smith's needs in a systematic'
rather than a haphazard way.
It is the relationship we develop with our
patients — a relationship that allows him anc
his family to take part in the nursing process,
(that is, the assessment of unmet needs or i
problems, planning nursing activities to solve'
these problems, implementing the actions and'
then evaluating whether or not the actions did
indeed meet these needs) — that constitutes j
the basis for our practice. As nurse educate I
and author Madeleine Leininger has said, {
"Nurses help people through a professional j
relationship that is learned. It is the use of the
therapeutic relationship with patients that 1
constitutes the heart of nursing practice andl
determines what is done to the patient and [
how it is done."^
In addition to information concerning the
patient's personal history, capabilities and
limitations, knowledge of current and
traditional theories from various disciplines
can help to provide a working basis for the
nursing process. A basic knowledge of
man/environment interactions in various
cultural settings may be an asset in assisting
the individual in the immediate situation. The
nurse must make full use of her knowledge of
physiology, pathology, psychology, hospital
and community facilities, family interaction
and support, as well as her own intuition. Use
of her knowledge base and constant
re-evaluation will help to develop the nursing
process into a personalized device, tempered
by personal experience as well as formal
learning. The nurse's efforts are aimed at
helping the patient cope with his environment
and society to their mutual benefit. It is often a
tall order.
I Brian — a case study
0 Assessment
"The assessment phase begins with the
nursing history and ends with a nursing
diagnosis. The purpose of this phase is to
identify and obtain data about the client that
will enable the nurse and /or client and his
family to designate problems relating to
wellness or illness. If problems exist, then the
first step toward a solution is to identify
them".^
Brian, a four-year-old victim of child abuse and
maternal deprivation, was admitted to hospital
for treatment of a fractured femur sustained
when he fell off his tricycle. Six months prior to
the accident, he had been taken away from his
parents and placed in a foster home. Little
personal history was taken at the time of
admission and his foster parents, living in
another town, were rarely able to visit.
To the nursing staff, Brian appeared to be
physically as well as mentally immature for his
age. He did not speak intelligibly and his level
of development was that of a one-or two-year
old. Brian was originally diagnosed as an
autistic child. Later it was recognized that
maternal deprivation was the cause of his
behavior.
Brian was immobilized in a hip spica cast
and restrained on his stomach in his crib. He
reacted to the pain in his leg, to immobilization
and to the strange environment by crying,
violently kicking his free leg and teanng the
bed sheets and toys. When someone
attempted to make contact with him, he would
either withdraw or lash out. He mistrusted
everyone who approached him.
In assessing Bnan s needs, the threats to
his wellness included not only his broken leg
but all the ramifications that this injury caused
in upsetting his physiological and
psychological patterns of daily living. For
example, he could not sit to eat and often
vented his frustrations by throwing his food.
Sometimes, he would refuse food altogether. If
he was hungry enough, he would eat anything
in sight. His dirty diaper proved to be no
exception. Elimination was a problem — any
gains made in toilet training had been lost. A
case of diarrhea made matters worse.
Bnans activity was largely curtailed by
the cast and restraints. Rest was
difficult because of his pain and
agitation. These difficulties
were compounded by an
unfamiliar environment,
and his great reluctance or
inability to trust those trying
to help him.
Generally, Brian dealt with
his situation by aggression —
by throwing or demolishing toys,
food, bedding and attempting
(sometimes successfully) to bite nurses.
When very angry, Brian would destroy things
with his teeth. When moderately upset, he
would seem to find comfort in sucking on a
diaper. It was interesting to note that in a calm
state after Brian became used to me, he would
examine and manipulate objects but made no
attempt to put them in his mouth. He would
sometimes even give the object back to me —
a developmental task descnbed by Enckson
as "holding on" and "letting go."'
In this, he showed signs of having
superseded Freud s oral gratification stage.
He also demonstrated his ability to make
choices, whether to let me have the object or
not. Often, he changed his mind and deaded
to keep it himself.
But when Brian actually tried to put his
fingers in my mouth, I decided that he trusted
me more than I trusted him . I didn't dare let my
hand go near those teeth of his.
In working with Brian, I felt that the
establishment of a trusting relationship was
the top priority. Without trust, all care was
inflicted on Brian by force and he, in turn, used
up all his energy in resisting it. Any effort to
restrain him, even to hold his wrist to take his
pulse, was violently resisted. The greater the
force used to restrain him, the greater were his
efforts to resist. For example, he proved this
'heroically' when it took an orderly and two
hefty nurses to hold Brian still for an X ray of his
leg (already immobilized in the cast).
□ Planning and giving care
During the assessment, the unmet needs of
the client have been identified. The
purposes of the planning phase, the second
step in the nursing process are:
1. to assign priority to the problems
diagnosed
2. to differentiate among those problems that
can be solved by the nurse, the health team
and the client /family
3. to designate specific actions and their
goals
4. to communicate the plan to others by
writing it down in a nursing care plan. = The
third step in the process is the implementation
of the plan.
Brian's priorities differed radically from
those of the health team in that he often did not
want anyone to touch or come near him . When
the goals of the patient and nurse are at odds,
problems are compounded.
The abused child has an innate mistrust of
those around him. In giving nursing care to
Brian, I found that his mistrust of me could be
overcome but that it reappeared with each
contact. In establishing a trusting relatioivship
with him, I had to follow a particular pattern of
behavior each time. I did this by staying with
him and letting him familiarize himself with me,
by touching and speaking to him gently. I
would let him handle the diaper I was going to
put on him, put his fingers in the skin cream
Lorraine Hagar of Englehart, Ontario is
a third year student in the Faculty of
Nursing, University of Toronto. She wrote
"The nursing process: a tool to individualized
care" as an integrative paper assignment
during her second year Her main areas of
interest in nursing lie in the fields of pediatrics
and community health, both of which she
hopes to pursue in a nursing career in
Ontario's northern communities.
References
1 Yura. H. The nursing process, by and M.
Walsh 2ed. New York. Meredith, 1973, p. 35,
2 Leininger, M.M. Nursing and anthropology:
Two worlds to blend. New York, Wiley, 1 970, p. 31 .
3 Yura, op. cit. p. 72.
4 Sutterley, D.C. Perspectives in fiuman
development, by... and G.F. Donnelly. Toronto,
Lippincott. 1973, p. 81.
5 Yura, op. cit. p. 93.
6 Ibid, p. 121.
and touch anything used in his care. The music
from a windup toy radio helped to soothe him
and I would hold his hand on the knob to wind it
up. Once a measure of trust had been
developed, he would allow me to wash him
and do cast care without too much fuss.
The importance of Brian's need to
manipulate, explore and exert some control
over his environment is emphasized by a
review of the developmental tasks of the
toddler stage. Although Brian was far behind
developmentally, his capabilities seemed to
vary with the degree of agitation he
experienced. Using this rationale to plan
activities and an environment conductive to
successful achievement of these
developmental tasks would, I hoped, prevent
Brian from regressing to a great extent while
hospitalized, and also provide him with
sensory stimulation.
Brian became much more approachable
and settled when freed from his restraints and
placed on blankets on the floor. He soon
learned to log roll over the cast and pull himself
around to reach a desired toy. If the room was
quiet, [ ian could be encouraged to become
interested in toys, instead of just throwing
them around to release his fnjstration. It also
I became apparent that Brian could feed himsoif
I with a spoon and drink out of a cup. His ability
to focus his attention and perform tasks varied
with his level of anxiety.
Brian's cooperation could only be enlisted
by a very slow, gentle approach, preferably by
a familiar person. If he was given no
\ opportunity to adjust to a new environment,
procedure, or person, the result was a
hysterical, kicking, screaming little monster,
' lashing out tooth and nail.
However, after he had tested out people
and his environment, assuring himself that
neither would harm him, his destructive
tendencies disappeared (for a time) and he
showed evidence of more advanced motor
! and social development such as feeding
i himself with a spoon, parallel play, interest in
my book, pen, watch. This first step towards
■ developing trust appeared to be the key to
j helping Brian achieve a sense of security and
i a balanced state from which he could
; progress.
G Evaluation
"Evaluation is always in terms of how the client
is expected to respond to the planned action
...(It) is the natural intellectual activity
completing the process phases because it
indicates the degree to which the nursing
diagnosis and nursing actions have been
correct."^
My primary purpose during the short time I
spent with Bhan was to establish a therapeutic
relationship which in itself would meet his
basic need for someone to trust. Brian's
mistrust of everyone appeared to stem from
the damaging effect of his previous
interactions with his parents as a victim of child
abuse. In nursi i Brian, I tried to concentrate
on ways of carii j for and assisting him rather
than to accomplish or inflict set procedures
such as taking vital signs, feeding, washing,
giving skin care, and doing cast care. My aim
was to involve him in his care, and find
acceptable ways to acquaint him with the
different procedures so that he would not find
them so frightening.
Brian's problems appeared to be
interrelated. In attempting to stabilize his food
and fluid intake, by providing a quiet
atmosphere and freeing him from his
restraints, I hoped that his elimination would
become more regular so that "bed pan
training" might be initiated in the future. If the
discomforts of indigestion, loss of bowel
control and emotional turmoil were
diminished, regular periods of rest and sleep
could promote his recovery and perhaps
improve his behavior.
Although Brian did not fit into any one
developmental level, appreciation of the
uniqueness of his personality and the effect of
stress on the individual prevented me from
vainly trying to categorize him. He presented
the sad picture of what can happen when basic
needs are not met early in life, and critical
developmental tasks are not successfully
accomplished. Brian had to repeatedly test out
people and his environment, to gain
confidence in his own ability to trust, or to
decide not to trust.
In my attempts to focus Brian's attention,
to promote familiarity, to provide a quiet
atmosphere, and to reduce the barrage of
incomprehensible stimuli, I was able to see
Brian's progress, or rather his reattainment of
a previous level of development.
Unfortunately, in controlling his environment, I
did not prepare or reconcile him with the
changing circumstances he would face again
the next day, when he would be open to the
approaches of many different and unfamiliar
people. He was considered a problem by most
of the nursing staff on the floor and care was
often given in the most expedient fashion, not
necessarily tailored to Brian's unique needs. It
would have been beneficial if the same nurse
could have arranged to care for him on a
regular basis.
Although I cared for Brian for only two
days, this proved long enough to utilize and
carry out the elements of the nursing process.
At times, the process seemed to be reduced to
a modified trial and error method, but its
effectiveness was measured by the change
observed in Brian's behavior. He began to
respond to verbal commands and his
destructive tendencies and wild behaviorgave
way to explorative interest in his environment.
I presented the approach I had used in
caring for Brian to the staff nurses I came in
contact with and also made explanatory
nursing notes. The staff did substitute mats for
his crib to eliminate the need for restraints and
provide Brian with more sensory stimulation
and freedom to explore his room.
In spite of this, however, my plan failed to
maintain the element of continuity and pattern
necessary to fulfill the purposes of care. It was
reported that by the time of discharge, he had
regressed further. The regular staff simply did
not have the time to devote to Brian to make
my plan a success.
Even so, this does not mean that the
nursing process is bound to fail on a busy
hospital floor. The key to the nursing process is
continuity and consistency. Interaction that
has proven to be effective needs to be
continued and reevaluated by all nurses in
contact with the patient. It takes a
reorganization of thinking — to look at needs in
an orderly, logical manner and to think things
through. "What is this person's need? What
actions can I take to help him meet these
needs? Were my actions effective?"*
The Canadian Nurse
"Doctors, nurses, health visitors, social workers, speech therapists, radiographers,
dieticians and teachers are educating others constantly about health both directly
and indirectly. It is not so much a matter of seeking special opportunities as of
making the right use of existing contacts with pupils, clients and patients. In
education for health we are learning together with other people, rather than
instructing the ignorant." (Micnaei wiison)
SECONDARY SCHOOL
NURSING
A CHANGING FOCUS
The Canadian Nurse October 1977
May Brown
In Eastern Ontario, where I work as a school
nurse, secondary school health service has
always been the responsibility of the provincial
Department of Health. Teams of nurses have
provided services such as immunization,
counseling, vision and hearing tests, health
teaching and consultant services.
The main focus of the school health
service in the past has been on prevention.
Mass screening devices were implemented to
reach large numbers. By throwing out a large
net we hoped to "catch' health problems. We
taught the healthy how to stay well, and we
counseled the ill as we came across them.
Attempts were also made to counsel all
grade 10 students in secondary schools, as
this age group is approaching adulthood and
many adolescent physical and emotional
changes are taking place.
The screening method is still an
acceptable standard where school health
services are being introduced to an area; for
example, trained teams of specialists and
technicians can, in only one to two days,
complete vision and hearing tests on an entire
school population. However, my own
experience as a school nurse led me to
question whether the screening method was
the best way to cope with the health problems
of high school students. Health is a large word;
it means more than giving polio shots or a
clean bill of health on a chest X-ray, important
as these may be.
Three years ago, when I was asked to
take responsibility for the health of a local high
school, I decided to try a more personal
approach with the students and a more
cooperative and collegial approach with
teachers and other school staff.
The local high school I was assigned to
had a population of 80-90 teachers and about
1400 students. The school health program at
that time included tuberculin testing forgrade 9
students, "boosters" for dipthena. polio and
tetanus in grade 10. *and counseling and
vision testing for all grade 1 0 pupils. Individual
health care problems were referred to us by
the teachers. Added to this was the need to
keep an eye on all those students whose
health problems had been discovered while in
elementary schools. I worked at the school
three half days weekly, Monday. Wednesday
and Friday mornings. I saw students by
appointment whenever possible, and planned
each interview to last ten minutes.
My interview questions were designed to
elicit information about a students daily
routine, his attitudes and his health. I checked
nutrition styles, bedtime habits, studying
patterns and work performance in school, that
is, the students last class average.
I usually tned to find out what the students
expectations were of himself. I was surprised
to find that when a student's school
performance was below par. he was usually
well aware of the fact.
During the interview I enquired about
tensions at home, part-time jobs, and
■"Boosters" — diphtheria, polio and tetanus for
students under 1 6 years, tetanus and polio for those
16 years.
Students' career aspirations. Students with
problems stemming from these were sent
directly to the guidance counselors for further
help.
I found this program most effective in my
first year. It gave me a picture of health
patterns and a good background of knowledge
and expenence. However, this approach also
had its drawbacks.
The workload became too heavy and took
up too much of my own and the students' time.
I found that a 10-minute health counseling
session cost each student at least half an hour
out of class. I worked with one grade 1 0 class
after another, seeing between seven and eight
pupils on an average morning. At the end of
each class group, I conducted a
guidance-health conference with the
counselor assigned to that particular class.
Healthy, above-average students were given
the same attention as those needing care and
advice. I felt this was a waste of
counselor-teacher nursing hours. After all,
parents still have the final responsibility for
their teenage children — why was I spending
valuable time with obviously healthy students?
A further difficulty was how to alert teachers to
the health problems in their classrooms, so
that they could refer them to us.
But by far the most serious problem, in my
opinion, was one badly neglected area of
health supervision — the multi-problem slow
learners in the occupational classes.
This school had at least three classes
each in grades 9 to 1 1 . for students who would
not finish high school but would "graduate"
straight to the working force. An average class
carried 15 to 20 students from vanous social
levels — the majority from lower-income
families.
Lifestyles in this group were less
restrictive and more relaxed. Less emphasis
was placed on class performance or career
goals. Bedtime habits were erratic and
students often had part-time jobs; they were
more assertive, and matured earlier.
Their casual attitudes and "don't give a
damn " air were a nightmare for their teachers.
Many were in trouble with the law, and their
names came up constantly across the
counseling tables.
In my first year, 1 saw these students only
towards the end of the term, too late to do
effective health teaching with proper follow-up.
Occupational students were isolated from
the greater student body. They had their own
teachers and counselors separate from the
regular student population In the four- and
five-year plans.
The students in this group presented a
real health problem but they were lost in an
upper middle class school, and were virtually
ignored by the regular staff. Their teachers
encountered constant frustration, limited
parental ability and interest, as 1 did myself.
One parent, who was advised to get a medical
assessment for her daughter, told me that
what the child needed was discipline, not a
medical referral!
I decided to start my second term at the
school with early emphasis on these
occupational students.
The Canadian Nurse October 1977
In September, I interviewed counselors,
teachers and department heads and altered
my program to give priority to the occupational
department. I organized classroom
conferences with teachers, so that I could
gather information about students before
assessing them individually. My goal was to
concentrate on interviewing and counseling
grade 10 occupational classes; I would take
the other students only when they were
referred to me.
I found the pupils very interesting. After
their initial shyness and distrust had passed
they were often eager to pour out their
problems. They were good listeners as well. I
attempted to reach them through a common
sense approach and adapted my standards to
their individual interests and abilities. In this
way we usually came to an agreement on
acceptable concepts of good health.
Early drinking, smoking and some drug
use surfaced. Many of these students had
been in and out of the courts, and had a
"street" knowledge that was superior to that of
the average student's.
Many of their problems were beyond the
scope of the health program but a good,
supportive psychology team had just been
added to our resources. We now had monthly
meetings with a psychologist and a social
worker, both of whom used private and group
therapy sessions to counsel and re-direct
students' lifestyles. This team has now worked
together effectively for three years. The
inclusion of professional help from a local
hospital-based psychiatric unit, has helped us
develop into a cohesive community service.
The result of these changes in my
approach to school health problems was that
my work began to extend more and more into
the community. Interviews were longer and
more searching. Often I followed the
student-nurse conference with a phone call. I
had soon discovered that "notes " home were
virtually ignored, but no one could deny a
properly recorded telephone message. Often I
was able to get parental backing on health
habits. Sometimes of course, I was not.
Typical examples of my 'cases" are
students "A" and "B. "
Student "A", a young grade 9 student,
was referred to me by his teacher following
complaints of blurred vision. On tests, he
performed at a normal 20/20 level, but
admitted during the interviews that his home
life was erratic, his nutrition was poor, he
smoked five - six cigarettes daily, and he
stayed up late at night. He liked sports, but
was unable to compete well on teams
because of wheezing and shortness of
breath.
I reviewed his nutritional requirements,
worked out a menu plan and advised him to
cut the cigarettes out to see if he perked up.
On review two weeks later, this student had
made an effort to improve his meals and
lifestyle, but still maintained irregular hours on
weekends. We felt parental supervision was
lacking here. After a conference with the
Occupations Department Head, it was
decided to visit the parents and request
stricter home supervision with attention to
teenage drinking at home, all-night parties
(also in the home), and early dating.
Extensive family therapy may have to be
initiated if this boy is to continue in the school
system.
Student "B" arrived at my office looking
pale and complaining of severe headaches.
His health record showed a history of vague
stomach complaints for which a physical
examination by the family doctor had
produced no diagnosis.
After a home visit with his parents, and
following several interviews with the boy, I felt
his main problem was deep anxiety for his
academic program. Under parental pressure
to produce academically, he had been
assigned a program above his achievement
level. The guidance counselor called in his
parents, and advised them that "B" required a
reduced workload at a more basic level. I
referred him again to the family doctor, who
agreed to send him for psychiatric
counseling if the headaches continued. Two
weeks later, he returned to the health office.
He was more relaxed and interested in
school, but still showed physical stress signs
— poor nutrition, heavy smoking, tiredness,
and so on.
The Guidance Department is aware of
the direction of my concern and referral to the
Mental Health Clinic has not been ruled out.
Another area of my new "look " involved
the recently organized Attendance
Department within the school system. The
board hired social workers to counsel
"A.W.O.L." cases, and others with chronic
absenteeism problems, which were often
covered up by the family through such means
as "doctored" notes. Chronically "sick"
malingerers were often found within this
group.
By inviting cooperation between the
Attendance Department and the Health
Service, I was able to teach and counsel very
effectively in this area. Many minor ailments
showed up: headaches, nerves, stomach
aches, ahd so on. In-depth interviews
uncovered deeper emotional problems or
unstable home conditions. I used a two to
three week trial period for improvement, and if
this was ineffective we called in our
counseling team and outside support. Table 1
shows how my workload changed as I
established contact with the other helping
units.
l_ast year, the school underwent major
renovations and we were forced to slow down.
This proved a good time to make changes in
our program without creating uneasiness.
We no longer use extensive screening
and we no longer have line-ups outside the
health room door. Referrals are by request and
appointment only; most are multi-problem
cases, attendance delinquents, and students
referred from the occupational and guidance
departments.
All the department heads are most
cooperative. Problem cases arrive more
quickly than in the past and are dealt with more
The Canadian Nurse October 1977
Table 1
Three year program for change
Time
1973-74
3 Mornings
Weekly
1974-75
2 Mornings
Weekly
1975-76
2 Mornings
Weekly
I
Activities
Nurse-guidance conferences — 13 Grade 10 classes.
Interviews — Grade 1 0 students.
Referrals — Grade 9, only major health problems.
(1st year with Psychology Team).
Conferences with vice-principal re:
attendance problems.
Conferences with guidance department re:
students with health problems.
Assessment of all Grade 10 occupational students.
(2nd year with Psychology Team).
New attendance department, referrals and
follow-up Individual conferences with
guidance department.
Occupational students on referral.
(3rd year with Psychology Team).
efficiently. We have monthly conferences
which last about one to two hours. More and
more I am "out" of the health room and "into"
the classroom, particularly, in the occupational
department and I have reduced my school
time to two half days weekly.
By offering support to the teaching
programs and with the aid of new pamphlets
and posters distributed by the health unit, we
can carry out health teaching in a group
setting. Topics such as nutrition, good
grooming, and sex education are discussed
openly in the classroom, with tact. Sex
education in secondary schools is still carried
out at the discretion of individual school
boards, but public health nurses are gradually
breaking down public reservations. If we
receive parental support for our teaching
methods on this subject, I hope the end result
will be better informed teenagers.
The changes I have built into my work as a
school health nurse are more goal-oriented,
and therefore make the work more exciting
and interesting .
I believe the trend away from mass
screening in the secondary schools will allow
more time to deal with individuals, and their
health and related emotional problems. The
trend towards prevention in a classroom
setting also permits the public health nurse to
become a valuable team member on a
consultative basis, available to students,
teachers, psychologists and counselors alike.
May Brown, who wrote "Secondary School
Nursing: a changing focus" is a member of the
staff of the Eastern Ontario Health Unit
working out of its Cornwall office. She
graduated from Hotel Dieu Hospital in
Cornwall and received her certificate in Public
Health Nursing from the University of Western
Ontario. Before returning to Cornwall, she
was a member of the staff of the Windsor and
Essex Health Unit in southern Ontario.
Bibliography
1 Bellaire, Judith. Teenagers learn to care about
themselves. Wurs. Outlook 19:12:792-793, Dec.
1971.
2 Fredlund, Delphie. Juvenile delinquency and
school nursing. Nurs. Outlook 18:5:57-59, May,
1970.
3 Hozzard, Mary Ellen. Family system ttierapy.
Nursing 76 6:7:22-23, Jul. 1976.
4 Malo-Juvera, Delores. Seeing is believing.
A/t/rs. Outlook 21:9:583-585, Sep. 1973.
5 O'Brien, M.J. Team nursing in school health.
Nurs. Outlook 17:28-30, Jul. 1969.
6 Ontario. Ministry of Health. Report of the task
force on school health services. Toronto, 1 972.
7 Prince, Gordon Stewart. Teenagers today.
London, National Association for Mental Health,
1968.
8 Rajokovich, Marilyn J. High schools need nurse
counsellors too. A/wrs. Outlook 18:5:60-62, May
1970.
9 Rich, John. Interviewing children and
adolescents. London, MacMillan, 1968.
10 Wayne, D. Sctwol nursing and team
teaching. A/urs. Outlook 17:37, Jul. 1969.
1 1 Wilson, Michael. Health is for People. Darton,
Longman and Todd Ltd. 1975.
The Canadian Nurse October 1977
***
***
G8BS ^8 WEE S>¥pWE.
%
f^
The Canadian Nurse October 1977
Last Spring, when the job market for nurses in Canada tightened up, hundreds of
graduates from schools of nursing In this country headed south of the border to find
work. Author Katherlne ZIn, valedictorian of her class at Seneca College in Toronto,
was one of them. She found a job in Florida — a state which Is always short of nurses
since It has only one school of nursing and a total of 22 hospitals. Unlike many of her
contemporaries, many of whom headed home after only a few months, Katherlne is
still working in the United States. Sometimes, though, she thinks about returning to
Canada. This is her story of what it's like to begin your nursing career 1 ,500 miles from
home and why she's coming back one day.
Katherlne Zin
The answers all came back the same. "We
regret to inform you that we have no position to
offer you at the present time. However, we will
keep your application on file for future
consideration ..."
The spring of 1976 was an exciting but
frustrating time for me and for other nursing
graduates across Canada. Our education in a
chosen field had almost been completed, but
the job market was bleak at best. Although I
very much wanted to stay in Ontario or go to
western Canada, there were few jobs
available. There seemed to be only one
alternative.
The United States provided a "land of
opportunity" as far as jobs were concerned.
Unlike Canada, the U.S. had, and continues to
have, a shortage of nurses. The job market
and professional opportunities were wide
open and I was only one Canadian nurse who
took advantage of the situation.
Florida was my choice because it not only
promised a job, but also the fringe benefits of
sun and surf. And so, after settling in an
apartment on the ocean, I began my career as
a registered nurse.
I found that nursing in Canada and the
United States has few basic differences. Many
of the adjustments that I had to make as a new
graduate starting my first job would probably
have been the same if I had begun work in
Canada. I became the subject of something
our teachers had warned us about — reality
shock.
The shortage of nurses in the United
States had benefits because it opened up
opportunities for Canadian graduates. But it
also meant difficulties, because everyone had
to deal with the shortage. I had to adjust
quickly to the realities of short staffing.
Orientations always promise ample time
to prepare a nurse to become an active and
productive memberofthe health team. Reality
however, often forces a new grad to be that
productive member before she is ready. From
the protective and safe environment of the
teacher-student relationship, I suddenly found
myself in charge of 38 patients on an
orthopedic ward at night.
I soon transferred to the intensive and
coronary care unit. During my training, I found
that specialty care areas often had to be
restricted to a day-long period of observation.
Certainly I found the opportunity to work in ICU
exciting, challenging and rewarding, but
adjusting to the pace had its ups and downs.
It became necessary for me to rethink
and redefine my attitudes about health care.
Those "respiratory patient" disputes, so
well-publicized through the media, became
real situations that I had to deal with daily. I
was forced to develop my own ideas about
"keeping patients alive" by mechanical
means. I found it very trying at times,
especially because it was coupled with the
ever-present threat of legal implications for
every nursing action. But helpful co-workers
and understanding supervisors helped me to
adjust to the new demands I faced. My
fulfillment as a nurse provided me with the
reward that kept me going.
These were some of the problems that
faced Katherlne Zin, R.N. But Kathy the
person had problems to face too. I was 1500
miles away from home in a foreign country. I
can't say it was always easy but I had a lot
going for me.
I had lived away from my home in
Windsor, Ontario for two years during my
nursing training in Toronto. I had also moved
to a country whose culture is very similar to
that of Canada. I've found Americans,
especially here in the south, extremely friendly
and helpful. Everyday life is very much the
same — although the pace here is so much
slower than in Toronto.
The biggest difference I guess, is that it's
just not Canada. I find myself living with a
nagging desire to be back in Canada no matter
how well things are going here. Homesickness
is always with me, in varying degrees. Perhaps
this is just something that everyone who
leaves home has to deal with.
I am still here in Florida, and enjoying it
very much. But to be honest, if a job were
offered to me in Canada, I would find it difficult
to turn down. Here, I am growing in experience
and knowledge. I hope that someday in the
near future I will be able to return to Canada
and contribute to our own health care system
all I have learned here in the States. Better still,
I hope that soon our Canadian graduates, who
have so much to offer, will have the opportunity
to care for patients in Canada from their first
day as registered nurses. «
Katherlne Zin (R.N.) graduated from Seneca
College School of Nursing In Toronto in 1976.
She is currently employed as an ICU-CCU
staff nurse and relief night charge nurse at
Hollywood Medical Center in Hollywood,
Florida. Kathy hopes to continue her
education In nursing and plans to move into ,
the area of teaching in the future.
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The Canadian Nurse w«.it/uer 1977
Resumes are based on studies placed
by the authors in the CNA Library
Repository Collection of Nursing
Studies.
Research
• Education
Internal Evaluation of an
Experimental Dacum
Curriculum in a Diploma
School of Nursing. Boston,
1976. Dissertation (Ph.D. in
Education) Boston University by
Jane Clare Haliburton.
An internal evaluation study was
done in one hospital school of
nursing to determine if the Dacum
system approach could be successful
in a nursing education program. The
criteria used were the pass rate on the
R.N. exams, and the philosophy and
objectives of the school. (The
Stufflebeam C.I. P. P. evaluation
model was used for the study).
The Dacum system approach
includes planning, implementation
and student evaluation. It is based on
the development of a Dacum Chart
which is a profile of the job as defined
by employers, supervisors and people
skilled on the job. The skills are
expressed in behavioral terms which
are meaningful to people on the job.
The chart is given to the faculty and
forms the basis of the curriculum.
Sources of data for the study
included minutes of meetings,
audiovisual tapes, feedback from
teachers, students, head nurses, and
employers as well as detailed records
kept during the experiment.
Evaluation of the learning
environment was done first, from
which evaluation criteria were
developed for minimum standards
expected of the student prior to
graduation. Two interim evaluations
were carried out during the program
and modifications were made when
needed. Rationale for the
modifications were recorded.
The program was run as close to
the Dacum proposals as possible for
the first two years. Students were
given freedom to learn in an
environment where all content had
been integrated into learning packets
or modules. Evaluation results
showed that integration had been
carried too far and some students
were confused, and could not
recognize the core information which
could be transferred to many
situations. Students Identified a need
for some deadlines and guidelines,
and frequently requested lectures.
In the third year of the
experimental period, the material was
presented to the first year students
with assignment guidelines that forced
the student to integrate the content.
These students were able to function
as independent learners in their
second year.
The school provincial standing in
the R.N. exams jumped four to seven
places: the students passed with high
marks. Faculty and students
expressed satisfaction with the
process. The Dacum systems
approach to curriculum planning,
implementation, and evaluation
proved to be successful in one school
of nursing.
• Continuing Education
The Continuing Learning
Activities of Graduates of Two
Diploma Nursing Programs in
Ontario. Guelph, Ontario, 1976.
Thesis (M.Sc), University of
Guelph by C. Marilyn Anderson.
The purpose of this study was to
determine the influence of
nurses' pre-professional learning
experiences on their participation in
professional continuing learning.
Relationships were also investigated
between participation in professional
continuing learning and selected
biographical and employment
characteristics, interest in nursing,
satisfaction with pre-professional
learning experiences and perception
of competency.
The study sample consisted of
191 registered nurses who graduated
from two diploma nursing programs in
Ontario in 1973 and 1974. A mail
questionnaire was used for the
collection of data. Factor analysis of
the pre-professional learning
experiences and multiple regression
analyses of independent
and dependent variables were the
statistical procedures used for testing
the major hypothesis.
The principal finding was that no
single pre-professiQnal learning
experience, or identifiable types of
learning experiences, had
significantly predictive value for
participation in continuing learning.
Rather, a wide range of learning
experiences in the pre-professional
period appeared to contri bute to a high
rate of participation.
The observation has been made
that in order to maintain competence
nurses need to become increasingly
self-directed in their continuing
learning activities. The findings of this
study imply that this goal may best be
achieved by making available to the
pre-professional and to the
professional nurse, a variety of
learning approaches and resources.
• Renal Failure
Knowledge Reported by
Chronic Renal Failure Patients
in Four Areas Related to
Self-Care. Toronto, Ont., 1976.
Thesis (M.Sc.N.), University of
Toronto by Susan Dawn Smith.
The purpose of this study was to
examine what selected
knowledge related to self-care was
reported by a group of patients with
chronic renal failure on a hospital
dialysis program. The ultimate
purpose was to identify omissions
and/or misinterpretations of
knowledge related to self-care, in
order to plan a suitable educational
program for chronic renal failure
patients.
Twenty-eight patients from three
hospital dialysis programs were
interviewed and questioned
concerning their knowledge related to
four areas of self-care, namely;
condition, effects of condition,
therapy, and effects of therapy.
Results indicated that, in terms of
the definitions employed, subjects did
not report knowledge in any area that
would allow them to assume
responsibility for self-care.
The findings in each area are as
follows:
1. Knowledge Related to Condition.
The majority of subjects who
experienced symptoms such as
dyspnea, ankle edema and weight
gain were able to associate them with
overhydration, but could not state
appropriate actions for prevention.
The cause and prevention of
hyperkalemia were better understood.
In general, subjects with more than six
months' experience on dialysis knew
more about the irreversibility of the
disease, its causal relationship to
overhydration and hyperi<alemia and
the appropriate actions to alleviate the
symptomatology.
2. Knowledge Related to Effects of
Condition.
Only two-thirds of the sample seemed
to recognize the dangers of infection.
In general, those subjects with more
than six months, experience on
dialysis were more concerned about
infection. The majority of all subjects
expressed little concern about
hemorrhage and failed to appreciate
the importance of extra-renal
complications.
3. Knowledge Related to Therapy.
Dietary and/or fluid restrictions were
seen as part of therapy by only a very
few subjects and only about
one-quarter of the sample could
correctly name or describe all their
medications.
4. Knowledge Related to Effects of
Therapy.
The majority of subjects were
unaware of side-effects of their
medications, and length of dialysis
experience seemed to have no
reinforcement value. Similarly, the
habit of daily weight-taking declined
with additional time on dialysis.
Since almost half the subjects
were employed and/or maintaining a
home, the study raises the question of
how much better they would function
with a broader knowledge base.
Recommendations included
more accurate initial assessment of
the patient's emotional and intellectual
status, and the development of a
formal teaching program emphasizing
knowledge areas identified as
unsound.
The Canadian Nurse October 1977
l{ook8
Creative Teaching in Clinical Nursing, 3ed.
by Jean E. Schweerand Kristlne M. Gebbie, St.
Louis, The C.V. Mosby Company, 1976.
Approximate price $8.35
Reviewed by Joyce Nevitt, Professor of
Nursing. Sctiool of Nursing. /Memorial
University of Newfoundland.
The authors provide the l<ey to this bool< in the
t preface, where they note that creativity cannot be
1 1 aught, but that each teacher has a 'potential for
iome degree of creativity . . . The degree and l<ind are
jependent upon the individual..."
Unit one places teaching clinical nursing in
jerspective. Development and trends are described
n relation to the scientific and social changes which
have influenced nursing education, and the
discussion is supported by reference to numerous
Utudies that have been done in the past decades.
Throughout the book, definition of terms with
wnphasis on key words, avoids ambiguity.
The second unit discusses both the
idministrative responsibility for providing a climate
within which teachers can be free to develop the
'potential ■ for creativity, and the personal qualities
Jf the effectively creative teacher.
The major part of the book is devoted to the
jpplication of pnnciples and methods of teaching
lursing. In their discussion of multimedia devices
ind methods, the authors focus on the person rather
tian on the equipment or method. Relative values of
ifferent methods of teaching are discussed against
clear understanding of the relationship between
he stated philosophy of the school and of the
)bjectives to be achieved.
The purposes and processes of evaluation are
lescribed in termis of meeting the goals of the
valuatee. whether of the student or of the teacher,
ather than as a supenmposed judgment based on
he intuition of the evaluator. The assessment of the
student's performance is viewed as a progressive
)rocess throughout the program, using a variety of
cols, and showing how the creative teacher applies
hem in cooperation with the student. The evaluation
>f the teacher is based on criteria acceptable to both
he evaluatee and evaluator.
Finally the teachers roles and responsibilities
0 the profession and to the community, are seen as
)ersonal commitments which are vital to the
tevelopment of creativity in the teaching of nursing.
Teachers who seek a "how-to-do-if handbook
be disappointed, but the thoughtful reader will
ind stimulation, support, and encouragement. She
vill discover a means of self-evaluation by which to
sompare her own performance with the precepts
and concepts presented in this well written,
inalytical, and thought-provoking book.
There is an impressive list of references at the
ilose of each chapter, and a comprehensive index.
The essence of this book lies on the pnnted
)ages. For those to whom eye appeal' has a
asychological attraction, it is suggested that they
ake time to study the contents carefully before
making a judgment, for in appearance, the book
lacks the sharp focus that artistic printing styles can
create.
Creative Teactiing in Clinical Nursing should be
in the hands of all teachers of nursing, all
administrators and others who are involved in
providing the teaching environment, and in
evaluating teaching.
Behavioral Methods for Chronic Pain and
Illness, by Wilbert Fordyce, The C.V Mosby
Company, St. Louis, 1976. Canadian Agent:
Mosby, Toronto.
Approximate price $10.00
Reviewed by Christina Mikoski. B.Sc.N.,
Teaching Master, Nursing Program,
Confederation College, Thunder Bay, Ontario.
A lengthy introductbn serves to familiarize the
reader quite well with what is to be expected
from perusing the book. It examines chronic pain
from a behavioral perspective, including the
manifestations in the affected individual, the effect
on significant contacts, and the proposed treatment
modalities. Many of the attitudes and approaches
developed in relation to chronic pain may be suitably
adapted to other problems one encounters in
chronic illness.
The book is divided into three main sections.
The first one covers concepts of pain and
psychogenic pain in behavioral terms. It also relates
operant conditioning learning theories to the
development of Isehaviors associated with pain.
Section Two, titled Evaluation, begins by
To The Nurse
Whose Professional
Standards Are As
High As Ours
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become part of MPP Nursing Services. The
advantages to you will be many, including top
pay plus continuing inservice education
programs. We respect you both as a
professional and as an individual; well make
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NURSING SERVICES
establishing treatment goals through examining
medical problems from a behavioral viewpoint.
There is a fairly comprehensive chapter presenting a
behavioral analysis guide which should help an
interviewer establish the degree of operant pain, the
presenting problems of the patient, and the
significance of other persons. The short chapter on
patient selection concluding this section examines
the suitability of potential patients for operant-based
management.
Section Three focuses on treatment methods
which are designed to reduce pain or sick behavior,
to increase exercise and activity level, and to modify
factors which positively or negatively reinforce pain
behaviors. Orientation of patient and family to the
treatment process serves as an appropriate first
chapter in this section. A useful chapter deals with
patients who have medication problems and a
medication deconditioning program involving use of
a "pain cocktail' at regular inten/als in steadily
dimishing strengths.
There is an adequate tHbliography and index in
the book. Numerous graphs and diagrams are used
to illustrate issues.
The book is well-written in a clear, easily
understood format. It would serve as a useful
reference in any nursing library and as a
thought-provoking resource for any individual
concerned with the problem of chronic pain.
Psychiatric Nursing in the Hospital and the
Community 2nd ed. by Ann Wolbert Burgess
and Aaron Lazare. 520 pages. Prentice-Hall
Inc., Englewood Cliffs, N.J. 1976.
Approximate price $12.95
Reviewed by Mona McLeod. Professor,
School of Nursing. University of Manitoba.
Winnipeg, Manitoba.
I liked the first edition of this book and find the
second edition equally satisfying. Both editions have
focused on people as human beings, and give
recognition to our shared humanity in all its
ramifications. Secondly the authors see emotional
disturbances as a sign of people suffering in their
behaviors, in their thoughts, and especially in their
feelings." Mental illness represents the patient's
attempt to cope with overwhelming expenences "
The book, altfiough directed to students and nurses
engaged in psychiatnc nursing, would be useful to all
nurses engaged in working directly with peof)le.
The format of the book is useful. For instance,
the introductory chapters help individuals recognize
and manage the feelings they experience when
working with people who are emotionally disturt)ed,
and again appeals to a wkJe range of concerns and
worries commonly shared by students. The second
chapter helps us to understand the anxieties and
worries experienced by the patient In a psychiatric
setting, anxieties added to the emotional problem for
which he or she is seeking help. It seems important
that these two areas of concern should be attended
Looking for up-to-date,
authoritative texts
for your curriculum?
Look to Mosby.
We've built a reputation for quality
and diversity in nursing publishing
MEDICAL/SURGICAL
New 2nd Edition!
ADULT AND CHILD CARE:
A Client Approach to Nursing
Focusing on the patient as client, this extensively revised new
edition reflects the same innovative approach as its successful
predecessor: it integrates adult and child care, according to basic
human needs (safety and security, activity and rest, sexual role
satisfaction, need for oxygen, nutrition and elimination). The authors
have added much in-depth information on pathophysiologic pro-
cesses and expanded all discussions of nursing care. Major
changes in the chapter on cardiovascular illness, and new matenal
on pathophysiology of cancer and assessment techniques for con-
genital anomalies are included. The chapter on sexual role satisfac-
tion provides new information on nursing assessment of breast
cancer and venereal disease, and a new section on rape.
By Janet Miller Barber, R.N., M.S.; Lillian Gatlin Stokes,
R.N., M.S.; and Diane McGovern Billings, R.N., M.S. March
1977 2nd edition, 1.036 pages plus FM l-XIV, 8" x 10", 738 illustra-
tions. Price. $18.85.
A New Book! NURSING MANAGEMENT
OF DIABETES MELLITUS. Edited by Diana
W Guthrie. R.N.. M.S. PH.. F. A.A.N. C. and
Richard A. Guthrie. M.D.. F.A.A.P.: with 9
contributors. This new supplementary text
presents up-to-date information to tielp your
students better understand diabetes mel-
litus — and to properly educate their diabe-
tic patients. The authors discuss every as-
pect of the disease — from definition and
diagnosis to nursing management, acute
and chronic care, complications, psycho-
social problems, and patient education.
March, 1977 294 pp 64 illus Price, $8.35.
New 2nd Edition! CONTROLLING THE
SPREAD OF INFECTION: A Programmed
Presentation. By Betty Mclnnes, R N..
B-Sc.N., M.Sc. (Ed.). Proceeding from sim-
ple to complex, this effective supplement
skillfully combines nursing management
with aseptic principles and control proce-
dures as they apply to patients and hospital
personnel. This revision retains the effective
programmed format of the previous edition,
with each section updated, expanded, and
clarified. Highlights include: new headings
for quick reference: a new glossary: and
three new appendices for summary reviews.
March, 1977 139 pp, 12 illus Price, $6.25.
New 9th Edition' Mosby's COM-
PREHENSIVE REVIEW OF NURSING.
Edited by Dolores F Saxton. fiiV,. B.S in
Ed.. MA. Ed.D.: Patricia M Nugent. R.N..
A.A.S.. B.S . MS.: and Phyllis K Pelikan.
R.N.. A.AS . B.S.. M.A.: with 10 contributing
authors. Revised reorganized, and field-
tested for accuracy, the new edition of tfiis
widely acclaimed review book examines
current practices in professional nursing. It
features new material on motivation and tfie
teaching process, psychosomatic disor-
ders, Canadian nursing history, physics and
chemistry. The revised medical-surgical
section emphasizes common or recurring
diseases January, 1977, 624 pp., 17 illus.
Price, $13.15.
PSYCHIATRY
A New Booi^^ REVIEW OF PSYCHIATRIC
NURSING. By Donna Conant Aguilera.
Ph.D.. FA A.N This new guide offers a con-
cise overview of the latest practices and
concepts in mental health nursing Easy-to-
read discussions examine such topics as:
maladaptive behavior; psychiatric symp-
toms; management of psychiatric units; and
crisis intervention. The author effectively
bridges the gap between theory and clinical
experience by allowing students to formu-
late the rationale for assessment, January.
1977 171 pp Price, $5.80.
FUNDAMENTALS
New 2ncl Edition' THE PROCESS OF
PLANNING NURSING CARE: A Model for
Practice. By Fay Louise Bower. R.N.. B.S..
M.S.N. This new edition provides a concise
up-to-date guide to the process of planning
holistic nursing care Discussions reflect the
nurse's increased responsibility for
decision-making, and offer new information
on nursing assessment and diagnosis.
You II also find updated case histories and
new problem-oriented care plans March
1977, 167 pp, 9 figs Price, $6.05.
A New Book! TECHNOLOGY FOR PA-
TIENT CARE: Applications for Today, Im-
plications for Tomorrow. By Joseph D
Bronzino. Ph.D. Written for students with lim-
ited background in advanced mathematics
or engineering, this important supplemen-
tary text provides current material on the
major technological developments that af-
fect todays health care delivery Clear
well-illustrated discussions explain the op-
eration of a wide variety of the latest instru-
ments used to monitor, diagnose, and treat
patients. Among the many informative topics
explored are: artificial heart development,
computed tomography, and nuclear
medicine June, 1977 270 pp , 135 illus
Price, $10.00.
MATERNAL/CHILD
New 3rd Eaition: PEDIATRIC NURSING.
By Helen C Latham. R.N.. M L.. M.S.. Robert
V. Meckel. B.S . MS.. PhD .Larry J Hebert.
B.S . M.D.. F AAP : and Elizabeth Bennett.
R.N . Ed D : with 3 contributors The revised
and updated 3rd edition of this basic text
helps you effectively prepare students to
meet the challenges of pediatric nursing.
This revision features an expanded, up-
dated section on promotion of health from
infancy through adolescence, with explana-
tions of individual variances, assessment
guides for particular age groups and nurs-
ing care Other highlights include ex-
panded material on genetic counseling and
genetic diagnosis, updated psychologic
tests; and updated material on the battered
child July 1977 622 pp. 253 Illus Price,
$14.65.
ISSUES, TRENDS &
ADMINISTRATION
A New Booki CURRENT PERSPEC-
TIVES IN NURSING: Social Issues and
Trends, Volume I. Edited by Michael H
Miller. PhD and Beverly C Flynn. RN.
Ph.D.; with 20 contributors This timely col-
lection of original articles examines signifi-
cant issues now facing the nursing profes-
sion Written by leading authorities in sev-
eral fields of nursing the papers focus on
five major topics ethics research health
care delivery, organization, and education.
Specific issues discussed include: the es-
tablishment of nursing unions, evaluation of
education programs, and establishment of a
joint commission between nursing and
medicine May 1977 188 pp 4 illus Price,
$11.05 (C); $7.90 (P).
A New Book! NUflSING CARE EVALUA-
TION: Concurrent and Retrospective Re-
view Criteria. 5y Sharon Van Sell Davidson.
R N.. B S N.. M.Ed., with Betty Clark Burle-
son. RN . BSN . M.N.: Jean Ellen Scheel
Crawford. R.N.. B.S.N.. M.N.and Sue Chris-
tofferson. RN This new text provides
guidelines and model criteria for both con-
current and retrospective nursing audit of
more than 250 diseases and medical condi-
tions. Arranged in alphabetical order, the
criteria are both comprehensive and flexi-
ble. The authors offer a systematic, or-
ganized approach to nursing care compat-
ible with PSRO and beneficial to patients,
October 1977 Approx 442 pp About
$15.70.
A New Book! NURSING RESEARCH: A
Learning Guide. By Natalie Pavlovich.
R N . Ph D. Covering every phase of the re-
search process, this concise workbook
helps students identify basic concepts and
apply knowledge and skills Eight well-
organized chapters discuss the problem;
review of literature; hypothesis, research
methodology, data collection, data analysis;
conclusions and recommendations; and
final reports You'll appreciate the many
helpful learning aids — including glos-
saries, selected readings and discussion
questions January, 1978, Approx 320 pp
About $7.30.
If
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MOSBV
TIMES MIRROR
THE C. V MOSBY COMPANY. LTD.
86 NORTHLINE ROAD
TORONTO, ONTARIO
M4B 3E5
The Canadian Nurse October 1977
Koohs
to before proceeding with theory related to patient
care.
Following the introduction. Part II considers the
theoretical framework underlying practice. The
conceptual models in patient care include biological,
phychological, behavioral, and social models. The
distinction made between models, in terms of
philosophy, theory and goals is a useful one, offering
guidance to the reader to explore further, as well as
indicating implications for nursing practice.
Psychodynamic concepts and personality
development are reviewed and illustrated.
The review of theory in Part II provides a base
for a consideration of the conceptual framework for
nursing practice in Part III. The chapter headings
include the Nursing Process, Techniques in the
Therapeutic Process, Stalls in the Therapeutic
Process, Interviewing Techniques and Therapeutic
Interventions. Stalls in the Therapeutic Process is a
particularly useful chapter in that it identifies
common and specific situations in which planned
therapy cannot proceed because the therapist
becomes stuck in managing some of her/his own
feelings.
The fourth part of the book is devoted to clinical
syndromes. The syndromes are viewed as specific
patterns of feelings, thoughts and tsehaviors. The
emphasis is on the genuineness of human feeling,
even though it may be considered pathological.
Each chapter includes the nursing management of
care.
The final section of the book is entitled The
Community. These remaining chapters consider:
social and psychological factors influencing human
behavior; the concept of the customer approach to
patJenthood showing how the health seeker can help
the provider: crisis theory and development; grief in
terms of normal bereavement; the elderly in the
community; alcoholism and drug abuse as
community health problems.
The authors indicate the necessity for nurses to
be socially conscious in their practice . The content of
this final part comprehensively supports this view.
All in all this is a timely text.
Are You Driving Your Children to Drink?
Coping with Teenage Alcohol and Drug
Abuse by Donald A. Ivloses. IvI.D andRot>ertE
Burger, 216 pages, Toronto, Van Mostrand
Reinhold Company, 1975.
Approximate price $10.75
Reviewed by Colleen Stainton, Associate
Professor, Faculty of Nursing, University of
Calgary, Calgary, Alberta.
This book addresses one of the country's
leading health problems — drug abuse and
alcoholism in teenagers.
The authors, Dr. D. A. Moses, a psychiatrist, ane
his colleague, R. Burger, have developed a bool<
that provides a framework for interviewing a
teenager and/or his family when alcoholism or drug
abuse is thought to be a problem, and for
participating in decisions related to treatment.
The book is divided into four parts. Part I,
entitled The Roots, describes the connection
between teenage drug problems and the
parent-child relationship. The absentee parent,
THE
LAST
THING HE
HEEDS
IC fiAS.
When a patient can't
move around, gas can be
a problem, and a painful
one at that. So for pa-
tients who are immobile
following surgery or for
post-cholecystectomy
patients, give them extra
strength OVOL 80, the
chewable antiflatulent
tablets that work fast to
relieve trapped gas and
Owl 80
I
tCOMPRMES
TABLETS
Ong^i^
HORHER
PrrtHimf mnnneraDh available on request.
The Canadian Nurse October 1977
istant parent, inadequate parent, and psychotic
a-ent are defined, with a psychoanalytical
escription of the effects these parent behaviors
ave on teenage offspring.
Part II, Storm Warnings, describes symptoms
le teenager with a drug related problem will
ave — depression, rebellion and dependency —
nd his resort to drugs as an escape from these
selings and their effects on parent and peer
i3lationships. Common misinterpretations of his
ehavior resulting from society's sterotypes and
xpectations are discussed and refuted, A clear
escription of drugs commonly used concludes this
e-.tion.
°art III, Healing, describes the current therapies
able: one to one psychotherapy, group therapy,
concept therapy. Comparison of these
• lods is made emphasizing that a key to success
I treating the teenager is the stimulation of the
arents to change their behavior.
Part IV, The Public Problem, discusses the
Bed for society at large to familiarize itself with the
Ovol 80
Tablets
Ovol 40
Tablets
Ovol
Drops
Antiflatulent Simethicone
INDICATIONS
OVOL is indicated to relieve bloating,
flatulence and other symptoms caused
by gas retention including aerophagia
and infant colic.
CONTRAINDICATIONS
None reported.
PRECAUTIONS
Protect OVOL DROPS from freezing.
ADVERSE REACTIONS
None reported.
DOSAGE AND ADMINISTRATION
OVOL 80 TABLETS
Simethicone 80 mg
OVOL 40 TABLETS
Simethicone 40 mg
Adults: One chewable tablet between
meals as required.
OVOL DROPS
Simethicone (in a peppermint flavoured
base) 40 mg/ml
Infants: One-quarter to one-half ml as
required. May be added to formula or
given directly from dropper.
real issue of teenage alcohol and drug abuse by
giving up value-laden, punitive attitudes.
Schools, clergy, law enforcement offices and
the parents must work cooperatively and
knowledgeably in recognizing factors conducive to
the development of this problem and in treating the
problem when it does occur. This part concludes
with a brief but thorough description of child-parent
development and the importance of responsible and
responsive love as the child moves from one stage
to another.
An interesting bibliography Is included.
This book would be an interesting reference
book for any health team member working in
schools, clinics or hospital units where teenagers
are part of the clientele.
Managementfor Nurses: A multldlsclplinary
approach. Edited by Sandra Stone. Marie
Streng Berger, Dorothy Elhart, Sharon Connel
Fersich and Shelly Baney Jordan. The C.V.
Mosby Company, St, Louis, 1976.
Approximate price S8. 70.
Reviewed by Joan Peters, Director of
Nursing Sen/ice, Charlottetown Hospital.
Charlottetown. P.E.I.
This book is a combination of articles written by
people in various disciplines and edited by a
group of professors of nursing at the University of
Oregon. It is divided into three distinct units with a
study guide and bibliography as a follow up to each
unit.
Unit one is concerned with structural factors
and their influence on efficient organizational
functioning.
When discussing philosophies, purposes and
objectives and why we have them, it is clearly
brought out that many times these are carefully
prepared by people just because the job is to be
done, that many times these philosophies and
objectives are neither practical nor funtional. Many
times "how" they are written and "what" they should
contain is more important than "why" they were
written and what one does with them.
Unit II deals with personnel factors and their
influence on efficient functioning. Leadership,
communications, motivations, job satisfaction, and
the change process are discussed and their
implications developed.
Unit III discusses the economic factors and their
influence on efficient organizational functioning.
The chapter on budget planning is of great
assistance to anyone who needs help with budget
planning; the illustrations are helpful in assisting
anyone working on a budget. Staffing patterns are
discussed with eleven steps to proper staffing.
Evaluation of nursing care is dealt with as well as the
evaluation of nurse performance.
Some political influence and negotiations are
also discussed. One author questions particularly
the role of collective bargaining in nursing,
suggesting that because nursing is a profession, it is
not the trend for nurses to follow.
There are some excellent forms, charts and
illustrations throughout the book e.g. evaluation of
nursing services on a patient care unit.
The book is a useful book for nurses in the area
of management. It is well written, concise and easy
to read.
Librarij I pdale
Publications recently received in the Canadian
Nurses Association Library are available on loan —
with the exception of items mari<ed 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 by lettergiving author, title and item number in this
list.
If you wish to purchase a book, contact your
local bookstore or the publisher.
Books and documents
1. Association des universites et coll6ges du
Canada. Inventaire des rectierches sur
I'enseignementsup^rieurau Canada 1976. Ottawa,
1976. 1v. R
2. Association of Universities and Colleges of
Canada. Universities and colleges of Canada, 1 976
Ottawa, published jointly by AUCC and Statistics
Canada, 1977. 1v.
3. Bailey, David S. Therapeutic approaches to the
care of the mentally ill, by... and Sharon O. Dreyer.
Philadelphia, Davis, 1977. 278p.
4. Bntish Columbia. Commission on Vocational.
Technical and Trades Training. Report. Victoria,
1977. lip. Chairman: Dean H. Goard
5. British Columbia. Ministry of Education.
Committee on Continuing and Community
Education. Report of the committee on continuing
and community education in British Columbia.
Victoria, 1976. 82p.
6. Claus, Karen E. Power and influence in health
care, a new approach to leadership, by... and June
T. Bailey. St. Louis. Mosby 1977. 191 p.
7. Darling, Martha. The role of women in the
economy: a summary based on ten nationat reports.
Paris, Organisation for Economic Co-operation and
Development, c1975. I27p.
8. Davison. Catherine V. A career planning guide,
by... and L. Glen Tippett, Ottawa. Manpower and
Immigration, 1977. 123p.
9. — .A job search guide, by... and L. Glen Tippett.
Ottawa, Manpower and Immigration, 1977. 130p.
10. Dubbin, Mabel Louise, 40 years a nurse.
Sydney, N.S., Martin Equipment ltd., c1975.
157p. R
The Canadian Nurse October 1977
POSEY FOR PATIENT COMFORT
The new Posey products shown
here are but a few included in 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
insure the original quality product,
always specify the Posey brand
name when ordering.
The Posey "Swiss Cheese" Heel
Protector has new hook and eye
fasteners for easy application and
sure fit. Available in convoluted
porous foam or synthetic fur lin-
ing. #6127 (fur lining), M122
(foam),
The Posey Foot Elevator protects
pressure sensitive feet by keeping
them completely off sheets. A
washable flannel liner protects the
ankle. Soft polyurethane foam ring
with slick plastic shell allows pa-
tient to move his foot freely.
#6530 (4 inch width),
The Posey Elbow Protector helps
eliminate pressure sores and fric-
tion burns. Three models are avail-
able. #6220 (synthetic fur wlout
plastic lining).
The Posey Foot-Guard with new
"T" bar stabilizer simultaneously
keeps weight of bedding off foot,
helps prevent foot drop and foot
rotation. #6472,
The Posey Ventilated Heel Pro-
tector helps prevent friction and
skin breakdown while allowing
free movement. The newly devel-
oped closure holds heel protector
on the most restless patient. #6770
(w/plastic shell).
Send for the free new POSEY catalog — supersedes all previous editions.
Please insist on Posey Quality — specify the Posey Brand name.
Serid your order today!
HEALTH DIMENSIONS LTD.
Commerce City
2222 So. Sheridan Way
Mississauga, Ontario
Canada L5J 2M4
Phone: (416) 823-9290
^^. A foreign language guide to health care:
English, French. German, Italian, Spanish.
Chicago, Blue Cross Assoc, 1975. 95p.
12. International Conference on Health Education,
Ottawa, 9th, August 28 — Sept. 3, 1976. Health
education and health policy in the dynamics of
development. Summary proceedings. Geneva,
International Journal of Health Education, c1977.
86p.
13. International Labour Conference, 63rd session,
Geneva, June 1977. Committee on nursing
personnel. Draft report Geneva, 1977. 87p.
1 4. Jensen, Margaret, Maternity care: the nurse and
the family, by... et al. St. Louis, Mosby, 1977. 764p.
15. Maurice, Marc. Shift work: Economic
advantages and social costs. Geneva, International
Labour Office, 1975. 146p.
16. Manitoba Association of Registered Nurses.
Position paper on occupational health nursing in
Ivlanitoba. Winnipeg, 1977. 98p.
17. Mason, Mildred A. Basic medical-surgical
nursing. 3ded. New York, Macmillan, 1974. 584p.
18. Morgon, Alain. Education precoce de I'enfant
sourd: a I'usage des parents et des educateurs,
par... Paule Aimard et Nathalie Daudet. Paris,
Masson, 1977. 99p.
19. Nadeau, Marc-Andr6. tVlesure et evaluation des
objectifs pedagogiques: Manuel
d'auto-enseignement sur les objectifs
pedagogiques et leur mesure. Quebec, P.O.
Editions Saint-Yves, 1975. 98p.
20. O'Connell, Brian, Effective leadership in
voluntary organizations: how to make the greatest
use of citizen sen/ice and influence. New York,
Association Press, 1976. 202p.
21. Page, Stewart. Mental patients andthelaw. 1st
ed. Toronto Self-Counsel Pr., 1973. 116p.
22. Pieron, Henri. Vocabulaire de la psychologie. 5.
ed. Paris, Presses Universitaires de France, 1973,
C1951. 575p. R
23. Pillitteri, Adele. Nursing care of the growing
family: a child health text. 1st ed. Boston, Little
Brown. c1977. 834p.
24. Repertoire des associations du Canada.
Prepare sous la direction de Brian Land, Toronto,
University of Toronto, 1975. 550p. R
25. Roper, Nancy. Man's anatomy, physiology,
health and environment. 5th ed. Edinburgh,
Churchill Livingstone, 1976. 520p.
26. The Royal College of Nursing of the United
Kingdom. Evidence to the royal commission on the
national health service. London, 1977. 69p.
27. Seguy, Bernard. Nouveau manuel
d'obstetrique, par... et al. 3. ed. Paris, Intermedica,
1973. 3v. (pagination multiple)
28. — . Obstetrique. 5. ed. Paris, Maloine, 1976.
528p.
29. Sutermeister, Robert A. People and
productivity. 3d ed. New York, McGraw-Hill, 1976.
475p.
30. Travelbee, Joyce. Inten/ention in psychiatric
nursing: process in the one-to-one relationship.
Philadelphia, Davis, c1969. 280p.
31. Vukovich, Virginia C. Care of the ostomy patient,
by... and Reba Douglass Grubb. 2d ed. St. Louis,
Mosby, 1977. 150p.
32. Western Interstate Commission for Higher
Education. Funding sources for research in the
health sciences compiled by Rosemary G. Campos.
Boulder, Co., 1975. 144p.
33. Williams, Melvin H. Nutritional aspects of human
physical and athletic performance. Springfield, III.,
Charles C. Thomas, 1976. 444p.
34. Women in nursing: a descriptive study. Directed
by Lisbeth Hockey. London, Hodderand Stoughton
C1976. 253p.
35. Woodbury, Marda. A guide to sources of
educational information. Washington, D.C.,
Information Resources Press, 1976. 371 p.
ine v.rans«an nurae
\jKiijt^gf ivi I
36. World Health Organization. Alcohol - related
disabilities. Edited by G. Edwards, et al. Geneva.
1977. 154p. (WHO Offset Publication no. 32)
Pamphlets
37. American Nurses' Association. The professional
nurse arid health education: a statement of the
American Nurses' Association Division on
Medical-Surgical Nursing Practice and the Division
on Community Health Nursing Practice. Kansas
aty, Mo., 1975. 7p.
38. — . Standards of rehabilitation nursing practice.
Kansas City. Mo., 1977. 12p.
39. — . Division on Psychiatric and Mental Health
'I Nursing Practice. Statement on psychiatric and
i mental health nursing practice. Kansas City. Mo.,
Ij 1976. 30p.
40. L Association des Infirmiferes Enregistrees du
Nouveau-Brunswick. Memoire a la commission de
fenseignement superieur des provinces maritimes.
Fredericton. 1977. 17p.
41. L'Association du Personnel Infirmier des
HOprtaux Publics. Constitution, Fredericton, 1975.
5p.
42. Association of Universities and Colleges of
Canada. Inventory of research into higher
education in Canada 1976. Ottawa, 1976. 1v. R
43. Blumen, Helen E. CCU design, staffing, and
operating policies. Santa Monica, Calif., Rand
Corp.. 1975. 14p.
44. Bower, Miriam T. Clothing for the handicapped:
fashion adaptations for adults and children.
Minneapolis, Mn.. Sister Kenny Institute, c1977.
40p.
45. Brashear, Diane B. The social worker as sex
educator. New York, SIECUS, 1976. 27p.
46. Canadian Council on Social Development.
Board of Governors Meeting, Ottawa Oct. 18-19,
1976. Review of draft federal legislation on the
social sen/ ices. Ottawa, 1976. I7p.
47. Canadian Public Health Association. The nurse
and community health. Functions and qualifications
for practice in Canada. Ottawa, 1977. 13p.
48. College of Nurses of Ontario. Report of the
Director, 1976. 1v. (various pagings)
49. Conseil canadien de Developpement social.
Reunion du Bureau des Gouverneurs, Ottawa 18-19
Oct. 1 976. Revue de la situation quant a la
legislation preliminaire sur les services sociaux
personnels. Ottawa, 1976. 17p.
50. Freese, Arthur S. Cataracts andtheii treatment.
New York. Public Affairs Committee. c1977. 24p.
(Public affairs pamphlet no. 545)
51. Gross, Ronald. New paths to learning: college
education for adults. New Yor1<, Public Affairs
Committee, c1 977. 28p. (Public affairs pamphlet no.
546)
52. Kelly, Gary F. The guidance counselor as sex
educator. New York. SIECUS. 1976. 32p.
53. MacVicar, Jean. Approaches to staff
development for departments of nursing; an
annotated bibliography, by... and Rose Boroch.
New York, National League for Nursing, c1 977. 38p.
NLN Publication no. 20-1658.
54. Michigan Nurses' Association. Position on
nursing practice. East Lansing, Mi., 1971. 12p.
55. Mortensen, Charles. Association evaluation;
guidelines for measuring organization
performance. Washington, American Society of
Association Executives, 1975. 42p.
56. Thiessen, G. J. Effects of noise on man. Ottawa,
National Research Council, 1976. 89p. (NRCC no.
15383)
57. National League for Nursing. Nursing's role in
patients' rights. New York, 1977. (NLN publication
no. 11-1671).
58. National League for Nursing. Dept. of Associate
Degree Program. Associate degree education for
nursing. New York, National League for nursing,
1976-77. 25p.
Students & Graduates
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Slow-f^folk
(ferrous sulfate-folic acid)
hematinic with folic acid
Indications
Prophylaxis of iron and folic acid
deficiencies and treatment of
megaloblastic anemia, during pregnancy,
puerperium and lactation.
Warnings
Keep out of reach of children.
Contraindications
Hemochromatosis, hemosiderosis and
hemolytic anemia.
Adverse Reactions
The following adverse reactions have
occasionally (seen reported. Nausea,
diarrhea, constipation, vomiting,
dizziness, abdominal pain, skin rash and
headache.
Precautions
The use of folic acid in the treatment of
pernicious (Addisonian) anemia, in which
Vitamin B12 is deficient, may return the
peripheral blood picture to normal while
neurological manifestations remain
progressive.
Oral Iron preparations may aggravate
existing peptic ulcer, regional enteritis
and ulcerative colitis.
Iron, when given with tetracyclines, binds
in equimolecular ration thus lowering the
absorption of tetracyclines.
Dosage
Prophylaxis:
One tablet daily throughout
pregnancy, peurperium and lactation.
To be swallowed whole at any time of
the day regardless of meal times.
Treatment of megaloblastic anemia;
During pregnancy, puerperium and
lactation; and in multiple pregnancy:
two tablets, in a single dose, should
be swallowed daily.
Supplied
Each off-white film-coated Slow-Fe tablet
contains 160 mg ferrous sulfate (50 mg
elemental iron) and 400 meg folic acid in
a specially formulated slow-release base.
Packaged in push-through packs
containing 30 tablets per sheet and
available in units of 30 and 120.
Full information available on request
References
1 Nutrition Canada National Survey A report
by Nutrition Canada to the Department of
National Health and Welfare, Ottawa.
Information Canada, 1973 Reproduced by
permission of Information Canada
2 R R Streitf. MD. Folate Deficiency and Oral
Contraceptives. Jama, Oct 5. 1970.
Vol 214, No 1
C I B A
DORVAL. QUEBEC
H9S 1B1
See advertisement on cover 4
C-6026R
The Canadian Nurse October 1977
Canesfen
Antifungal and
trichomonacidal agent
clotrimazole
PRESCRIBING INFORMATION
INDICATIONS Canesten Cream and Solution Topical
Ireatnienl of the following dermal infections tinea pedis,
tinea cruris and tinea corporis due to T rubrum. T menta
gropti/tes and Epidermophyton floccosum. candidiasis due
to C albicans, tinea versicolor due to Malassezia furfur
Canesten Vaginal Tablets Treatment of vaginal candidiasis
and trichomoniasis Canesten Vaginal Tablets may be used
in both pregnant and non-pregnant women as well as in
women taking oral contraceptives (See Precautions)
DOSAGE AND ADMINISTRATION Cream and Solution
Thinly apply and gently massage sufficient cream or solu-
tion into ttie affected and surrounding skin areas twice
daily in the morning and evening
For vulvitis. Canesten Cream should be applied to the vulva
and as tar as the anal region For balanitis and prevention of
vaginal infection or reinlection by the partner. Canesten
Cream should he applied to the glans penis
Vaginal Tablets One tablet a day for six consecutive days
Using the applicator, insert one tablet deep intravaginally,
preferably at bedtime In order to avoid treatment during
menstruation, it is suggested that treatment be started at
least 6 days prior to the anticipated menstrual period
DURATION OF TREATMENT Cream and Solution The
duration of therapy vanes and depends on the extent and
localization of the disease Generally, clinical improvement
with relief of pruritus usually occurs within the first week of
treatment Tinea infections require approximately 3-4 weeks
of therapy while in candidiasis 1 2 weeks treatment is often
adequate If no clinical improvement is observed after 4
weeks, the diagnosis should be reviewed
If a cure is not mycologically confirmed or in order that
relapses may be prevented (particularly m mycoses of the
foot), treatment should, as a rule, be continued for 2 weeks
after all clinical symptoms have disappeared
Vaginal Tablets The six-day therapy may be repealed if
necessary
SPECIAL REMARKS Cream and Solution traded hygien
ic measures are of special importance in the management
of the often refractory fungal diseases of the foot To avoid
trapped moisture, the feet - particularly between the toes
— should be dried thoroughly after washing
Onychomycoses, owing to their location and physiological
factors, generally respond poorly to topical antimycotic
therapy alone due to poor penetration into horny substance
Treatment with Canesten may be considered in cases of
paronychia and as adjunctive therapy in onychomycoses
following extraction or ablation of the nail
Vaginal Tablets Added hygienic measures such as twice
daily tub baths and avoidance of tight underclothing is
highly recommended
In the case of clinically significant trichomonal infection
additional therapy with a systemic trichomonacidal agent
should be considered Such therapy is essential for the
treatment of vaginal infections which may also involve
Bartholin's glands and the urethra
CONTRAINDICATIONS Except for possible hyper
sensitivity Canesten Solution, Cream and Vaginal Tablets
have no known contraindications
PRECAUTIONS As with all topical agents, skin sensitiza
lion may result Use of Canesten topical preparations should
be discontinued should such reactions occur and approp
riate therapy instituted
Canesten Solution and Cream are not for ophthalmic use
Canesten Vaginal Tablets are not for oral use
Use m Pregnancy Although intravaginal application of
clotrimazole has shown negligible absorption from both
normal and inflamed human vaginal mucosa, Canesten
Vaginal Tablets should not be used in the first trimester of
pregnancy unless the physician considers it essential to the
welfare of the patient
The use of the supplied applicator may be undesirable m
some pregnant patients, and digital insertion of the tablets
IS an alternative which should be considered
SIDE EFFECTS Large scale clinical trials haveshown that
Canesten is very well tolerated after topical and vaginal
application
Cream and Solution Erythema, stinging, blistering, peeling
edema, pruritus, urticaria, and general irritation of the skin
have been reported infrequently
Vaginal Tablets Skin rash, lower abdominal cramps, slight
urinary frequency, and burning or irritation in the sexual
partner, have occurred rarely In no case was it necessary
to discontinue treatment with Canesten Vaginal Tablets
AVAILABILITY Canesten Solution 1 % is supplied in 20 ml
plastic bottles, in carton Each ml contains 10 mg of
clotrimazole in a non-aqueous vehicle
Canesten Cream 1 % is supplied in 20 g tubes, in carton
Each g contains 10 mg of clotrimazole in vanishing cream
base
Canesten Vaginal Tablets 1 00 mg are supplied in boxes
containing one strip of six tablets with plastic applicator and
patient leaflet of instructions
REFERENCES ' Lohmeyer. H . Postgrad Med J . 50
SuppT 78 f 974 2 Schnell. J D . Ibid . p 79 3 Legal
HP Ibid, p 81 4 Widholm, 0 , Ibid .p 85 5 Couch
man J M Ibid p 93 6 Higton. B K Ibid . p 96 7
Gates J K Ibid p 99 8 IVIasterton. fvl B et al . Curr
Med Res Opin 3 83 1975 9 Sawyer PR et al
Drugs 9 424. 1975 10 Postgrad Med J . 50 SuppI
54 76 1975
For further prescribing information please consult the
Canesten Product Monograph or your Boehringer Ingelheim
representative
FBA Pharniaceutlcals Ltd.
Distributed by:
Boehringer Ingelheim (Canada) Ltd.
2121 Trans Canada Highway
Dorval, P.O. H9P 1J3
- ^ FBA -91 -77
aee advertisemeni on page 5.
(Continued from page 57)
59. — .A statement of concern about associate and
baccalaureate degree programs for nurses ttiat
have no major in nursing. New York, 1977. 1p.
60. New Brunswick Association of Registered
Nurses. A brief to the Maritime Provinces Higher
Education Commission. Fredericton, 1977. 16p.
61 . Nova Scotia Nurses' Union. Constitution Halifax,
1976. 23p.
62 Ogg, Elizabeth. New ways to better marriages.
New York, Public Affairs Committee, c1977. 28p.
(Public affairs pamphlet no. 547).
63. TheOperating Room Nurses of Greater T^oronto.
Standards of practice of operating-room nursing,
Toronto, 1976. 15p.
64. Pacela, Allan F. The guide to biomedical
standards, by... and Brenda E. Arnold. 5th ed.
Diamond Bar, California, Quest, 1976. 45p.
65. Public Hospital Nurses' Staff Association.
Constitution, sample. Fredericton 1975. 5p.
66. Registered Nurses' Association of British
Columbia. Committee on Assessment of Safety to
Practice. Report to Board of Directors, Vancouver,
1976. 30p.
67. University Of Minnesota Health Sciences Center.
Department of Nursing Services. Pr/ma/y nursing: a
handbook for implementation, Minneapolis, Mn.,
1972. 27p.
68. WIehe, Vernon R. Role expectations of board of
directors, executive directors and staff of voluntary
social sen/ice agencies. Lexington, Kentucky,
University of Kentucky, 1976. 19p.
69. World Health Organization. Regional Office for
Europe. Relevance of educational planning to
health problems: report on a Working Group,
Kuopio, 2-5 June 1975. Copenhagen, 1976. 31p.
70. — . Role of nursing in psychiatric and mental
health care: report on a working group,
Saarbrucken, 10-13 March 1975. Copenhagen,
1976. 30p.
71. Yale University School of Nursing. Studies in
nursing. Abstract of reports submitted in partial
fulfillment of the requirements for the degree of
Master of Science In Nursing. Series XIX. New
Haven, Conn., 1977. 1v. (loose leaf) R
Government documents
Canada
72. Consell de Recherches medlcales. Rapport du
President 1976/77. Ottawa, MInlstre des
Approvisionnements et Services Canada, 1 977.
187p.
73. Consell national de recherches Canada.
Rapport, 1976/77. Ottawa. Consell national de
recherches Canada. I08p.
74. Commission du syst^me m6trlque.
Bibliographie de la conversion au syst^me
metrique. Rev. ed. Ottawa, 1977. 40p.
75. Consell du Tresor. La mesure de la performance
— guide du gestionnaire. Ottawa, 1976. 23p.
76. Dept of Finance. Canada student loans plan,
report, 1975/76. Ottawa, Ministry of Supply and
Services Canada, 1977. 22p.
77. Health and Welfare Canada. Employee fitness,
by Collls, Martin L. Ottawa, Canada, 1977. I30p.
78. — . Family Planning Division. A manual on
establishing and operating community family
planning services. Ottawa. 1976. 2v.
79. — . Long Range Health Planning Branch,
Priorities and strategies for preventive actions, by
J.-M. Romeder and G.B. Hill, Ottawa, 1977. 31p.
Contents. -A. Development and application of a
conceptual framework. -B. An approach to the
selection of strategies.
80. — . Social Service Programs Branch. Social
services legislation kit. Rev. Ottawa, 1977. 6 pts.
Contents. -The proposed social services act.
Questions and answers: the federal legislation...
1977. -Bill C57, 1st reading. -News release
1977-100. -Communique 1977-100.
81. Labour Canada. Working conditions in
Canadian industry, Ottawa, 1976. 1v.
32 Medical Research Council Report of the
President 1976/77, Ottawa, Ministry of Supply ar ,
Services Canada, 1977. 187p.
83. Metric Commission. Bibliography on metric
conversion. Rev. ed,, Ottawa, 1977. 40p.
84. Mlnist6re des Finances. Programme Canadian
de prets aux 4tudiants. Ottawa, MInistre des
Approvisionnements et Services Canada, 1977.
22p.
85. Mlnlst^re des Communications. Rapport.
Ottawa, MInistre des Approvisionnements et
Services. 26p.
86. National Library of Canada. Newspaper Section,
Union list of Canadian newspapers held by
Canadian libraries, Ottawa, 1 977. 483p. R
87. National Research Council of Canada. Report,
1976/77. Ottawa, National Research Council of
Canada, 1977. 108p.
88. Sante et Blen-§tre social Canada. Sante
physique des employes, par Martin L. Collis,
Ottawa, Canada, 1977. 141 p.
89. Sant6 et Blen-Stre social Canada. Direction
generale des programmes de service social. Jeu de
documents sur la legislation federate sur les
services sociaux. Rev. Ottawa, 1 977. 6 pts.
Contents. -Projet de lol sur les services sociaux.
Questions et reponses; legislation fed^rale sur
les services sociaux, 1977. -Bill C-57, Ire
lecture. -Communique 1977-100.
90. — . Division de la planlflcation famlllale. Guide i
d' implantation et d'exploitation de services de
planification familiale a I'echelle communautaire.
Ottawa. 1976. 2v.
91. Statistics Canada. Degrees, diplomas and
certificates awarded by universities, 1974. Ottawa,
1977. 1v. (Catalogue no. 81-211)
92. Statlstlque Canada. Grades diplomes et
certificats decernes par les universites, 1 7.
Ottawa, 1977. 1v. (Catalogue no. 81-211)
93. Travail Canada. Conditions de travail dans
I'industrie canadienne, 1975. Ottawa, 1976. 1v.
(pagination multiple).
94. Treasury Board. A manager's guide to
performance measurement. Ottawa, 1 976. 23p.
Ontario
95. Ministry of Labour. Research Branch.
Cost-of-living provisions in Ontario collective
bargaining agreements October 1976. Toronto,
1977. 12p. (Bargaining Information series no. 20)
96. Ministry of Labour. Research Branch. Paid
absence provisions in Ontario collective bargaining ]
agreements June 1976 — company pay for union ■
business —jury duty and bereavement leave— rest >
periods and wash-up time. Toronto, 1977. 9p,
(Bargaining Information series no. 21)
97. — . Research Branch. Severance pay plans in'
Ontario collective bargaining agreements
December 1976, Toronto, 1977. 14p. (Bargaining i
Information series no. 22)
Quebec
98. Office des professions du Quebec. Rapport
d'activitis. 1976/77. Quebec. 1977. 139p.
Studies in CNA Repository Collection
99. Bolsclair, Laurent. Valeurs de travail des
hommes engages dans le nursing. Montreal, 1 969. i
93p. Th6se (M. Nurs.)-Montreal R
100. Petryshen, Patricia Rose, Recognition of
loneliness as a basis for psychotherapy.
Vancouver, c1977. 158p. Thesis (MN)-Britlsh
Columbia R
101. Saskatchewan. Department of Continuing
Education. Research and Evaluation Branch.
"Special" three month follow-up study of 1975
Saskatchewan nursing program graduates.
Prepared by Glenn M. Belsey, Reglna, 1 977. 60p. R
1 02. Turner, Lettle. A project on self and peer
teaching-learning evaluation in the Faculty of
Nursing, University of Toronto. Toronto, University
of Toronto, Faculty of Nursing, 1977. 56p. R
The Canadian Nurse October 1977
(la.s.sirk>d
Advert iseiiioiits
British Columbia
British Columbia
United States
tad Nurse required for a di-Dea umi m our Health Centre for
Children Patients ages range from newborn to earty adotescence and
mainly have a neurosurgical or neurological diagnosis. Head Nurse
also assists others in planning care c* pediatnc neurology patients
who are (due to age) admitted to other units. Applicants should have
competence m the field o* pediatnc neurology and neurosurgery.
Apply to Vancouver General Hospital. Employee Relations Depart-
menl. 855 West 12th Avenue. Vancouver. British Columbia.
V5Z1M9
■ Charge nurse wanted for i(H)ed Psychiatric Service BScN, recent
P.G. in Psychiatnc Nursing Apply: Director of Patient Care, Cran-
brook & District Hospital. 13-24th Avenue North. Cranbrook. British
Coiumbia. V1C3H9.
General Duty Nurses for modern 4i-t>ed hospital located on the
Alaska Highway. Salary and personnel policies m accordance with
RNABC Accommodal'on available m residence Apply Director o'
Nursing. Fort Nelson General Hospital, P.O. Box 60. Fort Nelson,
British Columbia. VOC IRO,
Registered Nurses — The Bntish Columbia Pubhc Service has vac-
ancies in me Greater Vancouver and Other Areas for Nurses who
are currently registered or eligible for registration m Bntish Columbia
Positions are in mental health, mental retardation, and psycho-
renalnc institutions Salanes and fringe benefits are competitive —
1 .184 to Si .399 for Nurse 1 Canadian citizens are given preference.
Interested applicants may contact the: Pubic Service Commission.
Valleyvtew Lodge, Essondate. British Columbia VOM IJO Quote
competition no. 77:449A.
Expertertced Nurses (eligible for BC registrationi required for
409-bed acute care, teaching hospital located m Fraser Valley, 20
minutes by freeway from Vancouver, and wrthtn easy access of
various recreational facilities Excellent onentation and continuing
education programmes Salary Si 184.00 to S1399 00 per month
Chnicai areas include Medicine Surgery, Obstetrics. Pediatncs,
Coronary Care Hemodialysis, Rehabilitation, intensive Care.
Emergency Apply to Nursmg Personnel, Royal Columbian Hospital
New Westminster, Bntish Columbia. V3L 3W7,
Ontario
RN or RNA, 5 7' or over and strong, without dependents, to care for
160 pound handicapped executive with stroke Uve-m, ' 2 yr m To-
ronto and ■ 2 yr. in Miami Preferably a non-smoker Wage $200.00 to
S220 00 weekty NET. deperxjing on expenence plus Miami bonus
Send resume to: M.D.C . 3532 Eglinton Avenue West. Toronto. Oi-
tano, M6M 1V6
Closure of St. Joseph's Regional School of Nursing. This school
which became the St Joseph s Campus, Fanshawe College m Sep-
tember. 1973 is no longer operational References, transcnpts. etc
can be obtained as follows for graduates and employees Prior to
September 1. 1973: Department c* Nursing Service, St Josephs
Hospital, 268 Grosvenor Street London. Omano. N6A 4V2 After
September l. 1973: Students: Registrars Office, Fanshawe Col-
lege. PO Box 4005. Terminal A. London. Ontano. NSW 5H1 Staff:
Dean, Health Sciences, Fanshawe College. PO Box 4005. Terminal
A London. On'ano, N5W5H1
Registered Nurses — Dunhili. with 200 offices n tne U S A has
exciting career opportunities for both new grads arxJ experienced
R N s Send your resume to; Dunhill Personnel Consultants. No 605
Empire Building. Edmonton. Alberta. T5J 1V9 Fees are paid tjy
employer
Registered Nurses — A vanety of nursirig openings in all serv.ce-::
indudtng iCU-CCU are available at the Univer&ty Hospital This
300-bed teaching hospital located with the University of Arizona Coi
lege of Medicine in the Arizona Health Sciences Center offers a
vanety of challer>ging professional assignments En)oy thedry, sunny
climate and pleasant way of lite in the attractive Southwest Contact
Staff Employment Center, University of Arizona 1 101 Babcock. Tuc-
son. Arizona 85721, 602 884-3666 An Equal Oppwlunity, Atfirma-
tive Action, Title IX Employer
Registered Nurses for Florida: immediate hospital openings in
Miami Fori Lauderdale Pa!m Beach and Stuart Nurses needed to-
Cnticai Care Medicai-Surgicai Pediatncs. Orthopedics and Operat-
ing Room We will provide the necessary work visa No fee to applic-
ant Write Medical Recruiters of America, Inc., 800 N W 62nd St
Ft Lauderdale. Flonda 33309. U S A *305) 772-3680
R.N.'s — Pacific Northwest' Idaho Openings in 229-bed. accredited
acute hospital serving as ma)or regional center for orthopedic
ophthalmology, dialysis, mental health, neurosurgery . and trauma A
modern hospital facility surrourxled by uncongesteo recrealiona
areas with close skiing, sparkling lakes arxl nversand ctean air. Salao
range S900toSl2i2p/mo commensurate with expenence Excelter^;
benefits, shift rotation, relocation assistance, and free parking, Write
or call Dennis Wedman. Personnel OHice. (208) 376-1211. Si Ai-
phonsus Hospital 1055 N Curlis Road, Boise, Idaho 83704 E O E
Overseas
Lecturers in Nursing
The Institute offers a three year tertiary nursing course leading to the
award of Diploma in Applied Science (Nursing), in conjunction with one of
Melbourne's larger general hospitals.
The Institute campus, on 40.5 hectares (100 acres), is situated 20 km
from the centre of Melbourne, the capital city of Victoria. The Institute
offers Degree and Diploma courses in Applied Science. Art and Design,
Business Studies. Engineering. Physical Education and Social Work.
The Nursing Department within the School of Applied Science, offers
the Diploma in Nursing, a Diploma in Community Health Nursing, a
Diploma in Psychiatric Nursing, and is developing further courses. (For
the traditional three year hospital course the terminology used in Australia
is: Certificate Course).
Applications for lectijrers in the Diploma in Nursing programme are
invited. Each lecturer will have an area of responsibility, related to his/her
particular interest and expertise. All lectijrers will share in the general
teaching activities within the programme, and will be expected to teach
and supervise nursing students within the hospital and community
setting. Applicants must be willing to actively participate in the
development of a relatively new department of nursing.
It is essential to have current expert knowledge in medical and surgical
nursing. Relevant teaching experience would be an advantage.
Applicants have to be eligible for registration as a nurse in the State of
Victoria.
Senior Lechjrer — the appointee to ttiis position will teach and be
responsible for the organization of a considerable part of the basic
nursing programme. Organizational abilities are essential. The
possession of a Degree in Nursing would be an advantage.
PRESTON INSTITUTE
of TECHNOLOGY
Plenty Road. Bundoora. 3083,
Victoria. AUSTRALIA.
f^^M^t**
For all other positions: A Degree in Nursing is desirable, but applicants
with other Degrees and/or Diplomas who have relevant nursing
experience, may be considered.
Positions available:
Senior Lecturer (1 position) Salary range $A1 9.290— 522,505 annually.
Lecturers/Senior Tutors (5 positions) Salary range $A1 2.346—518,884
annually.
Level of appointment will be commensurate with academic qualifications
and experience.
The salary for an Overseas appointee, will be calculated from the agreed
date of embarkation.
Re-location assistance:
The Institute has established loan schemes covering relocation expenses
for family and household goods, an immediate superannuation insurance
cover, and assistance with accommodation.
Applications:
I.
IV.
Normal curriculum vitae, transcripts of tertiary work, and names of
two referees.
Addressed to: Staffing Officer (Ref. 240) Preston Institute of
Technology, Plenty Road. Bundoora. Victoria. 3083, Australia.
Applications close November 15, 1977.
Appointees are expected to take up duties on 15th January, 1978.
The Canadian Nurse October 1977
Wish
you were
here
...in Canada's
Health Service i-^^^
Medical Services Branch
of the Department of
National Health and Welfare employs some 900
nurses and the demand grows every day.
Take the North for example. Community Health
Nursing is the major role of the nurse in bringing health
services to Canada's Indian and Eskimo peoples. If you
have the qualifications and can earn more than the
nomial load of responsibility. . . why not find out more.'
Hospital Nurses are needed tcxi in some areas and
again the North has a continuing demand.
"Then there is Occupational Health Nursing which in-
cludes counselling and some treatment to federal public
servants.
You could work in one or all of these areas in the
course of your career, and it is possible to adviince to
senior positions. In addition, there are educational
opportunities such as in-service training and some
financial support for educational leave.
For further information on any. or all. of these career
opportunities, please contact the Medical Services
office nearest vou or write to:
I
I
I
Medical Services Branch
Department of National Health and Welfare
Ottawa, Ontario K1A0L3
Name
Address
City
1^
Health and Welfare
Canada
Prov
Sanle el Bien-etre social
Canada
Senior Association Position
This senior staff position involves responsibility for
Investigating complaints against members, operating a job
information service and providing career counselling to
nurses. Some travel is required. Candidates must be
eligible for registration in B.C.
The position must be filled by January 2, 1978.
Candidates should have university preparation to at least
the baccalaureate level, background in nursing education
and/or nursing practise, experience in counselling, and a
commitment to professional nursing.
Written applications, including salary expectations,
should be submitted to:
Nan Kennedy, Executive Director
Registered Nurses' Association of B.C.
2130 W. 12th Avenue
Vancouver, B.C. V6K 2N3
Assistant Director of Nursing
To share the responsibilities of Nursing Sen/ice
Administration of a 539 bed general hospital. This
position offers an opportunity for professional growth.
Applicants should have had progressive nursing
experience in which leadership ability, administrative
skills and competency as a practitioner of nursing have
been demonstrated. Baccalaureate degree in nursing
required. A Master's Degree in clinical nursing
preferred. Attractive salary and benefits available.
Reply to:
Miss Myrna Sherrard
Director of Nursing
The Moncton Hospital
135 MacBeath Avenue
Moncton, N. B.
E1C6Z8
The Canadian Nurse October 1977
United States
registered Nurses — New Critical Care Areas ~ Wi shard Memor-
Hosprtal. Bum Center-lCU-CCU Rotation -Permanent evenings -
-■■^aneni nights Call Madefine DeTalvo. Nursing Service.
■ j-7032), or apply to: WishardMemonai Hospital. Nursinq Service
Of..ce. Indiana University Medical Center. 1001 West lOth Street.
Indianapolis. Indiana, 46202- The Health and Hospital Corporation,
AN EQUAL OPPORTUNITY EMPLOYER.
Nurses — RNs ~ Immediate Openir>gs in California — Florida —
Texas — Mississippi — If you are expenenced or a recent Graduate
Nurse we can offer you positions with excellent salanes of up to Si 300
per month plus ail benefits. Not only are there no fees to you what-
soever for plaang you, but we also provide complete Visa and Licen-
sure assistance at also no cost to you Wnte immediately for our
application even it there are other areas of the US. that you are
interested m We will call you upon receipt of your application m order
to arrange for hospital interviews Windsor Nurse Placement Service.
P.O. Box 1133, Great Neck, New York 11023 (516-487-2818)
Our 20th Year of World Wide Sen/ice
The best location in the nation — The world -renowned Cleveland
CInic Hospital, a progressive, I020-bed acute care teaching facility
committed to excellence m patient care currently has staff nurse
poeHlons available m several of our 6 ICUs and 30 departmentalized
med/surg and speaalty divisions Starting salary range ts Si 2,45-1 to
$14,300, plus premium shift and unit differential, progressive benefit
package and a comprehensive 7 week onentahon. For further infor-
mation contact Director — Nurse Recruitment, The Cleveland ClmK:
Fburxlation. 9500 EucSd Avenue. Cleveland. Ohio 44106: or caH
Cdtect 216-444-5865,
Registered Nurses for Texas, Louisiana and Arkansas: Hospital
openings m Texas, primarily m the Dallas and Houston areas Other
opportunities available m Louisiana and Arkansas Nurses needed in
Wspeoalties — Cntical Care, Medical Surgical, Operating Room.
Emergency Room and Pedtatncs. We will provide necessary work
visa. No fee to applicant Wnte Medical Recruiters of America, 3635
Lemmon Avenue, Suite 304. Dallas, Texas 75219 {2M] 521-4261.
Nurse Educators — Tunisia — Project Hope seeks nurse educators
for Current and projected positions for Tu nista program Individuals will
work with Hope and host country educators m development of basic
nursing programs and clinical facalities for student practice Teaching
expenence required, fluency in French arxJ English desired Similar
positions in South Amencan programs also available, 2 year contracts
(renewabiei Salary commensurate with education and expenence.
tul benefits and paid relocation expenses provided, Serxl resume to:
Project Hope, Dept of f^rs»ng. 2233 Wisconsin Ave.. N.W.,
Washington. DC, 20007 EO.E,
The Piovince of British Columbia
DIRECTOR OF NURSING
This position i n Ministry of Human
Resources, is located at Woo-
dlands a 900-bed centre in Van-
couver area for the mentally re-
tarded, which provides multi-
discipline approach to resident
care, treatment and program de-
velopment, as well as extensive
liaison with communities
throughout B.C.
Qualifications — Preferably Mas-
ter's degree in Nursing Adminis-
tration or related field; considera-
ble senior management expe-
rience in medical/psychiatric set-
tings.
Salary — $24,420 — S30,300
plus management benefits
Quote Competition No. 77:1420A
Closing Date — Immediately
ASSISTANT DIRECTOR OF
NURSING
At Riverview Hospital. Ministry of
Health, Essondale, to direct and
co-ordinate administrative and
clinical nursing activities during
hours of 1600—0010, being res-
ponsible for management and su-
pervision of total nursing services
and liaison with other depar-
tments of hospital.
Qualifications — Licensed to
practice nursing In British Colum-
bia under the Registered Nurses
and/or Registered Psychiatric
Nurses Acts: university degree in
Nursing or related field: conside-
rable supervisory and administra-
tive experience.
Salary — $19,188 — $22,476
Quote Competition No. 77:1 160B
Closing Date — Immediately
Positions are open to both men and women. Obtain applications for either
position from and return to the Public Service Commission, Valleyview
Lodge, Essondale, VOM 1J0.
Province of British Columbia
Public Service Commission
Advertising
rates
For All
Classified Advertising
315.00 for 6 lines or less
82.50 for each additional line
Rates for display
advertisements on request
Closing date for copy and
cancellation is 6 weeks prior to 1st
day of publication month.
The Canadian Nurses Association
does not review the personnel
policies of the hospitals and agencies
advertising in the Journal. For
authentic information, prospective
applicants should apply to the
Registered Nurses' Association of
the Province in which they are
interested in working.
Address correspondence to:
The Canadian Nurse
50 The Driveway
Ottawa, Ontario
K2P 1E2
4r
WE DON'T WANT YOU
FOR A DAY, BUT FOR ALL
THE DEDICATED TOMORROWS
Through the decades we have created a professional learning
environment for you. Choose from any of our 12 areas,
D Emergency Services D Intensive Care Unit D Medicine
D Neurology D Obstetrics — Gynecology D Oncology D
Ophthalmology D Pediatrics D Psychiatry D Surgery D
Out-Patient Services D General Operating Services. We are as
proud of our tradition as we are of our future potential. Come
share in our pride. Come, experience the 'exposure' of our multi-
faceted patient care facility. Learn for yourself the dedication
and professionalism that equal the Johns Hopkins reputation.
We have so much to offer, and you have so much to share.
Suzanne L Perry
Patti W. Wells
Nurse Recruiting
The Johns Hopkins Hospital
Baltimore. Md. 21205
1
k
The Johni
Hopkins
Hospital
"Where innovation is a tradition "
Please send me information about RN opportunities offered by Johns Hopkins
Hospital. SN D RN D
NAlv^E:
ADDRESS:
CITY:
STATE:
ZIP:
An Equal Opportunity Empfoytr
The Canadian Nurse October 1977
Canadian Lung Association
Nursing Fellowship
$7,500
For Master's or Post Master's Study in
the Clinical Speciality of Pulmonary
Nursing
For Further Information and
Application Form Please Write:
The Canadian Lung Association
75 Allsert Street, Suite 900
Ottawa, Ontario
K1P5E7
Application Deadline February 15, 1978
The Canadian Lung Association-
The Christmas Seal People
Nursing
Instructors
and
Public Health
Nurses
Are needed to work
in AFRICA
Sierra Leone — Tutor to teach State
Enrolled Community Health Nurses and a
Public Health Nurse to promote a Nutrition
Health Programme for pre-school children in
60 State Clinics.
Ghana — Tutor to teach Medical-Surgical
Nursing to students of 3 year SRN
programme.
For more information, please contact:
CUSO Health — 14
151 Slater Street
Ottawa, Ontario
K1P 5H5
Flin Flon General
Hospital Inc.
requires
Head Nurse,
Maternity & Nursery
(16 beds) (22 bassinnettes)
Qualifications:
Eligible for registration in Manitoba
Post-Graduate Course in
Obstetrical/Newborn Nursing and/or
Approved Course in Supervision
desirable
Position Available: September 12/77
Apply in writing to:
Director of Personnel
Flin Flon General (Hospital
P. O. Box 340
Flin Flon, Manitoba
R8A 1N2
UNITED STATES
OPPORTUNITIES
FOR REGISTERED NURSES
AVAILABLE NOW
IN CALIFORNIA
FLORIDA
MISSISSIPPI
NEW ORLEANS
TEXAS
WISCONSIN
WE PLACE AND HELP YOU WITH:
STATE BOARD REGISTRATION
YOUR WORK VISA
TEMPORARY HOUSING - ETC.
A CANADIAN COUNSELLING SERVICE
Phone: (416) 449-5883 OR WRITE TO:
RECRUITING REGISTERED NURSES INC.
1200 LAWRENCE AVENUE EAST, SUITE 301,
DON MILLS, ONTARIO M3A 101
j^Riyr
NO FEE IS CHARGED
TO APPLICANTS.
OPEN 7 DAYS A WEEK.
Assistant Director
of Nursing
Assistant Director of Nursing with
preparation in Administration and
Supervision, 5 years of progressive
public health nursing experience of
which two years were in a supervisory
position.
Duties to include program
development, inservice education and
supervision in an extensive northern
area.
Please apply to:
F. Tomlinson
Director of Nursing
Sudbury and District Health Unit
1300 Paris Crescent
Sudbury, Ontario
P3E 3A3
Needed for a fully accredited 650 bed
hospital— 1200 staff
Employee Health Nurse
• B.Sc.N. or Public Health Diploma
• Eligible for B.C. registration
• Experience in occupational health
required
Head Nurses — Surgical
Floor and Extended Care
• B.Sc.N. and experience required
Please apply giving full resume to:
Director of Personnel
Lions Gate Hospital
230 East 13th Street
North Vancouver, British Columbia
V7L 2L7
The Victoria General Hospital, a
422-bed acute care facility, invites
applications for the position of:
Associate Director of
Nursing — Patient Care
The Associate Director of Nursing — Patient
Care is responsible for establishing and
evaluating standards for the Quality of Patient
Care in the Department of Nursing. She/He
will work with all levels of staff in the Nursing
Department in formulating the philosophy
and objectives of Nursing Service and
in planning, implementing, and evaluating
programmes designed to provide optimal
patient care.
Applicants should posses a B.Sc.N. or
Masters degree plus at least three years
of Clinical experience in diversified fields
of nursing.
Interested applicants may apply to:
Personnel Officer
Victoria General Hospital
841 Fairfield Road
Victoria, British Columbia V8V 3B6
M.A.R.N.
Nursing Consultant
Responsibilities
Provide on request by individual health agencies, direct
assistance in the study of problems m nursing service areas,
in implementing changes to improve the quality ot patient
care and to establisti sound and efficient standards of
operation with full consideration of the latest developments
in administrative practice
Qualifications
A master s degree from a recognized university, experience
in the practice ot nursing, administration, and research,
eligible for registration m fvlanitoba, and demonstrated
leadership ability and communication sitills.
Salary
Commensurate with qualifications, and experience
For Information Contact:
Miss M. Louise Tod
Executive Director
Manitoba Association of
Registered Nurses
647 Broadway Avenue
Winnipeg, Manitoba R3C 0X2
(Telephone 204-774-3477)
Applications for the
position of
Supervisor
Operating Room and
Recovery Room
are now being accepted by this
300 bed fully accredited hospital.
We offer an active staff
development programme.
Salaries and fringe benefits are
competitive, based on
educational background and
experience. Temporary
accommodation available.
Apply sending complete
resume to:
The Director of Personnel
Stratford General Hospital
Stratford, Ontario
N5A 2Y6
..ooUM--"=«°'
■•>• '°*".^ Hern''""
o( tti« °*"*
„d exc»'"'
care
team*-
ot »
Hermann
become
Iiaitof
avery
H«rW»""
U¥
team!
Nurses join us and Cathy in a course toward leadership in progressive total patient care You will have the "FREEDOM TO BE" the nurse you
want to be
Located m the famed Texas Medical Center, we are the primary teaching facility for the University of Texas Medical School at Houston You'll
find this teaching and research atmosphere conducive to informal conferences about patient care goats or new developments The learning
environment includes a wide range of Inservice programs, and for the new graduate, a comprehensive 6-month intern program Continuing
education programs are available through our Career Development system and there are many major universities located rn and around
Houston
Jotn us as we grow We're expanding from 500 beds to l ,000 beds opening career opportunities at all levels and m all Nursing specialties We
have 19 OR Suites, Renal Transplant Unit. Psychtatric and Neuro Unrts, a Children's Center Orthopedics. Ophthalmology Pediatric ICU.
Neonatal ICU, Burn Unit and more
Discover Houston , . a city with an unlimited future A city alive We are now the 5th largest city in the US and growing Discover non-stop
nightlife, culture, sports. Discover year round recreational activities on nearby beaches, inland lakes and rivers— all an easy drive away.
Discover lower cost of living and no local or state income taxes that make it more than comfortable to pursue your profession
You'll find the salary program is more than competitive and we offer a comprehensive benefits package which includes 3 weeks paid vacation,
refresher training programs, relocation assistance, one month free rent, and tuition reimbursement If you are an experienced, professional
nurse, we would like to discuss the opportunities now available for you in our Primary Nursing programs For more information about
Hermann Hospital, mail coupon to or call Ms Beverly Preble, Nurse Recruiter 1203 Ross Sterling Avenue, Houston, Texas 77030 (713) 797-
3000
An equal opportunity employer m/f ,
Clty_
-Stat«_
-Zip,
Phone
Specific Aral of Interest
(circle) RN
LVN
CN 10/77
TTT Hermann
f Jl Hospital
The Canadian Nurse October 1977
Open to both
men and women
Health and Welfare Canada
Medical Services Branch
Manitoba Region
NURSES
Medical Services Branch, Manitoba Region requires nurses
urgently for both short-term and permanent positions at
various northern nursing stations and two hospitals situa-
ted in Norway House and Hodgson, Manitoba. Knowledge
of the English language is essential.
If interested, please call collect either Mr. A. Wozniak at
(204) 985-4183 or Mrs. D. Bodnar (204) 985-3637 or
write for futher information and details to:
Regional Personnel Advisor
Health and Welfare Canada
Medical Services Branch
500 - 303 Main Street
Winnipeg, Manitoba R3C 0H4
How to Apply
Forward completed "Application for Employment" (Form
PSC 367-41 10) available at Post Offices, Canada l\/lanpower
Centres or offices of tfie Public Service Commission of
Canada, to :
Public Service Commission
500 Credit Foncier Building
286 Smith Street
Winnipeg, Manitoba R3C 0K6
Please quote the applicable reference number at all times.
Index to
Advertisers
October 1977
Boehringer Ingelheim (Canada) Limited
5,58
Burroughs Wellcome & Co. (Canada) Limited
12
Canadian College of Health Service Executives 1
The Canadian Nurse's Cap Reg'd
57
Canadian Pharmaceutical Association (Insert) 16, 17
CIBA Pharmaceuticals 57,
Cover 4
Designer's Choice
Cover 3
Equity Medical Supply Company
13
Flint Laboratories of Canada
17
Hollister Limited
7
Frank W. Horner Limited
54, 55
J.B. Lippincott Company of Canada Limited
32,33
MPP Nursing Services
51
The C.V. Mosby Company Limited
52,53
Mostly Whites Limited
6
Posey Company
56
Procter & Gamble
2
W.B. Saunders Company Canada Limited
49
Searle Pharmaceuticals
15
Standard Brands Canada Limited
9
Uniforms Registered
48
White Sister Uniform Inc.
Cover 2
Advertising
Gerry Kavanaugh
The Canadian Nurse
50 The Driveway
Ottav(/a, Ontario K2P 1 E2
Advertising Representatives
Richard P. Wilson
219 East Lancaster Avenue
Ardmore, Penna. 19003
Telephone: (215) 649-1497
Gordon Tiffin
2 Tremont Crescent
Don Mills, Ontario M3B 2S1
Telephone: (416) 444-4731
Member of Canadian
Circulations Audit Board Inc.
desi^er'^
choice
A
UMITED
EDITION
Designer's Choice
One of Canada's truly greats in fashion design
A. Style No. 49283 — Pant suit. Sizes: 3-15. "Designer's Rib"
100% textured Dacron" polyester warp knit. White, Yellow: about $30.00.
B. Style No. 49258 — Pant suit. Sizes: 3-15. "Designer's Rib"
- 100% textured Dacron'' polyester warp knit. White, Robin: about $32.00.
Auailahio at loaHinn rlpnartmpnt ■;tnrp<5 and isnpriaitu <;hnns anrnss Canada
A different appearance-
A common need
Doth may benefit from SIOW-I^ fOlfC
Prophylactic iron and folic acid supplementation
during pregnancy is now an accepted practice
among Canadian physicians. It has also been
established, through the publication in 1974 of
Nutrition Canada \ that many Canadian women
may not be obtaining the necessary nutritional
requirements from their diets. For instance, 76.1%
of adult women (20-39) had inadequate or less than
adequate intake of iron and 67.9% were at high or
moderate risl< of low serum folate levels. More
recently, a numbefof physicians have queried the
effect of oral contraceptives on semm folate levels
in women. Dr. Streiff reports: "This complication
(of oral contraceptive therapy), however, may be
recognized more frequently in the future... Folate
deficiency associated with oral administration of
contraceptives does not necessarily require
discontinuance of the dnjg regimen but folic acid
therapy is definitely indicated."^
C I B A
Dorval, Quebec
I jrvO 1 D 1
tHo eawBadiawB
MBMmmo
ES7607615935
November 1977
978
58 HAkWct^ AVE N APT 3
OTTAWA ONT
»T6
1/
' \.
White Sister...
because good clothing is an investment
A& B)
Sizes: 8-W *"
"Royale W/S Impact" — 100% textured Dacron'
polyester warp knit
White, (Mint . . . about $38.00
r^scKG
"Royale W/S Impact" - 100% textured Dacron*
polyester warp knit
White, Blue . . . about $25.00
While
Sister
tHe enna^ian
November, 1977
The official journal of the Canadian
Nurses Association published
monthly in French and English
editions.
Volume 73, Number 1 1
B^HH^^HHBIHHI
Input
4
News
6
Calendar
12
Four Score and Ten: Part Two
Maudo Wilkinson
14
What's New
46
Body Image and the
Crisis of Enterostomy
Sandra Undensmith
24
Names
48
People with Temporary Colostomies:
Are We Meeting Their Needs?
Pamela Gaherin Watson
Robin Young Wood
28
Books
53
Alternative Birth Centers
Alison Rice, Elaine Carty
31
Library Update
56
Hospitalization: Is It Always
a Negative Experience?
Gail Patricia Laing
35
Hey, What About the Kids?
— A Knowledge/Practice Gap
— A Child Life Program in Action
— Commentary
Denise Alcock
Shirley Post
38
44
It's a long, long way from Victoria, B.C.
to Salonica, Greece, but that's where
the marchers on the cover were
headed. The year was 1915 and the
marchers were the Nursing Sisters of
No. 5 Canadian General Hospital
getting ready to board the train for a
trip across Canada before beginning
their tour of duty overseas. This
month, CNJ salutes all of the
registered nurses who served their
country in that war and the ones that
followed. Our Cover Photo appears
with the kind pennission of the family
of the late Gladys Stewart of Victoria,
B.C.
The views expressed in the articles
are those of the authors and do not
necessarily represent the policies of
the Canadian Nurses Association.
ISSN 0008-4581
Indexed in International Nursing
Index, Cumulative Index to Nursing
Literature. Abstracts of Hospital
Management Studies, Hospital
Literature Index, Hospital Abstracts,
Index Medicus. The Canadian Nurse
is available in microform from Xerox
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Michigan, 48106.
The Canadian Nurse welcomes
suggestions for articles or unsolicited
manuscripts. Authors may submit
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Postage paid in cash at third class rate
Montreal, P.O. Pennit No. 10,001.
* Canadian Nurses Association
1977.
Canadian Nurses Association,
50 The Driveway, Ottawa, Canada,
K2P 1E2.
Guidelines for
autliors
Who can write for The Canadian Nurse?
Anyone with information or ideas to share with members of the
nursing profession in Canada may submit this material —
manuscript, cartoon, photo or other original communication — to
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How are articles chosen for publication?
Manuscripts submitted for publication are acknowledged on
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The criteria used for selection of articles for publication include:
n originality
D timeliness
D significance and scope
D reader appeal
In reviewing manuscripts the editorial staff also take into
consideration plans for special or theme issues in coming
months and coverage already given to a particular topic in
previous issues of The Canadian Nurse and other nursing
journals. That's why, if you're planning to submit an article, it is
always a good idea to send a letter of enquiry beforehand,
outlining your subject matter and treatment. This will enable the
editorial staff to provide you with the appropriate editorial
guidance and let them know that this material will be available at
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What makes a good article?
The selection of editorial content for any publication is a
subjective process but an article is more likely to be accepted IF:
1 It deals with an interesting subject, i.e. a new program or
procedure, a better way of doing something, or an individual
interpretation of an issue or concern.
Because The Canadian Nurse is a professional nursing journal
dedicated to enhancement of the profession, we particularly
welcome clinical articles that promote improvements in nursing
care and also research articles that advance the level of nursing
practice and knowledge.
2 The author is knowledgeable and informed about the
subject he chooses. Controversy is not only acceptable but
welcome.
3 The style of presentation is personal, informal and readable.
The communication process bogs down under the weight
of big words and roundabout ways of saying things.
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Editing involves checking factual content, adding new
information, deleting unnecessary material and revising what
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Sometimes the author is asked to help with this process; usually
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always consulted before publication. Any changes made aftei
the author has indicated his/her approval will be minor ones '
dictated by make-up considerations.
1
A word about references
References and bibliographies are published to provide readers
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must be complete. This means indicating the full name of the
author, the correct title of the book, place and date of publication
the name of the publisher and (in the case of periodicals) name
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information in the order and style preferred by The Canadian
Nurse .
What about length?
There is no minimum length for articles but most short articles
are about 500-750 words (about four or five typewritten,
double-spaced pages). Articles of more than twelve pages wil
probably require editing to a more readable length. Be your owr
preliminary editor. Always check your material over
carefully and condense it wherever possible before
submitting it.
Would pictures help?
Illustrations — photos, drawings, graphs — are always
eye-catching and often make the difference between a so-so
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photographs are best but slides and color photos can be
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How do I go about submitting my article?
■Vou will need three copies of your manuscript — typed,
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Mail two copies (keep one for your records) along with a coverin(
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4f
The Editor,
The Canadian Nurse,
50 The Driveway,
Ottawa, Ontario,
K2P1E2.
Good lucl<! ... The Editor .
The Canadian Nurse November 1977
Per.speetive
When those of us who are a part
of what has been called the Me
Generation think of conservation, we
are apt to think of it as a relatively
recent phenomenon. We forget what
those who lived through a catastrophe
such as the Hungry Thirties or either of
the two World Wars, know all too well
— that conservation may not always
be a matter of individual choice.
Sixty years ago, the catastrophe
of war brought home the message of
conservation to another generation of
readers of The Canadian Nurse. Mary
Campbell MacQueen, writing in the
October 1918 issue of CNJ says that
"the word conservation is on the lips of
everyone, it is used almost as much as
efficiency and co-operation." She
urges readers to avert disaster by
reducing the amount of necessities,
comforts and luxuries which the
civilian population consumes. Take,
for example, the waste in fuel, keeping
houses unhealthily hot; having
needless clothing, needless servants;
excessive eating and drinking, and a
full garbage can.
"There are so many ways and
things in which we could save. Take,
tor instance, sugar. Forty-five percent
of the sugar consumed in the United
States and Canada is used in the
manufacture of candy and like
luxuries, and the consumption of
candy on this continent has increased
enormously in the past year, and now
we are about to be placed on sugar
rations. Butter is scarce, and the Allies
need fat perhaps more than any other
article of food ; still , Toronto alone uses
778,479 lbs. of butter fat every year tor
Ice-cream.
'...In hospitals where little things
mount so rapidly and count for so
much, there are a few "don'ts" we
might remember: Don't heat food in a
pan without water; don't use coarse
scouring powder; don't throw away
dippings of gauze or cotton; don't
scrape pans: soak them; handle
utensils with care. Where numbers
teve to be fed, the cafeteria plan has
proved economical; the loaf and
Sreadboard on the table saves bread,
tXJth from being wasted and becoming
stale. Barbers' towels are very
Eibsorbent and have effected a great
saving in gauze dressings. They have
Seen satisfactorily used instead of the
Mmbined absorbent and gauze final
an abdominal and other wounds; a few
strips of gauze are put next the
incision and the folded towel over this.
Also, in the maternity wards, they save
vaginal pads. For fresh cases, pads of
absorbent cotton and gauze are used
reinforced with a sterilized towel, and
after the first few days towels are
substituted altogether. It requires a
woman to wash these towels before
being sent to the laundry, but that is
much easier to have done than to
procure gauze and cotton.
"There are not nearly so many
dishes broken when each one has to
report every article she breaks. The
same applies to rubber goods and
thermometers; and the requisitions for
dressings will not be so large if each
ward is asked the exact number of
dressings to be done in twenty-four
hours."
In 1918it was sugar rationing and
barbers' towels. Today it is car pools
and compost heaps. Sixty years ago, if
was commonly believed that the
return to normal productivity that
accompanied the cessation of
hostilities would signal an automatic
and permanent end to the scarcities
that had characterized the war years.
Six decades later we are
gradually coming to the realization
that things are not quite that simple.
The Science Council of Canada, in its
most receni report, "Canada as a
Conserver Society," says that from
now on we must work together to
make conservation not consumption
the basis of our social order. The
author of the report. University of
Toronto professor and Science
Council member Ursula Franklin,
warns that "We don't have to, in fact,
we mustn't depend on catastrophe to
change us. It is only by being
intelligent... by changing the style of
some technologies, that we shall find
room for continuing growrth... (and)
keep our options open, rather than
being driven, by one supply crisis after
another, to desperate solutions."
How far away is The Conserver
Society? Let's hope it won't take
another sixty years for this generation
to find an acceptable solution.
— M.A.H.
j|^
Herein
Authors Alison Rice (above) and
Elaine Carty (right) are doing more
than just talking about alternatives to
the traditional hospital birth
experience. They are also engaged in
planning an alternative to
conventional hospital delivery in
Canada. Together with colleagues at
the University of British Columbia,
they are working on formulating a
proposal for a demonstration project
using nurse-midwives, nurse
specialists, obstetricians and
pediatricians to provide
comprehensive care for low risk
women and their families in a small
out-of-hospital birth center. For a look
at what has already happened in the
U.S., see "Alternative Birth Centers "
on page 31.
"You have been selected as nursing
sister for service abroad. Report
Quebec 23rd September." The order
to mobilize Canada's Army Nursing
Service went out within weeks of
Germany's refusal to withdraw troops
from Belgium as demanded in the
British ultimatum of August 4, 1914.
By the first week of October, the first
convoy was steaming across the
Atlantic from Canada and before the
end of that year more than 50
Canadian nurses had crossed the
Channel to begin active service in
Europe. This month, in the second
instalment of "Four Score and Ten, "
Maude Wilkinson remembers those
war years — the mustard gas and
champagne, the casualties and the
comrades.
Next month, author Jean Gurr of
Montreal, describes a school
screening program for scoliosis that
really works! A team of health
professionals including school nurses
from the Department of Community
Health at the Montreal General
Hospital, medical consultants at the
Shriners Hospital for Crippled
Children, physiotherapists and others,
opierate the program. It has proven
to be effective in detecting new cases
of scoliosis in adolescents, in
providing comprehensive follow-up
that involves family teaching and in
lowering health care costs.
Editor
M. Anne Manna
Assistant Editors
Lynda Fitzpatrick
Sandra LeFort
Production Assistant
Mary Lou Downes
Circulation Manager
Beryl Darling
Advertising
Gerry Kavanaugh
CNA Executive Director
Helen K. Mussallem
The Canadian Nurse November 1977
The Canadian Nurse invites your
letters. All correspondence is subject
to editing and must be signed,
although the author's name may be
withheld on request.
Input
Symbol of competence
For some months now I have
been concerned over the apparent
decline in the graduate nurse's pride in
one of the "badges " of her profession
— namely her cap. In our hospital the
only nurses who are requ ired to wear a
cap are the students. For the rest of us
it is an option and increasingly more
and more nurses are going capless.
We are also allowed to wear any style
and color of uniform or pantsuit as we
see fit.
It is no wonder that the patient, as well
as the doctors and visitors often have
a hard time in deciding who is a nurse
and who isn't. I have heard complaint
after complaint from patients, doctors
and visitors about this fact. The only
person they are sure is a nurse is the
student because she wears her cap.
I still remember the day I received
my cap — one of the highlights in my
lite. I worked hard for it and am proud
to wear it.
I feel that some of the
deterioration that is often apparent in
our profession starts with lack of
personal pride in our outward
appearance — dirty shoes, runs in
stockings, long straggly hair, fancy
uniforms etc. and now no cap. I
personally feel that a certain standard
in uniform is a good thing but is that
possible when the director and
assistant director of nu rsing and many
of the instructors do not even wear a
uniform let alone a cap?
Am I being old fashioned or are
there others who feel as I do?
— D. Sullivan, Victoria, B.C.
Epilogue...
Since I wrote "A Canadian Grad
Goes to the States" (October 1977), I
have returned to live in Canada. So it
seems that all the problems I outlined
in my article finally did cause me to
come back home. I am currently living
in Windsor and am about to start a new
job in Detroit as an emergency room
outpatient clinic nurse. So although I
am back In Ontario, the job situation
still forces me to work in Detroit for the
opportunities I want ...
— Katherine Zin, R.N., Windsor,
Ontario.
Keeping up with the times
I have been planning to write for
months and comment on how much I
am enjoying the "Update" articles and
the Wordsearchs that are in The
Canadian Nurse.
I find them informative and very
useful in keeping up with current
practices. Since I live in an isolated
community and, owing to this location,
am not working, I enjoy the monthly
reviews that these articles give.
Keep up the good work!
— e. Fiddes, R.N., Lac Seul, Ont.
Special community service
I always enjoy my copies of The
Canadian Nurse, but July 1977 was,
for me, the tops.
It was nice to see news published
of the "Future for V.O.N. " and to read
the report on Expanded Roles in
Respiratory Nursing.
Here at the North Shore Branch of
the V.O.N, in North and West
Vancouver, B.C., we have started this
year, a special service to the
community, mainly for chronic
respiratory patients. We are fortunate
in having three hospital out-patient
rehabilitation areas in Greater
Vancouver but those who are unable
to get to these areas are seen in the
home upon referral.
At present, I am the only nurse in
this Home Service and find it very
interesting to hear of other places and
what they are doing there.
— Ruth Darby R.N. , V.O.N.
Respiratory Nurse, Vancouver, B.C.
People power
I would like to start a campaign
called "The Pantyhose Ripoff."
It is time women demanded better
quality pantyhose. The manufacturers
need to be told that we expect better
value for our money. That we want
pantyhose with a month guarantee or
money refunded.
For this campaign to work I would
need women all across Canada to
write a similar letter to the editor of
their local paper and also to let all the
stores know.
Everyone should save their
throw-away pantyhose and return
them to the store.
— Kathleen Crowrley, R.N.,
Fredericton, N.B.
Island in the sun
I would like to say how much I
enjoyed Jane Graydon and Judith
Hendry's article "Outpost Nursing in
Northern Newfoundland," but was
disappointed with the map that
accompanied the article.
Did you not know that the land
north of Nova Scotia and New
Brunswick is a Canadian province
called Prince Edward Island — P.E.I,
for short? Anticosti Island isn't even a
province and yet it was clearly
marked. Surely P.E.I, wouldn't have
taken much room on the map!
This may seem petty griping but
to some of us "Islanders " it was sheer
neglect.
I know a visit to our fair island the
"Cradle of Confederation " would
imprint P.E.I, on your readers'
memories forever.
— M. Hughes, R.N., Charlottetown,
Prince Edward Island.
Editor's note: To each and every one
of CNJ's 888 readers in the Cradle of
Confederation — our sincere
apologies.
A stimulating issue
The September '77 issue was the
most provocative and informative in a
long while. Ella MacLeod's letter on
the use of the word chairperson
deserves a wide reading. It makes
sense.
Mohamed Rajabally's "Nursing
Education: Another Tower of Babel "
was thoroughly enjoyed by a number
of people I have spoken with as well as
myself. It was spirited, provocative
and engaging.
More writing on these
controversial issues would be
welcomed by many readers. Let's also
see articles like "The Tri-Hospital
Diabetes Education Centre" in future
issues. It was exceptionally well
written and packed with information
for anyone involved with this disease.
— Nancy Kyle, Montreal, P.O.
Nursing's inherent validity
I would like to thank Mohamed
Rajabally for thinking, and The
Canadian Nurse for printing, his
thoughts on nursing education. For a
longtime I have thought that nursing is:
not complicated in the way that its
educational theorists suggest; sub
rosa I have wondered about
overcompensation and reaction
formation.
Although I do not at all subscribe
to an anti-intellectual approach to
nursing, I do not believe that imposing
a pseudoscientific superstructure on i
what is essentially an applied art will<
give nursing validity. Nursing
synthesizes many disciplines —
medicine, epidemiology, sociology,
psychology, to name the obvious
ones. Its essence, it seems to me, i
an intelligent and informed caring or >
mothering.
Nursing, like mothering, is often'
devalued at the present time. I havei
noticed that as I become less
defensive about being a nurse — with!
all the connotations of second-class .
hospital citizenship that it can imply-
and have recognized both the
contributions and the limitations of myi
occupation, I have had less need to i
prove that nursing is a science, a
profession, a high-status job by virtue)
of the complicated theory surrounding
it.
— (name withheld) Montreal, P. Q.
Working nights
I would like to add one idea to the
article on shift work. I am wholly in
favor of permanent shifts. I believe thaJ
if the positions were advertised as
such and there were sufficient
differential in pay, there would be no>
difficulty in obtaining staff.
— Mary Lobb, R.N., Winnipeg, Man:
Did you know ...
Regina Grey Nuns' School of Nursing,
Class of "73 are interested in having a
five-year reunion tentatively
scheduled for May 28, 29, 1978.
But they need your support. If you are'
interested in attending the reunion
contact: Reunion Committee,
4721 Pasqua Street, Regina,
Saskatchewan, S4S 6N7.
The Canadian Nurse November 1977
conscious
Locked in the
hecirt of every
cholesterol-
patient is
the wistful
longing for
an egg.
Egg Beaters — yolk replaced eggs -reduce
cholesterol content by 98% .
C.H.D. patients and others at hyperlipid risk may now look
a real egg in the face without concern about cholesterol or
triglyceride build-up.
This is made possible by unique 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 vitamin and mineral fortified corn oil
nutrient plus flavouring agents. Egg Beaters are then
pasteurized, homogenized, and fast frozen.
Egg Beaters taste and smell like fresh farm eggs.
The result of this improvement on nature is an egg
equivalent— with the nutrition, taste, and smell of fresh whole
eggs. Minus the cholesterol disadvantages.
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. Each 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.
standard Brands Canada Limited
Consumer Service Division
550 ShertKOOke St. Wast
Montreal, Quebec
I would appreciate
a supply of your "Cooking
with Egg Beaters" recipe
booklet tor my patients
as marked lielow.
Numbers of copies requested: Engllstu.
IN YOUR GROCER'S FREEZER
-French-
NameL-
Address-
C N
ess
beaters
You can eat them every day.
The Canadian Nurse November 1977
News
MARN hosts first national seminar
on standards of nursing practice
The first national gathering of nurses
concerned at the provincial level with
the development and implementation
of standards of nursing practice ever
held in Canada took place in Winnipeg
on the last two days of September this
year. The meeting was convened by
the Manitoba Association of
Registered Nurses and attended by a
total of 21 nurses, including
representatives from eight provinces
and the Northwest Territories.
Also present were Norah
OLeary, nurse adviser, Health
Standards Directorate, Health
Programs Branch, Health and Welfare
Canada; Rose Imai, recently
appointed director of professional
services, Canadian Nurses
Association, and Miriam Pill of the
Canadian Council on Hospital
Accreditation.
The chairman of the meeting,
Deidre Blank, nursing consultant,
standards for the Manitoba Nurses
Association, welcomed participants to
the meeting. She explained that the
MARN decision to host the standards
meeting was based on the desire to
provide provincial counterparts with a
forum for sharing information on
progress within the various
jurisdictions towards the development
of standards of nursing practice at a
provincial level.
Day one of the two-day meeting
therefore was devoted largely to
explanations and descriptions of
relevant programs by the various
provincial spokesmen. As the
discussion proceeded, wide variations
in interpretation and approach
between the various jurisdictions
became apparent. A minority of
provinces (notably British Columbia,
Saskatchewan and Manitoba) have
some sort of quality assurance
program, incorporating standards of
nursing practice, already in effect.
Others, such as Alberta, are now in the
process of developing nursing
practice standards for approval by
their membership.
In spite of the differences which
surfaced, participants reached
agreement on two important points:
• there is no "right or wrong"
approach; each province must
proceed on the basis of its unique
situation towards a goal that is
acceptable for that province.
• there is a very real need for action
at the national level to provide the
provinces with guidelines that will
allow them to proceed from a- unified
base towards the implementation of
national standards of nursing practice.
Norah O'Leary, whose position
as nurse adviser with Health and
Welfare Canada involves coordinating
and facilitating work on guidelines and
standards of nursing practice at the
national level, outlined progress on
national standards to date.
"One of the priorities of the
Canadian Nurses Association over
the past two years has been the
development of a definition of nursing
practice and the establishment of
national standards," she said. The
association is now working jointly with
the Health Standards Directorate on
this project. O'Leary, who assumed
this post in July, will work with a
14-member National Steering
Committee composed of
representatives of the
provincial/territorial nurses
associations and provincial
governments.
Nurses who attended the
Winnipeg meeting agreed that their
efforts should be considered as
helping to lay the groundwork for this
National Steering Committee which
will hold its first meeting early in 1978
They also agreed that, in order for the
project to be a success, the CNA
should act to ensure that an evaluation
component is included in the work on
national standards. Their
recommendation will be forwarded to
CNA directors for consideration at the
October board meeting.
Emergency Nurses
hold sixth
annual conference
Emergency nurses from all parts of
Ontario took a long look at some
common concerns at the sixth annual
conference of the Emergency Nurses
Association of Ontario (ENAO).
Some 300 delegates-met in Ottawa for
the lively three-day meeting, including
some nurses from Quebec and
Manitoba.
The program of the conference
was geared specifically to the
educational needs of emergency
nurses. Guest speakers discussed a
number of topics pertinent to the
emergency nurse. These included
obs-gyn emergencies, hematological
crisis, ENT. dental and urobgical
emergencies, Gl crisis, sudden infant
death syndrome, dialysis in the ER
and emergency plastics.
A panel discussion dealt with the
subject of death in the emergency
department. Jill Courtemanche, R.N.,
talked about how the nurse in
emergency can help the relatives of a
deceased patient. Dr. James Dickson,
coroner for Ottawa-Carleton
discussed the medico-legal aspects of
death in the emergency room. Rev.
Dr. John Swift, chaplain at
Queensway-Carleton Hospital in
Ottawa, talked about the grieving
process and the use of grief workers to
help those whose relatives have died
in the hospital.
Another interesting and very
helpful presentation at the conference
was Penny Jessop's well-
demonstrated instruction in the
A.B.C.'s of cardiopulmonary
resuscitation. The coordinator of the
Ambulance Training Program of the
Ontario Ministry of Health, Jessop
explained the need for standards for
the application of CPR and outlined
clearly the steps to be taken in the
cases of witnessed cardiac arrest,
unwitnessed arrest, arrest in infants,
and obstructed airways.
The ENAO has come a long way
since its first annual conference
attended by 75 members in November
of 1971. Membership now stands at
approximately 800 nurses.
The purpose of the ENAO is to
upgrade emergency nurses within
their own specialty:
• to teach and exchange ideas
• to improve community relations
and communications by becoming
more knowledgeable about individual
hospital problems and patient needs
• to establish a program geared
specifically to emergency nursing in
order to improve the care given to
patients in emergency.
ENAO is affiliated with the
Registered Nurses Association of
Ontario, and has been involved with
interdisciplinary groups such as the
Ontario Medical Association and the
Association of Casualty Care
Personnel.
The executive of the Emergency
Nurses Association of Ontario at their
sixth annual conference. Seated (left
to right) are Kathleen t^cPhee, the
first president of ENAO; Gail
Lounds, president; and Kathleen
Kitney, past president. Standing (left
to right) are Cathy Barbour,
vice-president: Margaret Pook,
secretary; Diane Oixon, past editor;
Mary Arntfield, business secretary;
and Hilda Powis, past treasurer.
Members back MARN
at special meeting
Cose to 1,000 nurses attended a
^cial general meeting of the
:nltoba Association of Registered
rses held in early October, the
jest attendance at any general or
nual meeting in the history of the
sociation.
The meeting was called in
sponse to a request of association
-mbership. who indicated seven
Tis that they wished to have
cussed. At the time CNJ went to
^'ss. only four of these items were
ailabie.
Collective approval was given to
e following resolutions:
f that the Board of Directors
. estigate the feasibility of a
st-Diploma Baccalaureate program
registered nurses in Manitoba after
;eipt of the report from the Manitoba
Government of the Joint Ministerial
~=isk Force on Nursing Education and
ther information on the progress of
development of a B.N. program at
- University of Brandon and .... that
Board of Directors encourage that
- entrance requirements of the
.-year program be the successful
ripletion of R.N. examinations.
that the membership go on record
ds reconfirming the decisions made
' th respect to their direction to and
Dport of The Board of Directors
.icisions taken to date regarding the
position paper "Nursing Education:
Challenge and Change."
• that in the opinion of the
-embership, the conduct of the Board
Directors in negotiating with the
T^ervice Employees International
Union. Local 308. was fair and
•easonable.
A resolution was passed at the
' 'ay annual meeting to promote the
Tielopment of a Baccalaureate
.rsing program at Brandon
iversity. A progress report on this
■esolution was presented and
accepted by the assembly at the
October meeting.
Members attending were given
■ ery opportunity to participate in
scussion on all items on the agenda,
d many availed themselves of this
: portunity. Comments made would
dicate that members are interested
their professional Association and
■sirous of participating in and
Nurses try out
fitness model
Twenty-three nurse educators from
community colleges, hospitals, and
universities across Canada met early
in September to immerse themselves
in health, fitness and lifestyles as part
of CNA s Health Promotion Project,
Phase Two.
P""l'l|||||||ll '
The lively five-day workshop held
in the YMCA Conference Centre,
Geneva Park. Ontario brought
together provincial and territorial
delegates who were chosen by CNAs
member associations. Helen
Mussallem. executive director of CNA
and Joan Gilchrist. CNA president
were also in attendance for part of the
conference.
The program, which included
many well-known speakers, was a
mixture of theoretical information, idea
sharing and practical sessions of
fitness tests, exercising, eating
nutritiously and generally "getting
involved."
CNA project officer, Jean
Everard, stated that the expected
result of the conference was to effect a
personal change in the nurses who
attended so that they would act as
"role models ' to nursing students and
to nursing faculty members with whom
they come in contact.
Funding for the workshop and
much of the fitness expertise were
supplied by Recreation Canada.
Fitness and Amateur Sport Branch.
This follows the trend fostered by
lona Campagnolo. Minister of State
for Fitness and Amateur Sport, to
provide more opportunities for all
Canadians to be involved in exercise.
Mall Peepre, fitness consultant with
the Branch, stated that of all the health
professions, nursing has shown the
greatest interest in a health promotion
scheme. Workshops of this kind
where individuals are in the "living
situation" for five days work towards
changing attitudes about fitness and
lifestyle.
The nurses attending the
conference were able to express their
criticism, ideas and suggestions
through a questionnaire handed out at
the workshop. A follow-up
questionnaire will be sent to all the
delegates in six months time.
Later this year, CNA will request
further funds for health promotion
workshops for public health nurses
and occupational health nurses.
Those attending the workshop were: Back row, L to R: Joan Gilchrist, CNA
president; Betty Rideiro. Nfld.: Sharron Woodworth, N.B.; Alexa Brewer, Ont.;
Patricia Kurki, Ont.: Maureen Murphy, B. C, Jean Innes. Sask.: Nancy Wiggins,
N.B.; Joan Royle, Ont.: Nida Davediuk, N. W.T.: Barbara Stewart, P.O.; Margot
Phaneuf, P.O.: Helen Mussallem, CNA executive director Middle row, L to R:
Sandra Murphy, Nfld.: Jean Everard, CNA project director: Judy Macintosh,
P.E. /.; Leslie J. Robert. Alta.: Loni Sarsfield, Sask.; Donna Meagher, N.S.;
Bonnie A Friesen, Alta.: Janet Undquist, N.W.T.; Mall Peepre, fitness
consultant, Ottawa. Front row, L to R: Marilyn Mitchell, Man.: Nettie Peters,
Man.: Laurie Clarke, B.C.; Laura Saulnier, N.S.; Ginette Fremont, P.O.
The Canadian Nurse November 1977
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OTOSCOPE SET One ot
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Lores Ytterberg
VGH reorganizes
nursing department
The nursing department at the
Vancouver General Hospital,
Vancouver, B.C. has recently
undergone a major reorganization.
Each of five nursing specialties now
constitutes a department headed by a
clinical nursing director who brings to
the position the specialized
knowledge and competence required
to organize and deliver nursing care.
The five clinical nursing directors are
members of the hospital's Nursing
Advisory Committee which has
developed as a nursing parallel to the
Medical Board. The Committee's
responsibilities deal particularly with
the development of quality assurance
program for nursing care and
recommendations for nursing policies.
The five newly appointed clinical
nursing directors are: Anne Jenkins,
director, Pediatric Nursing; Bonnie
Lantz, director. Surgical Nursing;
Winifred M. Miller, director.
Psychiatric Nursing; June Nakamoto,
director. Obstetrical, Gynecological
Nursing; Lorea Ytterberg, director,
Medical Nursing.
The newly created staff position
of director. Nursing Administrative
Services, has been filled by Thurley M.
Duck.
Thurley M. Duck
As director, she is secretary to the
Nursing Advisory Committee and is
responsible tor the development of the
quality assurance program in nursing.
Winifred M. Miller
The four years of studies and
planning for the reorganization carried
out by the nursing staff and hospital,
revealed that a great deal of nursing
staff time was being spent on activities
related to nursing, but not actually
nursing functions. To allow nursing
staff more time for direct patient care,
an administrative support team for
nursing has b been established. Clara
Y. Lim has been appointed director.
Nursing Support Services. She will
supervise four administrative
managers.
The nursing reorganization was
implemented at VGH to give nursing
staff the opportunity to devote more
time to the care of patients and to work
more closely with the physicians at the
hospital. It is part of a plan to enhance
both job satisfaction for nurses and to
maintain a high quality of health care
for patients.
i^lli^
Clara Y. Lim
RNAO's nursing process
project underway
A two-year project to assist in the
implementation of the nursing process
by all nurses throughout Ontario is
well underway.
In November, 1 976, the
Registered Nurses Association of
Ontario's board of directors
authorized the project as a follow up to
the Team Nursing Project. The
nursing process project aims to
increase the effectiveness of the
nurse in her practice of nursing, to
endorse the Standards of Nursing
Practice recently issued by the
College of Nurses of Ontario, and to
assist hospital nursing departments
carry out accreditation guidelines.
The objectives of the project are:
• to promote utilization of the
nursing process by all registered
nurses throughout the province;
• to devetop the skills of the
registered nurse in assessment of
patient needs, planning for nursing
care, implementing the plan through
appropriate nursing action and
evaluation of the outcome of nursing
care; and
• to improve the problem solving
abilities of registered nurses.
The project consists of three
phases:
Phase I: An initial series of workshops
on the nursing process on a regional i
basis throughout the province.
Phase II: A follow-up series of
workshops approximately one year
later.
Phase III: Documentaton of all
activities and evaluation of the results.
In June 1977, Louise Lemieux
Charles was appointed project
co-ordinator. Since then, a provincial i
steering committee, acting as a
co-ordinating body for the project, has
developed guidelines outlining the
basic principles on which the
workshops will be based.
Regional planning committees
representing RNAO's six regions have
been formed. The committees will
identify the specific educational needs
of their area in relation to the nursing
process and identify available
community resources.
Seven workshops will take place
in late November 1977. Another two
regional planning committees will
meet soon to plan further workshops.
The Canadian Nurse November 1977
Xl»\Y.S
First Psoriasis
Education
and Research Centre
The Women's College Hospital in
Toronto has opened Canada's first
Psoriasis Education and Research
Centre (PERC). The cost of treating a
patient at this center is estimated at
one-third the cost of hospital
treatment.
Psoriasis, a chronic recurrent
n condition characterized by
• aking. scaling, and itching of the skin
has been estimated to affect between
800.000 and 1 .000,000 Canadians of
both sexes, and all ages, racial origins
and social levels.
The Education and Research
^ntre is set up to treat those patients
:n extensive disease that have
eviously required hospitalization to
?et their need for treatment. In
:clition to a flexible education
jgram, the Centre draws up
treatment schedules that are
individually tailored to meet the
patient's work pattern and lifestyle.
At the Center, a patient is taught
the skills of skin care as well as
learning howto minimize disability. He
earns howto maintain remission, how
to recognize and treat relapses at an
■■'y stage. He is encouraged to
iction at an optimum level, and to be
ndependent.
The objectives of the program
are:
• to teach patients to care for
themselves and recognize their
symptoms before the condition
ecomes full-blown
» to provide a center for training
medical, nursing and other
t-rofessionals in methods of
^prehensive and preventative care
■ chronic skin conditions
• to develop a less costly
alternative to hospitalization while
maintaining a comprehensive
program.
PERC is a demonstration model
for which operating funds were
provided by the Atkinson Charitable
Foundation, the federal government.
Health and Welfare Canada research
grants and the Women's College
hospital.
B^gin replaces Lalonde
in cabinet shuffle
Canadians have a new minister of
National Health and Welfare. She is
the Hon. Monique Begin, P.C, M.P.
for the Montreal riding of Saint-Michel.
Her appointment became effective
September 16 of this year.
First elected to the House of
Commons in 1972, Begin was
formerly Minister of National Revenue
(since September, 1976) and
Parliamentary Secretary to the
Secretary of State for External Affairs.
Begin has served on several
parliamentary committees, including
External Affairs and National Defence,
Broadcasting. Health and Social
Affairs, and Immigration.
In 1973, she was a member of the
Canadian Delegation to the
Commonwealth Conference held in
Ottawa and served as a permanent
delegate of the 28th session of the
United Nations in New York. She was
head of the Canadian ministerial
delegation, 25th Conference,
Colombo Plan in Colombo, Sri-Lanka.
Begin was born on March 1 , 1 936
in Rome, Italy and was educated in
Montreal. A former teacher, she
obtained her M.A. (Sociology) from
the University of Montreal, followed by
doctorate studies at the University of
Paris and post-graduate courses at
the Engineering Faculty of McGill
University in Montreal. She worked in
the private sector on applied social
research projects, before being
appointed executive secretary of the
Royal Commission on the Status of
Women. She was also administrator
of the research branch of theC.R.T.C.
oneuj
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The Canadian Nurse November 1977
Calendar
M
5
12
19
JUNE
T W T
6
13
20
1
8
15
22
29
2
9
16
23
30
3
10
17
24
Toronto's Great in '78 for the CNA convention.
Holding a conference or meeting
soon? If you are, CNJ wants to know
about it and so do our readers. But due
to production deadlines, we must have
the dates at least two months in
advance for inclusion on the
"Calendar" page. Send your
conference dates to: Calendar, The
Canadian Nurse, 50 The Driveway,
Ottawa, K2P 1E2.
November
Coping with Work Stress. A one-day
workshop to be held at the University
of Victoria, Victoria, B.C. on Nov. 25,
1977. Fee: $15. Contact: Division of
Continuing Education, Mrs. F.B.
Collins, Programme Officer,
University of Victoria, Box 1700,
Victoria, B.C., V8W 2Y2.
Annual Seminar of the Manitoba
Operating Room Study Group in
conjunction with the Manitoba Health
Organization Conference. To be held
on Nov. 22, 1977. Contact: Faith
Yundak, Operating Room, Children's
Centre. 685 Bannatyne Ave.,
Winnipeg, Manitoba, R3E OWI.
Symposium on the High Risk Infant
and Family, to be held on Nov. 30 and
Dec. 1, 1977 at the Netherland Hilton
Hotel in Cincinnati, Ohio. Presented
by the University of Cincinnati College
of Nursing and Health. Contact:
Michael Hyre, Executive Director,
Greater Cincinnati Chapter, The
National Foundation, March of Dimes,
324 East Third A St., Cincinnatti, Ohio,
45202.
Children and Infection. A one-day
conference to be held on Nov. 23 and
on Nov. 30, 1977 at the Hospital for
Sick Children, Toronto. Fee: S20.
Contact: The Coordinator of Nursing
Education, The Hospital for Sick
Children, 555 University Ave.,
Toronto, Ont., M5G 1X8.
December
Primary Health Care in
Industrialized Nations to be held on
Dec. 12-14, New York City. Contact:
Conference Department, The New
York Academy of Sciences, 2 East
63rd St., New York, NY. 10021.
Common Problems in Orthopedics
to be held on Dec. 8-10, 1977 in
Saskatoon. Contact: CME Office,
University of Saskatchewan, 408 Ellis
Hall, Saskatoon, Sask., S7N 0W8.
Call for papers for the 1978 Annual
Meeting of the American Thoracic
Society to be held in Boston, Mass. on
May 14-17, 1978. Papers on all
Eispects of respiratory disease are
welcome. Abstract in English, to be in
no later than Dec. 7, 1977. Contact:
Richard H. Winterbauer, M.D.,
Chairman, ATS Annual Meeting
Committee, American Thoracic
Society, 1740 Broadway, New York,
N.Y. 10019.
Training for Adult Educators. A
series of interprofessional seminars to
be held in Vancouver: Dacum — A
systems approach to training on Nov.
25-26; Design and management of
instruction on Dec. 2-3: Research for
the practitioner — the practitioner as
researcher on Dec. 9-10. Fee for all
seminars: $50.
Contact: Registrations, Centre for
Continuing Education, U.B.C.,
Vancouver, B.C. V6T 1W5. (604)
228-2181.
Conference for Senior Nurse
Administrators to be held at the
Ontario Hospital Association in
Toronto on Dec. 5-6. 1977.
Topic: Employee Relations;
Assertiveness Training. Contact:
Norma Clark, Coordinator, Nursing
Services, Ontario Hospital
Association, 150 Ferrand Dr., Don
Mills, Ontario.
Seminar Series on the Organization
and Delivery of Mental Health
Services to be held on Dec. 9-10,
1977 in Austin, Texas. Contact: Anne
E. Parsons, Community Relations
Officer, Thistletown Regional Centre,
1 1 FarrAve., Rexdale, Ont., M9V2A5.
Current Practices in Breast
Feeding and Maternal Infant
Bonding to be presented in Winnipeg
on Dec. 2, 1977. Fee $10. Contact:
Norma Buchan. Women's Centre,
Health Sciences Centre, 700 William
Ave., Winnipeg, Man., R3E 0Z3.
January, 1978
Overview of Paediatric
Rehabilitation Course: A
Multidisciplinary Approach to
Management. To be held in Toronto
on Jan. 23-27. 1978. Fee: $75.
Contact: Norma Geddes, R.N., The
Education Department, Ontario
Crippled Children's Centre, 350
Rumsey Rd., Toronto, Ontario.
M4G 1R8.
Royal College Medical and Surgical
Exposition to be held concurrently
with the 47th Annual Meeting of the
Royal College of Physicians and
Surgeons of Canada. To be held at the
Hotel Vancouver, Vancouver, B.C.,
Jan 25-27, 1978. Contact: Royal
College Medical and Surgical
Exposition, 481 University Ave.,
Toronto, Ont, M5W IA7.
Nursing Care of the Sick Newborn,
a five-day conference to be held the
week of January 30. 1978 at the
Hospital for Sick Children, Toronto.
Fee: $80. Contact: The Coordinator of
Nursing Education, The Hospital for
Sick Children, 555 University Ave.,
Toronto, Ont., M5G 1X8.
Hypertension Symposium to be
held on Jan. 20, 1978 in Saskatoon.
Contact: Dr. U.K. Bhalerao,
Saskatoon City Hospital, Saskatoon,
Sask., S7K 0N7.
Current Practices In Breast
Feeding and Maternal Infant
Bonding to be presented in Winnipeg
on Jan 27, 1978. Fee $10. Contact:
Norma Buchan, Women's Centre,
Health Sciences Centre, 700 William
Ave., Winnipeg, Man., R3E 0Z3.
February
Toronto Area Interest Group of the
Orthopedic Nurses Association
Two-Day Meeting to be held at the
Hotel Toronto, in Toronto, Ontario on
Feb. 9-10, 1978. Contact: Marion
Marshall, Chairman, Publicity
Committee, 35 Front Street, Apt 3 10,
Mississauga, Ont, L5H 2C6.
March
Sensitivity — An Integral Part of
Pediatric Nursing. A one-day
conference to be held on Feb. 22 and
on March 1 , 1978. Fee: $20. Contact:
The Coordinator of Nursing
Education, The Hospital for Sick
Children, 555 University Ave.,
Toronto, Ont.. M5G 1X8.
April
Patient Teaching Programs. A
one-day conference to be held at The
Hospital for Sick Children, Toronto on
April 19 and on April 26, 1978.
Fee: $20. Contact: T7ie Coordinatorot
Nursing Education, The Hospital for
Sick Children, 555 University Ave.,
Toronto, Ont., M5G 1X8.
National Drug Abuse Conference to
be held April 3-8, 1 978 in the Olympic
Hotel, Seattle, Washington. Contact;
NDAC 78, 200 Broadway, Seattle,
Washington, 98122.
CNA MEMBERS AND
ASSOCIATION MEMBERS
CNA members and association members are invited to
submit resolutions for presentation at the Annual
Meeting and Convention, June 1978.
Resolutions must be signed by a CNA member and
forwarded to the Resolutions Committee, CNA House
by 31 March 1978.
Resolutions received after 31 March 1978 cannot be
presented to the annual meeting.
NEW LOW PRICES
on Plastic Namepins Below! h
/warn rlKd 'k 7icf<^...^m ^
IT'S EASY TO ORDER REEVES NAME PINS FOR YOURSELF OR FRIENDS!
Choose Style you wan(. shown nghl Pnnt name (and ?r«J
line tf desired! on dotted lines below Check other mto m
boxes on chart, cIio this section and attach to couoon
twttom right Attach eitra sheet for additional pms
NOTE SAVINGS ON 2 IDENTICAL PINS . mtrc csneniciit
spare in case ot loss
Mrs. R. F. JOHNSON
SUPERVISOR
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s^'Tioofri edges, rowntjeacorriers Choose
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Umk^i SCISSORS and FORCEPS
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LISTER BANDAGE SCISSORS
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The Canadian Nurse November 1977
m
any professional women experienced the hardships of Army service
during World War 1. At the close of the war there were 1,901 Canadian
Nursing Sisters in the Army overseas. Nursing service abroad was
far from being a "picnic" or a "joy ride." Of those who went overseas, 53 are
listed in the Memorial at Ottawa as having given their lives in the Great
War.
This is the story of one of the women who served Canada so
faithfully during the years 1 91 4 to 1 91 8. This is the second chapter in the
continuing story of Maude Wilkinson.
'The following recollections are not written with any underlying thoughts of resentment or self
pity. My memories of Army service are very dear to me and I consider myself most fortunate to ha ve
been able to serve my country in her time of need. All of the events of those years have remained
very vivid in my mind — I have enjoyed relating them."
Maude Wilkinson
^.
\B|y nee we were on board the train in Toronto
the officers were directed to the first car,
nursing sisters to the second and all other
personnel followed. There was great
merriment and laughter in our car as friends
greeted each other warmly. Many parcels and
gifts from family and friends left behind were
unpacked. There seemed to be almost no end
to the boxes of candy and fresh fruit.
Newspapers and paper backed books were
scattered everywhere.
While all this was going on other nurses
sat quietly at their windows, gazing out at old
landmarks. These were the buildings and
places they had known for so long — no doubt
some of them were wondering if they had
made the right decision in leaving the positions
they had attained, their comfortable homes,
their friends and family.
We arrived at the docks in Montreal
sometime after nine o'clock. Our orders were
to prepare to leave the train and board a troop
ship to cross the Atlantic.
It had been a tiring trip; a long exhausting
day, both physically and emotionally. We were
all assigned cabins on the ship. All of the
cabins had four beds in them — bunk beds.
We found our steamer trunks under our bunks
with our canvas bags. It was terribly crowded;
four women with haversacks and coat pockets
filled with parcels took up a lot of room. There
was no place to sit down, except on the bunks,
and no room to dress or to hang our
greatcoats.
I don't remember there being any
discussion as to which bunk we would have.
We were just too weary to do anything but
stumble in and settle down for a good night s
sleep.
Pandemonium and chaos reigned
supreme in our cabin early the next morning.
To be late for a meal was a serious offence and
it was almost time for breakfast. The four of us
decided that the two nurses on the top bunks
should dress first. Hairpins and nets,
toothpaste and brushes were soon lost on the
floor with all of our luggage.
On top of this, time was passing quickly
and the women in the lower berths had to get
dressed too. But where could the ones from
the top go? They could hardly climb up again.
It was a trying and embarrassing
experience for all of us, one which we were all
sure no male honorary lieutenant would have
been subject to. But, at last, the four of us were
ready and we made our way to the dining area.
Our cabin was near the small serving
pantry by the saloon. We could smell the
coffee, toast and frying bacon and it made us
realize just how hungry we were. In spite of
this, we waited, and waited, and waited.
I am sure the doctors were unaware of the
fact that the more coffee they drank, the more
cigarettes they smoked and the more amusing
tales they told (some of which must have been
very funny, judging from the laughter) — the
longer we had to wait. The doctors in our unit
were usually very kind and considerate of the
nursing sisters and I know they were never
informed of the situation because it was often
repeated. But, "AH's well that ends well." and
in the end we really enjoyed that first breakfast.
A cautious crossing
We were all summoned to the upper deck
after breakfast. Here we met with the captain
and his crew. They gave each of us a life
preserver which we were to carry with us at all
times. We were also allotted space in a
lifeboat, supplied with the number of the boat
and the station to which we should report in the
case of an emergency. Lifeboat drill was
carried out each morning; we were entering
the War Zone.
I dont think any of us had realized just
how dangerous this crossing was to be. It was
not until our ship had set sail that we learned a
troop ship had been torpedoed near the
Canadian shore. It was absolutely essential
that we observe all regulations, not only for our
■//.
.^^^
/^yz^a^a/z^ ^^^^^^
16
The Canadian Nurse November 1 977
A^/
^a/B ^""^qlB
own safety but for the safety of all on board.
The nights were the worst; all portholes had to
be closed and darkened and there was no
smoking allowed on deck.
Before long the sea became very rough,
the air cold and windy, t^atron soon retired to
her cabin, many nurses were seasick.
The doctors tried to persuade us to walk
and exercise but this too was very difficult.
At night, those who wished could remain
dressed and sit out on deck. Very often I was
one of the bundled figures in the darkness,
clutching the few personal possessions that I
had with me, fingering from time to time the
little leather coin container with the five-dollar
gold pieces that hung around my neck.
(Someone at home thought that the gold would
ensure my safety if I was captured).
England 1915
It took twelve long days and nights to
cross the Atlantic. Finally, land was sighted
and we prepared to disembark. The arrival of
the Canadian nursing sisters created quite a
stir at Portsmouth. Matron arrived on deck
(looking quite rested) and told us to line up as
we had been instructed by the sergeant in
Toronto. We had to walk through the town to
the train station and after our long sea voyage
we certainly did not look our best.
One of the nurses who had a very deep
voice was detailed to keep us in line. As we
marched ahead of her "left, right left, right"
soon attracted the townspeople. There we
were clad in greatcoats, with haversacks slung
over our shoulders and hats worn at a rakish
angle; the English people no doubt wondered
what on earth had landed at their sophisticated
port.
One lady joined our procession at the
rear, declaring as she fell in line that she too
belonged to the Salvation Army and welcomed
her sisters from Canada. To our wonder and
relief she refrained from bursting into "Onward
Christian Soldiers." Wherever we went in
England or on the Continent, our uniforms,
especially the two pips on the shoulder straps,
awakened curiosity and amusement.
What a relief it was to be on the train and
traveling comfortably through the lovely green
countryside. The weather was just beautiful
and we glimpsed many little cottages with
thatched roofs as we sped through village after
village. All the cottages seemed to have small
gardens in the front, gardens (no doubt gay
with summer flowers in peacetime) now
planted with life-sustaining vegetables. We
saw only old men and women whenever the
train stopped at stations along the way. The
only young people in evidence were the
disabled or wounded; the able men were in the
army and the women in munitions factories.
It was late at night when we arrived in
London. Matron-in-chief, Margaret
Macdonald, was there to meet us and direct us
to one of the two old established hotels that
were reserved for us. The next morning Miss
Macdonald really endeared herself to us when
she told our Matron we were to go to specified
shops to have our dresses and coats
shortened and our hats (so unbecoming)
reblocked. She too must have been appalled
at our appearance when we arrived.
We were allowed a few days leave. I had
been to London before and I was very anxious
to revisit some of my favorite old haunts.' But it
was wartime now and I could not help but be
appalled by the many changes. There were
notices pointing to air raid shelters, fences and
barricades around partially demolished
buildings. There was rubble everywhere. The
beautiful parks, where nursemaids, in their
long blue capes and little bonnets used to sit
and watch children romp and play, were now
deserted and neglected. The whole city was so
lonely and sad.
We were all disappointed when we found
out that our hospital was not yet ready. The
only thing that anyone could (would) tell us
was that we would be going to the
Mediterranean, eventually — just when or
where no one seemed to know.
In the meantime, we were sent to the
Canadian Military Hospital at Shorncliffe near
Folkestone. Some nurses remained there;
others were sent to Canadian and British
hospitals in England or abroad.
Life was restful and relaxing at
Shorncliffe. Our duty was light and our safety
was assured. It seems that sometime early in
1914a German plane had been shot down off
the coast near Folkestone. Lifeboats had gone
out and rescued the pilot and his crew.
Although the Germans were officially
prisoners they had received consideration and
were treated with justice. Apparently, German
headquarters heard of this and informed the
Folkestone Council that the area would never. \\
knowingly, be bombed — to the best of my
knowledge it never was.
Before very long the four of us who hac
shared the same cabin while crossing the
Atlantic (our nickname was "the Odds and
Ends") were sent to a British hospital at
Boulogne, France. I don't remember anything
about our departure, crossing the channel c
the train trip but I do remember the
unenthusiastic welcome we received when we
arrived on June 15th. The Matron met us anc
promptly told us she did not understand why
we had been sent; she had not asked for, nor
did she require additional staff. It was most
disheartening. The following morning we lined
up for breakfast at 7 o'clock. Matron was there
and she asked for our ration books and
handed each of us a tin pie plate, enamel muc
and cutlery. Food was scarce in Boulogne but I
never heard any of the British staff complain
about it. I must confess that we Canadians felt
it was quite inadequate after being spoiled at
Shorncliffe.
It was interesting to observe the routine
carried out in British Military Hospitals as
compared with what we were used to. The ;•>
orderlies gave most of the bedside care while 1 1
the general nursing staff took temperatures,
gave out the medicines and supervised the
patients' nourishment. The sister-in-charge
(the one with the little red cape) kept the
records, made rounds with the doctors and
was responsible for carrying out their orders.
We were told that this system of patient care
was followed in every British Military Hospital.
Matron supervised our work closely but
we were only criticized if we tried to usurp the
orderlies' duties. The British sisters were very
kind to us. In fact, we were almost sorry to
ine v^anaaian nurse
novefTiD«r
leave on July 25th when our orders came to
return to England.
Matron arranged our transportation to the
station, returned our ration books and thanked
us. We were given our rations for the return
journey: a package of hardtack biscuits and a
tin of bully beef! The station master put us in a
compartment, locked us in and departed. We
soon found that there was no other door
except the one we had entered by, no aisle, no
sanitary conveniences and no drinking water.
We were not allowed out when the train
stopped at stations for refueling.
So there we were, four graduate nurses,
who before the war had held responsible
positions, and enjoyed comfortable
accommodation. I think it was our dignified
Johns Hopkins graduate, who put one of our
steamer rugs across the end of the
compartment and thereby gave us a little
privacy. The bully beef tin was opened, the
meat carefully wrapped and the empty tin (a
treasured possession) did valiant active
service. The night dragged on endlessly.
Early the next morning, while the train was
refueling, we saw two French Red Cross
volunteers peering in our window. By sticking
out our dry tongues and clutching our throats
we were able to convey the fact that we were
parched for something to drink. They looked at
one another and seemed to understand what
we needed for one of them ran off somewhere.
She returned with two bottles of cider which
she thrust into our hands just as the train
started to pull away.
You can imagine our relief. We had had
nothing to drink for twenty-four hours: the salt
in the bully beef and the dryness of the
hardtack worked together to create a terrible
thirst. The cider, which we drank from the
bottle, was cool and refreshing and it soon
disappeared. The four of us, ex-matrons and
senior supervisors became merry, in fact, very
merry and a little inebriated. What a scene for a
movie! To top it all off when we crossed the
channel we found that bully beef, hardtack and
cider do not mix very well. All of us were very
sick.
The train from Dover to London seemed
quite luxurious in comparison to our journey
through France. We were rested and relaxed
by the time we had lunched in London and
continued our journey to Shorncliffe. There we
told our friends all about our experience on the
train in France and we were able to appreciate
their amusement.
We were stationed at Shorncliffe until
October 18th. The wards were not filled and
once again our duty was very light. The
weather was warm in the daytime and the
nights were beautifully cool.
Moving to the Mediterranean
Rumors about our departure ran rampant
but it was autumn before we received our
orders to move out. We heard the doctors and
men of our unit (those who had not been
retained at Shorncliffe) had sailed on a troop
ship for some unknown destination. Soon the
rest of us were off to Tilbury docks to board the
Kildonan Castle, an old passenger ship
converted to carry troops. They told us that we
were bound for the Mediterranean. It had been
five months since we left Canada and yet we
were still unaware of the location of our
hospital.
Life on the Kildonan was very different
from our Atlantic crossing. The four of us had
comfortable two-berth cabins and plenty of
deck for exercise, shuffleboard and games.
Still there was the constant threat that we
might hit a mine or a submerged iceberg. I
never felt that we could relax and "breathe
easy."
Finally, our ship left the Atlantic and
entered the Mediterranean Sea: now the
weather was warm and the sea calm. We
sailed from island to island taking troops and
cargo back and forth. We began to wonder if
we would ever see land, surely our hospital
UNION OF
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FRANCE ,-':^K«=L^;^^ -'
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7
The Canadian Nurse November 1977
was ready now!
We had thought we would disembark at
Malta but instead we left the Mediterranean
and via the Aegean Sea entered the
Dardanelles. At Suvia Bay, Gallipoli.Turkey,
orders were received to transfer the nurses to a
hospital ship where sick and wounded were
waiting. British sisters had been expected but
their arrival was delayed.
We found the patients very ill, suffering
from malaria, typhoid, malnutrition and black
water fever. There were very few surgical
cases.
This was our first contact with British
military orderlies at sea. They took over
completely, removed filthy uniforms, washed
the patients and put them into cots. Each
man's uniform was folded, tagged, tied and
placed outside on deck. The uniforms were
alive with vermin; I do not exaggerate, those
bundles, out in the sun on deck actually moved
as the vermin rose to the surface.
Directed by the orderlies we, as nurses,
took temperatures, and gave medication and
nourishment. I had appreciated the service of
the orderlies while I was in Boulogne but out
here, in the middle of the ocean and under very
difficult circumstances, one could not help but
admire their devotion to duty, their care and
consideration of these helpless patients.
Eventually all of the patients were
transferred to another hospital ship to return to
England.
Matron decided that the nurses who had
been ill (including herself) would remain
behind recuperating. The rest of us (thirty-five
nurses) stayed on board and went back to
SuvIa Bay to see if another trip was necessary.
The decks of the ship were scrubbed, and
chairs were placed outside for us: the return
journey was most enjoyable. The British
doctors and crew were very pleasant and most
entertaining.
The British sisters still had not arrived and
so the major asked for volunteers from among
us to go further up the coast to a place he
called Hill 60'. There were men on the hill who
had been exposed to enemy bombardment
and they had to be rescued. Eight of us
>*^
1/
ihe Canadian Nurse November 1977
volunteered. We arrived at the "rock" and cast
anchor in the darkness. The crew started
bringing the patients on board as we looked
down at the sick bay.
I had never seen such emaciated human
beings as those they carried aboard that night.
Even the men who were able to walk were just
skeletons. We learned these men had been
left on this hill to be picked up later but while
there, they had been subjected to German gas
shells and daily bombardment by enemy
ships. All of them were suffering from dysentry
and malnutrition. As they were brought on
board the orderlies took off their filthy ragged
uniforms, wrapped them in blankets and
placed them in hammocks. At first the major
refused to let us go down to the sick bay and
this caused considerable argument.
Eight determined women insisted they
were on active service to serve and serve they
would. Finally he allowed four of us to go down
for ten minutes, to be relieved by the other four.
This was how we passed the entire night. The
air in the sick bay was foul, one could hardly
breathe. Other than offering the men a
spoonful or two of warm liqu id there was really
little anyone could do for them. Those who
were able, looked up, smiled and said, "Thank
you, sister. " It was hard to fight the tears back.
Every few minutes the engines would
slow down. The patients knew what this
meant: another lifeless body, wrapped in a
blanket, was lowered to his watery grave. The
Union Jack covered the body but as it
descended into the water the flag was hauled
back, ready for the next time.
Later in the day we transferred our
patients to a hospital ship that was bound for
England and we went back to Suvia Bay. I
never found out how many of our patients died
or how many were able to continue their
journey — it was a very helpless feeling.
In the meantime the British sisters had
arrived at SuvIa Bay and so we changed to
another ship and sailed to Malta. From there
we moved on to Salonica (now Thessaloniki)
Greece, — our hospital site.
Building our own hospital
We were taken out to our camp the minute
we arrived at Salonica. Our doctors and all the
other men had arrived a few days earlier.
Before they had even a chance to unpack their
personal belongings a convoy of sick and
wounded from a Casualty Clearing Station up
north, had arrived. There were no hospital
tents ready, no cots unpacked and the doctors
had to tend to patients who were wrapped in
blankets lying on the ground.
The next day they received word that a
second convoy was to be expected. When we
arrived the doctors were hastily putting up
tents and unpacking cots, mattresses,
blankets and pillows. We quickly discarded our
coats and luggage and worked with them. As
each tent was pegged down, cots were placed
in them (20 to a tent as ordered by the
quartermaster). We made the beds and used
packing crates to serve as bedside tables. It
was really thrilling to be assisting in the
establishment of our own hospital. We worked
side-by-side with the doctors of our unit, many
of whom we knew by reputation as professors
and deans of medicine in various Canadian
universities.
Early in the morning of our second day , I
was working in one of the tents carrying a load
of bed linen. I heard a voice behind me
saying, "That bundle is about as big as you,
here, let me help." I turned and looked up to a
tall man who was smiling down at me. I
thanked him and we worked together all
morning.
Everyone was helping each other, no
a/^^^^ ^^i^
introduction was necessary and there was no
exchange of names. It was at lunch that I heard
one of the doctors call him by name and I
realized he was a very well known surgeon in
Toronto. He appeared each morning and I was
very thankful for his help. In this informal way a
friendship started and lasted all the time we
were overseas. My friend' as I have referred to
him in these memoirs remained a sincere and
loyal companion.
All of the staff was assigned wards and
living quarters. I was to work in a medical ward
which was directed by a Toronto doctor whom I
had known and greatly respected at home.
One or two medical students assisted the
doctors on the wards. I loved ward duty and
was content and happy.
We were very busy organizing and
settling the tents. Each ward was made up of
three 20-bed tents placed end-to-end. Beds
were pushed to the sides so that an aisle
formed down the center. The whole thing
looked like a 60-bed ward with 30 beds on
each side.
The main entrance was in the first tent
where we arranged some space for the
nurses' station. The beds in this tent were
reserved for very sick patients.
Coffee, sugar and extra cans of milk were
available if charge nurses wanted to make
morning coffee for the doctors and
themselves. I was glad to do this and found
that I really enjoyed the custom. After the first
few mornings the doctor on my ward asked if it
would be possible for me to make a larger
quantity of coffee, he would like to have three
of his friends join him. He said he would
provide the extra coffee. The next morning his
three friends arrived; the former Dean of
Medicine at the University of Toronto, the chief
of Obstetrics and Gynecology of the largest
hospital in Toronto (an attractive Scotsman
and a bachelor) and my friend'. They were a
congenial group and they really enjoyed being
together. I usually left the doctors alone after
serving their coffee; there was always
something to see to on the ward.
Conditions at Salonica
At first everyone thought our camp had an
ideal location. We were six miles from the town
of Salonica, on the Aegean Sea and there was
a good road nearby for getting supplies from
town. By the end of November we realized that
everything was not as rosy as we had thought.
The weather became cold, rainy, windy and
very wet. Walking was difficult because there
was so much mud. We decided that when the
permanent huts were built in the spring they
should be located on higher ground.
My tentmates and I, (the Odds and Ends)
almost hated to think of leaving our tent which
we had arranged so comfortably. Nurses lived
in large square Indian tents; there was ample
room for each of us to have a corner for our
cots, a dresser (two packing crates), a wash
stand, a stool and a trunk. Our quartermaster
and his staff went into town to get supplies
every day. We asked him to buy us several
bright Indian cotton bed spreads. We used one
The Canadian Nurse November 1377
spread each to cover our beds and hung the
rest of them on wires around the corners. This
gave us all some measure of privacy and the
total effect was really very pretty.
Our tents had no floors so, even although
rush mats had been provided, they were
soaking wet each morning. We hung the mats
up during the day but they never really had
time to dry out.
Water for drinking and washing was
rationed; a quart to each person daily. As
tenmates we decided to put some aside each
day for our evening cup-o'-tea'. The
quartermaster supplied us with a primus stove,
a small kettle and four mugs. It was truly a gala
occasion when one of us received some
cookies or fruitcake from home. The four of us
were very happy together and our evenings
never seemed to lag.
Christmas 1915
One week before Christmas we were told
the boat from Canada which was bringing our
personal gifts and decorations for the trees
and tables would not arrive on time. The rumor
was that the boat had been torpedoed.
Each ward was expected to make their
line look festive using only the material we had
on hand. Both patients and staff worked
feverishly and soon wonderfully wrought
paper chains appeared. They were made of
looped rings of red blotting paper, the blue
tissue from absorbent cotton rolls and white
shelf paper. The chains were strung from the
center of the roof of each tent to the four
corners. Large colored paper letters were
pasted on the walls wishing everyone a Merry
Christmas. The decorating caused a good
natured rivalry between wards. — Whose ward
would be the most attractive?
Traditionally the V.D. wards in all British
hospitals were manned by trained medical
orderlies, under the supervision of a doctor.
Nursing sisters were not usually assigned to
these wards but this was not so in our hospital.
One of our most respected senior nurses, my
tentmate the Johns Hopkins graduate, was put
in charge. We felt that this was an international
slight but with her good sense of humor this
woman just smiled. She always spoke well of
the poor lads who were so far from home and
so lonely. She knew they had yielded to one of
the evils of war but she didn't think anyone
should punish them by denying them good
nursing care. The men respected her and
appreciated her acts of kindness.
When she entered her ward on Christmas
morning the first thing she saw was a red
blanket hung on one side of the tent — "God
bless our Sister — fVlerry Christmas." The
letters were made of absorbent cotton and
pasted on the blanket. My friend was very
touched — it was a tribute to a great woman.
Just where our quartermaster found
enough fowl and vegetables to feed all of our
patients, employees and staff we never knew.
There was wine and beer for those who wished
it. Bedside tables placed end-to-end
provided dining tables for up-patients on the
wards. When we covered these tables with
white sheets and decorated them with boughs
of evergreen they became very attractive.
After dinner everyone able went to the
assembly tent for the Christmas concert. It was
a wonderful opportunity for some of the men to
display their talents in both verse and song.
After it was all over we couldn't help but
wonder if things could have been better even if
the ship from home had arrived.
Early Christmas morning we nurses
discovered cards covering the ground outside
our tents. The French flying officers often had
tea with us in our mess. They seemed to enjoy
the hospitality and were very amused at our
efforts to talk to them (not many of us spoke
French ). The cards were printed in English and
wished the Canadian nursing sisters a "Very
Happy Christmas". They also added that we
would never know to what extent the sight of
our willowy frames broke the monotony of their
ceaseless nightly vigil, as they patrolled the
sky over our camp.
Our officers were very amused and never
missed an opportunity to remind us of our
obligation to "break that monotony."
Night Duty
Our coffee hour was particularly merry on
the morning after the New Year's Eve
Masquerade. The doctors were joking among
themselves and the patients (and myself) were
really enjoying hearing about the "dress-up"
affair. I was just pouring the coffee and sharing
in the light-hearted conversation when Matron
walked in. Her disapproval was most evident.
I was called to her office later in the
morning and told that our practice of a "coffee
hour" was to be discontinued. I tried to explain
to her that my doctor had asked me to do this
and I felt that if she wished the practice
discontinued she should talk to him about it. I
was promptly assigned night duty, — much to
my doctor's annoyance and my friend's
amusement. The coffee hour was continued
by the nurse who relieved me.
I did not look upon night duty as a
hardship. During the cold winter weather, the
little oil stove kept the office cozy and warm.
The very sick patients usually slept quietly
close at hand and there were two orderlies to
help with rounds. It was actually very peaceful
compared with the hustle and bustle of day
shift. Night duty also allowed time for me to talk
to the patients, to listen to their news from
home and to do little extras for the bed
patients.
'My friend' asked me if I disliked night shift. I
had to confess that I was afraid of falling
asleep after returning from the 1 1 o'clock
supper break. I usually took some sewing,
plenty of notepaper and some light reading
with me but some nights it was very difficult to
keep from 'nodding.'
'My friend' said he would remedy this
situation. From that night on he arrived
promptly at 1 1 :30 each night with a book or
some trifle he had picked up tucked under his
arm. One night I picked up a paper backed
book I had found. "Why," he asked, "do you
waste your time reading such trash? I'll bring
you something more worthwhile." True to his
word he arrived the next night with a couple o*
little books; classics he liked and carried with
him. I must confess I never told him that he wa'^
only adding to my misery. The books would be
beyond my comprehension in the daytime. Ir
the middle of the night they proved to be a mos
potent sleeping drug.
Days and sick leave
My term of night duty ended and I returned
to my ward. The up-patients came to me
almost at once begging for some odd jobs.
Some of them thought that if they made
themselves indispensable around the hospital
their transfer back to the lines might be
postponed. Who could blame them for feeling
this way when we knew all of the hardships
they had endured and the circumstances
which they faced on the front?
Our medical officer was most considerate
and understanding but at the same time he
knew he had to discharge them when they
were physically fit. It was always hard to see
our recovered patients off.
Although there was little serious sickness
among the staff of our unit, nurses were
beginning to show the strain of the intensely
cold winter and the hardship of their
experiences. The medical officers suggested
some of us should be sent to Malta on sick
leave. I thought I had been very well except for
a bout of rheumatic fever and malaria that kept
me in the nurses' sick tent for a couple of
weeks. I was sent with the first group to a rest
home in Malta.
It was wonderful to be able to relax and be
cared for. It also gave me an opportunity to
think seriously about the future — my future.
We had been told that our unit would be
leaving Salonica early in 1917 and would be
re-established in England. I did not want what
we considered 'home service'. I wanted to go
to France on active duty. I also wanted to have
one trip to Canada on transport duty if
possible. I returned to Salonica with renewed
energy and a planned future.
Our Johns Hopki ns graduate and a young
Sick Children's graduate were not as fortunate
as I was. They had been very ill with typhoid
fever in September of 1 91 6 and it was decided
they should go home. They both survived the
trip, recovered and were on hand to greet us
when we returned to Canada.
My first assignment, when I returned to
Salonica from sick leave, was to the pantry in
the officers' and men's ward.
The general kitchen staff did not have
time to prepare any spiced foods or dietary
/
Ja^ac^i^^ ,^^^^i^^
niceties. The sick officers were given the same
general rations as the men on the other wards
and it was up to the nurse in the pantry to use
this 'plain' food and serve it more temptingly. It
was quite a challenge but I had always liked
puttering around the kitchen at home.
"Soup! Sister we haven't had any for weeks,
where did you get it? " (a few oxo cubes
dissolved in the vegetable juice, the
vegetables, a wee bit of curry and butter. I
thickened it a little and served it hot with
croutons).
"Say sister, that meat roll was wonderful
how did you manage it?" (the meat ration,
chopped fine, a beaten egg, a little onion,
seasoned and rolled in the rationed mashed
potato, served hot).
Most of the nurses hated this job and we
were not kept in the kitchen for very long but I
really enjoyed it. I left determined to prepare
little extras for the sick on my own ward.
It was my turn for night shift again. The
weather was getting very warm and I was glad
to be able to sit outside late at night feeling the
cool airfrom the sea. I wish I could describe the
beauty of the moonlight shining on the
snowcapped peak of Mount Olympus, the sky
ablaze with stars.
I was still on night duty when we moved
into our "permanent" huts in the spring.
Although as many patients as possible had
been sent to other hospitals in the district the
move caused qu ite an upheaval. All of the staff
packed their personal belongings (which
seemed to have increased tremendously
since we had arrived) and ine quartermaster
and his staff transported everything to
designated huts. Miss Ferguson and I were
assigned a two-bedroom hut, our o.,,cir two
tentmates were next door. Although we
missed the homey atmosphere of our tent it
was nice to have a proper floor under our feet
and a window to open and shut. The bath
house, which served all the nurses in the
compound, had cold water (no hot), bathtubs,
showers and toilets with septic tanks.
The new huts made our work on the wards
so much easier. We still had 60 patients In
each ward but now they were all in one building
with 'built-in' washrooms.
We stayed in Salonica until early in July
1917. Then our unit returned to England and
was established at Basingstoke, Hampshire
County.
Back to England, 1917
In many respects I was sorry I had
decided to leave my unit. But I knew life in
England would be very different and I was sure
that wasn't what I wanted right away. Four
other nurses had applied for transport duty and
I decided to send in my application too. Our
orders came through in July and we left
Salonica on the Saxonia, a hospital ship,
bound for a southerly port in Italy. There we
boarded a train for Calais.
When we arrived in London we went
directly to headquarters to report to Miss
Macdonald and to find out when we would
leave for Canada. She could tell us only that
there was a long waiting list for transport duty
and we might have to wait until October. In the
meantime she sent us to nearby hospitals. I
went to Taplow in Buckinghamshire to the No.
3 Canadian Hospital based on Lord Astor's
estate Cliveden. Life there was very different
The Canadian Nurse November 1977
as compared to active service in the
Mediterranean. The nurses uniforms looked
almost new, their bibs and aprons were
starched and pleated, even their veils looked
different. I felt very shabby in my faded blue
and greyish apron. The atmosphere at
tea-time was very social': conversation was
gay and bright with the latest hit song and
movie in London being the major topic of
discussion.
By this time my unit had arrived at
Basingstoke and 'my friend' contacted me at
once. We were both about an hour and a half
from London and so we decided to meet there
on my free afternoon. In London I ordered
some new uniforms and aprons and then we
went to a cafe for tea. We had dinner together
later. My train left around nine so I was back in
plenty of time for curfew.
I told my friend' that I was stationed at
Taplow until transportation was available and
it might be October before I left for Canada. We
planned to meet each week on my afternoon
off.
An audience with the King
Everymonth, weather permitting, a group
of patients from Taplow were taken
sightseeing. A doctor and nurse accompanied
them. Most of the staff hated these exercises
but the patients loved them. I was detailed to
visit Windsor Castle. The medical officer
accompanying me looked bored to death right
from the start.
Upon our arrival at the castle we noticed
the Royal Standard was flying. We were
informed Their Majesties were in residence
and would receive us. The medical officer
certainly came to life quickly. He inspected
each man; ties were straightened, caps
adjusted. I found a pair of white gloves and we
proceeded to the state room. King George V
and Queen Mary received us. They were most
gracious, inquiring about Cliveden and our
work there. They shook hands with all of the
men and asked them about their service. Tea
was served downstairs after the reception.
Princes, Edward, Albert, Henry and Frederick
there. The Princess served us with a smile
while she made polite conversation. The
Princes, Edward, Albert, Henry and Frederick
stood grouped together in a corner looking
bored to death — they must have done this so
many times before.
Finally my orders for transport duty came
through. There was a permanent staff in the
sick bay on the boat so, as temporary staff, I
just assisted. Some of the patients were very ill
and would probably be bedridden for the rest
of their lives. Others were jubilant — they were
going home, at last. My duties were light and
the voyage was uneventful.
I wired home from Halifax just as soon as
we docked. I was allowed only seventeen days
shore leave and I could hardly wait to get
home. It was wonderful to be with my family
and friends again. They certainly spoiled me
(and I certainly enjoyed being spoiled). Time
passed all too quickly.
Special duty
I returned to Taplow and was there for
Christmas. Eary one January morning I
received word to report to Miss Macdonald's
office in London immediately. Naturally I was
worried, what in the world had occasioned
such an abrupt summons? My alarm was
unfounded. Miss Macdonald called me only to
put me on night duty with a repreentative from
the Canadian government who was ill in a
London hotel.
I found my patient irritable and
demanding. He was "suffering' from a mild
attack of influenza. He was critical of
everything; the food, the hotel service, his
medical doctor, but most of all, the weather. In
my heart I found it very difficult to be
sympathetic with him, especially when I
compared his comfortable suite with the
terrible conditions under which the troops lived
and the great hardships that they faced every
day.
In spite of this I could not blame my patient
when he dreaded nightfall. As soon as it was
dark, the bombing started. The hotel was
located in the center of the city, near the
building the enemy was trying to demolish. My
patient asked me to stand by his bed. I did but I
couldn't help but wonder what he thought I
could do if the hotel was hit. I disliked the whole
ordeal as much as my patient did and was very
relieved when the doctor said that he was well
enough to go home.
Matron said I was due for leave. First I left
to visit relatives in Hessel, then I returned to
London to visit with my friend.'
I stayed in a real Victorian guest home
while I was in London. A maid brought me tea
in the morning, lit the small grate and then
reappeared later with a brass jug of hot water.
"My friend' arrived from Basingstoke each
day on the noon train. We would have lunch,
tea and dinner together before he returned to
his station at night. Something made us realize
that this was the end of a happy relationship
which we had both enjoyed. We had spent
some pleasant afternoons together over the
last few months — these days were really our
farewell reunions. I was going to France anc
would probably be there until the end of the
war, he would stay with the unit at
Basingstoke.
I have hesitated introducing this personal
situation into these memoirs since it does not
relate specifically to my nursing service but i
feel I owe so much to this man's friendship and
guidance that I could not help but include him
Without his advice and counsel I may
not have been able to undertake some of the
unusual responsibilities placed on me during
those war years.
18^j^|,i
t \f4iiMnjiaii nui»v rw.fwv
Armistice and home
The routine followed at the hospital I was
sent to in France was similar to that carried oui
at all British military hospitals. The orderlies
gave most of the bedside care, the sisters
spent most of their time with the patients.
Oddly enough, it was difficult to make our
patients understand the war was over once
Armistice was declared. Each of them reacted
individually. Some were overjoyed at the
thought of home and reunion with their
families. Some were afraid they would not
survive the long journey, hoping and praying
transportation would be available soon before
their condition got worse. But others, and
these were the most pathetic, realized it was
too late ... they would never be able to leave.
I was sitting with a patient one night. Both
of us knew his time had come, he would not
live through the night. I thought he had slipped
into a coma but he murmured to me, "Sister,
would you give me my wife's picture, it's in my
haversack. " I put the picture in his hand, he lay
quietly for a while and then slipped away. I
wrote to his wife later that day and told her he
had died peacefully and of his request to have
her picture. Things like that happened so often
through those years and yet they never failed
to leave me feeling sad and empty.
Christmas was not very festive that year.
Most of our patients resented the long delay in
transportation home: the evacuation
proceeded very slowly. I was to return to
England on January 25th, 1919. 1 was glad that
I had been in Boulogne during those last
months. A close relationship developed
between patients and staff — the sort of
relationship we associate with a patient and
his family doctor in Canada, an understanding
and respect for each other. I had never
experienced a feeling like this before.
I returned to London and stayed in an
officers' convalescent home until I was notified
transportation home was available. For some
reason I did not let my friend' know that I had
returned from Boulogne. When I arrived at the
docks I learned that my unit had sailed without
me for Canada the day before.
When I arrived in Halifax I bought a
morning paper and boarded the train for
Toronto. On the front page there was a picture
of my friend , a prominent Toronto surgeon
who had died suddenly at sea. Respected and
honored at home and on active service, he
was a great scholar and a gentleman. I could
not help but mourn his death.
The long train trip from Halifax to Toronto
gave me an opportunity to think about and plan
for the future. I would not be officially
discharged until May ... where would I go then?
What would I do?
,J,^^ *'
The Canadian Nurse November 1977
Body.
. . ^ image
^■'^ the crisis
of enterostomy
Every one of us grows up with a body image — a unique way of
picturing our physical selves. What happens when this image
is suddenly disturbed by a radical change in our bodies?
Enterostomy surgery often poses a serious threat to an
individual's body image and self-concept. The following
article shows us how two patients reacted to. the crisis of
enterostomy.
Sandra Lindensmith
Each person has a mental picture of his
physical self — he may think of himself as tall
or short, fat or thin, beautiful or homely, or
somewhere in-between. He has spent years
learning to live with his body image. The
picture he has of himself affects how he feels
about himself as a person, and consequently
how he interacts with others.
Adjustment to any change that causes an
individual to perceive himself in a different way
may be difficult to make. Think of a friend who
has lost a great deal of weight in a short period
of time. You may notice that he is thrown
completely off guard when others do not
respond to him in the accustomed way, but
instead comment on how great he looks.
Inside, he may still feel like a "fat" person; he
may even respond to unfamiliar compliments
in a negative way.
As nurses, we come into contact with
those who undergo more radical physical
changes; illness itself alters a person's body
image. But when a person has an amputation,
enterostomy, or mastectomy, the sudden
change may be more than he can cope with,
because his perception of himself as a whole
person is altered. Not "himself" any longer, he
may feel threatened in his interactions with
those who have been very close to him. It is
important for us to recognize that these types
of surgery can pose integration problems for
the individual, problems as serious as any
other complications of surgery.
Body image has been defined as "the
constantly changing total of conscious and
unconscious information, feelings and
perceptions about one's body in space as
different and apart from all others. It is a social
creation developed through the reflected
perceptions about the surface's of one's body
... The body image is basic to identity ... "'
A dynamic concept
As a dynamic concept, body image is
subject to change in response to the aging
process itself. For most healthy adults, the
body image boundary ends at the body wall.^
At birth, the infant has no notion of his
body as separate from the rest of the world.
The infant's discovery of his body through
sensory experiences and sensations marks
the beginning of the growth process. His body
image becomes part of his identity.
Freud's psychoanalytic theory notes
three stages of early development: oral, anal,
and genital. According to this theory, a child
must master each of these stages as he grows
up in order to develop a mature body image. If
he cannot integrate the function of each of
these areas into his total body picture, his body
image will retain some immature aspects.
In relation to this article, mastery of the
anal stage and accompanying mastery of the
body and environment and their control can be
a factor in acceptance and emotional and
physical mastery of an enterostomy.
Body image does not develop in a
vacuum; it develops in response to the
attitudes and emotional overtones that each
individual experiences within a family or peer
group. Other individuals have a strong
influence because of their evaluations of an
individual's body. Acceptance of an
enterostomy may th us become very difficult for
an individual who has been raised with the
idea that bowel function is "dirty" and therefore
a taboo subject.
A disturbance in body image can occur
when a discrepancy develops between the
way an individual has always pictured his body
and the way he currently perceives it. This kind
of conflict can produce anxiety and fears of
being rejected, feelings of being "less than
The Canadian NurM November 1977
25
whole. " Body image disturbances commonly
occur with enterostomies, mastectomies,
amputations, and pregnancy and can occur
with any form of physical or emotional illness.
Enterostomies require both the removal of an
organ and removal of a form of bodily control;
as such they can represent a two-fisted
assault on the individual's body image.
Catherine M. Norris states that
"Adaptation to alteration in body size, function
or structure... depends upon the nature of the
threat, its meaning to the individual, his coping
ability, the response from others significant to
him, and the help available to him in
undergoing change and to his family."^ It is
important to keep in mind not only than an
individual's image of his body influences his
interactions with others but also that the
responses of those he loves influence his
ability to cope with a new body image.
For many middle-aged adults of today,
the feelings of masculinity and femininity are
strong. During their younger days, these two
concepts and their differences were
emphasized. Little girls looked like little ladies,
were quiet, and refrained from wearing pants
or playing rough games. Little boys were
rewarded for "toughness," not crying, for
being physically active, and for strength. The
concepts of masculinity and feminity are
integral components of the larger concept of
body image.
So far we have looked at theories of body
image. Now let's look at two patients of the
same age with colostomies and at how the
colostomy affected their feelings of
masculinity and femininity. In discussing these
two patients, Mrs. S. and Mr. C, three
categories of the nursing process will be used :
assessment (including data collection),
intervention, and evaluation.
Mrs.S.
Assessment
Mrs. S. was a 53-year-old Caucasian woman
who was treated for carcinoma of the colon
with a transverse colostomy. Her
postoperative recovery from surgery, except
for an immediate period of nausea and
vomiting, was described as uneventful.
Her physical status following surgery was
good: although she described herself as
'^fveak " and appeared to tire easily, her
appetite was slowly beginning to improve.
Except for her colostomy care (she refused, a
week after surgery, to look at her colostomy),
Mrs. S. attended to her own needs.
It was clear from Mrs. S.'s admission
onwards that she was a woman who was very
concerned with her appearance. On the day of
her admission she had just come from the
hairdresser, explaining, 'I knew it would be a
while before I had a chance to go again, and
well, you know, it makes me feel like a lady."
As soon as she had bounced back from the
immediate effects of her surgery, she asked to
see herself in a mirror, and was always
concerned with being well-groomed and
attractive.
Every day, before her husband's visit, she
would "freshen up, " and it was only a few days
post-op that she asked to exchange the
graceless hospital gown for a fresh nightgown
of her own. Her behavior in this regard was not
excessive; but it was readily apparent that
being lady-like was important to her.
Mrs. S. was a pleasant and friendly
woman, somewhat nervous, and very
concerned about being "a nuisance. " She was
also a very busy woman and kept herself going
with knitting and crocheting as soon after the
operation as she could.
There was evidence from the beginning
though, that the presence of the colostomy
disturbed her deeply. After her surgery, she
requested that the curtain between her
roommate and herself remain completely
closed, in spite of the fact that friendly
conversation from both sides of the curtain
was constant. Mrs. S. stayed out of sight of her
roommate for some time; she took her
exercise by walking around her bed many
times a day, refusing to venture from behind
the curtain, much less out into the corridor.
Dressing changes left her visibly shaken.
She refused to look at her colostomy, staring
up at the ceiling or out the window with tears in
her eyes, and remaining unusually silent. She
wouldsayafterthedressing was completed, "I
know I'm being silly, but I can't look at it, not
yet."
At the same time, she seemed to
recognize her own need to come to grips with
her situation, to realize that her limitations
were of a temporary nature, to know that she
only needed time. "Right now I'm being a
batjy, but you'll see — one of these days it
wont seem so bad to me and I'll be looking
after it myself, not bothering you."
During the first week, her visits with her
husband were controlled, and they talked for
the most part about what was happening at
home, or outside. This was something she
also seemed to understand, "It's hard for me to
talk about it, with anybody, and that means
Bob, too, right now. But I'll get there."
Intervention
My main concern for Mrs. S. was to show her
positive support, gentle encouragement, and
to let her know that I understood her need for
time. Just talking with her and showing
concern for her welfare seemed to help.
Initially she would only refer to her colostomy
obliquely, expressing instead concems about
her general welfare, her roommate s health, or
how her husband was managing at home. She
seemed satisfied that her prognosis, after
surgery, was good.
Mrs. S.'s colostomy however, became
something that was difficult for her to ignore,
because of the number of changes necessary
to keep her clean and dry. So much of my
intervention revolved around its physical care.
I tried to let her know that caring for her was not
'a nuisance" to me, that my interest in her as a
person involved all aspects of her care, and
not just the "messes" as she referred to them.
Because her colostomy care took a great deal
of time and a little ingenuity, it was not too long
before her curiosity got the best of her.
She took her steps slowly — initially, just
by looking at the colostomy after I had cleaned
her up one day. Her colostomy was large and
edematous at first, but she said "not as bad as
I had thought. " When I brought her lunch tray
that same day, Mrs. S. had opened the curtain
that sealed her off from her roommate and the
rest of the world.
A few days later, Mrs. S. was making
direct references to the stoma and began,
tentatively at first, to ask question about it and
to take part in changing her appliance. Up until
this time, she had left all care of the stoma to
me, but once she began to participate, she
learned very quickly to assess and solve any
problems she had. She learned about her
colostomy and its functions, and began to
develop the technical skills needed to take
care of the stoma.
It took a week for her to brave the halls of
the hospital; she would not try until she felt
secure that she didn't "smell " and wouldn't
leak. Soon after that she had a daily visiting
pattern worked out with other patients.
She also began to tell her husband all
about the stoma, and how she looked after it,
and the relaxed look on his face assured me
that the controlled conversations behind the
curtain had come to an end.
Evaluation
By the time of her discharge, Mrs. S. had
made many friends on the hospital ward.
Her interest in everything that went on
around her assured me that she was well over
the initial shock of having a colostomy. Her
face was less guarded; she expressed great
satisfaction and determination in being able to
take care of herself; she initiated conversation
about particular problems that she had in
caring for stoma, the "thing " that she had
formerly refused to acknowledge or even look
at.
I felt that with Mrs. S., adjustment to a new
body image was facilitated by her love of life
and of people. Mr. S. was warmly supportive of
his wife; he expressed his love for her openly;
and it was evident from the way that he
interacted with her that she would always be
his beautiful wife, colostomy or not. Although
he was distressed at her initial behavior, he
was also very patient, and seemed confident
that she would eventually be able to cope with
her colostomy, and see her situation in
perspective.
The Canadian Nurse November 1977
I feel that Mrs. S. was as honest in her
adjustment as she was in her initial feelings of
repugnance and consequent withdrawal.
Immediately post-op, she was in obvious
emotional distress, but given time, she could
handle the change in her body image.
Because of her interest in life, she could see
the colostomy as a challenge rather than as an
assault on her integrity as a person.
Mr.C.
Assessment
Mr. C. is a 53-year-old Caucasian male. On
September 28, 1 976 he was in a motor vehicle
accident and as a result sustained multiple
injuries — lacerated mesentery with bowel and
terminal ileum infarction, separation of
mesentery and ileum, active bleeding and
pulmonary contusions. His treatment involved
the surgical creation of a temporary loop
colostomy; his sigmoid colon was brought up
to the surface of the lower left abdominal
quadrant.
When I met Mr. C, his physical status was
fair to good. He had regained his bodily
functions — urinary, digestive and bowel —
following a normal postoperative course. His
stoma was very red and edematous (three
inch diameter, raised approximately three
inches from his abdominal surface). An upper
Gl series had recently indicated the presence
of a diaphragmatic tear and hiatus hernia;
consequently a surgical repair was planned.
His emotional status regarding the
colostomy was far from satisfactory. I felt that
this was largely due to the fact that he had no
preparation whatsoever before his surgery.
After his accident he had awakened from
anesthesia in a strange hospital with no family
members nearby and with a large and
unpleasant looking stoma. The situation was a
complete shock to him.
Mr. C. was uncomfortable with the
colostomy, unaware of its function or purpose,
and reluctant to assume responsibility for its
care. He used the words "it" or "thing" to refer
to the stoma, and although efforts were made
to make him aware of the proper term, he
refused to refer to the stoma correctly. He
appeared very upset at the thought that he was
"not a man anymore" and repeated over and
over "my wife will never see it."
The very thought of his colostomy
threatened the way Mr.C. saw himself; he
seemed to think of nothing else. He expressed
considerable concern about the fact that his
bowel function had become so visible. The
colostomy seemed to touch his whole life. He
worried about odor, expellation of flatus,
leakage, the sight of the stoma, and his activity
level. He was also concerned about his job,
which entailed some manual labor and lifting.
It was as if Mr. C. felt that he was no longer
himself; his masculinity was threatened.
Consequently, he wanted as few people as
possible to see the stoma (this included his
wife), and wanted no one outside of the
hospital staff to know about his operation,
especially his co-workers. It was so important
to him to be "one of the guys"; in his frame of
mind, to return to work with a colostomy was
impossible.
Mr. C. was adamant in his refusal to let his
wife share the crisis with him and help him
through it. From the very beginning, he told me
that he would never consider the idea of
having sexual relations with his wife or
returning to work until "it" was gone. He said
that any physical closeness with his wife would
only make matters worse.
Intervention
I spent most of my time with Mr. C. in
conversation, trying to help him accept the fact
that he had a colostomy. I taught him about the
way in which a colostomy functions and why
he had had the surgery, reinforcing the
teaching he had already had about appliance
changes. I also explained the properties of his
appliance — that it was an odor controlling and
"It just does." He also remained very closed
with his wife and children.
Mr. C. opened up a little during a
conversation we had about the future closure
of his colostomy. This discussion and a
conversation we had following closure of his
colostomy helped to explain some of Mr. C s
feelings.
Evaluation
On the second day that I cared for Mr. C,
he changed his own appliance. This seemed
to me to be a positive step. When I asked
him some basic questions about the
functions of his colostomy, he was able to
answer well. At least Mr. C. had a beginning
knowledge about his colostomy. He appeared
a little more relaxed as we talked about odor
and leakage. As I watched him attach the
appliance, he pressed all the air out of it to
allow for any flatus.
However, from our talks about closure
and following closure, it was apparent to me
that he had never accepted the colostomy. He
consistently refused to refer to his stoma as
anything but "it." When I saw him after the
practically leak-proof bag. We talked about the
correct technique for attaching the appliance,
so that flatus could be expelled with little
notice. We also discussed the practical
limitations on his activities that the colostomy
meant — I explained that in many areas he
didn't need to limit himself.
I tried to initiate open and honest
discussion with Mr. C. For the most part he
remained reticent and would not discuss his
feelings or fears. He viewed himself as an
"invalid" and a "baby" but did not want to
discuss the matter further because he said it
made him uncomfortable "just thinking about
it." When I asked him why, his only reply was
stoma was closed, the first thing he said to me
was "It's gone. I'm me again." There was relief
and happiness written all over him. He also
told me about his situation at home while he
had been waiting for closure.
Mr. C. had refused to show his family the
stoma, nor did he ever discuss it with them.
He slept in a separate bed, by himself,
downstairs, wholly removed from the
bedrooms of other family members. This was
necessitated in part by the breathing
difficulties that he encountered when climbing
stairs after his diaphragmatic tear repair. He
told me however, that he would have slept
downstairs on the sofa anyway. He said that
The Canadian Nurse November 1977
he refused to consider sleeping with his wife as
long as he had a colostomy.
Mr C. had not returned to work; the only
social contacts he made were with people he
met while he was taking walks. He and his wife
had no visitors and visited no one during the
time he was at home waiting for closure
surgery.
Mr. C.'s feelings about his colostomy had
upset his entire lifestyle. Because he knew it
was temporary, he felt that he did not have to
try to make any permanent adjustments. He
tried to ignore his colostomy completely. By
not sharing the situation with his family, he
could pretend that it didn't exist. Had the
colostomy been permanent, I feel that Mr. C's
period of adjustment would have been a long
and rocky one.
Healthy emotional recovery
An article by Dericks and Donovan"
identifies four developmental stages that the
ostomy patient must work through before
optimum rehabilitation can be reached. These
stages are narration, visualization and
verbalization, participation, and exploration.
Mrs. S. eventually worked through all
these stages and was well on the road to
healthy emotional recovery. Mr. C. was still
unable to refer to the stoma by its correct
name, one indication that he had not yet
learned to integrate the stoma into his body
image. Both were able to participate in their
own care, Mrs. S.more enthusiastically.
By the time Mrs. S. left the hospital, she
had already begun to master the exploration
stage, through her visiting rounds on the
hospital ward, and by having an extended
number of visitors while she was in hospital.
Mr. C. on the other hand was fearful and
hesitant about resuming normal social
functions: in fact, he refused to do so. His
refusal to visit anyone or return to work while
his colostomy was still in place indicated his
inability to reintegrate his body image; and his
self-concept suffered.
The awareness of a body image is one that
begins to develop in infancy and grows
throughout the lifetime of every individual. Our
feelings about our own bodies affect
our lives.
As nurses, we are often faced with the
individual whose body image has been
disturbed. In order to help, we must know first
of all how this person feels about himself and
how he has seen himself in the past. Dealing
with anyone who undergoes a traumatic shock
to his body image requires nursing care aimed
not only at the physical cause of the
disturbance but also at the emotional center of
the problem. ^
References
1 Norris. Catherine M. The professional nurse
and body Image. In Behavioral concepts and
nursing intervention, edited by Carolyn E. Carlson.
Toronto, LIppincott, 1970. p. 42.
2 McClosky. Joanne Comi. How to make the
most of body Image theory in nursing practice.
Nursing 76 6:5:68-72. tVlay 1976.
3 Norris, op. cit.
4 Dericks, Virginia C. The ostomy patient really
needs you by ... and Constance T. Donovan Nursing
76 6:9:30-33, Sep. 1976.
Bibliography
1 Carey, Phyllis. Temporary sexual dysfunction
in reversible health limitations. Nurs. Clin. North Am.
10:3:575-586, Sep. 1975.
2 Carter, Frances Monet. Psychosocial
Nursing: theory and practice in hospital and
community mental health 2d ed. New York,
Macmillan, 1976.
3 Dericks, Virginia C. The ostomy patient really
needs you, by... and Constance T Donovan.
Nursing '76, 6:9:30-33, Sep. 1976.
4 Jackson, Bettie S. Colostomates reactions to
hospitalization and colostomy surgery. Nurs. Clin.
North Am. 11:3:417-425. Sep. 1976
5 MacRae, Isabel. Sexuality and irreversible
health limitations, by... and Gloria Henderson. Nurs.
Clin. North Am. 10:3:587-597. Sep. 1975.
6 McCloskey. Joanne Comi. How to make the
most of body image theory in nursing practice.
Nursing 76, 6:5:68-72, May 1976.
7 Norris. Catherine M. The professional nurse
and body image. In Behavorial Concepts and
Nursing Intervention. Coordinated by Carolyn E.
Carlson. Toronto, LIppincott, 1970.
8 Watt. Rosemary C. Ostomies: why, how and
where: an overview. Nurs. Clin North Am.
11:3:393-404, Sep. 1976.
9 Woods, Nancy Fugate, Human sexuality in
health and illness. St. Louis: Mosby, 1975.
Sandra LIndensmith is currently a fourth
year nursing student at Queen's University in
Kingston, Ontario. She wrote "Body Image
and the Crisis of Enterostomy" as a term
paper during her third year surgical
experience. Upon graduation, Sandy hopes
to work in Kingston in the area of maternal
child nursing.
28
The Canadian Nurse November 1977
Almost every nurse who has worked with ostomy patients has met the
patient whose temporary colostomy became permanent, or the patient
who became a recluse during the time he had a temporary colostomy.
She may also have encountered the individual who refused to care for
the colostomy at all — because it was only temporary, or who developed
serious changes in behavior that continued even after colostomy
closure. All of these situations should prompt us to pause and take a
closer look at the person with a temporary colostomy. In the world of
ostomy patient care, this person may have become the lost soul with
limited access to the resources available to those with permanent
colostomies.
W:
People
with temporary
colostomies
"O
0)
Q)
O)-^
Robin Young Wood
Pamela Gaherin Watson
As we look at the way in which we meet the
needs of the individual with a temporary
colostomy, we should ask ourselves an
important question — "Is the approach we use
with the temporary colostomate subtlely
contradictory to the philosophy of
rehabilitiation that we offer to those with
permanent colostomies?"
The approach of the nurse, the surgeon
and other caretakers towards those with
temporary colostomies most often focuses on
the transient nature of the colostomy
experience, with an optimistic emphasis on a
return to normal life following colostomy
closure. What does this approach convey to
the person with a temporary colostomy?
It may convey strongly negative feelings
about the stoma, suggesting to the patient that
the colostomy is only acceptable because it
represents a time-limited experience. This
attitude may in fact create problems for
patients with temporary colostomies. For
example, it may increase the patient's anxiety
about stoma closure. If the situation arises that
the colostomy cannot be closed, it may leave
the patient with the feeling that he cannot
cope. Either situation may result in the
patient's depression, isolation, and
withdrawal.
Looking more closely, it is easy to see that
the rehabilitation needs of the patient with a
temporary colostomy are as complex as those
of the person with a pemnanent colostomy. In
both cases, the procedure is life-saving. We
still need to recognize the assault on the
individual's intact body image brought on by
the presence of the stoma. Our emphasis
ought to be on helping the person and his
family to live full lives.
It is not uncommon to hear a patient state
that he plans to remain at home — away from
people — as long as the stoma is present. This
isolation may include withdrawal from family
relationships and sexual activities. Such
interruptions of normal patterns of living are
obviously not in the best interests of the
individual. Irreparable changes may occur
unnecessarily in the patient's life, in
relationships that are meaningful and
important to him.
John H. provides us with an example of
how normal life can be interrupted unless a
positive adaptive response is made to a
temporary colostomy. John was a
twenty-two-year old man who was
hospitalized for intestinal obstruction following j
colostomy closure. He refused to talk about hi!
experience with the colostomy. He stated thatJ
he wanted to forget that he'd ever had it. He
also indicated that he had become alienated
from his family and friends while he had the
temporary colostomy, and that he was now
having great difficulty reestablishing these
relationships.
Situations like this can be avoided by our ■,
careful attention to the rehabilitation plans we i
develop and to the unspoken messages thati
we convey. The plans we develop ought to
include attention to the patient's stoma
management and activities of daily living.
Stoma management
Learning the skills necessary to manage the
stoma is an important component of the
rehabilitation process. The irregular
configuration of the loop colostomy stoma and i
the presence of the mucous fistula, or distal
non-functioning colon in a double-barrelled
colostomy, make stoma management
somewhat different from the management of a •
permanent colostomy.
A special gasket appliance with a plastic
Types of Temporary Colostomies
The types of temporary colostomies usually created tall into three
major categories as shown in Figure 1 . Loop colostomies and
double-barrelled colostomies are most common. The loop
colostomy is often performed in emergency situations as it is a
relatively simple surgical procedure.
The distal, non-functioning end of the double-barrelled
colostomy is often referred to as a mucous fistula. This term is
applicable whether the stoma is adjacent to the proximal stoma or
placed elsewhere on the abdomen. A temporary colostomy can be
performed in the right, transverse or left colon.
The Hartmann pouch is used infrequently as the resting
segment buried in the intrabdominal cavity often adheres to other
pelvic organs, and at closure it is difficult to extract and mobilize.
Pathophysiology
Most temporary colostomies are created to divert the fecal stream
because of diverticular disease, carcinoma of the colon or trauma.
Diverticular Disease
Diverticular disease can lead to obstruction or perforation
requiring surgical intervention. Surgery is often performed in three
stages:
• A loop colostomy is instituted as an emergency procedure to
relieve obstruction above the affected colon segment.
• When the patient's acute condition has subsided, usually within
seven to ten days, the diseased portion of colon is surgically
removed.
• The temporary colostomy is closed after allowing about three
months for the distal colon to rest and heal.
Carcinoma of ttie Colon
Carcinoma of the colon may not be detected or diagnosed until
the patient demonstrates symptoms of intestinal obstruction. Often,
when the disease has progressed this far, the cancer is not
resectable. A temporary colostomy will be performed proximal to the
tumor and radiation may be initiated to shrink the tumor mass.
Although the tumor may respond initially to radiation, the disease
process is often advanced and a deteriorating course of illness can
be expected. Local recurrence and metastasis is likely. Chronic
disease leading to deteriorating health may preclude colostomy
closure at a later stage. In these situations, the colostomy is
palliative — not temporary.
Trauma
Trauma from gunshot or stab wounds to the abdomen or
perineum usually necessitates emergency surgery. The colon may
also be traumatized without penetration through automobile
accidents, falls, or assault with blunt instruments. Most temporary
colostomies caused by trauma can be closed in three to four months.
but complications may prolong the time until closure, or. make
closure impossible.
Temporary colostomies may be performed for many other types
of bowel pathology, but the incidence of these is relatively rare. They
include rectovaginal fistula, ischemic colitis, sigmoid volvulus,
endometriosis of the colon, congenital anomalies (e.g.
Hirschprung's disease), post-irradiation stenosis.
Factors Influencing Closure
The time lapse between colostomy construction and closure varies
widely with individuals. Considerations are given to cause of
colostomy, the age of the patient, his general state of health, and
complications. The lapse may be from zero to fifty weeks, but
generally closure is performed within eight to twelve weeks.' A
substantial number of patients who think their colostomies are
temporary find that ckjsure is not possible. This fact constitutes a
real though often u nspoken fear for all persons who have temporary
colostomies — the fear of having to live with the colostomy forever.
Complications of Surgery
Complications of surgery which interfere with patient well-being may
develop prior to closure. Wound infection, peristomal or
intrabdominal abscesses, fistula formation, and peritonitis are
common. In addition, these patients are not exempt from the general
post-operative complications of atelectasis, hypostatic pneumonia,
thromtius and embolus formation and hypovolemic or endotoxic
shock.
Even after closure, the person is not always healed.
Complications occur in as many as 25-44% of patients post closure.
Colocutaneous fistula, incisional hernia and wound sepsis are the
most common post-closure complications. '■^■^••' Other post-closure
complications include wound sinuses, obstruction at anastomosis
site, peritonitis, and death. These complications are rare. However,
the view that colostomy closure is a minor surgical procedure without
substantial risk to the patient is fallacious. Patients' fears regarding
the operation are well-founded and should be recognized.
The Age Factor
Age is an important consideration for the physical and psychosocial
rehabilitation of persons with temporary colostomies. While a
colostomy may be necessary at any age, the person u ndergoing this
surgery is most often over sixty. Acute diverticular disease and
cancer of the colon are largely diseases of a geriatric population.
These people may already b>e at a greater risk for det)ilitating
disease prior to the assault on their gastrointestinal systems.
Further, they are certainly more prone to developing complications
after both the initial surgery and the surgery for closure. Trauma is
more common in young adults but is not reserved for any
age-specific population and may be superimposed on the aged and
infirm as well as on younger, more resilient persons.
Figure 1
w
o
E
o
_o
o
u
>«
(0
o
a
E
0)
I-
0)
a
Loop Colostomy
A loop of colon proximal to the
diseased portion is brought out to
the abdomen and supported there
with a plastic bridge or rod. The
exposed colon is then cauterized to
create an opening. The bridge or
loop is usually removed after several
days.
Double-barrelled colostomy
The colon is surgically divided. The
proximal or functioning segment and
distal or resting segment mature as
two separate and adjacent stomas
on the abdomen.
End Colostomy
with Mucous Fistula
This is the same as a
double-barrelled colostomy except
the distal (resting) stoma is matured
away from the proximal (functioning)
stoma. The disteil stoma is termed
the mucous fistula.
End Colostomy
and Hartmann Pouch
The colon is divided in surgery and
the proximal (functioning) stoma is
matured on the atxjomen. The distal
(resting) colon is sutured closed and
returned to the intrabdominal space.
No distal stoma is present on the
atxiomen.
The Canadian Nurse November 1977
bridge and karaya seal is available for use
the loop colostomy. The plastic bridge or glass
rod is removed before the patient is
discharged from the hospital. The Loop
Ostomy Gasket with Karaya Seal* may
continue to be used after discharge, or an
open-ended disposable appliance with an
adhesive backing large enough to
accommodate the stoma may be selected.
Most double-barrelled colostomies are
constructed so that the distal non-functioning
end of the colon is not directly adjacent to the
proximal stoma. In this case, an open-ended
disposable appliance with adhesive backing is
used over the proximal stoma. The mucous
fistula (distal non -functioning colon) is covered
with a four-by-four gauze pad. The patient can
expect mucus to drain from this fistula in
gradually decreasing amounts.
The patient should know that in time, both
the loop colostomy and the double-barrelled
colostomy stomas become less edematous
and therefore easier to manage. A skin barrier
such as a karaya ring or stomahesive should
be used with both types of colostomies to
prevent skin breakdown.
The patient can achieve odor control by
using an odor proof appliance or a commercial
liquid deodorant that is placed in the
appliance. Patients with temporary
colostomies can be encouraged to maintain
their usual diets, omitting only those foods that
may cause diarrhea or excessive production of
flatus.
Activities of daily living
The patient with the temporary colostomy
should be encouraged to resume his own
normal patterns of living as soon as he is
physically able to do so. The stoma care
routine can be planned to fit comfortably into
the person's pre-illness hygiene schedule and
should not interfere with his usual daily habits.
The nurse ought to emphasize preventive
health measures. The patient can be advised
of those signs and symptoms that warrant the
attention of their doctor, signs such as
constipation, excessive watery stoma output
or cessation of stoma output. Knowledge
about his own care helps the patient to take
responsibility for himself.
The patient with a temporary colostomy
needs the psychological support necessary to
help him maintain his relationships with others.
The need for sexual counseling should not be
overlooked. Frequently the patient's fears of
appliance leakage, odor, or damage to the
stoma make him reluctant to engage In sexual
activity. His altered body image and loss of
self-esteem may also interfere, as well as real
or imagined distaste on the part of his partner.
Open discussion and exploration of
■The Loop Ostomy Gasket with Karaya Seal is a
Registered Trademark of Hollister Inc., Chicago,
Illinois.
anticipated problems involving the nurse,
patient and his partner may be helpful.
Any nurse working with ostomy patients
can play an extremely important role in
determining the approach of other members of
the health team towards the temporary
colostomate. Conferences with surgeons and
staff nurses help to assure that all will maintain
a positive attitude towards the patient and his
stoma experience. Those involved should all
be aware of the importance of avoiding an
emphasis on the transient nature of the stoma,
focusing instead on living with the stoma as
long as it exists. All members of the health
team need to be aware of the effects of their
attitudes on patient welfare.
The individual who undergoes surgery for
the creation of a temporary colostomy has
many of the same rehabilitation needs as the
permanent colostomate. Rehabilitation goals
should be identified and measures instituted to
help the patient meet these needs early in his
hospitalization.
Health care providers may be tempted to
view this individual's needs as less critical than
those of a person whose colostomy or
ileostomy is permanent. But the sudden loss of
control and change in body image
accompanying colostomies are catastrophic
events for either individual. A sensitive nurse
will respond to the needs of a temporary
colostomate with the same degree of
supportive understanding and with the same
careful teaching that she would use in caring
for the patient with a permanent colostomy.*
References
1 Thibodeau. Omer A. Colostomy closure — a
simple procedure? J. Maine Med. Ass.
65:9:208-210, Sep. 1974.
2 Finch, D.R. The results of colostomy closure.
Br. J. Surg. 63:5:397-399, May 1976.
3 Knox, A.J. Closure of colostomy, by ... et al.
Br. J. Surg. 58:669-672, Sep. 1971.
4 Thomson, J. P. Results of closure of loop
transverse colostomies, by ... and P.R. Hawley. Br.
Med. J. 3:459-462, Aug. 19, 1972.
Robin Young Wood (B.S. Nursing, University
of fvlictiigan, M.S. Nursing and Ed. D. Boston
University) is currently an assistant professor
at the Boston University Sctiool of l^urslng In
Boston, l^assachusetts. Atttie time tfiis article
was written stie was Co-Project Director of the
Enterostomal Therapy Education Program
sponsored by the American National Institute
of Health — National Cancer Institute. Wood
has past experience both as a staff nurse and
as a teacher, and has taken part in numerous
workshops and seminars, Including a
two-day workshop at the University of Arizona
Medical Center held last March by the
International Association of Enterostomal
Therapy. She is an active member of a
number of nursing committees, and has acted
as a guest lecturer in many educational
settings.
Acknowledgement:
The preparation of this manuscript was supported in
part by the National Institute of Health — National I
Cancer Institute. U.S.A.
Pamela Gaherin Watson (R.N.,
Massachusetts General Hospital School of
Nursing, B.S. Nursing and M.S. Nursing,
Boston University) is also an assistant
professor of nursing at the Boston University
School of Nursing. She was formerly Project
Director for the Enterostomal Therapy
Education Program and Is now Chairperson
of the Rehabilitation Nursing Master's Degree
Program. With experience in staff nursing and
nursing education, Watson has also taken
part in workshops and nursing committees,
and has acted as a guest lecturer In a number
of educational settings.
'f
ALTERNATIVE
BIRTH
CENTERS
Alison Rice
Elaine Carty
"A hospital is a splendid place, but it is not, in my view, a place
in which the most beautiful celebration in the history of a
family, the welcoming of a new member into it, should
occur."'These are the words of anthropologist Ashley Montagu.
More and more, this sentiment is being expressed by childbearing
couples who wish to bring "birth back to the family." However, in
Canada there are few alternatives to the conventional hospital
birth. In the article that follows, the authors describe four U.S.
Alternative Birth Centers (ABCs) that attempt to give the birth
experience back to families while maintaining excellence in
obstetrical care.
The Canadian Nurse November 1977
ALTERNATIVE
BIRTH
CENTERS
In this age of consumer protection and
self-help groups, it is not surprising to find
childbearing women and their partners
expressing dissatisfaction with traditional
maternity care services. Many lay persons
have become increasingly knowledgeable
about the processes of pregnancy and birth
and wish to share in the responsibility for their
own care during this time. Often, this leads to
conflict with the prevailing attitudes of health
professionals. When this happens, the couple
feels frustrated in their attempts to seek a
childbearing experience which is not only
physiologically healthy but also
psychologically satisfying.
Signs of dissatisfaction
How do we know that couples are
dissatisfied? Childbirth educators are now
teaching couples who are eager for
information about the pros and cons related to
many of the traditional childbirth practices:
women ask physicians about their philosophy
on such measures as the use of medications
during pregnancy and birth, the necessity of
episiotomy and separation of parents and
infant at birth. As well, hospital personnel find
their established routines are being
questioned with increasing frequency;
sometimes, these routines are rejected
outright. Here in Vancouver, the Maternal
Committee of S.P.A.R.C. of B.C.^ has
received many letters from women and men
sharing their feelings about their persona!
childbirth experiences. Some letters express
joy, others express sadness and still others
anger.
Disenchantment with hospital obstetrical
care is almost certainly one of the reasons
behind the increasing number of home births.
In general, the medical profession has not
supported this alternative and, in fact,
discourages its members from attending at
home births.
Nonetheless, the home birth movement
grows as couples, many of whom are
professionals, value what they see as the
physical and psychological benefits of giving
birth at home. It is difficult to accurately assess
the number of births that are taking place
outside of the hospital but it is estimated that in
Vancouver there were approximately 300
such births last year. A recent article on home
birth indicated that only 2% of births in Canada
take place out of hospital but that there has
been an increase of 62.5% in the number of
home births in the Toronto area in the past
year.^ Clearly the numbers are growing; yet
the present health care system is extremely
slow in responding to the needs and desires of
these families.
But what is it about the present system in
Canada that is causing dissatisfaction? Many
women and couples have assumed the
responsibility for informing themselves about
pregnancy and birth; they want to be involved
in decision-making about their care. But many
are not allowed to be. They seek to actively
participate in the process of developing their
family in a healthy way. Simply following
instructions based on the information health
professionals choose to give them is no longer
enough. Some couples feel that the uninviting
environment of the hospital, embraced in rules
and regulations, interferes with the total
experience of childbirth in terms of personal
satisfaction and family development. Vaughan
has commented, "It may really be a disaster
that the medical model — or, still worse, the
surgical model — has been adopted for the
birth of a baby, which is actually a social event.
I think it is about time that we re-created, the
birth of an infant as a social event, taking it out
of the medical arena and giving it back to
families."" What are the alternatives?
Experiences in the U.S.
In the United States a number of
innovative programs have begun to appear in
recent years. These projects, commonly
called Alternative Birth Centers (ABCs),
attempt to give the birth experience back to
families while maintaining excellence in
obstetrical care. Philosophically the approach
of these centers is similar to family-centered
hospital maternity units, however, the
implementation differs for important reasons.
Couples are expected to actively participate in
decisions about their care so that their
individual wishes and needs can be met. Many
couples see birth as a spiritual and social
experience, one which is enriched by being
shared with loving family and friends. Bonding
occurs, with all those who are present at the
birth,* not only between the parents and
newborn infant. The sharing of this experience
is encouraged in ABCs in the belief that it
provides a wider support system than is
usually available to the nuclear family.
Nurturing behaviors are enhanced and family
relationships strengthened.
Parents, family and friends are
considered part of the birth team and are
supported by skilled professionals including
nurse-midwives, nurses and physicians.
Professionals are trained and equipped to
recognize and handle deviations from the
normal but the focus is on non-intrusive,
natural and supportive care to enhance the
highly emotional childbirth experience for the
family.
Typically, the physical settings provide
pleasant, home-like surroundings for labor
and birth in an attempt to facilitate relaxation
and reduce the anxiety inherent in a hospital
environment. The programs offered at the
centers include antepartum, intrapartum and
postpartum care for low-risk women plus a
variety of educational programs pertinent to
childbearing and parenting.
In an attempt to learn more about these
centers, we visited both in-hospital and
out-of-hospital Alternative Birth Centers. It
seems clear to us that health care
professionals are making these centers a
viable and valued part of their communities.
.1
ABC No.
The Alternative Birth Center at the San
Francisco General Hospital is an example of
an in-hospital setting which provides a
different kind of birth experience than the
traditional obstetrical unit. The birth rooms,
located within the obstetrics department, are
modified hospital rooms. Furnishings such as
a couch, comfortable chairs, a double bed for
the woman to labor and give birth in, cheerful
decorations, plants and other amenities create
a homelike environment. At present, 25 to 30
women deliver in this setting each month.
Women who register at San Francisco
General Hospital for prenatal care, and who
are assessed to be low-risk, are offered the
option of being cared for by a certified
nurse-midwife or a physician. Low-risk
patients (defined by clearly stated criteria),
particularly those registered with the midwifery
service, may elect to utilize the Alternative
Birth Center rooms for their labor and birth.
Women using the ABCs must have a
support person with them in addition to the
medical attendant. Usually, the rooms are
used by midwifery service patients, however,
some resident obstetricians and family health
physicians also use them. In this case a
qualified "labor coach" approved by the ABC
staff must be in attendance.
Since the emphasis is on natural,
prepared childbirth and on responsible
participation by the couple (or woman and her
"labor coach"), one of the requirements is
attendance at a childbirth education course
either at San Francisco General or in the
community. In addition, the Alternative Birth
Center staff give a series of three classes
specifically designed for people who plan to
use the alternative birth rooms.
Measures aimed at ensuring safe, high
quality care are built into the program.
Problems and circumstances necessitating
transfer from the birth rooms are clearly
defined. These possibilities are discussed with
prospective participants in the class sessions.
Other safeguards include the proximity of
emergency facilities and back-up medical
staff.
The professional approach to the labor
and birth is a calm, encouraging,
non-intervening one. Support persons are
allowed to attend as desired by the mother and
provisions may be made for the presence of
her children. As many decisions as possible
are made by the woman subject to the |
judgment of the attendant. Careful
consideration is given to enhancing
parent-infant bonding, for example delaying
silver nitrate eye drops for 30 minutes to one
hour after birth, so eye contact between parent
and infant can be established early.
Early discharge of the mother and infant,
between six and 48 hours postpartum, is
possible provided there is live-in assistance in
the home for at least three days, access to
telephone and transportation and the
condition of both the mother and baby is
satisfactory. Patients who do not wish to go
home early or require additional in-hospital
care are transferred to the regular postpartum
ward. ABC staff visit early discharge patients
in their homes within 24 hours for those
discharged six hours postpartum and within 48
hours for those discharged 12 hours
postpartum. In addition, telephone contact is
made in the interval between discharge and
the home visit.
2
ABC No.
The Alternative Birth Center at Mt. Zion
Hospital and Medical Center in San Francisco
is similar to the one at the San Francisco
General Hospital. Hospital rooms have been
converted to birthing rooms and decorated to
provide a homelike comforting atmosphere.
Wall-to-wall carpeting, a double bed. soft
lamps, plants and bean bag chairs are all
features of the Mt. Zion Alternative Birth
Center. The parents have access to a large
record collection, many of the records
contributed by couples who have used the
room. Couples are also encouraged to bring
personal comfort items from home.
The Center is available for use by patients
of house staff or private physicians. At present,
there are no midwives attending deliveries at
Mt. Zion. As at San Francisco General,
specific criteria relating to the woman's health,
course of the pregnancy and preparation are
clearly spelled out. The ABC at Mt. Zion
Hospital is staffed separately from the
Obstetrics unit. Although patients are
expected to have a coach/support person, the
Center guarantees one-to-one nursing care.
The woman may have whomever she chooses
at the labor and birth. Children attending are
screened for infectious diseases and must
have adequate adult supervision. The prime
concern is the woman's desire and tolerance
for company as labor progresses.
The mother and infant recover in the birth
room for four hours and then are transferred to
the postpartum ward. Discharge home can
occur as early as six hours, again depending
on mother's and baby's condition. Home visits
are made by the ABC nurses on the first and
third postpartum days. The purpose of these
visits is two-fold: assessment of the mother
and infant, and teaching.
The basic cost of the hospital services at
Mt. Zion's ABC is $400. This includes two
orientation classes, an optional antepartum
home visit, the special nurse during the stay in
the birth room, stay up to 48 hours in hospital
plus the home visits. It does not include the
physician's fee. In the U.S. there is
considerable competition for maternity
patients, particularly among private hospitals.
This service at Mt. Zion attracts patients and
according to the nurses at the Center, it is a
profit-making service for the hospital. Although
patients are pleased with the lower cost of this
service (a difference of about $400. - S500. to
the standard hospital cost) their main reason
for coming to the ABC is the style of birthing,
and the total experience.
3
ABC No.
New York's Maternity Center Association
operates an out-of-hospital Childbearing
Center in a townhouse on East 92nd Street in
New York City. An obstetrlcian/nurse-midwife
team provides care to expectant parents who
can anticipate a normal, uncomplicated
childbirth and for this reason a very careful
medical screening process is applied
throughout the pregnancy, labor and birth.
The midwives offer preparation for
childbirth and parenthood classes and all
those couples who plan to give birth at the
center are encouraged to participate. The
women become involved in their own care in
many ways. For example, they weigh
themselves, test their urine and record the
findings on their chart. They read their chart
and discuss all aspects of their care with the
nurse-midwife or doctor and make plans with
the midwife for the way they would like the birth
to be.
Every attempt has been made to create a
relaxing environment at the Childbearing
Center. A living room, kitchen, outside garden
and two bedrooms are available to the laboring
woman and her support person. Children are
also welcomed at the Center.
A nurse-midwife and midwife assistant
attend the births and an obstetrician is always
on call. A non-intervention philosophy
characterizes the practice of the nurse-
midwives. Parents inspect, touch and cuddle
their babies immediately after birth, never
being separated unless some complication
arises where mother and/or infant have to be
transferred to hospital. There are three
hospitals within a ten-minute drive of the
Center. After the birth, the baby is examined by
a pediatrician who discusses the examination
with the parents. Families leave the Center
when the condition of both mother and baby
stabilizes, usually within 12 hours after the
birth. The Center's fee also includes two home
visits by the Visiting Nurses Association of
New York City. The woman and baby are
examined at the Center within a week to 10
days following the birth and again at five to six
weeks postpartum. Parents report that they
are delighted with their experience at the
Childbearing Center. The cost of the total
program is $750, another attractive feature of
the Center since a normal childbirth occurring
in a hospital in New York City costs about
$1,500.
As a result of the occurrence of factors
associated with increased risk to mother and
baby, approximately one-third of the women
have been transferred out of the Childbearing
Center program at some time during the
antepartum, intrapartum or postpartum period.
The transfers have involved mostly
primiparous women and none of these have
involved an emergency transfer.
At present, the staff at the Center feel the
critieria used in assessing high risk cases may
be too strict. As they gain more experience in
an out-of-hospital setting, the staff hopes to be
better able to identify those factors which truly
The Canadian Nurse November 1977
indicate tlie need for a hiospita! birth. A
research study comparing data on mothers
and infants giving birth at the Center with a
matched group of mothers giving birth at a
hospital is currently underway.
0)
4
ABC No.
Lucinia, a Birth Center In Cottage Grove,
Oregon, consists of a house and adjacent
offices decorated in Scandinavian fashion.
The program offered by this out-of-hospital
birth center is similar to that of the center in
New York City. Expectant women are carefully
screened for any high risk factors as only those
parents expecting a normal pregnancy and
birth are accepted into the program. The
Lucinia Birth Center registers about 20 new
clients per month and is in such demand that
many more must be turned away. A
nurse-midwife and obstetrician provide care to
the families while experienced nurses are
involved in the educational program. The Birth
Center offers an extensive range of
educational programs including classes for
childbirth preparation, parenting,
grandparenting, nutrition, fitness, parent
effectiveness training, babysitting and
mother's helpers.
"The philosophy of the Birth Center is as a
triangle, placing the pregnant couples at the
apex or top in a leadership role with rights and
responsibilities for their own health care.
Across the base of that triangle are the
professionals with different areas of interest
and expertise. Though those areas often
interface they are also separate professions
working in harmony."^ From February 1, 1976
to February 1, 1977, 275 families were
involved with the Birth Center. The outcomes
of the pregnancies of all women enrolled at the
Lucinia Center (now 150) are shown in Table
1.'
How parents feel
Parent satisfaction with all of the
Alternative Birth Centers we visited is reported
to be high. To date the statistical data available
on perinatal, infant and maternal morbidity and
mortality suggest that such centers can
provide a safe alternative to traditional
obstetrical services for selected clients. As
further studies are carried out to evaluate
these programs, we may gain some valuable
insight into the effect of environment and a
non-intervention philosophy on the process of
labor and birth as well as on the family's ability
to nurture.
Alternative Birth Centers represent
positive consumer initiated change in the
American health care delivery system. The
psychological benefits and lower cost offer an
attractive alternative to families.
What's happening in Canada?
In Canada, we too are faced with
consumers who are actively seeking a more
satisfying childbirth experience. Moreover,
Outcome
Number
Percentage
Spontaneous abortion
13
8.6
Advised to transfer to other facility due
to past obstetrical history or distance
3
1.9
Moved out of area
15
9.87
Lost to follow-up
5
3.31
Transferred to Home Delivery witfi traditional birth
attendant or Certified Nurse-Midwife in area
10
6.6
Delivered at Birth Home*
78
51.3
Delivered at Community Hospital or Medical Center
26
17.2
Not pregnant
2
1.3
Total
152
100
"All normal spontaneous vaginal deliveries of viable infants with Apgar greater than 7 at 1 minute
both the government and the taxpayer are
concerned about the rising health care costs in
this country. Financial ceilings imposed by
many provincial governments on the health
care dollar are making us take a look at less
costly alternatives to traditional hospitalization
that still maintain a high quality of care.
Some encouraging trends are already in
evidence in our maternity units. To a great
extent, these trends have been influenced by
consumer demands for greater participation in
the birth process and by research which shows
that such activities enhance
maternal-infant-family bonding. IVIany
hospitals, for example, are liberalizing sibling
visiting and encouraging participation of
fathers throughout the hospital stay.
Some are attempting to provide a setting
which appears less institutional. McMaster
University Medical Centre in Hamilton, Ontario
is an example. Here the woman can labor and
give birth in a brightly decorated room. Her
partner is always welcome and she is not
separated from her baby after birth.
Even with these changes, however, much
remains to be done. The rationale for
traditional hospital procedures needs
examination and clearly we need to further
examine the effect of the hospital environment
on the birth process. Also we need to
re-examine our roles as health care providers
and the way in which these roles relate to the
expressed wishes of childbearing families for
more control over their care.
Surely the time is ripe for those involved in
the character of the health care system to
respond to consumer demands and social
needs by designing innovative health
services. *
Acknowledgement: The authors wish to
express their thanl<s to the nurses and
midwives at the centers they visited who
shared generously their time, ideas and
experience.
Bibliography
1 Bradley, Robert A. Husband-coached
childbirth. New York, Harper and Row, 1 965, p. vm.
2 S.P.A.R.C. Social Planning and Review
Council. The Maternal Health Committee is made up
of concerned women and men in British Columbia —
potential parents, workers in the health and social
services and representatives or organizations
providing services to childbearing families —
working for improvement of resources available to
families ' during pregnancy, childbirth, infancy and
childbearing.
3 Maynard, Fredelle. The joy of having your
baby at home. Chatelaine. 50:8;29, Aug. 1977.
4 Klaus, M. Maternal-infant bonding: the impact
of early separation or loss on family development.
by ... and J. Kennell. Saint Louis, Mosby, 1976.
5 Lang, Raven. The Birth Book. Ben Lomond,
Genesis Press, 1972.
6 Neilson, Irene. Nurse-midwifery in an
alternative birth center. Birth Fam. J. 4:1 :24, Spring
1977.
7 Ibid. p. 27.
Alison Rice, (B.S.N. , M.S.) has worked in
intensive care nurseries and as a nurse
practitioner in maternity and family planning.
Elaine Carty, (B.N., M.S.N., C.N.M.) is a
midwife and has worked in a variety of
maternity settings. She is a member of the
Maternal Health Committee of S.P.A.R.C. of
B.C. and N.A.P.S.A.C. (National Association
of Parents and Professionals for
Safe Alternatives in Childbirth). Both authors
are currently assistant professors at the
School of Nursing, University of British
Columbia.
Along with a group of nursing colleagues
at the University of British Columbia, they are
engaged In planning an alternative to
conventional hospital delivery. Work is in
progress to formulate a proposal for a
demonstration project using nurse-midwives.
nurse specialists, obstetricians and
pediatricians to provide comprehensive care
to low risk women and their families in a small
out-of-hospital birth center. The formulation
phase of this project is funded by Health and
Welfare Canada.
ine vanaawn raurav novemovr or/
HOSPITALIZATION
IS IT ALWAYS A
EXPERIENCE?
In recent years much has been written about
patients' negative reactions to hospitalization. In nursing
journals as well as in lay publications, first person chronicles
of sad and tragic hospitalization experiences are fairly
common. ^^ But are all hospitalization experiences negative?
Recent nursing research suggests that they are not. In the
article that follows, the author presents data, raises questions
and you. the nurse, are asked to draw your own conclusions.
Gail Patricia Laing
The experience of hospitalization is thought to
harbor many potentialities for degradation,
depersonalization and threat to self-esteem
for patients. Brown and Field, among others,
have pointed out that the authoritarianism and
bureaucratic social structure of the hospital
with its rigid schedules and unvarying routines,
and the loneliness, isolation, loss of privacy
and identity of the patient tend toward loss of
control and loss of self-esteem. 3 ■» Brown s
image of the anonymity of the patient in a
horizontal position tsetween white sheets,'
or "a situation in which going to the bathroom
is regarded as a privilege" is particulariy
poignant.*
With this in mind, I wondered whether or
not all patients experienced negative feelings
while hospitalized. I decided to include
questions directed towards the patients
reactions to hospitalization in a study that I was
conducting on the self-esteem of patients who
have suffered a myocardial infarction* (See
Table 1). The sample was comprised of
twenty-nine English-speaking Toronto
residents who had been admitted to one of four
city hospitals with a diagnosis of myocardial
infarction. Twenty-five of the subjects were
male, four were female. All subjects were
between the ages of 40 and 81 years with nine
of the patients having a previous history of
myocardial infarction. In all of the hospitals,
patients were admitted through the
emergency department to a coronary care unit
and then transferred to a general medical ward
for the hospital convalescent phase of their
illness. Staff in all hospitals included registered
nurses and registered nursing assistants. One
hospital had a clinical nurse specialist for
teaching and continuity of care with coronary
patients ; another hospital had delegated these
duties to the assistant head nurse in the
coronary care unit. The other two hospitals
had no organized teaching program or liaison
from the coronary care unit to the general
ward.
The interview
I interviewed the patients in their homes
during the second week after their discharge
from hospital. The interviews were scheduled
after the patients discharge to minimize bias
arising from fear of repnsal If they said
anything derogatory about the hospital while
still dependent upon its care. When
conducting the interviews, I identified myself to
the patients as a nurse but emphasized that I
was not connected with any particular hospital.
The interview was tape-recorded and was
semi-structured; that is, most of the questions
could be answered with a "yes " or "no , but I
encouraged the subjects to elaborate on the
"yes" and "no" answers. Open-ended
questions also permitted the subjects to
express additional concerns. (See Table 1)
The Canadian Nurse November 1977
Table 1
Questions in the study
re hospitalization.
1. Did you feel that you were treated with
respect?
2. Did you feel valued as an individual?
3. Did you feel that you had control over
what was happening to you in the
hospital?
a) did you want to have control?
4. How would you describe the
atmosphere in the hospital?
(friendly? impersonal?)
5. Did you feel isolated?
6. Did you feel that the hospital personnel
were concerned about you?
7. Did you feel cut off from family and
friends?
8. Did you feel that you got enough
emotional support?
a) from family?
b) from nurses?
c) from doctors?
9. Were you kept informed about your
progress?
10. Did you have enough opportunity to asl<
questions?
1 1 . Were your questions answered to your
satisfaction?
12. Were procedures and tests well
explained?
13. Did you understand the hospital
routines?
14. Did you make any of the decisions
about your care?
15. Did you want to make the decisions?
Do you have other reactions to your hospitalization that we have not mentioned?
If so, would you tell me about them?
Findings
Subjects' responses to questions
regarding their hospitalization were generally
positive. Analysis of individual subject's
responses across all the q uestions showed an
average of only three negative responses out
of a possible eighteen per subject. The range
of negative responses was from zero to ten per
subject. In Table 2, the questions were
grouped for clarity into categories of
(a) general ambience of the hospital.
(b) feeling of isolation, (c) dependence-
independence, (d) emotional support, and
(e) information.
Most of the 29 subjects were satisfied with
the general ambience in the hospital. They
stated that they were treated with respect and
felt valued as individuals. They reported that
hospital personnel were concerned about
them and described the atmosphere as
friendly. Seven subjects singled out the staff of
the coronary care unit as being particularly
friendly and concerned, and some subjects
expressed surprise at the excellent, speedy
treatment they received in the emergency
department. Negative responses were usually
directed at perceived ill treatment by one or
two particular staff members.
Only three subjects indicated they felt
isolated in the hospital, indeed many subjects
expressed feelings of enhanced closeness
and support from their families during this
period.
In answer to the questions: "Did you make
any of the decisions about your care? " and
"Did you want to make the decisions?"
fourteen subjects reported that they had no
control over what was happening to them in
the hospital and eighteen subjects reported
that they made no decisions. However, only
three of those stating that they made no
decisions indicated that they would like to have
made more decisions about their care. The
other 26 subjects stated they felt either control
or decision-making on their part was
inappropriate or they were satisfied with the
level of control that they exercised, even if it
was minimal.
Sixty-five out of a total of eighty-seven
responses to questions regarding emotional
support were positive. The proportion of
positive to negative answers was the same
regarding support from family, nurses and
doctors. Interpretations of emotional support
varied as the following responses
indicate: "they used to kid me along," 'they
were kind and thoughtful, " "they were
cheerful," "their attitude was assuring." Two
subjects who answered negatively indicated
that doctors and nurses were too busy to give
any emotional support. Three subjects said
they did not need any emotional support.
Subjects were generally satisfied with
information they received regarding hospital
routines, procedures and tests. However, nine
subjects expressed dissatisfaction with
information given them about their progress.
They gave reasons such as "the doctor is too
busy ", and "they deliberately don't tell you."
There was a strong impression that patients
look exclusively to their doctor and not to
nurses for information and answers to
questions regarding their progress.
Older subjects viewed their
hospitalization more positively than younger
subjects; subjects who were suffering their first
heart attack took a more negative view of their
hospitalization than those who had had a heart
attack before.
Negative or positive?
In general, the responses to questions
regarding the subjects' reactions to
hospitalization do not support the contention in
the literature that hospitalization is a
degrading, depersonalizing experience.
Although these results could be spurious due
to small sample size and other limitations in
the study, there are other possible
explanations which are worth exploring.
Perhaps statements in the literature by
Brown^ Wu^, Field^ and others are not
applicable to the findings in this study
because:
• their studies refer to long-term
hospitalization rather than to short
three-to-four week stays such as these
subjects had;
• the literature refers to the situation in
hospitals in the United States but not
Canadian ones;
• the literature refers to the hospital
situation in the 1950's and 1960's but not the
1970's.
Perhaps with the current focus on
research and the present interest in coronary
care some of the past problems in
hospitalization have been overcome. Finally,
perhaps there is something unique about the
hospitalization experience associated with
myocardial infarction.
Another consideration is that satisfaction
is a function of how well expectations are met:
that is, if expectations are low, satisfaction is
easily achieved. In this regard, it is interesting
that the older subjects tended to view their
hospitalization more positively than younger
subjects. The age differential might be an
indication that the hospitalization experience
is improving. Older subjects, whose
The Canadian Nurse November 1977
expectations might be lower because of past
experiences, might tend to view their
hospitalization more positively than younger
subjects with higher expectations of the
hospital. On the other hand, studies of the
normal aging process in our society indicate
that men past sixty seem to move to a more
passive, dependent, compliant position
whereas the helpless dependent role is more
alien to younger people, particularly men.'°
Thus the older person might more readily
accept the limitations imposed by illness and
hospitalization and report a more positive
experience.
Interestingly, questions specific to the
subject of "dependence-independence" did
not show an age differential related to the
desire for control over the hospital experience.
The age range of the four subjects who said
they wanted to have control was from
forty-eight to seventy-eight years.
Indeed the passive role appeared to be
comfortable to the majority of subjects as
evidenced not only by the responses to
questions specific to control over the
hospitalization experience but also by the
large number of subjects who did not want to
ask questions about what was happening to
them. Perhaps the passive role, defined as an
element of the sick role,'' influences
expectations which in turn explains the high
rate of satisfaction with hospitalization. Illich'^
expressed a similar idea with his phrase
"medicalization of expectations." whereby
patients or clients, due to the extreme passivity
of their role vis-a-vis physicians, accept the
medical system's standards of care without
question.
The other significant relationship between
sample characteristics and reactions to
hospitalization was that subjects who had had
a previous heart attack viewed their
hospitalization more positively than those who
were in hospital with an M.I. for the first time.
The subjects with a previous heart attack were
perhaps more apt to have lower expectations
engendered by more and longer experience
with the sick role. Perhaps also they were
more passive and content due to some
familiarity with the experience than for
subjects encountering the unknown" for the
first time.
The suggestion that possibly there is
something unique about the hospitalization
experience associated with myocardial
infarction deserves further consideration.
Certainly the intense, highly technical nature
of the coronary care unit is a unique situation
which might encourage subjects to feel that
judgments and control of their care would be
most properly delegated to those with superior
knowledge and competence, a competence
which they may feel they lack. The
seriousness that people usually associate with
a heart attack would add to their feeling of
incompetence and thus influence their
willingness to adopt a more passive role. The
awe, loyalty and gratitude given to nurses and
doctors who work in such a specialized unit
and who guide patients through the extreme
crisis of a myocardial infarction may help to
Table 2
Frequency and type of subjects' responses to categories describing reactions to hospitalization
Category of
Subjects'
responses
Question
Negative
Positive
Equivocal
Total
General ambience of the hospital
6
100
10
116
Feeling of Isolation
3
53
2
58
Dependence-I ndependence
Had control
14
15
0
29
Wanted control
4
25-
0
29
N^ade decisions
18
11
0
29
Wanted to make decisions
3
26-
0
29
Emotional support
65
16
87
Information
30
107
8
145
Total
85
402
36
522
• Marked positive if subject was satisfied with the level of control or decision-making that he had.
Negative response: The subject indicated feelings of dissatisfaction, unease or unhappiness.
Positive response: The subject indicated feelings of pleasure, satisfaction or happiness.
Equivocal response: A response which was not classifiable as negative or positive.
explain the generally positive attitude of these
subjects toward the hospital experience.
Summary
In conclusion, it appears that rather than
anything definitive about the goodness' of the
hospitalization experience in an objective
sense, these findings are more plausibly
interpreted as an indication of how well the
subjects' expectations of hospitalization
were met. Remember, too, that the data
reflects a subjective rather than an objective
analysis of the patients experience. There is
some indication that expectations of
hospitalization were influenced by the
patient's age and past history of myocardial
infarction. Expectations may also have been
influenced by the iinique nature of the illness
and by its treatment in contemporary
hospitals. A possible bias due to the fact that
the interviewer was a nurse cannot be ruled
out.
In the final analysis these data raise more
questions than they answer. Are there
differences between the reactions to
hospitalization of patients who have had a
myocardial infarction and those of patients
with other acute and chronic illnesses? Are
there differences in the reactions of patients
whose experience includes admission to a
coronary care unit from those with the same
diagnosis admitted to a general intensive care
unit or a general ward? Studies done by
clinical nurses who are alert to their patient's
reactions to hospitalization may answer some
of these important questions. *
References
1 Bartlett. Beverly J. Fan's baby. Nursing '75
5:12:16. Dec. 1975.
2 Kern. Arthur. Hospitals are no place for sick
people, by ... and Elizabeth Keiffer. Good
Housekeeping. 184:5:111 passim. May 1977.
3 Brown, Esther Lucille. Newer dimensions of
patient care. Vol. 1. New York, Russell Sage
Foundation. 1962. p. 11.
4 Field. Minna. Patients are people: a
medical-social approach to prolonged ///nesss New
York, Columbia University Press, 1953. p. 53.
5 Brown, op. cit. p. 15.
6 Laing, Gail. P. Relationship of self-esteem
and the myocardial infarction experience. Thesis
(M.Sc.N.) Toronto, 1976.
7 Brown, op. cit. p. 1 1.
8 Wu. Ruth. Behavior and illness. Englewood
Cliffs, New Jersey, Prentice-Hall. 1973. p. 31.
9 Field, op cit. p. 56.
10 Gutmann, David L. An exploration of ego
configurations in middle and later life. In Newgarten,
Bernice Levin. Personality in middle and later life:
empirical studies, by... et al. New York. Atherton,
1964. p. 145.
1 1 Parsons, Tateott, Social System. New York,
Free Press. 1964, p. 437.
12 lllich, Ivan, t^edical nemesis: the
expropriation of health. Toronto, McClelland and
Stewart, 1975, p. 51.
This article by Gail Patricia Laing (B.Sc.N.,
University of Saskatchewan. Saskatoon;
M. Sc. N. , University of Toronto) is based on a
study entitled Relationship of Self -Esteem and
the Myocardial Infarction Experience. It was
written in conformity with the requirements for
the degree of Master of Science in Nursing.
Presently Laing is assistant professor of
nursing at the University of Saskatchewan
Saskatoon, where she teaches intensive care
nursing.
The Canadian Nurse November 1977
The Canadian Nurse November 1977
Is there a knowledge/practice gap when it comes to caring for children in hospital? Last year
the Association for Care of Children in Hospitals was able to compile a bibliography of more
than 400 publications available to anyone who wanted to learn more about the hospitalized
child, particularly his emotional and developmental needs.
In actual practice, however, many of the children admitted to Canadian hospitals this year
will be the recipients of care that ignores much of what has been discovered about how to
reduce the trauma of hospitalization and help them continue to grow and develop in the
hospital setting.
Denise Alcock
In December 1 976, the author set out to survey
pediatric units throughout Ontario in an effort
to learn more about how these hospitals are
equ ipped to meet the non-clinical needs of the
children who are admitted to them. Her
findings are similar to the results of an earlifc,
survey in the Maritime provinces' and indicate
important ways in which hospitals in this
country are failing to provide the facilities,
personnel and environment that the pediatric
patient needs.
The questionnaire
A total of 74 questionnaires were sent to
!l Ontario hospitals listed in the Canadian
"ospital Directory as having more than 20
pediatric beds. Fifty-five hospitals (74%)
responded; five of these respondents
indicated that their pediatric units had been
closed, leaving a survey base of 50 hospitals.
All questionnaires were addressed to the
hospital administrator. In many instances, the
administrator receiving the questionnaire
designated a member of the nursing
department to respond to the questionnaire.
The rationale for the survey was explained as
follows:
"It is known that illness and
hospitalization interrupt a child's normal
life activities and that this interruption can
affect growth and development. It is also
known that illness, treatment and
hospitalization can be stressful and that
stress can be harmful if a situation
arouses more anxiety than a child can
cope with. Therefore, pediatric care must
include the opportunity for continued
normal life activities, and ways must be
planned to reduce anxiety and to help a
child cope with his concerns.
This survey is an attempt to
appreciate the different ways in which the
hospitals in Ontario are dealing with
concerns centered around the
hospitalized child's emotional and
developmental needs."
Findings
1 . Visiting hours
Since one of the most fundamental means of
diminishing anxiety in hospitalized children is
to encourage the continued closeness of
parent and child, the questionnaire concerned
itself with visiting policies and whether or not
parents could stay overnight.
• Less than half (44%) of the hospitals
responding to the questionnaire Indicated
that parents were permitted to stay
overnight;
• 34% said parents could stay but
"only with special cases;"
• 18%indlcated that overnight stays are
not permitted.
Hospitals that have established open
visiting policies and those which encourage
care by parent units are helping parents
continue to parent and are contributing to the
child's sense of security in a strange
environment. Parents who can visit at any time
become more confident that twenty-four hour
quality care is being maintained and their
comfort with the hospital environment is felt by
their child. Nursing staff do not experience the
tension and congestion that restricted
visiting hours impose on nursing units and they
have more opportunity to share information
and skills with parents concerning the care of
their child. This can be particularly beneficial to
parents who must care for their child during an
extended convalescent period at home.
Frequent and extended parent-child contact is
essential to the parent-infant bonding process
for the hospitalized neonate and young infant.
Four hospitals listed different rules
according to the age of the child, as follows:
1 . A hospital with open visiting for parents of
children under fourteen, permits only six hours
of visiting for parents with children over
fourteen.
2. A hospital which permits eight and one-half
hours of visiting for parents of children under
twelve, permits eight hours for parents of
children over twelve.
3. A hospital which permits nine hours of
visiting for parents of children over thirteen,
permits only eight hours for parents of
children under thirteen.
4. A hospital which permits five and one-half
hours of visiting for parents of children over
five, permits only four and one-half hours for
parents of children under five.
2. Sibling visits
Siblings of hospitalized children often worry
alone and tend to experience less attention
from their parents whose thoughts and
presence are with the III child. Younger siblings
may even be separated from their parents and
cared for by helpful friends or relatives. In
some cases, schoolwork has been affected
and regressive or neurotic behaviors noted in
siblings of hospitalized children.
Understandably, visiting by siblings needs to
be monitored by nursing staff and in some
instances may be undesirable, but the benefits
to both the ill child and the sibling of continued
contact while in hospital are obvious.
• 12% (6) of the fifty hospitals
responding do not permit any visits by
siblings;
• another 12% permit sibling visiting
only on Saturdays and Sundays. This
weekend visiting appears to exist primarily
for the benefit of long-term patients and is
usually limited to one or two hours on each
day;
• 36% of hospitals responding indicated
that siblings were permitted to visit
regardless of their age.
Age restrictions on visiting exist in
sixty-four percent of the hospitals surveyed.
Lower Age
16
15
14
13
12
10
6
no restrictions
Number of Hospitals m
3 1
16
18
^K
3. Pre-admission orientation
One of the accepted methods of reducing the
emotional stress to which hospitalized children
are subject, is familiarization with the hospital
environment and procedures prior to
admission.
• 40% of the hospitals that responded
indicated that they make no provision for
pre-admission visits of children to the
hospital;
• 16% indicate that if parents take the
initiative to request an orientation to the
unit before admission, their request will be
met;
• 28% have tours, slides or other
pre-admission programs organized by
nursing staff, auxiliary members or teen
volunteers. The frequency of orientation
program varies from weekly to monthly to
"irregularly scheduled;"
The Canadian Nurse November 1977
• 8% (4 hospitals) state that an
orientation program is in the planning
stages;
• 10% have community slide-talk
presentations especially suited to
kindergarten and primary school children;
• 4% mentioned that they distribute a
hospital coloring book.
4. Provision for child-oriented care
It is known that children express themselves
through play, that they learn through play,
socialize through play, and that they work out
their problems through play. It is vital that
children be given the opportunity to continue to
play in hospital and nursing units which
provide this opportunity to create a receptive
child-oriented environment and a happier
nursing unit.
If space that is allocated as playspace is
at least a symbolic recognition of the need for
the hospitalized child to play, then 96% of
hospitals surveyed at least symbolically
recognize this need. Only four percent said
they have no playspace. The location or
suitability of the playspace available was not
determined by the questionnaire.
In response to a question asking "What
concerns you most in terms of the emotional
and developmental needs of the children in
your care?", many respondents referred to the
need for staff knowledgeable in child
development and familiar with hospital
procedures whose primary function would be
to help the child cope with illness and
hospitalization. Here are some of the concerns
expressed ;
"Presently nursing staff have time to
look after physical needs of the child. An
organized play program is needed to help
make the child's stay in hospital less
traumatic."
"Cuts in nursing staff leave
permanent staff excessively busy with
insuficient time to look after the child.
Part-time staff have difficulty giving
necessary support."
"Lack of consistency in staffing
patterns to accommodate needs of
children. Unable to assign patients to one
person for any length of time so they can
relate more easily."
"Need to find way to make staff
aware of children's needs and how to
cope with them and to find way to make
staff comfortable with parents."
"There is a lack of understanding that
pediatrics differs from other areas in the
hospital. "
'Not enough people trained and
experienced in caring for emotional and
developmental needs to properly cover
these areas of patient care."
• 54% of the responding hospitals have
paid staff who attend solely to children's
emotional and developmental needs.
Variance in the amount of coverage is
wide. For the most part, staff concerned with
children's activities work four hours per day
and in others only three days per week. Only
the larger institutions servicing children have
evening and weekend programs.
The most commonly stated qualifications
of staff responsible for children's activities in
hospital are a degree or college diploma in
education or recreation and experience
working with children. The backgrounds listed
however are diverse: nursing plus education
degree; nursing plus early childhood
education; teaching, recreation; early
childhood education; behavioral science
diploma; psychology degree; community
college child care program; registered nursing
assistant plus experience; twelve
week on-the-job training.
These staff comprise separate
departments in six hospitals. Three are large
institutions caring for children and three are
general hospitals with pediatric units of
twenty-eight, thirty-one and forty beds
respectively.
• 20% of responding hospitals set aside
sepa.ate budgets to meet children's
non-clinical needs.
In one hospital a special gift fund is
established and in three hospitals the auxiliary
funds the program. In the remaining hospitals
these programs are funded under the
pediatric, occupational therapy or
physiotherapy budget.
Staff dealing with children's activities
report within the hospital structure as follows;
• administrator — 3%:
• assistant executive director — 11%;
• nursing department (director, coordinator
or head nurse) — 55%;
• chief of pediatrics — 3%;
• chief of rehabilitation — 3%;
• physiotherapy department — 3%;
• playtherapist responsible to head nurse,
(budget from occupational therapy) — 3%
• not indicated — 1 9%.
5. Schooling in hospital
For children of school age, the focus of dai
Monday to Friday activity centers around
school. The continuation of schooling durinc
hospitalization or during an extended
convalescent period at home enables the chih
to maintain contact with a very important are;
of normal daily activity. It must not be assumei
that school means work and, therefore, will b
stressful; many children enjoy learning and
miss school. For some hospitalized childrer
such as those who need to be on dialysis foi
two or three days each week, schooling in
hospital offers an opportunity to keep up
academically with their peer group and
keeping up with a peer group is difficult but
very important to the chronically ill child's
sense of self-esteem.
• 16% of surveyed hospitals have a
teacher or teachers as part of the hospita
staff but paid by a local board of education
The most commonly identified persons t
make the arrangements for schooling are: thf
doctor, parent, head nurse, public health
nurse, child's school teacher or principal, chile
life worker, play therapist or social worker.
Some hospitals indicate there is difficulty in
obtaining teachers for hospitalized children
even if the child has already been out of schoc
for the four-week period deemed necessary i
order to qualify for hospital or home teaching
• Twelve hospitals have space used b
teachers as classroom space and these j
areas were noted as being play areas, smaj
conference rooms or classrooms. Wherej
classroom space is not available or the '
child cannot be moved, teaching takes
place at the bedside in the child's room.
One hospital states that their Pediatric
Committee sees the education of the child t
resting solely with the parents and not with the
nursing personnel. This is a disturbing
H%
in« ^^aiiduiaii r«ur»v nuvvntuvt tvtt
in
/
The situation in other countries
In Canada, a number of persons feel that the Canadian Council on Hospital Accreditation should
review the present requirements for accreditation of pediatric units and insist that the emotional
and developmental needs of the children be considered in terms of policies and facilities before
accreditation is granted.
What is happening in other countries?
In Britain. James and Joyce Robertson led the way in urging the formation of a parents'
organization to work for changes in hospital care. Their efforts resulted in an official government
statement, "The Piatt Report." which among other things recommends that in all new hospitals,
facilities for "living-in" be included in the planning of children's units.
In Australia, The Association for the Welfare of Children in Hospital prepared policy
recommendations entitled 'Health Care Policy Relating to Children and Their Families" which
was declared the official policy of the Health Commission on September 1 , 1975. This document
states that parents should have the right of access to their children at any time, that play facilities
must always be available, that parents should be encouraged to be invotved in the care of their
child, that care-by-parent units should be planned for all new hospitals, that it be mandatory for
brochures to be available on the preparation of the child for hospital and that parents should be
fully informed and have access to inquiry. There are many other special policy considerations
included in this document.
In Sweden, on January 1. 1977. a new law was passed which reads as follows: "The
principals of any hospital or other institution receiving children for care are under the obligation to
make proper arrangements for offering these children participation in activities of the same kind as
are provided by preschool or leisure time centers.' To ensure that this law is carried out the
National Board of Health and Welfare has become involved in the planning and the organization of
play programs in all hospital children's units in Sweden.
Statement in that It suggests a lack of
appreciation of the benefits to the child, the
nurse and the teacher of shared information
and concerns regarding the child's schooling
program.
6. Volunteer programs
Men, women and teens of both sexes who
volunteer to work with children in hospital have
more than time to offer. They bring with them
their own areas of expertise and are one of the
hospital's strongest links with the community.
It is also the volunteer who realizes the lack of
good children's literature or magazines for
parents, or a specific playroom need, who
prompts friends or clubs to meet these needs.
• 56% of the hospitals which responded
have volunteers who work with children.
The responsibilities of the volunteers
would appear to vary greatly from hospital to
hospital. Among the responsibilities noted are:
to entertain, give TLC, feed, do crafts,
transport patients, prevent fighting in the
playroom, play with children, read to children,
conduct weekly orientation program. One
hospital has Early Childhood Education
students two days a week in the playroom who
work in a volunteer-student work placement
capacity.
Implications
The number of responses (74%), personal
notes from respondents expressing interest
and requests for survey results, indicate a
definite interest in questionnaire subject
matter. For the most part, pediatric staff seem
aware of children s needs but uncertain about
the best way of dealing with these concerns.
Improvements do not always depend on
the expenditure of large sums of money. Much
can be done on pediatric units at little expense
and, as Elizabeth Crocker discovered in The
Maritimes,^ these things are being done in
settings where staff are aware of the potential
impact of hospitalization on both children and
parents. Policy changes are more a matter of
attitude change than a matter of money,
although, as Crocker notes, most hospitals
need both guidance and money to meet child
care objectives.
• Nurses, who fully appreciate the value to
the child, the parents, the siblings and
themselves of liberal visiting policies, can
become advocates of more liberal visiting
policies.
• Nurses who are fully aware of the
significance of continued schooling for the
long-term orthopedic patient or the chronically
ill child will, when necessary, agitate for
continued schooling for these children.
• Nurses who are fully convinced that
pediatric care involves special programm ing to
meet children's non-clinical needs will push for
Child Life programs and volunteer
assistance.
It is necessary for all of us to periodically
examine our knowledge-practice gap to
determine what more we ourselves can do and
then mobilize our efforts in unison with
disciplines with similar concerns in order to
effect changes that will ensure better pediatric
care. *
References
1 Crocker, Elizabeth J. Child Life Programs in
the Maritime Provinces: A Study of the Non-Medical
Needs of and Future Directions for Hospitalized
Children. 1974, Atlantic Institute of Education.
2 Ibid, page 30.
Suggested Resource Material:
1 Brooks. Mary M. Why play in the hospital?,
Nurs. Clin. North Am. 5:3:431-44*1, Sep. 1970.
2 Hardgrove, Carol. Parenting during
hospitalization, by ... and Ann Rutledge. Amer. J.
Nurs. 75:5:836-838, May 1975.
3 Harvey. Susan Play in hospital by ... and Ann
Hales -Tooke. London. Eng. Faberand Faber. 1972.
4 Johnson, B.H.. Before hospitalization; A
preparation program for the child and his family.
Child Today, 3:6: 18-21, Nov. /Dec. 1974.
5 Petrillo, Madeline. Emotional care of
hospitalized children.an environmental approach
by ... and Sirgay Sanger. Toronto, Lippincott. 1972.
6 Plank, Emma N. Working with children in
hospitals. 2d ed. by...etal. Chicago, year bk,med.,
1971,
7 Stainton, Colleen. Preschoolers' orientation to
hospital Canad. Nurse 70:9:38-40. sep. 1974.
8 The hospitalized child bibliography compled
by th Association for the Care of Children in
Hospitals, Box H., W. Virginia, 24983, 1976,
9 To prepare a child. Media Centre, Children's
Hospital National Medical Center, Washington, D.C.
20009. 16mm, 32 min.
Denise Alcock, R.N., B.Sc.N., S.R.N. .
M.A.(Ed), the author of "Hey, what about the
kids?" has been chief of the Child Life
Department of the Children's Hospital of
Eastern Ontario for the past three years. The
study on which her article is based was
carried out in December 1976.
A graduate of the University of Toronto
School of Nursing she received her S.R.N,
from Radcliffe Infirmary, Oxford, England,
and her t\A.A. in education from the University
of Ottawa. Before joining the staff of the
CHEO, she spent three years as a Sister tutor
at Radcliffe and four years with the Canadian
l^othercraft Society doing prenatal and postal
counseling and home visiting.
The Canadian Nurse November 1977
A CHILD LIFE
PROGRAM
IN ACTION
Child Life prog rams at the Children's Hospital of Eastern Ontario began three years ago at the same time
the hospital was opened. A total of nine Child Life staff and more than 1 50 volunteers are involved in the
various programs.
When children or adolescents are ill and hospitalized there is interference with the normal life
activities which foster grourth and development. There is also stress and anxiety concerned with illness
and visits to the hospital. The aim of the Child Life programs is to minimize the traumatization of illness
and hospitalization and to encourage the continued growth of the child or adolescent — physically,
emotionally, intellectually and socially. The Child Life staff also aim to foster involvjement in children's
activities on the part of all who are in contact with the child and his family.
Some of the services and resources made available to patients at the CHEO include:
1. Infant program
Infants respond selectively to their environment and appropriate
environmental stimulation during infancy is important for later
cognitive growth as is the opportunity to play and explore.
Physical activity such as rolling, crawling, standing, etc. lays the
foundation for proper motor development.
The Child Life Worker acts as a comforter, a role model, and
a teacher. She is concerned with the baby's sense of security,
with the comfort of the parents so that their interaction with their
baby remains as relaxed as possible and with the l<inds of
environmental stimuli available. Taking into consideration the
baby's illness and treatment she tries to ensure continued
developmental progress and to identify areas of developmental
lag.
2. Preschool program
Monday — Friday 8 :30 to 1 6 :00 hours and Saturday 8 :30 to 1 2 :00 hours.
A Ctiild Life Worker visits children on a one-to-one basis and also runs a
play program in the playroom on each unit. The playroom contains the
familiar — toys. Children, parents and staff can play and learn together.
The child can express his feelings and thus communicate through play as
well as continue to learn and socialize. The staff can learn about motor or
perceptual problems, language development, social skills and intellectual
development. In the hospital environment play Is crucial to the child's
affective development. It is through play that tension is released and that
fears may be expressed.
3. Schoolage program
Each unit has an activity room and a Child Life Worker. The forced
dependency and restriction of freedom associated with illness and
hospitalization is felt by all age groups but in the 7 to 1 2-year-old group it is
often through choosing a project and completing it to one's satisfaction
that self-esteem is kept intact. The children do pottery, macrame,
leatherwork, weaving, Indian beading, etc. Games are often educational,
diversional and socializing. Feelings are more easily expressed through a
non-verbal media and it is necessary to become the child's friend before
he will express his deepest fears. The Child Life Worker's report to the
health care team may be in terms of the child's ski lis, fears or behavior as
it is in the setting of the activity room or In a play situation that the child as a
person becomes clearer.
4. Education program
Since most children over the age of five spend a large part of their week in
school, consideration must be given to the fact that school is for most
children a "normal life activity. " Bilingual teachers are made available
through the Ottawa Board of Education and their office is located on
second floor in the Child Life area. The nursing and medical staff identify
potential students, the nursing staff obtain signed consents for tuition
from the attending physician and the parent and then notify the teacher.
The teacher contacts the child's school so that the child will follow the
same curriculum in the core subjects as the peer group to which he will
return. Thus, it is hoped that a child hospitalized for any length of time will
be only minimally behind as a result of having been away from school.
5. Youth Unit program
Hospitalization is particularly difficultfor the teenager. What is happening
to me? What is going to happen? How long do I have to be here? Am I
going to get my credits this term? Why isn't my girlfriend /boyfriend visiting
me? The adolescent wants to be kept informed and needs to understand
his illness, treatment, prognosis. The Child Life Worker finds ways often
through special projects, one-to-one conversation or games, or group
activities and entertainment to help the teenager cope with his condition
and hospitalization. It is sometimes necessary for the worker to interpret
the adolescent's behavior to parents and staff. A weekly group meeting is
held to facilitate patient-staff communication.
6. C.I.D.U., I.C.U. and Evening programs
One Child Life Worker Is available to cover all of these areas. She is on the
Clinical Investigation and Dialysis Unit on Monday and Friday 8:30 to
1 6:30 hours and Tuesday, Wednesday and Thursday from 1 3:00 to 1 7:00
hours. She also runs a Tuesday evening craft program, a Wednesday
evening music or special project night and a Thursday games evening.
I.C.U. is visited daily by this worker. Play serves an important expressive
function in these areas where the tension of parents and children tends to
be high. In the dialysis area the education program is especially important
The Canadian Nurse November 1977
Since for the child dialysed on three school days a week, schooling takes
place mainly in the hospital and the one-to-one tuition better enables
remedial instruction to be carried out.
7. Kitchen program
Attached to the large activity room on the second floor is a
non-institutional kitchen area. A dietitian (Food Service Department)
plans "cooking is fun' activities for children of various age groups
(parents may participate as always) and for groups with common dietary
concerns. Parents cook for their children or have a family meal together
with the doctor s consent. Often Mom s cooking is the stimulus to prompt
a reluctant eater. There is resource material available through the Child
Life office re the use of the kitchen by parents and staff to make cooking a
fun and educational program. (Children learn math concepts, new words
e.g. grate, sift, cream, and exercise motor skills).
8. Children's Library
The library on the second floor contains an excellent selection of English
and French children's literature. It also serves as a classroom, a teacher's
office, a meeting place for school tours and for the diabetic education/
recreation program. Bookcart service manned by volunteers visits all
units Monday-Friday and book returns are between 70-100 a day. The
library contains the classics, current children's literature, books to help
prepare children for hospital procedures and some reading material for
parents. The library is an important resource to the teachers and
students. The library is managed by the Child Life Department and
clerical and tKDokcart service manned by Volunteer Services.
9. Outdoor facilities
These include a playdeck and a playground. The playdeck has
vegetables and flower boxes and is used for infant sunning, an outing for
children who need to be close to a unit for possible medical emergencies
and for the preschool children on that floor.
Playground activities are compiled into a schedule and circulated by
the Child Life Department. Children using the playground must be
supervised by hospital personnel or parents, and medical and nursing
permission is needed before inpatients can be involved in playground
activities. Daily inpatient usage averages 12-16 inpatients per day and a
daily average of 36 children (inpatients, outpatients, special groups).
10. Special entertainment
The Child Life Department works closely with the Community Relations
Office and community groups that have undergone an initial screening
process as to suitability of performance, length of performance, space
required, etc. These groups are booked into the monthly program of
activities which is circulated to all units. Community participation is
particularly active at Christmas. We have enjoyed professional ballet, the
National Arts Centre orchestra, children s theater and several amateur
entertainment groups. The Ottawa School Board, the National Film
Library, the Museum of Man, the Ottawa Public Library, all generously
contribute to our educational /recreational programming.
11. Weekend programs
During the summer, weather permitting there are Saturday barbeques.
The rest of the year a preschool program is provided Saturday morning
and a schoolage program or feature film on Saturday afternoon.
Each Sunday the Christian Council of Churches sponsors a
Friendship Hour. The Friendship Hour leader plays guitar and the children
join in the action songs.
12. Inservice education and practicum placements
Nursing, education, dietetic and recreoiogy students spend varying
amounts of time in the Child Life Department. Workshops focused on
therapeutic play or adjustment to hospital or specific craft demonstrations
are held frequently but on a request basis.
13. Orientation
Pre-operative classes are given Tuesday in French and Thursday in
English by the anesthetic nurse in the second floor activity room.
School tours organized by the Volunteer Department begin in the
Child Life Library.
14. Outpatient program
The Child Life Worker s role on the diabetic team is to coordinate an
education/recreation program every Tuesday 7:30-12:00 hours. This
program consists of an exercise program followed by age suitable
activities to help children learn about and cope with their diabetes.
Information concerning appropriateness of play materials and
activities for specific age groups is available to volunteers and staff in the
O.P.D. area through the Child Life Department.
15. Special projects
The department has a continuous supply of toys which are tested and
evaluated for the Canadian Toy Testing Council.
One of the staff has rewritten the booklet for parents. "Your Child
Goes to the Children's Hospital of Eastern Ontario. ♦
44
The Canadian Nurse November 1977
COMMENTARY
Shirley Post
Children admitted to hospital are plunged into
infamiliar and frightening surroundings,
separated from their family, and subjected to
intrusive, often painful procedures. Without
support and assistance in coping with the
otress of these experiences, some of them are
slow to recover, exhibit developmental
regression, develop fears of abandonment
and mutilation, or exhibit emotional problems
dt home and at school after they leave
lOspital.
Despite the fact that for the past twenty
years we have had quantities of research and
documentation regarding the emotional and
developmental responses of children to illness
and hospitalization, the policies, routines, and
environments of many of our pediatric units
have changed little in the last decade.
In 1975-76 as I travelled about Canada
talking with persons about what they
perceived to be problems and issues in child
health that a national organization might
address, the care of children in hospital was
often raised as a concern. Parents in every
I uovince voiced unhappiness with the hospital
arrangements for children in their
communities. They took for granted that the
.echnical and medical care was good but were
often critical of visiting policies, the lack of
facilities for parents to stay overnight, the
inadequate information they received from
medical and nursing staff, the lack of play
facilities and the opportunity for a child to
continue with his studies. In some hospitals
children are still placed on adult wards where it
seems to be even more difficult to meet their
special needs.
It is evident that there is much to be done
to improve the standards of care for children in
hospital and the Canadian Institute of Child
Health will be reviewing the situation. It is my
hope that studies such as this will stimulate
hospital boards and personnel to begin to
question and review their policies in relation to
the needs of hospitalized children and their
families.
Many changes have been identified which
could improve the hospitalization experience
for children. Most of these do not require new
legislation or large amounts of money but,
rather, involve changes in attitudes, policies,
and the recognition that we cannot model or
transfer traditions and policies established for
adult units to children's units. Children have
special needs and problems that we must not
continue to ignore. Some of these special
needs are:
1. Visiting
An important change that is needed is
complete elimination of restriction on parental
visiting rights. Parents should be encouraged
to feel they are important participants in the
child's hospital care.
Not all mothers can or wish to stay
overnight with their children, but the
opportunity should be available. Some
"live-in" facilities should be available for
mothers especially those with infants or
pre-school children.
2. Play programs
Physical activity is important to children and
is essential that space, equipment and a
program be provided. Someone must be
assigned the responsibility of seeing that
opportunities are available for the children
paint, to play out their fantasies, to work of
tensions through motor activity, crafts and
games. Play activities are not 'just for fu n, " b
provide learning and therapeutic experience
for the hospitalized child and should be an
integral part of an child's hospital experienc
3. Schooling
All hospitals should have written, agreed upo
policies and procedures with the local
school boards for the referral of children as
soon as they are able to continue their studif '
in hospital.
4. Information and Orientation
Parents and child should be prepared for th'
hospitalization experience whenever posslbli
Pre-admission visits and books for parents '
read themselves or read to their child helpi
them to understand what to expect. It shouli
also be possible for them to have an admissic
interview with the child's nurse which gives
them an opportunity to ask questions and b
involved in the plan of care for their child.
Where to from here?
The author of "Hey, what about the kids';
suggests that we need nurse advocates wh(
are fully convinced that pediatric care involve;
meeting the special needs of children and an
prepared to push for the necessary changes
I agree, and I believe that we have man
informed nurses who have read some of th
relevant literature and are aware of the man
excellent programs that some hospitals hav(
organized for children and theirfamilies. But, i
is discouraging to discover that some nurs-:
still regard parental visits, toys, schooling 6
explanations as "frills, " or believe that they
might be desirable but "it would be impossible
to have such a program here. "
Some administrators are also reluctant ti
change. They are ready with a string of
excuses such as 'lack of space, " "rigid
nurses, " "traditional doctors," "no money,"
"the children are not in hospital long enough.
Some doctors also feel that "this
component of care has nothing to do with
medical care, " that "parents are a nuisance,
The Canadian Nurse November 1977
I
M
3
that "infection will result," and that these
changes involve nursing and administration
more than medicine.
It is apparent that before we get any action
or change of attitudes in some hospital units, a
multldisciplinary approach will be necessary.
In 1965 a group of Child Life Workers
organized an international group to focus on
the psychological and social aspects of care of
hospitalized children and their families. This
organization is called the Association for Care
of Children in Hospital. They decided to open
membership to a// profess/ons working within
pediatric settings. They have representation
from nursing, psychology, psychiatry,
pediatrics, occupational and physiotherapy,
recreation, education and administration.
They hold an annual meeting and have a
journal. About two hundred Canadians belong
and affiliate groups have been organized in
Manitoba, British Columbia, and Nova Scotia.
Membership is available by writing A.C.C.H.,
P.O. Box H. Union, West Virginia. 24983.
If professional providers do not make
some of the most urgent changes, then I
believe that hospitals will be faced with parent
groups demanding that these changes take
place. Parents are also going to be asking why
some children must be hospitalized at all; they
will want to know why improved ambulatory
services, day care and home care services are
not available as alternatives to hospitalization.
There is much to be done. Many of us in
the nursing profession are aware of the
changes that must take place.
Lets get on with it. Sr
Shirley Post was a key figure in the
establishment in July of this year of the
Canadian Institute of Child Health,
co-founded by the Hospital for Sick Children
Foundation in Toronto and the Canadian
Council on Children and Youth. Now
Vice-president of the Institute, she was
formerly Director of Nursing at the Children's
Hospital of Eastern Ontario.
Photos courtesy of Children s Hospital of Eastern Ontario
The Canadian Nurse November 1977
Information is supplied by line
manufacturer; publication of tfiis
information does not constitute
endorsement.
Wliat's New
Hospital Bed Shampooing
Made Easier
Important as patients'
appearance is in contributing to their
well-being, shampooing and rinsing of
hair has always presented a problem
to hospital staff. "Comfort-Cleanse" is
a new shampoo and rinse basin which
not only works well but is comfortable
when placed under a patient's head
because it's soft and durable. The
shampoo basin incorporates plastic
liners which collect shampoo and
rinse water and are disposable.
Because the basin material is of
the soft "memory " type, it molds itself
to the back of the patient's neck and
forms a fluid-tight seal which prevents
shampoo and rinse water from wetting
patient's clothing or bed covers.
For information write: Oxford
Enterprises, Inc., 333 Nortfi t^ichigan
Avenue, Chicago, Illinois 60601.
Reference Chart for
Emergencies
"Emergency Procedures for
Dangerous Materials " is the title of a
35 by 45 inch washable reference
chart. The chart lists many chemicals
and describes how to store, handle
and dispose of them. If these
chemicals penetrate the skin, get in an
eye, or are swallowed, a glance at the
chart tells how to handle the situation.
Handy for shops, chemical
plants, laboratories, safety
departments, first aid rooms and
hospitals, the chart is printed in large
type, is color coded, and has metal
mountings for hanging.
For information write: Safety
Supply Company, 214 King Street
East, Toronto, Ontario, M5A IJ8.
Dennison Stockinette
A sterile, tubular, unbleached
stockinette from Dennison
Manufacturing Company saves labor,
time and cost by eliminating the need
for hospital preparation. Patient safety
is insured by the minimization of cross
contamination caused by
unnecessary handling.
The pre-cut, pre-sewn stockinette
is made of 100 per cent long staple
cotton. It is packed in a water-repellent
pouch that Is tear and puncture
resistant, adding to its shelf life.
An innerwrap of Dennison
Aqua-Plus, a non-woven,
water-repellent, soft, drapable
material insures sterility.
The rolled-to-size Dennison
Stockinette comes in a variety of
widths and lengths in single or double
ply to accommodate a variety of
orthopedic surgical requirements.
For information write: Dennison
Manufacturing Company, Hospital
Products Section, Specialty Products
Group, Framingtiam, t^assactiusetts
01701.
Sniffle Free Land
Guinne's Sniffle Free Land
provides children with a fun way to
learn good health habits. Teaching
basic hygiene is an important job for
both teachers and parents. By
presenting this information in game
form, learning about good health
habits is enjoyable for children.
The element of competition is
challenging for children from 5 to 9
years of age. Did youwash your hands
before breakfast? If yes, advance two
spaces; if not, go back two spaces. Did
you eat your breakfast today? If yes,
advance two spaces and so on.
Appropriate behaviors result in
positive reinforcement and bad habits
lead to negative reinforcement.
Sniffle Free Land helps to teach
good hygiene and nutritional habits
that are important to form at this stage
of development. It also helps to
promote honesty and self-evaluation.
Sniffle Free Land is available for
$6.95 plus $1.00 postage from
Guinne's Games Inc., 1717 Penn
Avenue, Scranton, Pennsylvania
18509.
Maddak Hand Gym
Daily use of the Maddak Hand
Gym has proved in actual testing to
improve muscle strength, range of
joint motion and useful hand function
in a majority of rheumatoid arthritis
and osteoarthritis patients.
According to the Arthritis
Foundation, there are five million
Americans with rheumatoid arthritis
serious enough 'to require medical
care. When this disease affects the
joints of the hand particularly the big
knuckle joints, it often leads to muscle
imbalance and abnormal push and
pull of ligaments and tendons. This
can cause dislocation of the big
knuckle joints, sideways twisting of the
hand and fingers, and deformities
which make normal use of the hand
difficult or impossible. Quite aside
from the severe pain that
accompanies joint inflammation, this
can have a shattering effect on the
daily lives of the victim.
Arthritis experts have long known
that special exercises to strengthen
weakened muscles and maintain
normal range of motion are essential
to effective arthritis treatment. Usually
complex hand exercises require the
help of a physical therapist. But the
Hand Gym is designed to make
appropriate finger and hand
exercises, both passive and resistive,
possible without the help of another
person.
It is also contrived to keep the big
knuckle joints in an extended position
— the so-called "protective hand
position. " When a rheumatic hand is
used functionally, keeping it in this
position helps prevent further
damaging stresses, deformities and
pain.
The Hand Gym is a
three-dimensional triangular device of
transparent plastic sheets with slots
for the fingers, an adjustable "hand
rest bar," exercise bars and elastic
bands. The Gym permits a variety of
finger and thumb resistive and
non-resistive movements. Patients
get detailed exercise instructions to
achieve specific goals, such as
improving agility, dexterity, flexibility,
muscle strengthening, etc.
For furthier information contact:
fvladdak Inc., Pequannock, New
Jersey 07440 U.S.A.
Serving Tray
A new serving tray has been
introduced for use with the Stretch?
patient transfer device. This whole
grained hardwood tray is
stain-resistant and features a
retaining lip. In addition, the tray eas
and rigidly attaches into the arm
support holes on the Stretchair.
The new product provides a
convenient surface for reading,
writing, eating, and playing games
The tray also serves as a safety
feature which helps support seriou;
injured patients.
Stretchair is a new patient
transfer system from Mobilizer whi
converts into a wheelchair or
stretcher.
For additional information, u
Mobilizer Medical Products, P.O. a
147, Summit, New Jersey 07901
Disposable Electrodes
Dispoz-lf Disposable Electrode
are pre-gelled with a specially
formulated adhesive gel combinatic
specifically designed for routine EKC
in EKG Labs, doctors' offices.
Emergency Rooms and Paramedic
Units. Because there is no need to
apply gel and no cleanup required
afterwards, they are both labor anc
cost saving.
Dispoz-lt Electrodes give
superior recordings and consistent
EKG tracings. For convenience an
ease of use, Dispoz-lt Electrodes
come packed with either 4 or 6
electrodes per package.
For furttier information, write: Ml
Systems, Inc., 782 Burr Oak Drive,
Westmont, IL 60559.
The choices of nursing professionals everywhere-
Lucknunn & Soren*en:
$23.50. Order #3803-9.
T
Creighlon;
$12.13. Order #2732-8.
Stryker:
$10.80. Order #8637-0.
Dripps, Eckenholf & Vandam:
$14.60. Order #3193-2.
t
K
Oorland'^ Dictionary:
$24.30. Order #3148-7.
Dorland's Pocket Dictionary:
Indexed. $11 .43. Order #3162-2.
Plain: $9.70. Order #3163-0.
t
Marlow:
$18.30. Order #6099-1.
Howe:
$8.40. Order #4788-X.
binson:
$10.80. Order #7621-9.
Asperheim & Eisenhauer:
$11.60. Order #1437-X.
Phillips & Feenev:
$14.60. Order #7220-5.
t
uve & Pecherer:
.85. Order #7939-0.
Wood & Rambo:
Vol. I: $8.10. Order #9603-1.
Vol. 2: $8.10. Order #9604-X.
; Sc 2 Combined: $12.95. Order #9606-6.
Vol. 3: $8.63. Order #9602-3.
Take your
pick!
>i
ro order titles on 30-daY approval, enter order number and author:
check enclosed — Saunders pays postage J send C.O.D.
Bill me—
~ I have an open account with Saunders
Z My credit card or bank account reference is:
FULL NAME
POSITION AND AFFILIATION (IF APPLICABLE)
HOME PHONE NUMBER
HOME ADDRESS
City province
ZONE
SIGNATURE
v.. w. B. Saunders Company Canada Ltd. T!o?o'nTon"t'a?roT8z sts rzT
y
The Canadian Nurse November 1977
iVaiiics and Faces
CNJ talks to ...
Glenna Rowsell
This September, Glenna Rowsell
assumed the new position of director
of Labor Relations Services at CNA
House in Ottawa, bringing with her a
wealth of experience in nursing
service and education, and especially
in the field of collective bargaining in
nursing.
Glenna has been involved in
collective bargaining in nursing since
its infancy, and says "now that it is an
established fact, we have a whole new
set of problems that must be dealt
with."
An important function of CNA's
Labor Relations Services will lie in the
collection and analysis of data on
collective bargaining throughout
Canada bringing together the
available material across the country.
In addition to building up these
resources, Glenna will be involved in
establishing communication lines,
building a worl<ing relationship
between CNA and provincial
professional organizations and
collective bargaining units, and
establishing a much needed
educational program about collective
bargaining in nursing.
Glenna sees the educational
component of the services to be
provided as very important. Programs
are to be developed on regional,
provincial and national levels, for
union members, professional
associations, and for those who
represent the management side of the
bargaining table. Another important
and necessary task will be that of
fostering communication in each
province between professional
associations and collective bargaining
units, now that the two are distinctly
separate units.
Glenna comes to CNA House
from Fredericton, where she was
employment relations officer for New
Brunswick's Provincial Collective
Bargaining Council and consultant in
social and economic welfare for the
New Brunswick Association of
Registered Nurses. But she is no
stranger to Ottawa, having worked
with CNA from 1961 to 1966 as
director of CNA's school improvement
program and from 1966 to 1969 as
consultant in social and economic
welfare.
Glenna's post as director of Labor
Relations Services is already proving
a welcome one. After only a week in
Ottawa, she remarked, "Since I
moved into my office here, my phone
just hasn't stopped ringing. It's just like
home."
Laura W. Barr, past executive
director of the Registered Nurses
Association of Ontario has been
appointed assistant executive director
of patient services at Sunnybrook
l^edical Centre, University of Toronto.
The appointment was effective
August 1, 1977. In her new position,
she will have direct responsibility for
professional services related to the
hospitals patient care program.
In addition to her fifteen years at
the RNAO, Barr has served on various
academic and health care
committees, including the recent
Ontario Counci I of Health task force on
the 'Distribution of Beds in Hospitals
and Nursing Homes in Metropolitan
Toronto.' In April 1977, she was
appointed by order-in-council to the
Ontario Mental Health Foundation.
Gayle Biette, a member of the RNAO
Eastern Chapter, received the Lillian
Campion Award from RNAO
Foundation President, Laura W. Barr.
Mrs. W. Foukes, a member of the
Campion family, also attended the
ceremony.
Biette is on leave of absence from
her position with the Toronto
Department of Public Health while
completing a graduate program
leading to arv<A.Sc.N. degree.
I
A. Judith Prowse has recently been
appointed chairman of the Health
Sciences Department, Grant
MacEwan Community College in
Edmonton, Alberta.
Having received a B.Sc.N. from
the University of Alberta, Prowse
taught pediatrics and behavioral
sciences at the Medicine Hat General
Hospital School of Nursing. This was
followed by clinical supervision in
pediatrics and then surgical nursing at
the Royal Alexandra Hospital,
where more recently, she was Director
of Inservice Education. A past
president of the A.A.R.N., she has
been actively involved in her
professional association at provincial
and national levels. She is currently
completing her Master's in Health
Services Administration at the
University of Alberta.
Prowse will succeed Sister T.
Castonguay who has been with the
College since its opening in 1971.
Arlene Draffin Jones, Patient and
Family Education Nurse at the
Respiratory Centre, Health Sciences
Centre, Winnipeg, Manitoba, has
been named chairperson of the
Canadian Tuberculosis and
Respiratory Disease Association
Nurses' Section. She succeeds Dr.
Shirley Alcoe of Fredericton.
Jones, a graduate of the
Salvation Army Grace Hospital School
of Nursing in Winnipeg, received her
B.Sc.N. from Lakehead University in
Thunder Bay, Ontario. She has had
experience as a staff nurse in a wide
variety of cli nical settings and has also
worked as a clinical instructor.
Jones is past chairperson of the
Respiratory Interest Group of the
Manitoba Lung Association.
Angela Kucinskas, R.N. of Torontij
Ontario and Gayle Maclntyre, R.N.c
New Westminster, B.C. have been
awarded the Judy Hill Memorial
Scholarship for 1977. Both nurses w
use the $2,000 scholarship to study
midwifery in Britian and will then retur
to serve in northern Canadian nursin
stations. This marks the first time tha
two scholarships have been awardei
The memorial scholarship is
awarded each year to commemora
Judy Hill, a nurse who died while
serving in northern Canada.
Joan Mills has been appointed
Executive Secretary of the Registere
Nurses Association of Nova Scotia
effective Sept. 15, 1977. She
succeeds Frances Moss.
Mills is a graduate of the Halif-,
Infirmary School of Nursing and
obtained her B.Sc.N. at St. Franc
Xavier University. She has wori<e
both as a staff nurse and as an
instructor. For the past ten years, sh
has been a faculty memtjer of the
department of nursing of St. Fran
Xavier University teaching "Nursii .
the Adult."
RNAO Fellowships have been
awarded to two RNAO members
Marjorle Walllngton (R.N., Oshaw
General Hospital, B.Sc.N., Universi
of Western Ontario: M.Sc.N., Bostc
University) who plans to attend the
Catholic University of America in
Washington, D.C. to pursue study
towards a degree in Doctor of Nursir
Science in Mental Health/Psychiati
Nursing. She plans to return to
Lakehead University in Thunder Ba
Ontario where she is an assistant
professor.
Carol Woods (B.Sc.N., Lakehead
University) is a lecturer in
medical-surgical nursing at Lakehet
University. She is enrolled at the
University of Toronto in the Master
Science in Nursing Program where
she will pursue her interest in medic
surgical nursing. On completion of h'
degree, she plans to teach nursing
and to provide direct patient care as
clinical nurse specialist.
^
irw \««iiauHin nurse novemowr o//
New Appointments
Ruth Mellor has been appointed
Regional Director for Ontario of the
Victoria Order of Nurses for Canada.
She takes over from Catherine
Maddaford who retired June 30 after
a distinguished career with the VON
Sheila Ryan (B.Sc.N., M.H.S.A..
University of Alberta) has resigned her
position as Associate Vice-President
(Nursing) at the University of Alberta
Hospital in Edmonton to take up the
position of Director of Nursing,
Jniversity of British Columbia Medical
Centre, Department of Psychiatry.
In the past, Ryan has served on
several AARN committees, on the
board of the Victorian Order of Nurses
and on the fvlanpower for Mental
Health Education and Training Study
Group for the Report on Alberta
Mental Health, 1968.
The Jewish Convalescent Hospital in
Chomedey, Laval, Quebec has
announced the appointment of
Bonnie Lee Smith (R.N., B.Sc.N.) as
director of nursing. Prior to this
appointment, Smith was employed at
the Montreal General Hospital as a
head nurse. She has also had
extensive teaching experience both in
Quetec and in Ontario.
Jean Murdoch (R.N., St. Martha's
Hospital, Antigonish. N.S.; B.Sc, St.
Francis Xavier University) has been
appointed director of the school of
nursing at the Halifax Infirmary,
Halifax, N.S.
Murdoch has been director of
nursing at Hopital Des Sept lies. Sept
lies, Quebec and director of nursing
education at Jeffery Hale s Hospital in
Quebec City. Currently, she is a
member of the Corporation of Nurses
of Quebec's Education Committee
and is the first vice-president of the
provincial committee of directors of
nursing.
^
George Bergeron has been
appointed the new liaison officer for
the New Brunswick Association of
Registered Nurses. A former
newspaper reporter, photographer
and editor, Bergeron is a graduate of
Carleton University in Ottawa. He
replaces Nancy Rideout who has
been NBARN s liaison officer for
nearly ten years.
Marvin M. Burke, executive direcior
of the Nova Scotia Commission on
Drug Dependency is the new
president of the Canadian Addictions
Foundation (CAF) formerly the
Canadian Foundation on Ateohol and
Drug Dependencies.
(SutHains Ointment, N.F.)
niursiiig care.
detruMtus aKem tiy lysing
•i:
r>
SISIANT
Travase
(Sutilains Ointment. N.F.) i
INDICATIONS: For wound debridement. Travase
Ointment is indicated as an adjunct to established
metfiods of wound care lor biochemical debridement of
the following lesions: Second and third degree burns:
Decubitus ulcers: Incisional, traumatic, and pyogenic
wounds: Ulcers secondary to peripheral vascular dis-
ease CONTRAINDICATIONS: Application of Travase
Ointment is conlraindicated in the following conditions:
Wounds communicating with major txxly cavities:
Wounds containing exposed major nerves or nervous
Irssue: Fungating neoplastic ulcers WARNING: Do not
permit Travase Ointment to come into contact with the
eyes In treatment of burns or lesions about the head or
neck, should the ointment inadvertently come into
contact with the eyes, the eyes should be immediately
rinsed with copious amounts of water, preferably ^terile
PRECAUTIONS: A moist environment is essential to
optimal
activity of the en-
zyme. Enzyme activity may be im- —
paired by certain agents (see package insert). Al-
though there have been no reports of systemic allergic
reaction to Travase Ointment in humans, studies of
other enzymes have shown that there may be an
antibody response in humans to absorbed enzyme
material. ADVERSE REACTIONS Consist of mild,
transient pain, paresthesias, bleeding, and transient
dermatitis Pain usually can be controlled by adminis-
tration of mild analgesics Side effects severe enough to
warrant discontinuation of therapy occasionally have
occurred If dermatitis or unusual bleeding occurs as a
result of the application of Travase Ointment, therapy
should be discontinued No systemic toxicity has been
observed as a result of the topical application of Travase
Ointment DOSAGE AND ADfitlNISTRATION
Cs% Strict adherence to the following is required
' <-^ lor effective results of trSatment: 1 Thor-
■ ■ v'^r*' oughly cleanse and irrigate wound area with
sodium chloride or water solutions Wound must
be cleansed of antiseptics 01 heavy-metal antibacterials
which may denature enzyme or alter substrate charac-
teristics leg, Hexachlorophene Silver Nitrate Benzal-
konium Chloride Nittofurazone. etc ) 2 Thoroughly
moisten wound area either through tubbing, showering,
or wet soaks (eg., sodium chloride or water solutions)
3 Apply Travase Ointment in a thin layer assuring
intimate contact with necrotic tissue and complete
wound coverage extending to '4 to ' 2 inch tieyond ttie
area to be debnded 4 Apply loose wet dressings 5
p. Au| Repeat entire procedure 3 10 4 times pet day
C c PP I for best results c Fl.nt1977
\JM FLINT LABORATORIES OF CANADA
^^^A 6«05NortnamDr>M MMon Onta«oL4V)J3
The Canadian Nurse November 1977
Refining and reevaluating
your teaciiing program?
Rely on Mosby.
A New Book!
MATERNITY CARE:
The Nurse and the Family
Emphasizing rhe human dimensions of
childblrrh, rhis dynamic new basic rexr
helps you prepare srudenrs ro funcrion
Qs comperenr, sensirive marerniry
nurses in today's changing soclery. Dis-
cussions inregrore psychosocial focrors
with current clinicol information and
show how ro apply this to actual patient
core. Chapters examine such unique is-
sues as rhe fother's role, nutrition, gene-
tics, ond home delivery. Throughout,
the outhors provide detailed plans for
nursing intervention based on diagnos-
tic, therapeutic, and educational objec-
tives. They stress the importance of set-
ting core goals before planning core or
ortempting to ossess tesults. Ail informa-
tion IS logically arranged ro follow the
chronologic order of conception, preg-
nancy, labor and complications, birth,
post delivery and parenthood. More
than 650 superb drawings ond photo-
graphs augment rhissignificont addition
to maternity literature.
By Margaret Duncan Jensen, R.N,
M,S.; Piolph C. Benson, M. D.; and Irene
M. Bobok, R.N., M.S.; with 2 con-
tributors. April, 1977. 764 pages plus
FM l-XX, 8V2" X 11", 684 illustrations.
Price. S18.40.
MEDICAL/SURGICAL
ENDOCRINE PROBLEMS IN NURSING: A
Physiologic Approoch. Dy Judith Amerkon
Krueger, R. N, , M. S. and Jams Compron Roy.
R. N., M.S. This vQluobie rext provides stu-
dents with Q sound physiologic basis for core
of patients with endocrine disorders. The au-
thors describe both the function and dysfunc-
tion of rhe pituitary, odrenol, parathyroid,
thymus and pineol glonds; ond the pon-
creos. gonads, ond gosrroinrestinal hor-
mones. Other discussions exploin oppro-
priore diognosric procedures ond phar-
macologic treatments. Mony helpful charts
summarize potienr problems ond their impli-
cations for nursing core. 1976. 175 pp. ,41
illus. Price. S6.60,
A New Book! PEDIATRIC NEUROLOGIC NURS-
ING. Dy Dorboro Long Conwoy, R. N.. M.N.
This important new book con help your stu-
dents recognize signs of pediatric neurologic
abnormalities. The author first presents o
cleor. detailed occounr of physiology; then
offers informative discussions on neurologic
disorders and oppropriare nursing care. Feb-
ruary, 1977. 375 pp., 102 illus. Price,
$15.25.
No other publisher
offers so many
choices in every
nursing specialty.
n
PHARMACOLOGY
New 2nd Edirioo' INTRAVENOUS MEDICA-
TIONS: A Handbook for Nurses and Other
Allied Heokh Personnel. By Deny L Gohort
(X.N The new editon of rtiis popular hand-
book offers convenienr access ro currenr in-
formarlon on I V medicotions: dosages
rheropeuric oaons indiconons. conrrolndi-
carions precounons. incomporlbillries ond
onrldoies More rhon 60 new dajgs hove
been added and obsolete drugs deleted.
For rapid reference oil drugs ore cross-
referenced by both generic and trade
nomes. and the drug index is printed cxi col-
ored paper May 1977 246 pp Price,
$7 90
New 4rh Edition! THE ARITHMETIC OF DOS-
AGES AND SOLUTIONS: A Progrommed Pre-
sentation. Dy Louro K Hart R,. N. D.S.N,
M.Ed,, M.A-, Ph,D, Mony instruaors find this
programmed opprooch on ideol way for
students to master or review the basics of
drug colculotion This 4th edition features
new information on children s dosages, insu-
lin ond intravenous colculotions, along with
mony new problems using the metric sys-
tem. January, 1977 62 pp Price S6 05
A New Oook! CALCULATION OF DRUG DOS-
AGES: A Wor«<boat<. Dy Ruth K. Radcliff. R. N.
M, S. ond Sheilo J Ogden, R, N, , D, S, This new
workbook helps students refresh their know-
ledge of the mothemoiicol skills needed to
correaly colculote drug dosages After o
pretest to determine specific needs the
book discusses bosic oreos of general
marhemotics: froaions decimals, percen-
tages, ratios, and proportions Helpful study
Qjds — flosh cords, worl'^sheets, ond quizzes
— enable students to reinforce their skills ond
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202 flosh cords. Price S6 95
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moving from one system to the other: ond
basic concepts of the "old' and "new" moth.
This updated revised edition incorporores
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74 pp 1 illus Price S5, 55
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New 2nd Edition' BEHAVIOR MODIFICATION
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The Canadian Nurse November 1977
Resumes are based on studies placed
by the authors in the CNA Library
Repository Collection of Nursing
Studies.
Research
• Consumer Rights
Consumer Rights and Nursing.
Edmonton, Alberta, 1977. Thesis
(Master of Health Services
Administration), University of
Alberta by Janet L Storch.
The purpose of this study vi/as to
provide a background study for the
use of nurses, and other health
professionals, in examining consumer
rights in health care.
Seven major societal changes,
identified by Roland Warren, were
employed as the basis for analyzing
cnanges in society, in health care
organization and in nursing.
Reactions to these societal changes,
including growth of human rights
concerns, with particular reference to
Canada: the emergence of a new
consumerism: and the refinement of
community development processes
were examined.
Consumer rights issues in health
care were examined as part of the
same reaction to change, this time
related to the health care system. The
right to information, the right to
respect, the right to participate, and
the right to equal access to health care
were discussed as the central
concerns in consumer rights. The role
and function of the patient
representative, a new worker in health
care, was compared and contrasted to
the role and function of the legislative
ombudsman,
A brief analysis of nursing, past
and present, discloses both areas of
strength and areas of weakness
affecting nursings ability to be
responsive to consumer rights in
health care. While nursing has
evidenced considerable interest in
consumer rights issues, it would seem
that nursing has been almost
immobilized in acting on these
concerns by an inability to grapple with
the problems of nursing itself.
It was concluded that nursing
must strive to overcome the problems
within nursing, reassume a vital role in
consumer advocacy, and above all
implement consumer rights in health
care and in nursing. Failure to act is to
jeopardize the consumer's realization
of his rights in health care, and to
jeopardize the future development of
nursing.
• Nursing Practice
The Practice Environment as
Perceived by New Graduate
Nurses. Nursing research
conducted at the Sunnybrook
fyledical Centre, Toronto by
Gloria Kay.(M.Sc.N.).
This is a descriptive-comparative
study of 134 (2 groups of 67)
newly graduated nurses, who began
practice as general staff nurses in a
university medical center in the
summer-fall period of two consecutive
years. Itwas hypothesized that factors
promoting job satisfaction/
dissatisfaction would retain
consistency in content and
importance for neophyte nurses
despite differences in staffing ratios
and changed economic conditions;
and that interpersonal relationships at
the patient care level would be a more
important factor than the literature
indicated. Data supported these
predictions.
Collected by questionnaire
completed on termination of a
60-worked-days probation period,
findings are compared for both grou ps
under (1) characteristics of the nurse
as a person: (2) factors influencing job
seeking and acceptance: and (3) new
graduates' perceptions of: job
environment, patient care,
impediments to practice, her
competence, her needs and
problems, and satisfying and
dissatisfying aspects of practice.
Recommendations focus on the
needs for (1) realistic molding of
student nurse expectations of practice
as well as competence through
changes in education; (2)
assessment, clarification, and
collaboration by service agencies
concerning their patient care tasks
and problems: and (3) the
responsibility and opportunity
afforded the organized profession to
orchestrate the needs of patient,
employer, and practitioner to meet the
humanistic goals of all concerned.
• Education
Education in IHeaith Care in an
Intercultural Maternity Service.
Edmonton, Alberta, 1977. Thesis
(iVi.Ed. in Anthropology and
Intercultural Education),
University of Alberta by Emma
Nemetz.
Health care provided by the
modern medical establishment
includes education of clients,
concommitant with the change
— disease, trauma or condition —
which dictates treatment. Expertise in
providing such education is based
' upon education of the health care
worker in both medical and
extra-medical domains of knowledge,
definitive of a knowledge-oiiented
work community.
This study is an exploration of
several educational aspects of the
health care of maternity patients in a
Canadian hospital which serves a
population of both native and
non-native clients. Interviews with
health care workers document a
difference between natives and
non-natives as perceived by those
health care workers. The specific
differences are categorized and data
gathered through participant-
observation in the hospital is
compared to the health-care workers'
perceptions, using several variables in
ante, peri and postnatal care and
education.
It was found that differences
exist, both in native and non-native
response to the treatment surround! ng
maternity health care, and in the
workers' interactions with clients,
based on the workers' apparent
definitions of a native/non-native
distinction. The findings reflect a need
for a better definition of such
differences, where they in fact exist,
and for subsequent improvement in
the education of health-care workers.
• Pediatrics
Early Identification of
Developmental Impairments in
Infants Birth to Nine Months of
Age. Vancouver, B.C. Thesis
(M.Sc.N.) by M. Grace Doherty.
Early recognition of real or
jotential developmental
mpairments in infants is an important
Dublic health role. This experimental
study was undertaken to determine
the effectiveness of scheduled
nursing assessments of growth,
development, vision, hearing and
nutrition from birth to nine months of
age. A secondary purpose was to
determine the predictive validity of
currently used pregnancy and infant
profiles for subsequent
developmental impairment.
The null hypotheses tested were:
I. That the scheduled community
health nursing assessments between
birth and nine months of age will not
detect any developmental
impairments whicfi have not already
been detected by existing health
services.
II. That there is no significant
difference in the number of
developmental impairments detected
at nine months of age, between a
group of infants screened by the
proposed schedule of assessments
and a group not so screened.
III. That there is no significant
difference in the number of children
exhibiting developmental impairments
by nine months of age, between a
grou p of "at risk " and a grou p of not 'at
risk" infants, using the criteria from the
Vancouver Health Department's
Pregnancy Profile and Infant Profile At
Risk Criteria.
After a study of 100 infants from
one health unit area who were
alternately assigned to an
experimental and a control group, the
findings supported scheduled
community health nursing
assessments of infants from birth to
nine months of age. The pregnancy
and infant profiles were found to be
sensitive but not specific tools for
prediction of subsequent
developmental impairment. The three
null hypotheses were rejected.
Implications for nursing practice
are discussed and recommendations
for further research suggested.
The Canadian Nurse November 1977
Books
Love, sex and sex roles by Constantina
Safilios-Rothschild, Englewood Cliffs, N.J.,
Prentice-Hall. 1977.
Approximate price $8.95
Reviewed by Sharon Turnbull, Assistant
Professor, School of Nursing, University of
British Columbia, Vancouver, B.C.
Tfiose who seek answers to the "many
profound and difficult dilemmas" of sexual
relationships and love will not necessarily find them
in this book, but many of the Issues raised by the
authors are Issues of significance to the health
professional. Rapid changes in social and cultural
values tax the ability of man to adapt or even to cope.
The nurse can benefit considerably from the
author s delineation of many of the binds we face In
todays society.
The major thesis of this book Is that changes
that would eliminate social inequalities and sex-role
stereotyping should create a milieu conducive to
supportive, game-free loving and and sexual
expression. The author brings the sociologist s
perspective to a cross cultural analysis of love, sex,
and gender in order to identify and define the
problems we face. The enormous task of defining
and analyzing the vast realm of human experience in
sex and loving must tax the limits of any singular
discipline, and what is missing in this analysis is the
richness of psychological theorizing, historical
analysis and literary illumination. Recognizing these
limitations, the reader may find this book a stimulus
for thought, discussion and clarification of values.
Therein lies its greatest value.
The author must be commended for the serious
consideration she gives to the problems faced by the
male of our species, a lamentable deficiency In most
writings that promote social equality. Unfortunately,
her analysis of problems as they affect different age
groups is somewhat superficial.
In the reviewer's opinion, two major deficiencies
are apparent in this book. The author, while
recognizing the difficulties inherent in developing an
adequate definition of love, offers a rather weak
operational definition. For example one of the
elements she includes is "the willingness to please
and accommodate the other even if this entails
compromises and sacrifices." She says in following
that if this element is not present to ' any degree and
intensity" the relationship is apt to be exploitative,
but it IS often argued that it is the existence of just
such an element that encourages exploitation. Her
further categorization of types of love is helpful as it
applies to the traditional male-female lovers context
but does not address aspects such as parental love,
homosexual love or the love of friends. Perhaps a
broader perspective would have contributed more to
an understanding of the topic.
The major weakness, however, is the statement
of the author's conclusions which are not always
adequately supported by the data she presents, are
contradictory, or which are not based on sound logic.
For example, the author states that women have
"not particularly valued " the friendships of other
women "because of the prevailing notion that
women are less valuable than men.' No data are
given tD support this claim that women do not value
these friendships, and no effort Is made to
substantiate a causal relationship.
In her discussion on humanizing sex and love,
the author offers a prediction that men will no longer
■judge, appreciate and be attracted to women
primarily in terms of their physical appearance' and
will instead desire women who are "competent and
intelligent" or "financially and /or occupationally
successful. " Undoubtedly, we pay the high costs the
author describes for over-valuing the fleeting and
often unattainable goal of feminine beauty, but
wouldn't another caste of unloveables (e,g. the
unintelligent and incompetent ) be created if such a
shift in values were to occur? These sorts of
premature generalizations suggest that some rather
strong biases were at work.
This book covers ground that is familiar to
anyone who has read seriously in this area, but is
thought provoking. It presents a challenge to
consider the frontiers and the limits of some
important human relationships and in so doing
merits our attention. While it fails to offer any new or
definitive answers to the profound and difficult
dilemmas, it does accomplish something that may
be much more important: it identifies the questions.
For as a great wit once said, "Love may be the
answer, but what is the question? "
To The Nurse
Whose Professional
Standards Are As
High As Ours
if your skills are current, you are invited to
become part of MPP Nursing Services. The
advantages to you will be many, including top
pay plus continuing inservice education
programs. We respect you both as a
professional and as an individual; we'll make
every effort to provide the satisfactions and
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NURSING SERVICES
The Expanded Family: Chlldbearlng by
Carole L. Blair and Elizabeth M. Salerno. 261
pages. Boston, Little, Brown and Co. 1976.
Approximate price $8. 95.
Reviewed by Margaret Richardson, l^urse
Clinician, The Moncton Hospital, Moncton,
N.B.
This book, written by two nurses, is divided into
two parts. Section One presents an innovative
approach to the fundamentals of nursing practice.
Although the title may mislead some who are not
interested in obstetrics, this section would be
beneficial and worthwhile in medical -surgical
nursing, or in any other milieu. The approach used
broadens the nurses perspectives of the patient and
summarizes expenences. It also relates theory and
knowledge to patient settings.
The book is concise, easy to read and contains
categorized assessments of situations encountered
in nursing.
Section Two of the book, relates the "tables'
presented to the childtiearing process, but they
could also be related to any individual life event or
illness.
This book should prove useful to both
undergraduate and post-graduate nurses.
Nursing care of the growing family; a
maternal-newborn text by Adele Pillitteri.
Boston. Little, Brown and Co,, 1976.
Approximate price $15.00
Reviewed by Marilyn Andrews, Maternal-Child
Instructor, General Hospital, St. John's,
Newfoundland.
"Nursing Care of the Growing Family is a text
designed to cover the nursing care of the mother and
family from the time of diagnosis of pregnancy to the
child's first weeks.
The book has seven chapters, beginning with
prenatal care and progressing through labor and
delivery, and dealing with the postpartum period and
the newborn. The last two chapters discuss the high
risk pregnancy and the high risk infant.
I found that the chapters of this book are
outlined cleariy and concisely, and the pictues and
diagrams are excellent. The reference lists at the
end of the chapters are detailed and comprehensive.
I feel that this text covers the theory and the
psychosocial aspects of nursing quite well. I like the
fact that it discusses the needs of the whole family
(i.e. thefathers and sibling's role), while considering
the mother and child. This is a necessity today when
our health care and our educational systems are
family life centered.
I feel that this book would be useful to a student
as an adjunct to her prescribed texts. Nursing
personnel in clinical areas should also find this book
helpful for quick reference.
54
The Canadian Nurse November 1977
Itoohs
The Pediatric Nurse Practitioner; Guidelines
for Practice, 2ed, by Fernando DeCastro et
al . . 21 1 pages, St. Louis, The C.V. Mosby
Company.
Approximate price $6.85.
Reviewed by Julia A Shea, nurse practitioner
and head nurse — Medical Specialties —
Ambulatory Services, The Hospital for Sick
Children, Toronto, Ontario.
The second edition of this book contains
thirty-two chapters and is divided into four
thematic sections: 1 . introduction 2. health appraisal
3. clinical problems 4. the child and the family in
society. It is a comprehensive reference text for all
nurses practicing in expanded roles; its emphasis is
on the actual practice of nursing in a pediatric
setting.
Chapter two features three guest authors, all
nurses, who present the various aspects of the role
of the nurse as a pediatric nurse practitioner from the
American point of view. Chapter three features yet
another guest author, whose concern is with the
nurses' role in working with parents to promote the
well-being of children.
Section two on health appraisal has been
re-organized and updated since the first edition
appeared in 1972; it includes the same clear
black-and-white drawings that appeared in the first
volume, plus a fold-out Denver Developmental
Screening Test for growth and development in
chapter seven.
In Clinical Problems in section three, two new
chapters have been added on neonatal and parasitic
diseases.
The concluding section entitled "The Child and
the Family in Society' was called "Social Problems "
in the book's first edition. Chapter twenty-eight deals
briefly with the psychodynamics in childhood and
touches on the subjects of temper tantrums,
masturbation, nail-biting, etc. In Chapter thirty-two
— a final guest author offers an overview of the role
of the nurse as a pediatric nurse practitioner in the
chronic care setting.
A well annotated bibliography appears at the
conclusion of each chapter, and offers the reader a
wealth of resource material for future reference.
This book will prove invaluable to clinicians
practicing in varied settings, nursing students
looking to a career in pediatrics, and anyone
interested in updating their knowledge of normal
pediatrics as it relates to nursing practice.
Emotional Care of the Facially Burned and
Disfigured, by Norman R. Bernstein, Boston,
Little, Brown and Co., 1976.
Approximate price $12.50.
Reviewed by Ann G. Staley. Head Nurse, Burn
Unit, Vancouver General Hospital, Vancouver,
British Columbia.
I do not believe anyone can experience the total
impact of the social, psychological, economic, and
physical devastation of a severe burn unless they
are directly involved. Let's hope through Norman
Bernstein's compassionate boo\<. Emotional Care of
the Facially Burned and Disfigured that all members
of the burn team and medical profession will have
more insight into the severe psychological trauma of
burn victims.
Tuvo careers in one.
Have you ever thought ol combining two
careers in one'' As a Canadian Forces nurse
you could, because you would also be an officer,
eligible tor regular promotion, enjoying a mini-
mum of four weeks vacation your very first year,
free transportation privileges to many parts of
the world, early retirement including a generous
lifetime pension and a number of other bene-
fits. The Canadian Forces will give you every
opportunity to continue your nurse's training,
while using the skills you already have in one
of the many military medical installations in
Canada or overseas. You might qualify for flight
nurse's training or even for a complete doctorate
study course.
If you're a graduate (female or malel of a
school of nursing accredited by a provincial
nursing association and a registered member
of a provincial registered nurses' association,
a Canadian citizen under 35 with two years' post-
graduate experience in nursing, you owe it to
yourself to en|oy two careers in one
Contact your nearest Canadian Forces
Recruiting Centre or write to:
Director of Recruiting and Selection
National Defence Headquarters
Ottawa, Ontario
K1A0K2
"m^
ASK US
ABOUT YOU
THE CANADIAN
ARMED FORCES
Dr. Bernstein points out the social importance of
beauty and body image, our repulsion from ugliness,
and our fear of the facially scarred. He writes of
"social death" of patients who cut themselves off
from medical contacts and friends, withdrawing from
the world to become shut-ins.
Today through greater education and exchange
of ideas and thoughts, we can learn as professionals
to understand and accept such traumatic injuries
and try to meet the needs of the patient and his
relatives.
Case histories of both patients and relatives in
Dr. Bernstein's book are excellent examples of
"listening " to ways in which all levels of personnel
can be more helpful and compassionate in their
care.
Nursing staff, who are the most involved in
direct personal care, give the greatest percentage of
time to burn patients in treatments, teaching, and
emotional support. Therefore nursing personnel
should understand the mechanisms of psychosocial
responses in their patients as well as in themselves.
A very important aspect of attitude in
inexperienced nursing personnel can be manifested
through nightmares, anxiety and feelings of
incompetence. These are not uncommon in the first
few months of working on a burn unit. Nursing staft
should be able to discuss these feelings and be
made aware that they will probably have them until a
more mature level of confidence is attained. Had I
read Dr. Bernstein's book a few years ago I know I
would have found it extremely valuable.
Through reconstructive plastic surgery,
planned social and physical rehabilitation, Jobst
pressure garments, and a tremendous amount of
caring and understanding, I hope our determination
will eliminate some of the anguish and emotional
scarring inflicted upon our patients.
Ivly only criticism of Dr. Bernstein's book is I
would like to have seen more follow-through
photographs of the pictures shown.
The book touches many pertinent areas:
the concept of appearance and society's
eactions to the "normal " and the disfigured
ways of coping with major changes in body
image and self representation
responses to disfigurement according to age
psychiatric care of the burned patient
burn care personnel and their attitudes
the burn patient in the family
routes to rehabilitation.
I would suggest this book should be read by all
members of the burn care team, especially burn
clinicians, head nurses, and post-graduate nurses
specializing in psychiatry or specialized trauma
units.
lyjay I also suggest we follow the author's
guidelines for more effective and comprehensive
care.
Human Development by Grace J. Craig. 497
pages. Englewood Cliffs, New Jersey,
Prentice-Hall, 1976.
Approximate price $12.95. '.
Reviewed by Jane Wilson, Richmond Hill,
Ontario.
Another general growth and development tf •
— how could it differ significantly from others?
The author proposes to depart from the conventiona
texts in two ways: firstly, the presentation of diverse
concepts regarding the human lifespan; and
secondly, the discussion of current issues relating tc
various stages of development, for example, genetic
counselling, early education, intelligence testing,
youth culture, "middle life crisis," retirement. I car
see the need for frequent revisions of the book as
current issues change.
The first section is devoted to an overview of
various theories of development and a review of the
The Canadian Nurse November 1977
biological, cognitive, social and emotional aspects of
development. This section takes up about one
quarter of the total text. The remainder of the book
follows the human lifespan, referring frequently to
issues and pertinent research. My only
disappointment with the content is the small
proportion devoted to middle age and old age, a
shortcoming I have noticed in other texts used for
education of nurses.
The format of the chapters is easy to follow;
topic and subtopic headings are printed in the
margin for quick reference. However, lines drawn
across the page between topics are distracting. The
photograpfis, all black-and-white or
brown-and-white, are often fuzzy or too dark.
Diagrams and charts are clear and useful. The
review questions are disappointing in that they ask
for verbatim repetition, only occasionally drawing
from the reader s experiences. Each chapter ends
with a short annotated list of suggested tradings.
Annotation in the extensive bibliography as well
would have been useful.
The subject matenal is concentrated
throughout: there is much essential information per
page. Supplementary readings would be necessary
to give interest and depth to the subject. I cannot see
the use of this book for a short overview course in
human development. However, it would be a
well-organized reference for these programs, and
an excellent basic text for in-depth studies.
Management of Hospitals by Rockwell
Schultz and Alton C. Johnson. Scarborough,
McGraw-Hill Ryerson, 1976.
Approximate price $14.25.
Reviewed by Janet Moore, Assistant
Professor, Faculty of Nursing, University of
Calgary, Calgary, Alberta.
"Management of Hospitals" by Schultz and
Johnson of the University of Wisconsin,
Madison, was designed for individuals involved in
the administration of hospitals, including medical
and nursing personnel, other professionals, staff
specialists, and department heads. In organization
the book uses a systems approach, focusing on the
health spectrum, hospital programs and staff,
transformation of inputs into outputs, and
environmental influences and constraints.
Part One considers the hospital as a subsystem
of the health care system. It sees the hospital as the
center of the health care system but suggests that
although it may be the center for treatment of the sick
and injured, most communities could play a larger
role in improving health.
Part Two describies the hospital as a system
composed of medical staff, nursing, and other
services, and the coordination of these services with
governing boards, administrators, and functional
specialists. These elements, together with patients
and their problems are inputs into the system. The
hospital must provide high-quality and efficient
service in order to transform the ill patient into one on
the road to recovery. This is the output.
Part Three examines the transformation of
inputs to outputs through management of quality,
management of costs, and management of conflict.
Part Four considers environmental influences
and constraints. Collective bargaining is discussed
as an important environmental influence effecting
the internal operation of the hospital. External
influences on the regulation of hospitals is
considered. A look to the future suggests
environmental changes that may have an influence
on hospital management.
This book could be suggested as a reference for
nursing faculty, as well as those nurses involved in
nursing administration. This is an organized
resource book, collating current thinking and
research in the administration of health care
institutions.
Geriatric Nursing by Alison Storrs, 220 pages.
London, Balli6re, Tindall, 1976.
Approximate price $1.60.
Reviewed by Donna Hinde, Instructor, Division
of Nursing, Mount Royal College, Calgary,
Alberta.
This book presents practical information which
serves as a useful guide to geriatric nursing
care.
It begins with a general discussion of several
modesof health care delivery for the elderly in Great
Britain, These include the use of day hospitals,
holiday beds (which allow families to have elderly
members admitted to hospital for short periods),
specialized treatment units such as geriatric
orthopedic wards, and of course, general geriatric
care nursing units.
The book goes on to discuss care of the elderly
in any setting, including assessment of common
health problems and diseases. The author
emphasizes preventive care for the elderly. Such
concerns as prevention of skin breakdown are
discussed as integral to good nursing care of the
elderly.
The problems of proper nutrition are covered in
depth and include information concerning special
needs of the elderly regarding diet.
A chapter on the incontinent patient
emphasizes the importance of patience and
understanding on the part of all staff in dealing with
this problem. Incontinence is categorized according
to cause; various practical approaches are
presented which can be used to deal with each
situation.
Of particular significance is the fact that the
author stresses careful medication of the elderly
several times throughout the book. The problems of
overmedication are considered. The author
emphasizes careful administration of drugs and
observation of effects of the drugs on the patient.
The author points out that nurses must recognize
that the aging body does not metabolize and excrete
drugs very well and thus drug toxicity is a common
problem in the elderly.
One chapter is entitled "Mental Disease" and
includes discussion of several diseases which
cause tjehavioral changes in the elderly (e.g. Stroke.
Chronic Brain Syndrome). Perhaps one
disadvantage of the book is that it attempts to label
most emotional reactions (e.g. Anxiety State,
Depression, Mania), an approach that does not give
much regard to the fact that the elderly often suffer
what appears to be mental or behavioral changes due
to isolation, sensory deprivation and loneliness. The
nursing role in dealing with such behavioral
problems could be more comprehensive, for it is in
this area that the nurse often needs assistance to
give helpful rehabilitative care to the elderly.
The author emphasizes that geriatric nursing is
not for everyone. She points out that the rewards of
geriatric nursing are much different than those of
acute care nursing. In discussing the long-term
geriatric patient, she discusses feelings nurses may
have when caring for an elderiy patient who seems
to make little or no progress in the terms that we
measure medical progress, i.e. "getting better."
However, the discussion includes a positive
approach to nursing the long-term patient which
looks at him as a human iDeing.
In summary, the book is a helpful digest of
information for nurses caring for elderly patients. It
uses a direct, realistic approach to patient problems.
It is easy to read and can t)e read in a short time in its
entirety, or chapters can be identified for quick
reference about a particular problem. Its concise
direct approach makes it a useful book for all levels
of staff caring for geriatric patients. *
Students & Graduates
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The Canadian Nurse November 1977
Lil>i-ary Ipdato
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, al,?o
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 giving author, title and item number in this
list.
If you vi(ish to purchase a book, contact your
local bookstore or the publisher.
Books and documents
1 . Acronyms, initialism, & abbreviations dictionary;
a guide to alphabetic designations, contractions,
acronyms, initialism, abbreviations, and similar
condensed appellations, Edited by Ellen T.
Crowley et al. 5th ed. Detroit, IWIich., Gale
Research, c1976. 3v. R
2. Augustin, P. Neurologie, par... et L, Hebert.
Pans, tvlasson, 1977. 203p. (Cahiers de
I'infirmi^re, 12).
3. Blondis, Marion Nesbitt. Nonverbal
communication with patients: back to the human
touch, by... and Barbara E. Jackson. Toronto,
Wiley, 1977. 110p.
4. Brun, B. Hematologie. Paris, Ivlasson, 1976.
126p. (Cahiers de linfirmi^re, 9).
5. Canada Safety Council. Dafa sheets:
occupational health and safety. Produced by the
Occupational Section of the... Ottawa, c1977. 1v.
(loose-leaf).
6. Colonna, L. Psychiatrie. Paris, f\/lasson, 1977.
143p. (Cahiers de I'infirmi^re, 17).
7. Conference on the theme Nursing of the future.
Uppsala, Jan. 20-21, 1977. Stockholm, Swedish
Nurses Association, 1977. Sponsors: Swedish
Committee on International Health and Welfare,
Swedish Nurses Association, University Hospital,
Uppsala. tVlain guest was Miss Dorothy C. Hall,
Chief Nursing Officer, Copenhagen, who
presented the "Medium-term programme in
nursing/midwifery in Europe". 91 p.
8. Conseil canadien d'agrement des h6pitaux.
Guide d'agrement des hopitaux. Toronto, 1977.
138p. R
9. Cope, Zachary. Florence Nightingale and the
doctors. Philadelphia, Lippincott, c1958. 163p.
10. Cunningham, Robert M. The holistic health
centres: a new direction in health care: an
experience report. Battle Creek, Mi., W.K. Kellogg
Foundation, 1977. 55p.
1 1 . The current industrial relations scene in
Canada 1977. W.D. Wood and Pradeep Kumar
editors. Kingston, Industrial Relations Centre,
Queen's University, 1977. 7 pts. in 1.
12. Darragon, Thierry. Reanimation. Paris,
Masson, 1977. 171p. (Cahiers de I'infirmiere, 18)
13. Dealing with death and dying. 2d. ed.
Jenkintown, Pa., Intermed Communications, 1976.
189p. (Nursing 77 Skillbook Series).
14. Elkins, Valmai Howe. The rights of the
pregnant parent. Ottawa, Waxwing Productions,
1976. 289p.
15. L'enfance handicap^e. Toulouse-Privat,
C1977. 416p
16. Epstein, Charlotte. Learning to care for the
aged. Reston, Va.. Reston Pub. Co., 1977. 219p.
17. Fream, William C. Wofes on obstetrics.
Edinburgh, Churchill Livingstone, 1977. 179p.
18. George, Anne. Occupational health hazards to
women-synoptic view. Ottawa, Advisory Council
on the Status of Women, 1976. 128p.
19. Gosciewski, F. William. Effective child rearing:
the behaviorally aware parent. New York, Human
Sciences, c1976. 158p.
20. Hasquart, Gilberte. Aspects economiques de
I'unite de soins hospitaliere. Paris, Editions
medicales et universitaires, 1976. 326p.
(Collection economie et sante).
21. Hubner, P.J.B. Guide de I'infirmiere pour la
surveillance des moniteurs cardiaques en centres
de soins intensifs. Paris, Maloine, 1977. 83p.
22. Huckbody, Eileen. Nursing procedures for skin
diseases. Edinburgh, Churchill Livingstone, 1977.
135p.
23. Illich, Ivan. Limits to medicine. Medical
nemesis: the expropriation of health. London,
Marion Boyars, 1976. 294p.
24. Keane, Claire Brackman. Saunders review for
practical nurses, by .. with a contribution by Verna
Jane Muhl. 3d ed. Philadelphia, Saunders, 1977.
490p.
25. Keywood, Olive. Nursing in the community.
London, Bailli6re Tindall, c1977. 21 2p.
26. Lemperi^re, T. Abrege de psychiatrie de
I'adulte, par... et A. Feline. Paris, Masson, 1977.
430p.
27. Lerch, Constance. Le nursing en maternite. 2
ed. Traduit de I'anglais par F. Polge d'Autheville et
R.H. Polge. SL Louis, Mosby, 1977. 439p.
28. Mager, Robert F. Comment definir des
objectifs pedagogiques. G. Decote. trad. Paris,
Bordas, 1975. "La premiere edition de ce livre est
parue sous le litre: Vers une definition des
objectifs dans I'enseignement. ' English Edition:
"Preparing instructional objectives. 1962 by
Fearon Publishers." 60p.
29. Manuila, A. Dictionnaire franqais de medecine
et de biologie. par... L. Manuila, M. Nicole et H.
Lambert. Paris, Masson, 1970-1971. 4v. R
30. The nurse's dilemma; ethical considerations in
nursing practice. Geneva, International Council of
Nurses; Florence Nightingale International
Foundation, c1977. 114p. (Project director:
Barbara L. Tate).
31. Nursing standards & nursing process, edited
by Marion E. Nicholls, Virginia G. Wessells.
Wakefield, Mass., Contemporary Publishing,
01977. 164p.
32. Payet, M. Les maladies d'importation , par... et
J. P. Coulaud. Paris, Masson, 1976. 119p.
33. Petit Larousse de la medecine sous la
direction du Professeur Andre Domart et du
Docteur Jacques Bourneuf. Paris, Librairie
Larousse, c1976. 842p. R
34. Physical illness and handicap in childhood: an
anthology of the psychoanalytic study of the child,
edited by Ruth S. Eissler, et al. New Haven,
Conn., Yale University Pr., 1977. 321p.
35. Psychoanalytic assessment: the diagnostic
profile. New Haven, Yale University, 1977. 372p.
36. Quinet, Felix. The role of the pay research
bureau and the process of technological change.
A paper by..., to the Collective Bargaining
Counterparts Conference, Nurses' Staff
Associations, Ottawa, October 19, 1976, Ottawa,
1976. 1v. (various pagings).
37. Registered Nurses' Association of British
Columbia. Quality assurance program; syllabus.
Approved by..., Vancouver, 1976. 98p.
38. Roberts, Florence Bright. Perinatal nursing;
care of the newborns and their families. New
York, McGraw-Hill, 1977. 282p.
39. Rosser, James. M. An analysis of health care
delivery, by... and Howard E. Mossberg. New
York, Wiley, c1977. 176p.
40. Sarano, Jacques. La relation avec le malade:
Obstacles et perspectives de la relation entre
soignants et soignes. Toulouse, Privat, c1977.
138p.
41 . Sexual behaviour in Canada: patterns and
problems. Edited by Benjamin Schlesinger.
Toronto, Univ. of Toronto Pr., c1977. 326p.
42. Stone, Leroy O. Canadian population trends
and public policy through the 1980s, by... and
Claude Marceau. Montreal. McGill-Queen's
University Press, 1977. 109p.
43. Tremblay, Brigitte Van Coillie. Guide pratique
de correspondence at de redaction. Quebec
(Ville), Editeur officiel du Qudbec, 1976. 201 p,
44. Verhonick, Phyllis J. ed. Nursing research II.
Boston, Little, Brown, c1977. 266p.
45. Wilson, Betty. To teach this art, the history of
the schools of nursing of the University of Alberta
1924-1974. Edmonton, Hallamshire Publishers,
C1977. 191p.
46. World Health Assembly, 30th, Geneva 16-20
May 1977. Procedural decisions, list of resolutions
and provisional records. Geneva, 1977. 1v.
(unpaged).
47. World Health Organization. The primary health
worker; working guide, guidelines for training,
guidelines for adaptation. Experimental edition.
Geneva, 1977. 338p.
48. Yearbook of international organizations, 1977.
Brussels. 1v. R
Pamphlets
49. American Association of Occupational Health
Nurses. A guide to interviewing and counseling
for the occupational health nurse. New York,
1977. 16p.
50. The American Nurses' Association.
Ovol 80
Tablets
Ovol 40
Tablets
Ovol
Drops
Antiflatulent Simethicone
INDICATIONS
OVOL is indicated to relieve bloating,
flatulence and other symptoms caused
by gas retention including aerophagia
and infant colic.
CONTRAINDICATIONS
None reported.
PRECAUTIONS
Protect OVOL DROPS from freezing.
ADVERSE REACTIONS
None reported.
DOSAGE AND ADMINISTRATION
OVOL 80 TABLETS
Simethicone 80 mg
OVOL 40 TABLETS
Simethicone 40 mg
Adults: One chewable tablet between
meals as required.
OVOL DROPS
Simethicone (in a peppermint flavoured
base) 40 mg/ml
Infants: One-quarter to one-half ml as
required. May be added to formula or
given directly from dropper.
tHORneR
V NV^it-ea. 0.:v .xiJ
The Canadian Nurse November 1977
57
ANA/MCH-NAACOG joint certification for the
recognition of professional achievement and
excellence in the practice of
maternal-gynecological-neonatal nursing, by...
and The Nurses Association of the American
College of Obstetricians and Gynecologists,
Kansas City, Mo., 1975.
51 . Grace, Helen K. Doctoral education in nursing:
an overview. Address presented at Rush
University. Chicago, University of Illinois, 1976.
24p.
52 Institute for Research on Public Policy.
Research program, 1976. Montreal, P.O.
53 Manitoba Association of Registered Nurses.
Continuing nursing education in Manitoba.
Position paper, Winnipeg. 1977. 8p.
54 New Brunswick Association of Registered
M"^ses. Submission to the Sub-Committee of the
ew Brunswick Health Services Advisory Council
on Mental Health Services. Fredericton, 1977.
,10p.
|55. The New Zealand Nurses' Association Inc.
[New directions in post-basic education Policy
iStatement on nursing in New Zealand. Wellington,
[N.Z., 1976. 39p.
,56. New Zealand Nursing Education and Research
: Foundation: Nursing Research Special Interest
■Section. Ethics of nursing research; approved by
New Zealand Nurses' Assoc. Wellington, 1977.
4p.
1 57. Occupations in medicine and health; a
bibliography of publications about careers in
Canada. Edited by James Huffman and Sybil
Huffman. Toronto, University of Toronto, Faculty of
Education, Guidance Centre, 1977. 29p. (Career
information Book 1 ).
|58. Ontario Hospital Association. Guidelines lor
'discipline procedure; a constructive approach to
isciplining employees. Toronto, 1977. 3p.
59. — . Report of the Ontario Hospital Association
competency model project. Toronto, 197V. 6p.
60. The Operating Room Nurses of Greater
Toronto. Standards of practice of operating-room
nursing. Toronto, 1976? 15p.
61. Organisation mondiale de la Sant6. Bureau
regional de lEurope. La planification de
I'education dans ses rapports avec la solution des
probl^mes de sant6; rapport dun groupe de
travail, Kuopio, 2-5 juin, 19^5. Copenhague, 1977.
62. Ozimek. Dorothy. Students have
responsibilities as well as rights, by... and Helen
Yura. New York, National League for Nursing, 1 977.
8p. (NLN Publication No. 15-1666).
63. Registered Nurses Association of British
Columbia. Guidelines for patient care in licensed
health agencies. Joint statement of British
Columbia Health Association, British Columbia
Medical Association, College of Physicians and
Surgeons of British Columbia, Nursing
Administrators' Association of British Columbia
and Registered Nurses Association of British
Columbia, Vancouver. 1977. 7p.
64. Registered Nurses Association of Ontario.
Statement on the clinical nurse specialist.
Toronto, 1976. 3p.
65. University of Minnesota Health Sciences
Center. Department of Nursing Services. Primary
nursing: a handbook for implementation.
Minneapolis, Mn., 1972. 27p.
Government documents
Canada
66. Advisory Council on the Status of Women.
Health hazards at work. Ottawa, 1977. 16p. (The
Person papers no. 7).
67. Bureau de la coordonnatrice. Situation de la
femme. Ressources federates pour la femme,
1977 . Ottawa, Ministre des Approvisionnements et
Services, 1977. 1v.
68. Bureau de Recherches sur les fraitements.
Commission des relations de travail dans la
fonction publique. Avantages sociaux et
conditions d'emploi au Canada; principaux points
des etudes conduites de 1967 ^ 1976 sur la
frequence des caract6ristiques et des couts.
Ottawa, 1977. 113p.
69. Institute for Scientific and Technical
Information. Report, 1974-1977. Ottawa, National
Research Council of Canada. 1977. 42p (NRC no.
16014).
70. Conseil 6conomique du Canada. La
population active et les politiques economiques —
une analyse econometrique , par Tom Siedule.
Ottawa, 1976. 99p.
71 . Economic Council of Canada. The impact of
economy-wide changes on the labour force: an
econometric analysis, by Tom Siedule. et al..
Ottawa, Economic Council of Canada, 1976 94p.
72. Health and Welfare Canada. Long Range
Health Planning Branch and Non-Medical Use of
Drugs Directorate. Smoking and health in Canada.
Ottawa, 1977. 160p. Health and Welfare Canada.
Staff papers. Long Range Health Planning (77-3).
73. Institut canadien de I'information scientifique et
technique. Rapport 1974-1977. Ottawa. Conseil
national de recherches Canada, 1977. 42p. (NRC
no. 16014).
74. Office of the Co-ordinator. Status of Women:
Federal sen/ices for women, 1977. Ottawa,
available from Minister of Supply and Services. 1v.
75. Law Reform Commission. Report on evidence.
Ottawa Minister of Supply and Services, 1977.
76. Pay Research Bureau. Public Service Staff
Relations Board. Employee benefits and
conditions of employment in Canada; highlights of
studies on prevalence, characteristics and costs
from 1967 to 1976. Ottawa, Supply and Services
Canada, 1977. Hip.
LAST
THING HE
NEEDS
IS GAS.
When a patient can't
move around, gas can be
a problem, and a painful
one at that. So for pa-
tients who are immobile
following surgery or for
post-cholecystectomy
patients, give them extra
strength OVOL 80, the
chewable antiflatulent
tablets that work fast to
relieve trapped gas and
bloating.
OHORRER
Mor-trftal Canada
Product monograph
available on request.
The Canadian Nurse November 1977
77. Sante et Bien-Stre social Canada. Direction
g^neraie de la planification ^ long terme (sant6).
Le tabac et la sante au Canada, par... et al.
Ottawa, 1977. 175p.
78. — . Directeur general des programmes.
Formation medicale en geriatrie: rapport d'un
groupe de travail mis sur pied par la direction des
normes sanitaires et des experts-conseils .
Ottawa, 1977. 45p. (Main-d'oeuvre sanitaire
rapport no 1-77).
79. Statistics Canada. Hospital morbidity, 1974.
Ottawa, Statistics Canada, 1977. 1v. Catalogue
no. 82-206.
80. — . La morbidite hospitaliere, 1974. Ottawa,
Statistique Canada, 1977. 1v. Catalogue no.
82-206.
81. — . Traitement annuel du personnel infirmier
des hopitaux, 1974. Ottawa, 1977. 1v.
82. Dominica, Laws, statutes, etc. Nurses
registration. Laws of Dominica. 1961. CH. 152.
Rev. Dominica, West Indies; London, England,
1963. p. 1391-1397, 791-806.
Great Britain
83. Dept. of Health and Social Security. Report on
departmental researcli and development, 1975.
London, H.N.S.O., 1976. 1v.
Quebec
84. Service de protection de I'environnement.
Rapport, 1975-76. Quebec (Ville). 1v.
Scotland
85. Home and Health Department. Wurse staffing
(community) survey of book of tables. Edinburgh,
HMSO, 1976. 67p. (Its. Nursing manpower
planning report no. 4).
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86. — . A profile of qualified nurses working in ttie
Scottisfi community nursing service in 1973.
Edinburgh, HMSO, 1976. 24p. (Its Nursing
manpower planning report no. 7).
Studies deposited in CNA
Repository Collection
87. Bonin, Marie A. Sister. Trends in integrated
basic degree nursing programs in Canada
1942-1972. Ottawa, 1976. 546p. Thesis —
Ottawa, Author was CNF scholar. R
88. Castonguay-Souillac, Jeannine. Etude d'un
aspect de la communication entre I'infirmiere, le
malade et sa famille. Montreal, c1974. 70p. Th6se
(M.N.) Montreal. R
89. Doherty, M. Grace. Early identification of
developmental impairments in infants from birth to
nine montfis of age. Vancouver, c1976. 89p.
Thesis (M.Sc.N.) — British Columbia. R
90. Du Mont, Gertrude. Cholinergic nursing care
for high risk infants. Vancouver, 1975-76. 39p. R
91 . — . Les soins infirmiers cholinergiques pour
les bebes en detresse. Vancouver, 1975-76. 41 p.
R
92. Dupuis, Helen. A study to examine the rectal
temperatures of normal newborns in the
immediate neonatal period , by... Ellen Rosen and
Nina Wichman, London, Victoria Hospital, 1977.
14p. "A study conducted as members of the
Nursing Research Committee, Victoria Hospital,
London, Ont". R
93. Fitch, Margaret Isabell. The communication
process and patients' perceptions while receiving
mechanical ventilatory assistance. Toronto,
C1977. 116p. Thesis (M.Sc.N.) — Toronto. R
94. Humanisation des soins aux salles d'urgence
et aux cliniques externes. Montreal, Association
des Hdpitaux de la Province de Quebec, 1974.
lOlp. R
95. Maccan, Ivy, Sister. Report of survey of unmet
health needs of an age group sample 65 years
and older within the town and county of
Antigonish, Nova Scotia, Antigonish, N.S., Sisters
of St. Martha, 1976. 77p. R
96. Picard-Grondin, Monique. Etude des
interventions therapeutiques de I'infirmiere face
au couple agressif: perception du couple.
Montreal, 1974. 113p. Th6se (M.N.)-Montreal. R
97. Saskatchewan. Department of Continuing
Education. Research and Planning Branch.
"Special" fifteen month follow-up study of the
1975 graduates of the certified nursing assistant,
diploma nursing, and psychiatric nursing
programs of Kelsey and Wascana Institutes.
Prepared by Barbara Hauser. Regina, 1977. 73p.
R
98. — . "Special" three-month follow-up study of
the 1976 certified nursing assistant, diploma
nursing and psychiatric nursing graduates of
Kelsey and Wascana Institutes. Prepared by
Barbara Hauser. Regina, 1977. 73p. R
99. Saskatchewan. Department of Continuing
Education. Research and Evaluation Branch.
"Special" three month follow-up study of 1975
Saskatchewan nursing program graduates.
Prepared by Glenn M. Belsey. Regina, 1977. 60p.
R
100. Storch, Janet L. Consumer rights and
nursing. Edmonton, 1977. 235p. Thesis (M.H.S.A.*
— Alberta. R
Audio-visual aids i
101. Canadian Nurses Association. General
meeting. Ottawa. Inarch 31, 1977. Record of
annual meeting and program. 6 audio tapes. 5
reel. 3 3/4 ips. 2 tracks. 420 min. R
102. Emory, Florence. Faculty status for university
schools of nursing education. Tape interview by j
Verna Huffman Splane and Helen Mussallem, j
1977. 1 audio cassette. 60 min. R
I ne wartaoian nurae
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Advert isiMiKMiLs
British Columbia
British Columbia
British Columbia
Bctor of Nursing required for 192-bed intermediate (chronic) care
ic ity in the balmy mtenof of B C The successful applicant will be
^>onsible for all nursing services. We offer a mutti-discipinary ap-
ii to resident care and program development m this intriguing
of health care. Appicants should have ai least 5 years former
Liperveory experience and some post-graduate tramirig
^ary S21.000 00 Complete resume of experience, qualifications
■ references to Mr H Bohm. Administrator Ponderosa Lodge,
Columbta Street. Kamloops. British Cofcimbta. V2C-2T4.
El Nurse required for a 41 -bed unit m our Health Centre for
en Patents ages range from ne^jom to early adolescence and
ly have a neurosurgical or neurological diagnosis. Head Nurse
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are (due to aget admitted to other units Applicants should have
Nnpetence m the field of pediatnc neurology arxj neurosurgery
ly to: Vancouver General Hospital. Employee Relations Depan-
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Nurses — The Bntish Columbia Pubhc Service has vac-
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are m mental health, mental retardation, arxj psycho-
nstitutions Salanes and fnnge benefits are competitive —
,184 to Si. 399 tor Nurse 1 CanatJan citizens are given prefererKe.
led applicants may contact the: Pubic Service Commission,
lew Lodge. Essondale, Bntish Columbia VOM 1J0. Quote
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tive Action. Title IX Employer
Registered Nurses (or Florida: Immediate hospttal openings in
Miami, Fort Lauderdale, Palm Beach and Stuart Nurses needed for
Cntical Care. Medicai-Surgicai, Pediatrics. Orthopedics and Operat-
ing Room We will provide the necessary work visa. No fee to applic-
ant Write Medical Recruiters of America, Inc., 800 N W. 62nd St..
Ft. Lauderdale, Flonda 33309. USA, (305) 772-3680.
Nurses — RNs —Immediate Openings in California -Florida —
Texas — Mississippi — if you are experienced or a recent Graduate
Nurse we can offer you positions with excellent salanes of up to Si 300
per month plus all benefits Not only are there no fees to you what-
soever for plaang you , but we also provide complete Visa and Licen-
sure assistance at also no cost to you Wnte immediately for our
application even if there are other areas of the US that you are
interested in We will call you upon receipt of your application m order
to arrange for hospital interviews Windsor Nurse Placement Service.
P.O Box 1133, Great Neck, New York 11023 (516-487-28181
Our 20th Year of World Wide Service
The best location in the nation — The wo rid- renowned Cleveland
Clnic Hospital, a progressive. i020-bed acute care teaching facility
committed to excellence m patient care currently has staff nurse
positions available m several of our 6 iCUs and 30 departmentalized
med'Surg and speaalty divisions Starting sal«iry range is Sl2.454to
S14.300. plus premium shift arxJ unit differential, progressive benefit
package and a comprehensive 7 week onentation For further infor-
mation contact Director — Nurse Recruitment, The Clevelarxl Clnic
Foundation. 9500 Eucid Avenue. Clevelarxl, Ohio 44106. or caR
collect 216-444-5865.
Come to Texas — Baptist Hospital of Southeast Texas is a 400-bed
growth oriented organization kx)king for a few good R.N.'S- We feel
that we can offer you the challenge and opportimty to devetop and
continue your professional growth We are kx;ated in Beaumont, a city
of 150,000 with a small town atmosphere but the convenience of the
large city We re 30 minutes from the Gulf of Mexico and surrounded
by beautiful trees and inland lakes. Baptist Hospital has a progress
salary plan plus a bberal fringe package. We wiH provide your immigra-
tion paperwork cost plus airtare to relocate For additonai information,
contact: Personnel Administration. Baptist Hospital of Southeast Te-
xas. Inc , P. O Drawer 1591 , Beajmont. Texas 77704. An affirma-
tive action employer.
Registered Nurses for Texas. Louisiana and Arkansas: Hospital
openings m Texas, pnmanly m the Dallas and Houston areas Other
opportunities available m Louisiana and Arkansas Nurses needed m
all speaalties — Cntical Care. Medical Surgical. Operating Room.
Emergency Room arx3 Pediatncs We will provide necessary work
visa. No fee to applicant. Wnte Medical Recruiters of America, 3635
Lemmon Avenue. Suite 304. Dallas. Texas 75219. (214) 521-4261.
The Canadian Nurse November 1977
Foothills Hospital, Calgary,
Alberta
Advanced Neurological-
Neurosurgical Nursing
for Graduate Nurses
A five month clinical and academic
program offered by Tfie Department of
Nursing Service and Thie Division of
Neurosurgery (Department of Surgery)
Beginning: March, September
Limited to 8 participants
Applications now being accepted
For further information, please write
to:
Co-ordlnator of In-service Education
Foothills Hospital
1403 29 St. N.W. Calgary, Alberta
T2N 2T9
UNITED STATES
OPPORTUNITIES
FOR REGISTERED NURSES
AVAILABLE NOW
IN CALIFORNIA
FLORIDA
MISSISSIPPI
NEW ORLEANS
TEXAS
WISCONSIN
WE PLACE AND HELP YOU WITH:
STATE BOARD REGISTRATION
YOUR WORK VISA
TEMPORARY HOUSING - ETC.
A CANADIAN COUNSELLING SERVICE
Phone: (416) 449-5883 OR WRITE TO:
RECRUITING REGISTERED NURSES INC.
1200 LAWRENCE AVENUE EAST, SUITE 301,
DON MILLS, ONTARIO M3A 1C1
JURIST
NO FEE IS CHARGED
TO APPLICANTS.
OPEN 7 DAYS A WEEK.
Assistant Director
of Nursing
Assistant Director of Nursing
required for accredited 160-bed
general hospital in northern
Newfoundland.
Active registration with ARNN,
post-basic preparation,
preferably baccalaureate in
nursing. Desirable combination
of training and experience.
Salary: $16,115.00 —
$20,567.00 per annum.
Apply to:
Mr. Lloyd Handrigan
Personnel Director
Curtis Memorial Hospital
International Grenfell Association
St. Anthony, Newfoundland
AOK 480
NURSE/MIDWIVES
required immediately for accredited
160-bed hospital In northern
Newfoundland.
Also nurses required for nursing
stations in Labrador.
Nursing duties include clinic, health
care and education work in isolated
settlements. Diploma In outpost
nursing, community health, public
health, nurse practitioner or
experience In nursing In isolated
communities required. Subsidized
accommodation, fringe benefits,
salary In accordance with collective
agreement.
Apply to:
Lloyd Handrigan
Personnel Director
International Grenfell Association
St. Anthony, Newfoundland AOK 4S0
Fishermen's
IVIemorial Hospital
requires
One(1) "Operating Room Technician"
Operating Room Technician General
Duty OR
One (1) "Operating Room Nurse"
Registered Nurse General Duty OR
Post Graduate desirable, however, all
applicants will be considered.
Please address all inquiries to:
Director of Nursing
Fishermen's Memorial Hospital
Lunenburg, Nova Scotia
NURSE PRACTITIONER
PROGRAM — NURSING
DIRECTOR/CO-ORDINATOR
THE UNIVERSITY OF ALBERTA
Applications are being accepted for the above
position. Ttie program is funded by the Federal
Government and based at the University of Alberta.
The major responsibility of the position is
co-ordination of the program with opportunities for
some classroom and clinical teaching.
Requirements:
R.N.
A B.Sc.N.
Graduate of a Nurse Practitioner Program
and/or Nursing Station experience
Send curriculum vltae to:
Nurse Practitioner Program
3-103 Clinical Sciences Building
The University of Alberta
Edmonton, Alberta, T6G 2G3
This appointment would commence in January, 1978 on
confirmation of funding. Salary negotiable.
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
Closing date for copy and
cancellation is 6 weeks prior
to 1st day of publication
month.
The Canadian Nurses
Association does not review
the personnel policies of the
hospitals and agencies
advertising in the Journal.
For authentic information,
prospective applicants
should apply to the
Registered Nurses'
Association of the Province
in which they are interested
in working.
Address correspondence
to:
The Canadian
Nurse
50 The Driveway
Ottawa, Ontario
K2P 1E2
ine l,anaaian Nurse November 1977
ot
*<e
•re'
pfOOf »"',!'■" tunctton
,nW»«'"°"
ottW
otW
,ver^c»l»JT.''n o««
Y«,rm»n"
Hermaiin
become
part of
aveary
specim
team!
Nurses ioin us and Cathy in a course toward leadership in progressive total patient care. You will have the 'FREEDOM TO BE" the nurse you
want to be
Located in the famed Texas Medical Center, we are the primary teaching facility for the University of Texas Medical School at Houston You'll
find this teaching and research atmosphere conducive to informal conferences about patient care goals or new developments The learning
environment includes a wide range of Inservice programs, and for the new graduate, a comprehensive 6-month intern program Continuing
education programs are available through our Career Development system and there are many major universities located m and around
Houston
Join us as we grow Were expanding from 500 beds to 1 .000 beds opening career opportunities at all levels and m all Nursing specialties We
have 1 9 OR Suites. Renal Transplant Unit. Psychiatric and Neuro Units, a Children's Center. Orthopedics. Ophthalmology. Pediatric ICU,
Neonatal ICU, Burn Unit and more.
Discover Houston a city with an unlimited future. A city alive. We are now the 5th largest city in the US and growing Discover non-stop
nightlife, culture, sports. Discover year round recreational activities on nearby beaches, inland lakes and rivers— all an easy drive away
Discover lower cost of living and no local or state income taxes that make it more than comfortable to pursue your profession
You'll find the salary program is more than competitive and we offer a comprehensive benefits package which includes 3 weeks paid vacation.
refresher training programs, relocation assistance, one month free rent, and tuition reimbursement If you are an experienced, professional
nurse, we would like to discuss the opportunities now available for you m our Primary Nursing programs For more information about
Hermann Hospital, mail coupon to or call Ms. Beverly Preble. Nurse Recruiter. 1203 Ross Sterling Avenue, Houston. Texas 77030 (713) 797-
3000-
An equal opportunity employer m/f .
Name.
Clty_
-State-
_2ip_
PhOCM .
Specific ATM ot IntarMi
(drcta) RN
NURSE INTERN
CN 11/77
'^O.VTl'*^'
Ffermann
Hospital
The Canadian Nurse November 1977
HEALTH PROMOTER
St. Anthony, Newfoundland
Required immediately. Challenging position. Opportunity to
)0in expanding public health team developing a
comprehensive programme lor residents m northern
Newfoundland and Labrador served by the Grenfell
Association,
Responsibilities include assessing community health
educational needs, developing and evaluating individual.
group, and community health promotion resources and
programmes acting as resource person m health education,
stimulating and assisting others who are m a direct teaching
role.
Will be responsible to the medical health officer.
Considerable travel by air to points served. Position
demands initiative, self-reliance, resourcefulness, and the
ability to dialogue with community members, groups and
health professionals. Salary based on qualifications and
experience
Applicant should have bachelor or masters degree m either
health, social sciences or education with applicable
experience in health or related field (adult education or
community development).
Apply to:
Mr. Lloyd C. Handhgan
Personnel Director
International Grenfell Association
Curtis Memorial Hospital
SL Anthony, Nfld., AOK 4S0
Co-Ordinator
Obstetrics, Gynaecology, Nursery,
Delivery and Pediatrics
Applications for the above position are
now being accepted by this 300-bed
accredited general hospital.
Baccalaureate Degree in Nursing and
experience in these areas preferred.
We offer an active staff development
programme, competitive salaries and
fringe benefits based on educational
background and experience.
Apply sending resume to:
Director of Personnel
Stratford General Hospital
Stratford, Ontario
N5A 2Y6
INTERNATIONAL
NURSING
ASSIGNMENTS
Nurses are needed to teach student
nurses and to work in public health
nursing projects in Ghana, Sierra Leone
and the Sudan.
Community health nursing
responsibilities may include supervision
of clinics and planning with health workers
for the instruction of mothers in child
development, hygiene, nutrition-local
food demonstrations and communicable
disease control.
For more Information about CUSO
assignments please contact:
CUSO Health — 11
151 Slater Street
Ottawa, Ontario
K1P5H5
COMMUNITY HEALTH
NURSES TAKE NOTE!
A JOB OFFER TOO GOOD
TO REFUSE
Assistant Supervisor of Nurses
(Salary — $16,500 — $20,000)
This position offers a cfiallenge to tfie nurse who enjoys
creative program developmenl,
DUTJES
• To assist with the supervision of the 17 nurses
serving Grande Prairie and surrounding distnct.
• In consultation with the nursing personnel, to plan
and implement a program of staff development
• To take part in a management team s effort to build an
effective preventative health program.
QUALIFICATIONS
B Sc-N or diploma in community nursing with several
years expenence as a community health nurse.
Supervisory experience an asset. Experience in rural
areas is desirable but not required.
Forward resume to:
Administrator, Grande Prairie Health Unit
9640 — 105 Avenue
Grande Prairie, Alberta T8V 385
or call collect: (403) 532-4441.
McMASTER UNIVERSITY
EDUCATIONAL PROGRAM
FOR NURSES IN
PRIMARY CARE
McMaster University School of Nursing In
conjunction with the School of tvledicine,
offers a program for registered nurses
employed in primary care settings who
are willing to assume a redefined role in
the primary health care delivery team.
Requirements Current Canadian
Registration. Sponsorship from a medical
co-practitioner. At least one year of work
experience, preferably in primary care.
For further information write to:
Mona Callin, Director
Educational Program for Nurses
in Primary Care
Faculty of Health Sciences
McMaster University
Hamilton, Ontario L8S 4J9
Applications for the
position of
Supervisor
Operating Room and
Recovery Room
are now being accepted by this
300 bed fully accredited hospital.
We offer an active staff
development programme.
Salaries and fringe benefits are
competitive, based on
educational background and
experience. Temporary
accommodation available.
Apply sending complete
resume to:
The Director of Personnel
Stratford General Hospital
Stratford, Ontario
N5A 2Y6
CO-ORDINATOR OF
PUBLIC
HEALTH NURSING
SERVICES
St. Anthony, Newfoundland
Required immediately. A challenging senior
position. Responsible to the medical health officer
co-ordinating all public health nursing activities in
northern Newfoundland and Labrador served by the
Grenfell Association. Position involves
considerable travel by aircraft. Duties involve the
planning, administering and evaluating of public
healtti nursing activities in co-ordination with other
members of the health team.
Qualifications: masters or bachelor degree in
nursing with major emphasis on public health
nursing and administration. Experience in various
supervisory positions in public health nursing.
Salary commensurate with experience and
qualifications. Apply to:
Mr. Lloyd Handrlgan
Personnel Director
International Grenfell Association
Curtis Memorial Hospital
St. Anthony, Nfld., AOK 480
South Okanagan General Hospital
Oliver, British Columbia
Nurses
Registered nurses required for a new
75-bed extended care unit, located in
the vacationing and fruit growing
area of the South Okanagan.
This unit is to open in March 1978.
Applicants please apply to:
Mrs. D. Bonnett
Director of Nursing
South Okanagan General Hospital
Box 760
Oliver, British Columbia
V0H1T0
Public Health Nurse
Wanted
Position:
Community Human Resources and
Health Centre in a young, dynamic mining
community requires a Public Health
Nurse to provide statutory and other
health services in the communities of
Granisle and Topley.
Salary:
Salary and tsenefits according to RNABC
contract.
Apply to:
The Co-ordinator
Granisle Community Human
Resources and Health Centre
Box 219
GRANISLE, B.C.
V0J1W0
Telephone: 697-2251 collect
DIRECTOR OF NURSING
Applications are invited for this Senior
Administrative position in a 330 bed acute
care general hospital.
Previous experience and post-graduate
training are required, and applicant must be
eligible for registration in Saskatchewan.
Interested applicants should submit a
resume of educational and supervisory
experience to:
Executive Director,
St. Paul's Hospital (Grey Nuns')
of Saskatoon,
1702 — 20th Street, West,
SASKATOON, Sask. S7M 0Z9
me ^anaoian r«urse novemoer ^vff
DALHOUSIE UNIVERSITY
School of Nursing
Faculty positions will be available in this School of Nursing
within the Faculty of Health Professions for 1978/79 in the
following programnnes:
Masters Degree
Baccalaureate Four Year Basic Degree
Baccalaureate Three Year Post R.N. Degree
Applicants, preferably with doctoral or masters degree
qualifications, are invited to apply for these appointments.
Specialization in mental health, community health, adult or
child health will be required. Previous experience in teaching
and clinical nursing will be an advantage.
One or two short term appointments to replace faculty on
leave of absence may also be available.
Level of appointment and salary will be commensurate with
qualifications and experience.
Apply to:
Dr. Margaret Scott Wright
Professor and Director
School of Nursing
Dalhousle University
Halifax, Nova Scotia B3H 4H7
McGILL UNIVERSITY
SCHOOL OF NURSING
ANNOUNCING A NEW PROGRAM FOR REGISTERED NURSES
BACHELOR OF SCIENCE IN NURSING
This program has been developed for graduates of
nursing programs located in Community Colleges,
Colleges of Applied Arts and Science, Colleges of
General and Vocational Education or other similar
post-secondary institutions.
Preparation for leadership roles in nursing practice
within the developing health care delivery system is
provided. This includes primary care nursing in
community-based facilities and programs as well as all
phases of acute care within the network of McGill
teaching hospitals.
Length of Program: 3 years
Language of Study: English
Satisfactory Record of Employment as R.N. Required.
Due to variation in college-based programs,
applicants should inquire for detailed information
on prerequisite courses and application forms
from:
Admissions Office
McGill University — Administration BIdg.
845 Sherbrooke West
Montreal, Quebec, H3A 2T5
The Canadian Nurse November 1977
can go a long way
...to the Canadian North in fact!
Canada's Indian and Eskimo peoples in the North
need your help. Particularly if you are a Community
Health Nurse (with public health preparation) who
can cany more than the usual burden of responsi-
bility. Hospital Nurses are needed too... there are
never enough to go around.
And challenge isn't all you'll get either — because
there are educational opportunities such as in-
service training and some financial support for
educational studies.
For further information on Nursing opportunities in
Canada's Northern Health Service, please write to:
Medical Services Branch
Department of National Health and Welfare
Ottawa, Ontario K1A0L3
Name
Address
City
l«
Prov.
Health and Wellatu
Canada
Sant6 et Bien-etre social
Canada
Index to
Advertisers
November 1977
Abbott Laboratories
Cover 4
The Canadian Nurse's Cap Reg'd
55
Connaught Laboratories Linnited
10, 11
Department of National Defence
54
Equity Medical Supply Company
8
Flint Laboratories of Canada
49
Hollister Lfmited
9
Frank W. Horner Limited
56,57
Lowell Shoe Inc.
Cover 3
MPP Nursing Services
53
The CM. Mosby Company Limited
50,51
Nordic Pharmaceuticals Limited
58
Reeves Company
13
W.B. Saunders Company Canada Limited 47
Standard Brands Canada Limited
5
White Sister Uniform Inc.
Cover 2
Advertising
Gerry Kavanaugh
The Canadian Nurse
50 The Driveway
Ottawa, Ontario K2P 1 E2
Advertising Representatives
Richard P. Wilson
219 East Lancaster Avenue
Ardmore, Penna. 19003
Telephone; (215) 649-1497
Gordon Tiffin
2 Tremont Crescent
Don Mills, Ontario MSB 281
Telephone; (416) 444-4731
Member of Canadian
Circulations Audit Board Inc.
s
I
Heart-Throb
Why walk
when you can float?
Shoes are foi' walking. Sweethearts are for floating.
Sweethearts, the lightest, most comfortable shoe
on earth. And off!
Floating across this page is the Heart-Throb. The soft
tie shoe with sleek snake-stitch trim. All our lightweights,
above and below, are made of glove white leather with
the exclusive, specially
constructed Sweethearts
sole. The only sole to
wear a little blue heart.
If you'd like to float
through your day, get to-
gether with Sweethearts
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For the individualist
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Lowell Shoe, Inc., 95 Bridge Street, Lowell, MA 01852, U.S.A. Dept.CXll
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the original and universally accepted
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-■no. T. M.
^Ho eawBMdiawB
December 1977
i HRS EP MCCUh
^78
, 58 hA«MER AVE N APT 3
I
1/
/
^
/
Zhe season 's best wishes to you
and your entire staff who give patience and
understanding all year 'round.
Your Clinic Shoemal<er
tHe enwBadinn,
nwBmmo
December, 1977
The official journal of the Canadian
Nurses Association published
monthly in French and English
editions.
Volume 73, Number 12
^^^^^^^^^^^^^^B
Input
4
News
8
Names
14
Calendar
15
Research
44
Books
45
Frankly Speaking:
Dear Mr. Rajabally
G. Prowse, J. de Cangas
B. Boyle, J. Murthy, 1. Sebum
6
Library Update
47
Four Score and Ten: Part Three
Maude Wilkinson
16
Annual Index
55
A School Screening
Program That Works
Jean F. Gurr
24
Why Nursing?
D. J. Loree, 1. Leclde
30
Flying to Work
Janet Mclvor
34
Clinical Wordsearch # 9
Mary Bawd en
37
Spouses Need Nurses Too
Mary Cipriano Silva
38
Murphy's Glue
Laura Hall
42
The winter woods are full of
Christmas trees, and all December
stars are Christmas stars. Our
December cover photo is courtesy
of National Film Board of Canada,
Phototh6que.
The views expressed in the articles
are those of the authors and do not
necessarily represent the policies of
the Canadian Nurses Association.
ISSN 0008-4581
Indexed in International Nurcing
Index. Cumulative Index lo Nursing
Literature. Abstracts of Hospital
Management Studies, Hospital
Literature Index. Hospital Abstracts,
index Medicus. The Canadian Nurse
IS available in microform from Xerox
University Microfilms, Ann Arbor.
Michigan, 48106,
Trie Canadian Nurse welcomes
suggestions for articles or unsolicited
manuscripts. Authors may submit
finished articles or a summary of the
proposed content Manuscripts should
be typed double-space. Send onginal
and carbon. All articles must be
submitted for the exclusive use of The
Canadian Nurse. A biographical
statement and return address should
accompany all manuscripts.
Subscription Rates: Canada: one
year, S8.00: two years, SI 5.00.
Foreign: one year, S9.00; two years,
SI 7.00. Single copies: Si 00 each.
Make cheques or money orders
payable to the Canadian Nurses
Association.
Change of Address: Notice should be
given in advance. Include previous
address as well as new, along with
registration number, in a provincial/
terntorial nurses association where
applicable. Not responsible for
journals lost in mail due to errors in
address.
Postage paid in cash at third class rate
Montreal, P.O. Permit No. 10^1.
* Canadian Nurses Association "
1977.
q5^ Canadian Nurses AssociaL
*^ 50 The Driveway, OttawM
K2P1E2. "^
ladc.
The Canadian Nurse December 1977
Herein
Tinker, tailor, soldier, sailor ... what
made you decide to become a
nurse? Most of us, according to
manpower experts, just sort of slide
into a career — or out of it, as the
case may be. Two professors at the
University of New Brunswicl<,
pwever, decided last year to tal<e a
ser look at why young people in
province were deciding to enter
The story about what they
legins on page 30 of this
In the past five years, McMaster
University Medical Centre in
Hamilton, Ontario has developed a
different approach to the head nurse
role. People there have successfully
combined the traditional roles of
head nurse and supervisor to create
a "middle manager," known as the
Patient Care Coordinator. Next
month, author Aileen McPhail
describes the McMaster set up, the
job of the middle manager , and how
it all works. As well, four PCC's talk
atXDut their new role.
Life and death is what nursing is all
about so it's not surprising that the
one question that sooner or later
every nurse must face is her legal
and ethical involvement with a
patient who is terminally III. Next
month, author Gilbert Sharpe, legal
counsel for the Ontario Ministry of
Health, shares his ideas about
euthanasia, living wills and the legal
responsibility of health professionals
in "Listening for the death-bells."
Editor
M. Anne Hanna
Assistant Editors
Lynda Fitzpatrick
Sandra LeFort
Production Assistant
Mary Lou Oownes
Circulation Manager
Pierrette Hotte
Advertising Manager
Gerry Kavanaugh
CNA Executive Director
Helen K. Mussallem
The Canadian Nurse December 1977
Discover the latest methods
in outstanding
MARLOW: Textbook of Pediatric Nursing,
New 5th Edition
Marlow is a book nursing educators everywhere know and trust
for the complete coverage of the nursing care needs of children
from birth through adolescence. New illustrations, including color
plates, and new topics such as Fetal Alcohol Syndrome, Genetic
Counseling and the Nurse. Rape, Hypertension, and Reyes Syn-
drome make this new 5th edition even more valuable to you.
By Dorothy R. Martow, RN, EdD, formerly Dean and Prof, of Pediatric
Nursing, Villanova Univ. 927 pp. About 395 ill. $18.65. July 1977.
Order #6099-1.
DuGAS: Introduction to Patient Care, New 3rd
Edition
This brand new edition contains additional material on the health
care system, major health problems, and the role of the nurse.
Entirely new chapters on Nursing Practice, Communication Skills,
and Sensory Disturbances, more than 70 new photographs, and its
considerably expanded glossary make this revision an even better
introduction to the fundamentals of nursing.
By Beverly Witter DuGas, RN. MN. EdD. Health Science Educator, Pan
American Health Organization, Barbados. 686 pp. 218 ill, $14.25. June
1977. Order #3226-2.
LUCKMANN a SORENSEN: Medical-Surgical
Nursing
This text contains 1,634 pages of vital, accurate information on
effective patient care. It clearly and lucidly presents both the
"thinking" and "doing" components of today's medical-surgical
nursing practice. Points of particular interest are summarized
and highlighted with arrows and boxes to facilitate review. Cover-
age in three sections includes genera/ concepts, theories of dis-
ease and causation, and the patient's emotional response to
illness: the body's response to psychologic and physiologic imbal-
ances; and the nursing and medical care of patients experiencing
specific disturbances of the total body or of particular systems.
By Joan Luckmann, RN, BS. MA: and Karen Creason Sorensen, RN. BS.
MN. 1634 pp.. 422 ill. $23.95. Sept. 1974. Order #5805-9.
SAUVE & PECHERER: Concepts and Skills in
Physical Assessment
This book can save you valuable time in learning the basics of
physical examinations. It's a modular syllabus for self-study (with
instructor guidance). Each of its 23 units includes a pre-test,
glossary, clinical component, a self-test, response sheets, and
handy reference cards for use during actual examinations. This
outstanding text is a perfect adjunct to a wide range of learning
activities. An Instructors Guide will be available.
By Mary Jane Sauve, RN, BSN, MSN, Asst. Prof, of Nursing, Calif. State
College. Sonoma. Rohnert Park; and Angela R. Pecherer, RN, BSN, MSN,
Asst. Prof of Nursing Education. Intercollegiate Center for Nursing Educa-
tion, Spokane, Wash. 427 pp. Soft cover. $12.05. Feb. 1977.
Order #7939-0.
ROBINSON: Psychiatric Nursing as a Human
Experience, New 2nd Edition
A popular text, well known and respected for its humane concerns,
Psychiatric Nursing as a Human Experience will be more interesting
and informative in its new 2nd edition. It has been substantially
expanded, and now offers totally new chapters on Human Sexual-
ity, Psychosomatic Illness, Antisocial Personalities, Family
Therapy, and Group Therapy. In addition, material on transactional
analysis has been added throughout, and the excellent bibliog-
raphies have been thoroughly revised.
By Lisa Robinson, RN, PhD. Univ. of Maryland School of Nursing; and
School of Medicine. Univ. of Maryland. 459 pp. $11.00. April 1977.
Order #7621-9.
GUYTON: Basic Human Physiology: Normal
Function and Mechanisms of Disease, New
2nd Edition
Ideal for the study of nursing physiology, Guyton's Basic Human
Physiology presents the same concepts and principles as in
Guyton's Textbook of Medical Physiology, but it omits most of the
references to research work, many of the special qualifying ex-
planations, and some of the references to clinical problems.
By Arthur C. Guyton, MD. Univ. of Mississippi School of Medicine, Ja"'- ;:-
931 pp. 458 ill. $17.60, Jan. 1977. Order #4383-3.
ru
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The Canadian Nurse December 1977
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Input
Babel revisited
I want to comment on Mohamed
Rajabally's article (Frankly Speaking,
September 1977).
Mr. Rajabally seems to find it
dishonest to dress up the
problem-solving approach and "call it
the nursing process in an attempt to
make it unique to nursing." To my
knowledge no nurse educator wants
to make it unique to nursing but rather
to apply it to nursing. Mr. Rajabally
laments that "students lose valuable
time trying to learn something that
they ought to know." Perhaps they
ought to know the problem-solving
approach but suppose they don't?
And assuming that they do know it and
use it intuitively, will they necessarily
apply it to their work with a client?
I agree with him that nurse
educators should be concerned with
accountability. I do not, however, see
accountability as incompatible with a
solid scientific basis for practice.
Looking at a theoretical foundation is
not done "instead of better nursing
care" but rather to lead to improved
practice.
Mr. Rajabally sees a conceptual
framework in fashion today, as rock
and roll was in vogue in the Fifties. It is
my contention that nursing programs
have always been founded on some
conceptual framework. Whether or not
that term was used, and whether or
not the theoretical foundation was
solid or shaky, confused or clear,
programs in schools of nursing were
buiW on something. Mr. Rajabally
quotes Edith Lewis' description of the
confusion introduced by "all those little
arrows." In the same editorial Lewis
states that "not all models, of course,
twial; " she also acknowledges
s, "in providing meaning
'such
of nursing as
oy's to name
^^^^ s that not
and dnei
conceptual
Orems, R
only a few
ar
CO
CO'
po
M'.Haic-
model. I pret
conceptual mocel anc
means a conceptual m
nursing. I suggest that Mr HajaL
already using a conceptual mode
teaching must be based on
something. He must have a way ot
looking at nursing, he must have an
idea of what nursing is, if he is
teaching it. And his mental image of
nursing, however inexplicit and
incomplete it may be is his
conceptualization of nursing.
Mr. Rajabally finds it unfortunate
that Redman did not answer her own
question. I beg to differ. In reply to
"what difference does it make? " she
writes "... a conceptual framework or
theory alters how one sees reality;
nursing needs to experiment with a
number of such frameworks in order to
gain an expanded and clearer
definition of itself as a discipline and a
field of practice."
Mr. Rajabally apparently thinks
that a conceptual model is "a device
that alters perceived reality " and takes
issue with Johnson, who, in my
opinion, clarifies that point very nicely.
I would like to ask Mr. Rajabally how a
conceptualization of a reality could
possibly be that reality.
Mr. Rajabally states that "the
adaptation models described by
Helson and Roy are
thought-provoking." Personally I do
not know of any adaptation model by
Helson. Helson, a physiological
psychologist developed a theory
(adaptation-level theory) from which
Roy, a nurse drew the assumptions
that underly her conceptual model for
nursing. And it is quite unnecessary
for Mr. Rajabally to pity the students
who "often in a state of frustration"
must classify their patients' problems
as focal, contextual or residual. It is the
stimuli to which the patient responds
that are classified in those terms.
In his concern for students, Mr.
Rajabally also asks "... how can the
student concentrate on what she is
doing if she must constantly think of
the model?" My concern for that
student includes offering her an
explicit way of looking at nursing so
that she knows on what to
concentrate.
Mr. Rajabally wonders at "... our
apparent desire to eradicate the
influence the medical profession has
had upon us ...." No such desire is
apparent to me. On the contrary, the
^conceptual models for nursing that
^ave been developed all indicate the
[iportance of knowledge in the
edical sciences.
I am at a loss to understand Mr.
Rajabally's observation that "if we are
in fact so antagonistic towards all
things medical, we shouldn't really be
heading for doctoral degrees in
nursing." As for his remark about "the
first people to be called doctors," allow
me to point out to Mr. Rajabally that
the first doctoral degree was awarded
at Bologna, at the end of the twelfth
century, — in civil law!
Mr. Rajabally reports that eleven
nursing experts in Europe are
studying "this magnificent thing called
the nursing process, available only in
North America." Those same
European experts said of the same
nursing process: "It is simply a way of
planning nursing care," and "It is really
only a more systematic way of looking
at what the best nursing care has
always consisted of. " Their choice of
words does not indicate to me any
exaggerated admiration of an
American invention.
Mr. Rajabally terminates his
article with the pious wish that ""we
assess before we implement." May I
suggest that we begin by
conceptualizing?
— Evelyn T. Adam, associate
professor, Faculte de Nursing,
University de Montreal, Quebec.
Editor's note: Evelyn T. Adam is the
author of "A Conceptual Model for
Nursing," The Canadian Nurse,
September, 1975.
Right as rain
Knowing my intense dislike for
the pseudointellectual jargon
appearing in the professional
literature today, a nurse recently
presented me with a reprint from The
Canadian Nurse written by Mohamed
H. Rajabally titled ""Nursing Education;
Another Tower of Babel. "
Mr. Rajabally is as right as rain in
this article and his criticism of nursing
education is absolutely on target. The
nursing literature today atx)unds with
bloated verbalization and jargon.
Unfortunately such verbalized jargon
conceals more than it tells, and often
conceals the fact there is nothing to
tell.
It is comical and it is sad.
— H.U. Waggener, M.D., Denver,
Colorado.
Saved by the babel?
Mohamed H. Rajabally, author of
Nursing Education: Another Tower of
Babel?, has a very refreshing , realistic
assessment of the current terminology
'"fashion" in nursing education.
Nursing and medicine have
historically shrouded the professions
in mystery, partially through
terminology. Now that the consumer Is
able to interpret medical terminology,
does this mean we are losing our
mystique and "babel" is a way of
correcting this?
— Dorothy J. Irvin, R.N., Springfield,
Illinois.
Editor's note: See also page 6
Publications available
Your readers might be interested
in learning of three publications of
special interest to nurses and now
available through the University of
Alberta bookstore. They are as
follows;
1 . Consumer Rights and Nursing,
J. Storch (Edmonton, Alta. Master's
in Nursing Research Trust, University
of Alberta, 1977) 235 pages. Price
including postage $5.75.
2. Preventive Mental Health: A Basic
Component of Public Health
Services. L. McCullagh (Edmonton,
Alta. Master's in Nursing Research
Trust, University of Alberta, 1977)
132 pages. Price including postage
$2.55.
3. Development and Use of
Indicators in Nursing Research.
G. Zilm et al. (Edmonton, Alta.
University of Alberta, Faculty of
Nursing, 1975). 220 pages. Price
including postage $2.00.
The Consumer Rights text is an r"';
unusually thorough analysis of the ^ '
trends, issues and problems.
McCullagh's Mental Health text is
valuable in three major respects; the
focus is upon primary prevention, the
context is public health, and practical i
aspects regarding the provision of L '
mental health service delivery in the
community are discussed. The
Indicators text is in its fourth printing •
due to a heavy international demand. 1 "
— Shirley M. Stinson, professor.
Faculty of Nursing and Division of
Health Services Administration,
University of Alberta, Edmonton,
Alberta, T6G 2G3.
Sharing rewards and
frustrations
I would like to comment on a
ecent article in The Canadian Nurse
"How do you feel about working
lights?" (September 1977).
I must say that I feel it was an
sxcellent article because it gave a
i/oice to a wide and varied
TOSS-section of nurses who do work
nights. It got to the point, and my
•eaction to it was very empathetic.
....I feel that these types of ■polls"
3lay a very important role for
Ilanadian nurses. I think it would be a
jood idea to carry on with such
:iuestionnaires in various areas of
lursing — specialty areas, med-surg
lursing, public health and so on.
All of us feel the frustrations and
ewards of nursing, no matter where
ve work ... it would be a good idea to
air" these feelings ... it lets us know
low other nurses across the country
eel. and gives us an idea of where
lursing is heading now.
- Maureen Morrice, Winnipeg,
/fanitoba.
An international role
We read with great interest the
Vugust issue of The Canadian Nurse
vhich carried articles on international
lursing and in particular a report on
he recent proceedings of the
nternational Council of Nurses.
This organization of nurses
trikes us as one of the most
Tiportant, in fact, necessary
levelopments in the nursing
•rofession . This is particularly true in
ght of the call and obvious need for
hange within health care systems
iroughout the world — including
Canada.
The World Health Organization,
s noted in your issue, is promoting
rimary health care systems in the
bird World. The financial drain of our
iwn modern health care systems and
ie exclusion of individuals and
ommunities in their own care has led
3 a call in some quarters in North
tfnerica f or an expansion of the role of
urses and other health care workers
nd to the promotion of "self-care".
In all of these needed changes,
18 role of the professional nurse is
aramount, both in his/her role in
iringing about the changes and in
lartiapating fully in a new role.
Irma Sandoval Bonilla points out on
page 47 the implications for nurses of
this expanded role;
— "training in primary care of
community members and nursing
auxiliaries,
— coordination and integration in
manpower resources for the health
sector,
— new concepts of nursing
legislation."
We share responsibility with our
nursing colleagues around the world
for the evolution of better and more
appropriate health care systems.
We would welcome more such
articles and feel that by discussing and
presenting international health
concerns and issues Canadian
nurses will become aware of their
broader responsibility and role.
— Janet MacLachlan, Margaret
Graham, CUSO Health Programme,
Ottawa.
Did you know
A highly succesful workshop in
cardio-pulmonary resuscitation was
held in Sioux Lookout, Ontario on
Oct 4-5, 1977. Sponsored by the
Ontario Ministry of Health
Ambulance Services Branch, the
program was initiated by the Sioux
Lookout Chapter of the Registered
Nurses Association of Ontario and is
the first of its kind in northwestern
Ontario.
Canada may have a second
research center devoted to the study
of ethics for all professions, including
law, medicine, science and business,
by July of next year. The
announcement that plans for such a
center were under active
consideration was made during a
Colloquium on Bioethlcs held at the
University of Western Ontario in
London in October and came in the
form of a joint statement issued by
UWO president. Dr. George Connell,
and W. Lockwood Miller, president of
Westminster College.
Canada's first center for enthical
studies, the Center for Bioethlcs,
Clinical Research Institute in
Montreal, was founded in 1976.
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The Canadian Nurse December 1977
FIMNKLY SPMKING
From a letter to Mohamed Rajabally . . "every day we at CN J receive another response to your "Tower of Babel" article.
So many articles appear in print with never a whisper of a reply to their content. Now, nurses, and especially nurse
educators, are talking to other nurses across the country. It seems you have touched a nerve . ."
Dear Mr. Rajabally
Theory in Practice
Gail A. Prowse
My comments are a response to the
September article "Nursing
Education: Another Tower of Babel"
by Mohamed H. Rajabally. I felt
obligated to provide a perspective on
nursing education that differs
considerably from that of Mr.
Rajabally.
To begin, I would like to
comment on Mr. Rajabally's initial
suggestion that the nursing process
is a deceptive attempt to make
problem solving unique to nursing;
that, furthermore, it is a waste of time
teaching students something that
any rational creature already knows.
Rational creatures may solve
problems daily. But if they are not
nurses, they are not solving nursing
problems. Hopefully, it is the
application of rational
decision-making to the nursing
situation that nursing students are
learning. The fact that we have been
busy "consuming time and money"
to integrate the nursing process into
our curricula and texts (not to omit
nursing practice as does Mr.
Rajabally) only attests to our
historical reluctance to clearly state
what problems and decisions nurses
do make.
Mr. Rajabally continues that
nurse educators ought to be
accountable to consumers who "cry
out for better nursing care, not more
elaborate theories." I agree that in
any service enterprise, accountability
the consumer is important. It is my
able experience that
pa of demand better care-
howevci. r they do, then they shall
naturally w^^ia support only the
make for
support
teach
b^l
kinds of th
better car9
ttieories whii
nurses to give care
knowledge and e—
rather than on ha
performance). To ti
Mr. Rajabally is su
nursing care has nijiiiiMy ^j i:
theories of nursing practice, he ;
prompting an antiprofessionalisn.
which I have confidence no
self-respecting nurse will tolerate
Mr. Rajabally also questions the
use of conceptual frameworks,
pictorial or graphic ways of
illustrating the design of an
educational program. Apparently, he
discards what he states is a common
defence for the use of a conceptual
framework — that it provides a series
of reference points — and he never
makes it clear why having a
framework is so objectionable.
He refers instead to Lewis's
editorial, an editorial stating that
conceptual frameworks "sometimes
do more to confuse than enlighten."
Obviously, such frameworks are not
useful, but this is no reason to
abandon conceptual frameworks
altogether. It merely calls for
developing or finding frameworks
that do the job better.
Next, he wonders why we use
models to help nursing students
understand their role. It is a big
transition for general practitioners of
nursing to grow from nurses who
perform (and thus see themselves)
as doers of tasks fo patients for
doctors, to nurses who practice
according to an internalized
understanding of who they are. The
latter recognize that they are the
health team members whose chief
business is to knowledgeably
anticipate, recognize and respond to
the general effects of the diagnosis,
the treatment and the experience on
the patient's optimal (normal)
functioning.
Any kind of model (traditional or
new) is understood when we
understand the concepts that
underlie it. Newer models of what a
nurse is require the student to
understand such concepts as
nursing process, adaptation, the
subjective nature of health and
illness, physical and psychosocial
development and general
pathological processes, to name only
a few.
The fact that investigators like
Margretta Styles discover that we are
using many variations of a few major
patterns or concepts is not evidence
at we should not use concepts at
I, as Mr. Rajabally seems to claim.
erely indicates that with more
parison of models we will evolve
fe common language with which
scribe the nursing perspective
on patient care and the nurses' place
in the health team.
Mr. Rajabally misses that point
in his notion that models or theories
are invented for their own sake or to
distract students from what they are
doing. Models evolve from and are
tools used to explain or describe the
real world of nursing experience.
Hopefully, his closing remark
about our desire to eradicate the
influence of the medical profession is
a generalization which has offended
most of my nursing colleagues.
Antagonism towards any team
member based on their professional
category is indeed irrational
behavior. Should Mr. Rajabally meet
with such attitudes in nurses, I would
hope he would see his responsibility
in helping them examine the basis
for their anarchistic desires.
Gail A. Prowse (R.N., Nightingale
School of Nursing, Toronto, Ontario:
B.N., Dalhousie University, Halifax,
N.S.) has had six years teaching
experience in Ontario diploma
programs. She is presently an M.Ed,
student at Queen's University,
Kingston, Ontario.
The unreal world of
nursing theory
Jos6 de Cangas
I have read with great interest and
glee Mr. Mohamed H. Rajabally's
article, "Nursing Education: Another
Tower of Babel?", which appeared in
the September issue of the
Canadian Nurse.
As someone who has for a
long and unfruitful time, pointed out
the danger of pursuing a "model,"
which is preceded by the word
"nursing," for the purpose of jumping
onto the bandwagon for professional
status, I find Mr. Rajabally's
comments realistic in this most
unreal world of nursing theory.
I also wonder if this futile search
for a "scientific model of nursing
practice" through borrowing and
relabeling concepts long ago
discarded by other disciplines, is not
akin to the search for
professionalism that the
chiropractors, and before them, the
neuropaths indulged in some years
ago. It is clear to me that our
colleagues have read the
sociological theory concerning
professionalism, and without much
thought, are desperately trying to
apply it, regardless of the situation,
to nursing. What is probably more
dangerous are the statements of
nursing practitioners regarding
clinical expertise
As a member of the 'old"
school, I still believe that Mr.
Rajabally put his money where his
mouth is, — our profession is at the
side of the patient (at least largely),
and not by discrediting nursing
practice and appealing for the
application of obscure and
non-testable models.
Of course, if one builds a theory
around false premises without
testable hypotheses and lacking the
power of inferential analysis, he or she
may be accused of charlatanism. But
this seems to be of no concern to some
in our discipline.
I agree with Mr. Rajabally's
comments about the medical
profession. After all, it seems that
Nursing and Medicine have the same
relationship as the partners of a
neurotic marriage, where one partner
complains of being mistreated,
beaten, abused, and the other
partner complains that he beats
because his partner demands it.
Neither partner can bear to separate
from this neurotic pattern.
In any case, regardless of what
our "nursing leaders" are trying to
pull in front of a naive and easily
impressed discipline, it will be clinical
proficiency that pulls us through
when all the blocks and arrows of the
"modelist" become unglued and hit
them in their coccyx.
I enjoyed the article, and it is
refreshing to find that someone still
looks ahead without fear and
pretensions.
Jos6 de Cangas (R.N., R.P.N.,
B.N.) is presently Director of Nursing
Education, Brandon Mental Health
Centre, Department of Health and
Social Development, Brandon,
Manitoba.
,
I In defense of
the nursing process
Isabelle Seburn
Nursing has been evolving through
many centuries. It has manifested
itself in the mothering activities of
women, as the handmaiden of the
physician, as healer on the battlefields
,Aof the world's wars, and more recently,
Mas the instrument of complex
1 institutions. Nursing has been
1 involved in a struggle against
i servitude, military domination and
j ex).'oitation by employing institutions.
I As Ashley states "Our very history can
be described as a power struggle: the
I struggle to obtain a proper education,
... to throw off the burden of
oppression ... for the freedom to
practice without ... extraneous
restraints and restrictions."'
I With freedom however comes
I responsibility ... and responsibility for
[nursing lies in gearing most of its
[energies toward improving nursing
Ipractice ... a responsibility that will
jonly be realized when nursing defines,
jdelineates and articulates its purpose
jand function scientifically. Any
; science demands a scientific
[approach, and nursing has just begun
jto make such demands of itself. Not as
I a fleeting fancy or "in" trend but rather
las part of its natural evolution into a
;science and a profession.
What name shall be given to
j nursing's scientific method?
!• the nursing process?
j* problem-oriented nursing?
!• nursing diagnosis?
It doesn't matter.
How many steps shall there be in
the process?
• four? ... identification of the
jproblem, data gathering, planning and
'evaluation?
• three broader categories or
steps? ... assessment, intervention
and evaluation?
Again, it doesn't matter.
What matters is that the nurse
I approach nursing as "a critical thinker
' who begins each problem solving task
[with "why" and not "how" ... as one
iwho does not observe passively but
rather explores. Such a nurse is more
than a fact gatherer but is a seeker of
the optimum care for his or her patient
at this time in view of his or her
Knowledge of the patient yesterday
and today, and in view of his or her
inticipations of the patient's
■esponses tomorrow "^
Of course the elements of the
lursing process are not revolutionary
3r even totally new, but putting all of
tie elements together in a logical way
s new. The complexity of care today
makes it essential to determine where
nursing intervention is needed, why it
is needed, and how it should be
accomplished. Nurses have always
had to determine what nursing actions
they would perform, but their
decisions have rested to a great extent
on intuition, experience, habit,
knowledge and sometimes, on
ignorance. Now nurses have at their
disposal a means by which they can
make rational and orderly decisions,
with striking and beneficial results for
their patients and for nursing itself.'
For too long nursing has been the
passive, obedient shadow of
medicine, its practitioners frustrated
and dissatisfied. This predicament
could not be explained away as a
deficiency in behavioral traits or
attitudes of nurses. Nor could it be
explained as a need to enhance the
quality of nursing education.
Both these problems have been
dealt with and yet the predicament
remains. In education and in practice,
nursing has not been able to articulate
and exercise a distinct function which
characterizes and justifies its work as
a profession."
Today nursing literature bulges at
the seams with statements of nursing
function and schemes for its
implementation. Any who speak for
nursing are speaking about a function
that is unique to nursing — the nursing
process.
It is paramount that we read the
literature carefully in order to organize
and assimilate the many parts into a
meaningful whole. The message will
in the end be clear, for nursing has a
definite structure and a unique method
of function.
Like any profession struggling to
be born, nursing will feel discomfort
and confusion. Efforts are already
merging into a clearly definable
statement of function that will be
articulated and exercised in
education, theory and practice. I
believe this clearly definable
statement of function to be the nursing
process ... The key to nursing as a
unique and viable profession.
Isabelle Seburn (R.N. Toronto
General Hospital School of Nursing,
Toronto, Ontario: B.Sc.N. Ed.
University of Ottawa, Ottawa, Ontario;
M.Sc.Ed. Niagara University, Niagara
Falls, New York) is presently on ttie
teaching staff of The Mack Centre of
Nursing Education, Niagara College
of Applied Arts and Technology,
Wetland, Ontario.
Nursing:
The total concept
Barbara Boyle
Joan h/lurthy
The knowledge explosion that has
taken place in the Twentieth Century
has affected every field of endeavor
and nursing is no exception. The
question is, how can nurses deal
effectively with the amount of
information and the rapidity with which
it is produced?
The Conceptual Framework
A conceptual framework provides
us with a method of organizing an
ever increasing body of nursing
knowledge, giving us a logical way to
view the phenomena with which we
are concerned. A coiiceptual
framework abstractly freezes a
moment in time, allowing us to view
components separately in relationship
to each other and as an integral part of
the whole. In this way it provides
direction in utilizing that knowledge
because it helps us realize who we
are, what we are and where we are
going.
How does a conceptual
framework provide this guidance?
Simple analogy helps:' a pile of brush
consisting of roots, leaves and
branches can be perceived as
meaningless unless we recognize the
relationship of the separate
components to each other and as part
of the whole, unless we recognize a
tree.
Conceptual frameworks are both
personal and professional. Each
individual has a personal conceptual
framework which reflects his values
and beliefs, and is reflected in his
conduct. This may be referred to as a
personal philosophy of life and is
present whether or not the individual is
aware of it.
The professional conceptual
framework may be a simple statement
of philosophy or a more complex
model. IVIodels can be in a variety of
forms but usually include major
concepts such as Man, Society,
Health, and Nursing as well as
sub-concepts and theoretical
formulations that relate to the major
concepts, thus providing a series of
reference points.
If our personal and professional
conceptual frameworks do not
coincide, conflict will ensue. For
example, if an individual does not
personally view man as a unique
person with worth and dignity, it would_
be impossible to portray this belief^
his professional practice.
In developing and utilizing ai
conceptual framework, care mu
given to prevent it from becoming
more important than the real world. It
is intended as a guidance mechanism
and must be consistent with reality,
rather than forcing reality to be
consistent with it.
The Nursing Process
Nursing process is a way of
actualizing the conceptual framework.
You cannot put the cart before the
horse' and in the same manner you
cannot utilize nursing process without
direction. It is true that nursing process
is a problem-solving approach, but it
has been developed as a tool to deal
with both simple and complex
problems in nursing practice by
defining patient problems, the
patient's role, assessment criteria,
and the when and how of nursing
intervention and evaluation.
In summary
Mr. Rajabally suggests in his
article that complications have been
created by the conceptual framework
and nursing process. We do not
believe this is the case and, in fact,
believe that the conceptual framework
provides the opportunity to visualize
nursing as a total concept with three
essential components — practice,
education and research.
Problems arise when these three
components are viewed in isolation
from one another rather than in their
inter-relatedness and
interdependence. We must, as
individuals and as professionals,
realize the merits of practice,
education and research individually
and collectively and be able to
combine all three components in order
to make available to the consumer all
that nursing has to offer.
Footnote :
7. Personal communication with Anne
Blatz, B.Sc.N., Assistant Director of
Nursing, Edmonton General Hospital,
Edmonton, Alberta, September 28,
1977.
Barbara Boyle f/W.S.W.j is assistant
director of nursing. Standards and
Education, at the Edmontob General
Hospital, Edmonton, Alborti^ - ^
Joan Murthy (B.N.) i^Sj^'se
clinician at the E^^^SvGi^np ^i
Hospital.
Refetgrtcflg and ^bSographies for
tliAi^Bi' ailable on request
c ry.
The Canadian Nurse December 1977
JVews
Pictured at the ceremony honoring
Dorothy Percy are, (left to right)
Isabel Black, chairman, National
Health Committee, Canadian Red
Cross Society: Helen K. Mussallem,
executive director, CNA; Dorothy
Percy: Gov. Gen. Jules Leger: Janet
Chatterson, national coordinator.
Health and Community Services,
Canadian Red Cross Society.
Canadian nurse receives
international recognition
One of this country's most distinguished nurses, Dorothy May Percy, has
become the thirteenth Canadian to receive the Florence Nightingale
Award. Governor General Jules Leger made the presentation, the highest
international aw/ard a nurse can receive, at a ceremony at the national
headquarters of the Canadian Red Cross Society in Toronto on November 1 .
Until her retirement in 1967, she held the post of chief nursing
consultant for the federal Department of Health and Welfare, forerunner of
the existing position of principal nursing officer, Health and Welfare
Canada.
Dorothy Percy began her 42 -year career in nursing following graduation
from Toronto General Hospital in 1924. She obtained her Public Health
Nursing Diploma from the University of Toronto one year later and worked at
the Ottawa Civic Hospital before joining the Victorian Order of Nurses. She
lectured at the University of Toronto school of nursing until the outbreak of
World War II when she joined the Royal Canadian Army Corps. She was
discharged with the rank of Captain.
As supervisor of nursing counselors for the newly created Department of
National Health and Welfare, she was instrumental in
organizing and setting up facilities for the implementation of Canada's
social service program.
~ jrinji her career, she was awarded the Red Cross Medal of Honor,
Coronation Medals, the Canadian Volunteer Medal and
Medal. She was the first recipient of the honorary
from the University of Ottawa and served for
advisor to the Canadian Red Cross Society and
on committees of the Canadian Nurses
Social Development and University of
bl. John .-^nl^
Association.
Ottawa
T^
more than 36
-Oil rifi
distinguished themselves by ttip'
Sick in times of war and pe
The International Comm
award to worthy recipients in 19.2, ._
until May 19, 1920. the 100th birthda,
presented every two years to no
throughout the world who have
ievotior to the wounded and the
k Cross decided to present this
prst distribution was not made
ksary of Florence Nightingale.
Cardiovascular nurses converge
on Toronto for fifth meeting
Where is nursing headed? Has
nursing responded appropriately to
scientific and technological
progress? Are accountability and
responsibility inherent in the nursing
role? These were some of the issues
addressed by Dorothy Wylie
keynote speaker at the Fifth Annual
Meeting of the Canadian Council of
Cardiovascular Nurses.
Approximately 150 nurses from
across Canada came to Toronto to
attend the two-day October meeting
to discuss topics of common interest
including: standards of nursing care;
current findings in detecting
hypertensive patients; and the child
with congenital heart disease and his
family.
The first day of the meeting
focused on standards of nursing
practice. As director of the nursing
division of the Registered Nurses
Association of Ontario and a former
cardiovascular nurse, Dorothy Wylie
shared her observations of where
nursing is headed. She stated that in
post-industrial society, needs change
very quickly.
"It is the age of specialization but
we are still producing the generalist
nurse. It is the age of research but
we have only a few nurse
researchers in Canada. "
An anti-intellectual bias is still
evident in nursing according to Wylie,
who says that there is a great need
for higher education if nursing is to
produce dynamic leaders.
Inherent in the nursing role is
accountability and responsibility, an
accountability which can only be
measured against established
standards of nursing care. At
present, each province is at a
different stage in establishing
standards of care. With the
assistance of nurse adviser Norah
O'Leary, the Health Standards
Directorate of Health and Welfare
Canada is also establishing
standards for nursing. In Wylie's
view, if nursing does not set
standards for itself, then others will
impose them.
The U.S. experience in
implementing standards of
cardiovascular nursing practice was
described by Grace E. Brown,
clinical nurse specialist at Cornell
University Medical Center in New
York State and president of the
Council on Cardiovascular Nursing of
the American Heart Association.
Th6rfese Poupart
specialist in medical-surgical nursing
and part-time professor at Montreal
University, discussed the possible
effects of standards of cardiovascular
nursing in Canada.
Audience discussion at the end
of the day made clear that the
question of standards is a complex
issue, and that one of the first
priorities is to establish common
definitions of terms.
Day two of the conference dealt
with many topics:
• the results of hypertensive
screening clinics in Newfoundland;
• a discussion on patient
compliance;
• the needs of children and
parents;
• a look at activity levels of M.I.
patients as perceived by the patient
and spouse.
At the close of the two-day
meeting, members elected a new
executive to the CCCN. They are:
Chairman: Jean Petrie, Halifax, N.S.
Vice-Chairman: Judith Shields,
Vancouver, B.C.
Treasurer: Glenys Whelan, St.
Johns, Nfld.
Recording Secretary :Th6rfese
Poupart, Montreal, P.O.
Membership Secretary: Madeleine
McNeil, Halifax, N.S.
Immediately following the CCCN
meeting was the annual meeting and
scientific sessions of the Canadian
Heart Foundation and the Canadian
Cardiovascular Society, meetings
which CCCN members were invited
to attend. Of particular interest was a
one-day symposium on cardiac
pacing.
The CCCN began in 1973 with
some 200 members. With more than
700 members now, the council seeks
to promote the quality of health care
as it relates to cardiovascular
function.
Nurses from all across Canada
attending the national seminar on
standards included: Seated (left to
right) Jean Dalziel, assistant director,
professional standards, College of
Nurses of Ontario; Norah O'Leary,
nurse adviser. Health Standards
Directorate, Health and Welfare
Canada: Debbie Lee, chairman,
special committee on standards.
MARN; Deidre Blank, nursing
consultant, standards, MARN;
Margaret Han/ie, vice-
chairman, special committee
on standards, MARN; Dorothy
Wylie, director, nursing service,
RNAO. Standing (left to right)
Qarrie Case, assistant director of
nursing, Grace General Hospital, St.
John's, Nfld., ARNN; Alice Furlong,
assistant executive secretary, ARNN;
Vivian MacDougall, nursing
coordinator, NBARN; Jean MacLean,
consultant, nursing service, RNANS;
Harriett Hayes, chairman, nursing
committee, NBARN; Mary Johnson,
director of nursing, Camp Hill
Hospital, Halifax, N.S., RNANS;
Miriam Pill, Canadian Council on
Hospital Accreditation, Toronto, Ont.;
Marjorie Hevi/itt, nursing consultant,
SRNA; Kitty O'Shaughnessy. project
coordinator, SRNA; Barbara Boyle,
subcommittee to develop practice
standards, AARN; Linda Ross,
supervisor, Stanton Yellowknife
Hospital, NWTRNA; Myrtle Tregunna,
assistant director, nursing services,
RNABC; Anita Whittal, general duty
nurse, H.H. Williams Memorial
Hospital, Hay River, NWTRNA;
Betty Sellers, nursing consultant,
service, AARN.
ARNN presents brief
on nursing homes
In reaction to the Chafe Nursing Home
Fire in suburban St. John's,
Newfoundland last December, the
Association of Registered Nurses of
Newfoundland has submitted a brief to
the Royal Commission charged with
investigating the incident. The brief
was presented to Judge Gushue by
Ada Simms, chairman of the AARN
committee in late September.
The brief attempts to address the
serious problems related to the aging
population and the kinds of facilities
currently available to them. Among
other facts known and recognized by
professionals, the brief points out that:
• in some cases, staffing in senior
citizen homes is "insufficient in
numbers and quality to care for these
persons"
• "with some obvious exceptions,
nursing services are provided by
untrained personnel"
• "with limited community
services, converted residences have
been the only alternate
accommodation for most bed-fast
patients"
• "the application of sound
standards for the operation of Homes
for Special Care is the only means
whereby adequate care of the
individual therein can be assured."
In the section entitled "Staffing
and its relationship to standards of
care, " the brief states that in some
institutions for the elderly "there is no
preparation for the dying patient. In
order to prevent upsetting the aged ill,
these patients are moved from wards
to the corridor to die. In other
institutions, they are left alone in a
room without the support of caring
skilled persons to provide comfort.'"
The brief cites other examples of
neglect. "These situations are, in our
view, not only illegal but grossly
immoral," it states.
The many recommendations of
the brief touch on alternatives to
residential homes for senior citizens,
on the need for a clearer definition of
the role of existing Special Care
Homes, on the need for formal
administrative education for nursing
home administrators and directors of
nursing and on the need for an
increased number of professional staff
to work with the elderiy in nursing
home settings.
The main recommendation of the
submission is "the need for the
implementaiton of the Accreditation
Program for Extended Care Centres,
through the Canadian Council on
Hospital Accreditation in all Homes for
Special Care in this province."
At present, the Royal
Commission is still conducting its
hearings.
Yukon federal health
services transferred
Two hundred and fifty employees,
many of them nurses, are among the
people affected by the transfer of
federal medical services to the
Yukon Territorial Government.
Announcement of the transfer, which
Is scheduled for completion by March
31, 1978, was made in mid-October
by Health and Welfare Minister
Monique Begin.
Six hospitals, three
stations and nine healthM^BkS''^
affected. All fedeiBlflWoleeier-'
being given th|
transfer.
Uidar the terofw of the new
[it, the "Yukon Terrir-
&nt accepts respon;
all health care in the
including the delivery of
I'services to status Indians, for
the federal government
retain ultimate
The Canadian Nurse December 1977
National Association Directors
Meet at CNA House
CNA directors held their last meeting of 1977 In Ottawa on October 20 and 21. Three new directors, elected president
of their provincial association since the last meeting of the CNA Board of Directors, were in attendance. They were:
Sue Rothwell, RNABC; Irmajean Bajnok, RNAO; Judith Oulton, NBARN. Three new advisers to the directors also
attended: Mary Lou Pilling, registrar, NVyTTRNA; Maureen Powers, executive director, RNAO, and Joan Mills, executive
secretary, RNANS.
Directors were brought up-to-date on a variety of nursing concerns by reports from a dozen sources, including
committee chairmen, CNA staff, representatives of Health and Welfare Canada and the Canadian Council on Hospital
Accreditation. Highlights of these reports follow.
Annual Meeting and Convention Program Committee
Three widely known personalities from the contemporary Canadian
scene will headline the program for the 1978 CNA meeting in
Toronto next June, according to the chairman of the planning
committee, Lorine Besel, member-at-large for nursing practice.
They are:
• David Suzuki , world-renowned geneticist and controversial host
of several CBC radio and television programs, including Science
Magazine.
• David J. Roy, mathematician and philosopher, director of the
Centre for Bioethics, Clinical Research Institute, Montreal, which he
founded in 1976, and still the only one of its kind in Canada.
• Laurier Laplerre, popular television personality, host and
interviewer.
More details about the convention program, which is built around
the theme of "Ethical Issues in Nursing," will be featured in
subsequent issues of The Canadian Nurse.
Standing Committee on Testing Service
Chairman Jean Dalziel indicated in a written report that the
Blueprint for the Comprehensive Examination for Nurse
Registration/Licensure, scheduled for introduction in the Summer of
1980, had been released to agencies which will be involved in
implementing the new examination. The Comprehensive will
replace the present CNA Testing Service exams that are divided
into five clinical areas — medical, surgical, obstetrics, children's and
psychiatric nursing.
The project has been under study by the COTS since 1971.
When completed, it will make Canada the first country in the world
to use a comprehensive examination for nurse registration on a
national basis. It also marks the first time that a national registration
examination has been developed in both French and English
simultaneously.
Special Committee on Nursing Research
On request, this group carried out an evaluation of the Report of the
Ontario Hospital Association Nursing Competency Model Project.
This study, involving 45 Ontario hospitals and assessments of more
than 800 individual nurses, was highly critical of the "clinical skills,
knowledge and confidence " of recent graduates from two-year
diploma programs. The report formed the basis of an OHA
recommendation that "graduates of two-year nursing programs be
required to complete a six-month period of clinical experience
before nurse registration is granted. '
In their critique, members of the Nursing Research Committee
stated: "Based on the incomplete methodology and total lack of
lof the analysis used, the summary of results is, in the
imittee, meaningless. For example, there was
the selection of categories and no report of
This leads the committee to query the
s presented."
d unanimously agreed" that the
g profession" and expressed
v>n ;erf I^^^^^K '^^^^ '" ^^^ ^^^ ^^ nurses.
c^HI^^HA directors voted unanimously
to maki oj^^^HSing profession to the OHA
Report K . . to^^^Kfil ministries of health and
education ana to other agencies.
Principal Nursing Officer
In her first report to CNA directors since assuming office in
September, Principal Nursing Officer Josephine Flaherty provided
an ongoing review of activities of Health and Welfare Canada. In
this, she described some of the implications for nursing of:
• new cost-sharing arrangements between the federal
government and the provinces
• the transfer of health services from federal to provincial
jurisdiction in the Yukon
• fitness and lifestyle programs
• occupational health programs and the proposed Canadian
Centre for Occupational Health and Safety
• the Canada Health Survey which will provide information on the
health status and risk factors of Canadians of all ages.
Standards of Nursing Practice Project
Norah O'Leary, nurse adviser, Health Standards Directorate, Health
and Welfare Canada, reported to directors on this project which is
being carried out in collaboration with CNA and undenwritten
financially by this branch of the federal government. O'Leary, who
began wori< on the project this Fall, defined the objectives as
follows:
• to develop a definition of nursing practice
• to develop standards of nursing practice which are general in
nature and applicable to all fields of practice
• to develop standards which are specific to designated specialty
areas of practice
• to publish and interpret the approved standards of practice.
Work on the project will be carried out by a 14-member
steering committee with national representation and by working
parties of experts in the vanous specialty areas. The first meeting of
the national steering committee will be held eariy in 1978 and
working parties will be formed subsequent to that meeting. A target
date of two years following the first meeting of the steering
committee is visualized by the project director.
Directors approved a recommendation from nurses attending a
meeting in Winnipeg on September 29 and 30 (see The Canadian
Nurse, November, 1977) supporting, in principle, the need for
inclusion of an evaluative mechanism/component in the standards
of nursing practice project.
Committee on Finance m
Directors received a progress report on the implementation of 5
program planning and budgeting by the association in 1978 and
endorsed the principle of zero growth for the rest of this year and
the year ahead. President-elect Helen Taylor pointed out that
stringent efforts to reduce the anticipated deficit were required in
order to put the association on a firmer financial footing and prepare
it to meet the challenges that nursing will face in the near future. As
a result, no new CNA programs will be undertaken without curtailing
existing projects.
Canadian Council on Hospital Accreditation
Since April, CNA has had two seats on the board of this national
association which, on demand, provides hospitals throughout
Canada with survey teams trained to evaluate services provided by
these institutions. CNA representatives are Helen Taylor of
Montreal, who was appointed chairman of the CCHA board last
Spring, and Fernande Harrison of Edmonton. The CCHA is
currently engaged in preparing a guide to accreditation of long-term
centers of care.
The Canadian Nurse December 1977
A sabbatical year
in international development
"V
■-»...>'
INTERNATIONAL
DEVELOPMENT
RESEARCH CENTRE
The IDRC offers ten awards for training, research or investigation
in international development to Canadian professionals/practitioners
in 1978-79.
The Award
Stipend up to 220,000
Travel costs for award holder and family variable
Travel in the field up to $ 1,000
Research costs up to $ 2,000
Training fees variable
The Candidate
1. The professional with no specific experience in inter-
national development, who wishes a year for training or
personal study with a view to pursuing a career in this
field.
2. The professional in the development field who wishes
to improve skills or do personal research.
Applicants must be at least 35, Canadian citizens or landed
immigrants with 3 years residence, and have 10 years professional
experience.
Research and training areas
Any area dealing with international development, such as
agriculture, nutrition, information, communications, population.
health, social sciences, technology transfer, education, engineering,
etc.
Tenure
To begin before January 1979 for one year only.
Application
Applications may be obtained from:
Research Associate Award
International Development Research Centre
P.O. Box 8500
Ottawa, Ontario, Canada
K1G 3H9
Forms must be submitted by February 15th, 1978.
Awards will be announced May 15th, 1978.
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 Re-
search in the field of international development.
WHEREAS the Canadian Nurses Association will hold
its biennial convention in Toronto in 1978;
WHEREAS the Registered Nurses' Association of
Ontario is preparing to roll out the red carpet;
WHEREAS Toronto offers a wealth of professional and
social opportunities;
THEREFORE BE IT RESOLVED to attend the CNA
Convention in Toronto from June 25 to 28, 1978.
The Canadian Nurse December 1977
Xe\V8
First national survey identifies
nurse researchers in Canada
What is the current state of nursing
research manpower in Canada? Up
until now, no one source has
estimated the number of nurses
engaged in research in this country
But Jan Storch, Clarke Hazlett and
Shirley Stinson of the University of
Alberta have completed a beginning
study to help answer this question by
identifying the numbers and types of
nurses involved in research in Canada
in 1976.
Responses to their survey
provided an estimate:
• they fou nd 1 30 nurses engaged
in research;
• 49 to 53 of these nurses were
classified as nurse researchers;
• six were full-time nurse
researchers;
• over 70% of these nurse
researchers were located at
universities;
• slightly less than 50% were
located in Canada's western
provinces.
Who are the nurse researchers?
The study focused on the research
process in order to measure and
define researchers. This process
involves generating the research
question, designing the study,
selecting instruments to collect data,
supervising sample selection,
content analysis, interpreting the
findings, and reporting the results of
the study.
For the purpose of the survey,
master's and doctoral level
qualifications were accepted as
suitable preparation for the
principal investigator role. Full-time
and part-time researchers were
included in the study. Respondents
engaged in thesis or dissertation
researaj^Ms not Included because
the^^^^^^Uhe study was to
ctetsFffl^^H^^^Jpruximate number
of nurses engaged in research as an
occupation. Research corj^nt areas
were not restricted. ^
Letters and question"" ^ -"re
sent to 192 teaching h ^
universities, provincial atii. -.. ^^
departments, hospital and ni:
associations, and other selec;. .
institutions. The authors of the stuc;/
recognized that their selection of
institutions meant that some
researchers would be missed.
Response to the questionnaires
(86.5%) was exceptionally good. Of
168 questionnaires returned, 130
respondents met the requirements of
the survey.
Over half of the respondents
devoted less than 40% of their time to
research, while almost a fifth spent
more than 80% of their time engaged
in research. Exactly 50% of all
respondents held master's degrees;
nine per cent held doctoral degrees.
The location of respondents by
type of organization showed a not
unexpected concentration at
universities (47.7%). It was
encouraging to find however that
31% of respondents engaged in
research were employed in teaching
hospitals and 12% in health
departments. The majority of
respondents were engaged in nursing
practice or health services research.
What was the source of funding
for research projects? Thirty-seven
percent of nurses reported no
outside funding, 37% had complete
outside funding, and the remainder
reported some outside funding. The
number of full-time respondents
funded from outside the employing
organization was cause for both
encouragement and concern: outside
funding may serve as an indication
that the research was worthy of
support; at the same time, the
research commitment of health
related organizations can be
questioned. While nurses in hospitals
and nurses' associations drew over
65% of their funds for research from
within the organization, nurses in
universities drew over 85% of their
funds from sources outside the
organization.
What roles do nurses play in
research? The authors of the study
assigned a research role to each
responding nurse. Nurses who were
responsible for generating the
research question and providing
supervision for the study and who
possessed at least a master's
Igree, were categorized as
ncipal investigators. If the nurse
k responsible for at least three
research activities including
supervision of data collection,
content analysis, interpreting the
findings or reporting the results of the
survey, that nurse was assigned the
role of research director /associate.
A research assistant was defined as
a person totally or substantially
involved in no more than three
research activities, not including
generation of the research question,
designing the study, supervising
sample selection, or interpreting or
reporting the findings.
Sixty to 66 nurses were
classified as principal investigators.
This range encompasses those who
stated their role as principal
investigator (66) and those who were
assigned that role on the basis of
their answers to the questionnaire
(60). Using the same method, the
surveyors identified 1 9 to 24 research
directors and 19 to 20 research
assistants and five "other" (often
consultant to one phase of a study).
Forty-nine to 53 nurse
researchers identifying themselves
as principal investigators held either
a master's or doctoral degree. This
group included six of the 19 full-time
nurse researchers, four located in
Alberta, one in Ontario and one in
Quebec. Of the six, four were located
in universities, and two in health
departments.
Of the 47 nurses for whom
research was not a full-time endeavor
(who stated their role as principal
investigator and who held at least a
master's degree) 43% were located in
the western provinces, 34% in
Ontario, 1 7% in Quebec and 6% in the
Atlantic provinces. Seventy percent of
these nurse researchers were located
in universities, and approximately
20% in teaching hospitals.
A full copy of the report "Canadian
Survey for Nurse Researchers " is
available on Interlibrary Loan from
the C.N.A. Ubrary.
N.B. infection control
nurses organize
Infection control nurses in the
province of New Brunswick will soon
have their own organization reflecting
the objectives of their particular area
of practice.
Nine nurses working in the field of
infection control met this Fall to
appoint a president, Helen Parchello,
of Saint John, N.B., and to study
proposed by-laws. Others on the
executive are Denise Boulay of
Bathurst and Joline Voye of
Woodstock.
The group, which is presently
recruiting new members, hopes to
become a specialty group of the New
Brunswick Association of Registered
Nurses and a chapter of the Canadian
Hospital Infection Control Association.
The organization's main objective
is to encourage the development and
standardization of effective and
rational infection control programs in
provincial health care agencies.
Their second objective is to
initiate and develop effective
communication among Infection
Control Practitioners in order to share
acquired knowledge and exchange
practical experience.
The Infection Control Group
hopes to convince hospitals that
infection control is an important part of
the hospital health team.
N.S. directors form
special interest group
Nova Scotia directors of nursing
service from 32 hospitals in the
province have formed a special
interest group under the umbrella of
the Registered Nurses Association of
Nova Scotia. At a meeting organized
by the RNANS in October, directors
agreed on the need to form a united
front. Their consensus was that the
views of directors should be
considered when important decisions
about health care are being made.
One director commented: "August
bodies are developing policies which
affect hospital care and nursing and
which must be implemented by
nursing departments, yet nursing
service directors are not consulted."
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The Canadian Nurse December 1977
JVanies and Faces
Eileen Flanagan former director of
nursing at the Montreal Neurological
Institute for 27 years, has been
awarded the honorary degree Doctor
of Laws (LLD) at (\/lcGill University's
Founder's Day Convocation.
Flanagan is a graduate of the
Royal Victoria Hospital School of
Nursing, the McGill School for
Graduate Nurses and McGill
University. Following her retirement
from MNI in 1961, she returned to
McGill to study law to aid her in
drafting legislation dealing with the
nursing profession.
She has made active
contributions to nursing especially in
the areas of labor relations,
leadership, administration and
research as well as contributing to
many other organizations. Co-author
of The History of the Nursing
Profession in the Province of Quebec,
Flanagan is a recipient of the Jubilee
Medal (1935), the Centennial Medal
(1967), the Province of Quebec
"Order of Nurses " (1976) and the
Distinguished Citizen Award (1971)
from the Montreal Citizen Council.
Most recently she has researched a
book on the history of tuberculosis in
Canada, called The (Miracle of the
Empty Beds.
Scholarships totaling $6,000 have
been awarded by the New Brunswick
Association of Registered Nurses to
students enrolled in university
nursing programs during the 1 977-78
academic year.
A $2,000 scholarship has been
awarded to Michellne L^ger of
Moncton to pursue a Master's level
program at McGill University,
Other scholarship awards went
to nurses engaged in nursing
education at the baccalaureate level.
They are:
Fernando Fournjer Moncton, N.B.;
Nancy J^^lkBlackville, N.B.; Paula
I- QuinnO^Bw^N.B.; Lynda
B Flniay of FredeflB^^B.; Diane
Frazer of Mcoc^i^^^^uanne
Ann Glass of Hamilton, C
Geraldine Ball, Frederictor , rj
Vivian MacLeod of St. Stephen, f. B
Two non-nurses have been appointed
for a two-year term to the board of
directors of the Registered Nurses
Association of British Columbia. They
are:
Mary Jane Mulligan of Vancouver,
who was nominated for the position by
the B.C. Minister of Health. She will
serve on the RNABC committee on
referral and review which investigates
complaints of misconduct by nurses.
Barbara Rolls of Victoria was
nominated by the B.C. Branch of the
Consumers Association of Canada.
She is CAC's Victoria president and
chairs its B.C. health committee.
Dorothy Hibbert (M.A.. B.Sc.) has
been appointed Acting Dean of the
Faculty of Nursing, University of
Western Ontario in London effective
July 1 , 1 977 until June 30, 1 978 or until
the appointment of a new dean. A
faculty member since 1963, Hibberl
succeeds Josephine Flaherty who has
been appointed Principal Nursing
Officer in the federal ministry of Health
and Welfare.
Vivian Wood, prof essor in the Faculty
of Nursing, The University of Western
Ontario has been included in the book,
'Women of Action 1876-1976." The
centennial book, published by the
Local Council of Women in St.
Catharines, Ontario, includes 128
biographical sketches of celebrated
women from the area.
Wood is a graduate of the
Hamilton General Hospital School of
Nursing in Hamilton, Ontario, later
attending the University of Toronto
and the University of Western Ontario
to receive her B.Sc.N. and Boston
University for her Master's degree in
education. She has taught and
researched such topics as student
personnel services in nursing
education and evaluation in nursing
education. Her numerous articles
have appeared in many nursing
journals. She was an elected member
of the Council of the College of Nurses
for four years. At present, she is active
m the university community.
Judy Lathrop (R.N., University
School of Nursing, Edmonton; B.Sc,
Nursing, teaching and administration.
University of Alberta) has been
appointed chairman of the nursing
department. Mount Royal College,
Calgary, Alberta. She has been
employed as a general duty nurse and
nursing instructor at hospitals in
Alberta and British Columbia and has
been a member of the faculty of Mount
Royal College since 1973. Currently,
Lathrop is completing a Master's
degree in educational administration
at the University of Calgary.
ThereseSchnurr (M.N., University of
Washington) director of nursing
services for the RNABC has been
appointed director of nursing at the
Royal Columbian Hospital, New
Westminster, B.C. She is a former
director of nursing services at St.
Paul's Hospital in Vancouver.
Betty Oka (B.Sc.N., University of
Washington, M.N., Montana State
University) has been appointed
director of nursing of the Shaver
Hospital for Chest Diseases in St.
Catharines, Ontario. Oka was
formerly a clinical specialist in
cardiovascular nursing in Chatham,
Ont., a faculty member of the
McMaster University School of
Nursing, Hamilton, and most recently
a consultant-supervisor with the
Niagara Regional Health Unit,
Thorold, Ontario.
Among the 18 nurses honored at the
1977 St. John Ambulance Investiture
were Margaret M. Hunter formerly
chief nursing officer for St. John
Ambulance in Canada and now
national nursing consultant for that
organization and Alice Girard,
past dean of the Faculty of Nursing,
University of Montreal, and former
ICN and CNA president. Both were
invested in the Grade of Commander
at the October ceremony held in
Ottawa.
Other nurses honored at the
Investiture were:
Grade of Dame of Grace: Irene R.
McPhall, Ottawa; Lillian Bibby,
Alberta.
Grade of Commander: Rita
Choquet, Quebec; Janice 8.
Morgan, P.E.I.
Grade of Officer: Major Nicole M.
Du Mouchei, executive director of
the Order of Nurses of Quebec; Jean
Nelson, N.S.
Grade of Serving Sister: Doria
Vermette, Quebec; Tristam T.
Coffin, N S.; Michael Hewitt,
N.W.T.; Thelma J. May, Ontario;
Mabel W. Linguist, Ontario; Mary
Lynch, Ontario; Margaret Cameron,
Ontario; Joyce Hastings-Trew,
Ontario; Margaret A. Fulkerth,
Alberta; Jean E. Lewis, Nfld.
Mae Wright, a graduate of the St.
Boniface Hospital, Winnipeg, Class of
1 930, was honored recently when she
was presented with an honorary
membership in the Northwest
Territories Registered Nursing
Association by the Hay River Chapter.
A resident of Hay River, N.W.T.,
Mae has been involved in the health
care of that community since 1949.
She contributed to the eariy nursing
needs of the Hay River community
and was instrumental in the
development of medical services.
Among other programs, she started
the first Hay River Christmas Seal T.B.
campaign, the first Immunization
program and was directly involved in
the planning and building of the first
nursing station there.
ft
The Canadian Nurse December 1977
IS
Calendar
January, 1978
Health Educators Mini Health Care
Conference sponsored by the
Association of Canadian Community
Colleges. Topic; Why Clinical
Practice? with keynote speaker. Dr. J.
Flaherty, Principal Nursing Officer. To
be held at CEGEP Ahuntsic in
Montreal on Jan. 16-18, 1978.
Pre-registration on Jan. 15 . Fee: $60
for members, $75 for non-members.
Contact; Sr. Therese Gauthier,
Chairman, Health Sciences, CEGEP
Ahuntsic, 9155 St. Hubert Street,
Montreal, Quebec, H2M 1Y8.
Diabetes in Review: Clinical
Conference 1978. To be held in New
York City, Jan. 25-28, 1978. Contact;
Harry Hansen, American Diabetes
Association, 600 Fifth Ave., New
York, N.Y. 10020.
Overview of Paediatric
Rehabilitation Course: A
Multidisciplinary Approach to
Management. To be held in Toronto
on Jan. 23-27, 1978. Fee: $75.
Contact: Norma Geddes, R.N., The
Education Department, Ontario
Crippled Children's Centre, 350
Rumsey Rd., Toronto, Ontario.
M4G 1R8.
Nursing Care of the Sick Newborn,
a five-day conference to be held the
week of January 30, 1978 at the
Hospital for Sick Children, Toronto.
Fee: $80. Contact; The Coordinator of
Nursing Education, The Hospital for
Sick Children, 555 University Ave.,
Toronto, Ont., M5G 1X8.
February
Toronto Area Interest Group of the
Orthopedic Nurses Association
Two-Day Meeting to tDe held at the
Hotel Toronto, in Toronto, Ontario on
Feb. 9-10, 1978. Contact; Marion
Marshall, Chairman, Publicity
Committee, 35 Front Street, Apt. 310,
Mississauga. Ont. L5H 2C6.
March
' Sensitivity — An Integral Part of
1 Pediatric Nursing. A one-day
I conference to be held on Feb. 22 and
I on March 1 , 1978. Fee; $20. Contact;
The Coordinator of Nursing
Education, The Hospital for Sick
Children, 555 University Ave.,
Toronto, Ont., M5G 1X8.
Current Practices in Breast
Feeding and Maternal Infant
Bonding to be presented in Winnipeg
on March 17, 1978. Fee $10. Contact;
Norma Buchan, Women's Centre,
Health Sciences Centre, 700 William
Ave., Winnipeg, Man., R3E 0Z3.
April
Patient Teaching Programs. A
one-day conference to be held at The
Hospital for Sick Children, Toronto on
April 19 and on April 26, 1978.
Fee; $20. Contact; The Coordinator of
Nursing Education, The Hospital for
Sick Children, 555 University Ave.,
Toronto, Ont., M5G 1X8.
British Columbia Operating Room
Nurses Group's Sixth Biennial
Institute to be held April 13-15, 1978
at the Hyatt Regency Hotel,
Vancouver, B.C. Contact: Mary E.
Raikes, 106-14412 W. 14th Ave.,
Vancouver, B.C. V6H 1R3.
May
Current Trends in Pediatric
Feeding Techniques. A one-day
conference to be held at The Hospital
for Sick Children, Toronto, on May 31 ,
and on June 7, 1978. Fee: $20.
Contact; The Coordinator of Nursing
Education, The Hospital for Sick
Children. 555 University Ave.,
Toronto, Ont., M5G 1X8.
Nursing Care of the Sick Newijom,
a five-day conference to be held the
week of May 1 , 1 978 at the Hospital for
Sick Children, Toronto. Contact; The
Coordinator of Nursing Education,
Hospital for Sick Children, 555
University Ave., Toronto, Ont.,
M5G 1X8.
Autism: Research and Practice. A
research symposium and conference
to be held at the University of British
Columbia in Vancouver on May
24-26, 1978. Contact; Lois Myerhoff,
P.A.A.C. Office, 4125 — West 8th
Ave., Vancouver, B.C. V6R 2X3.
Pediatric Nursing Conference for
nurses wishing to increase their
knowledge of common pediatric
problems and nursing approaches. To
be held at the Hospital for Sick
Children, Toronto on May 24-26,
1978. Fee; $50. Contact: The
Coordinator of Nursing Education,
The Hospital for Sick Children, 555
University Avenue, Toronto, Ont.,
M5G 1X8.
International Congress of the
World Federation of Public Health
Associations and the 69th
Conference of the Canadian Public
Health Association to be held on
May 23-26. 1978 at the Hotel Nova
Scotian, In Halifax. N.S. Theme;
Primary Health Care — A Global
Perspective. Contact: Canadian
Public Health Association, 1335
Carting Ave., Suite 210, Ottawa,
Ontario. KIZ 8N8.
Call for Abstracts for the 2nd
International Congress of World
Federation of Public Health
Association and the 69th Annual
Conference of the Canadian Public
Health Association to be held in
Halifax, N.S. on May 23-26, 1978.
Theme: "Primary Health Care — a
global perspective." Papers relating to
primary health care as front-line care
in both urban and rural settings are
sought in the following categories;
1 . Health as an integral part of human
development
2. Primary health care as a part of
community development activities
3. Primary health care as part of a
general health care system.
Papers must be in English, French, or
Spanish. Send abstracts before Dec.
31 to; Dr. Lloyd Hirtle, Chairman,
Scientific Program Committee. Room
439, 1557 Hollis St., Halifax, N.S.
B3J1V6.
September
18th International Congress of
Midwives to be held Sept. 3-8, 1 978 in
Jerusalem, Israel. Contact; Iris E
Campbell, Secretary, Western Nurse
Midwives Association, 4007 - 108
Street, No. 35, Edmonton. Alberta,
T6J 2L5.
At Last... <
a Canadian supplier
for nurses needs
io worrying about Customs — No duir to pay.
STETHOSCOPES
P'eces Cncoae .-ea. L-ae. flreen
S'lver iwilh black tubing), gold,
gray No 110 S17.as Mch.
SINGLE HEAD TYPE As abo>e
t-i A •.-■-..'j: te. SaTie targe
-■a^n-a.;-^ 'c 1■5^ sensiti»i!y
s-_ ■:■: sn 95 Mch
SPHYGMOMANOMETERS
MEflCUflY TYPE. The uilimaie
inaccuracy Fo"<35 -nto i'9M twjT
'uggea metal c*»e H^avy duty
.•; ;-:■ cuf and iiHai'On S/Siem
No «30»5a-00— eh.
ANEROID TYPE
NOTE WE SERVICE AND
STOCK SPARE PARTS FOR
ABOVE ITEMS
OTOSCOPE SET One 0-
I"', s 'inesi mslruments
ra ummalion. po«e'-
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363 Weial carrying case
nednilhso't Ctotfi No 309
ER BANDAGE SCISSORS
.sr 'Q' e.er, Nufse. Ma/iL
,■£■:: ot finest sJeei and
• ■i-z in samlary chrome
6>9 *', S3.49
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designed 10 sho* yourproles-
sio^.ai status Jewelry quatJtv in
"^eaTj gold plate With safety
ciasp No 101 RN' with
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FllJOt:> AlP^^ A.ae'Slv«9.
NURSES EARRINGS Fo' pierced
ears Dami, Caduceus <n gold
ptaie witr^ QQ'a I'lied posts
Beautifully gift ooied No 325
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NURSES CAP TACS Go. a
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mpon T
DELUXE CAP TOTE Ai?
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HE POCKETSAVEB '
sso's etc pius
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Canadian Nu'ses Slro'^g stee' BoODy Pms with Nylon
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NURSES 4 COLOUR PEN for recording temperature,
biood- pressure eic Or>e-nana ODeraoon selects Red.
B\ack 6'ue Cf Greef Ho 32 $2 29 ea.
16
The Canadian Nurse December 1977
jfo^Mm
a^B
s
his is the last in our series of excerpts from the unpublished memoirs
of Maude Will<inson. Here we share with Maude her years in the rough
'bush' country of Northern Ontario as she supervises the formation of
Outpost Hospitals, her years as Lady Superintendent of a tubercular
sanitorium, the fulfillment and ruin of her dream to own and operate a
ursing home and then, late in her 79th year, Maude's retirement from
sing. As a Canadian nurse for 47 years Maude Wilkinson's story is a
lection of our own career history. Maude is now 96 years old and living
«ii ?i<nnybrook Medical Centre's Extended Care Facility, Toronto.
The Canadian Nurse December 1977
"If I should live to be the last leaf on the tree in the spring,
Let them smile, as I do now, at the old forsaken bough where I cling.'
Maude Wilkinson
C\
^
went to work at the Department of Soldiers
Civil Re-establishment (DSCR) soon after I
returned to Toronto at the end of the War.
The events in Europe had left so very
many scars everywhere. I wanted to try to help
veterans and their families adjust to their new
world both economically and psychologically.
I found a great many confused and
bewildered families during my investigations.
The war was over now and the husband had
returned home. With his return, his wife's
separation allowance had stopped. If the
veteran had a pensionable disability, the
amount the family received depended on the
degree of his disability. In a great many cases
the injury was slight and the pension was
small.
Then again very often the disability was
not pensionable, but still sufficient enough to
keep the veteran from finding employment. In
these cases the husband had to stay at home
and care for the children, his wife had to go out
and work.
There were also the young veterans,
those who had enlisted while still in theirteens
before having had a chance to establish
themselves in a job. Those men were left
loafing around, unemployed. Recognizing the
situation the Canadian government organized
Training Centres, paying trainees minimum
wage. Some took advantage of this offer,
others said such training only prepared them
for dead-end jobs.
I was faced with many problems. How
could I advise these men?
f^/liss Graham, my supervisor, resigned
from the DSC R in the fall of my first year there.
I was asked to succeed her. Thinking a short
course in Social Services might help me, I
asked permission to attend a course at the
University of Toronto. Permission was granted
as long as I could supervise the office at the
same time.
Obviously I had to establish a routine
which would include the office work and my
studies. Between meeting with and discussing
the investigators reports and attending
lectures, I had little leisure time that year. I
received my diploma from the Chancellor of
the University on May 13, 1921.
The office work increased and it became
necessary for us to employ more staff. I asked
the officer who was interviewing applicants to
be careful not to hire anyone who had not been
in the army. The successful applicant must be
able to look at things from a veteran's point of
view.
We hired two knowledgeable young men
wtio were ex-officers, and several graduate
nurses, ex-nursing sisters. Included in the
group of nurses was a full time graduate of the
Social Service Course, Miss Edith Rogers. I
really appreciated having Miss Rogers on my
staff and grew to depend upon her
recommendations.
I stayed with the DSCR for four years
and I really enjoyed my work. But I could not
avoid the fact that I was still very occupied with
returned veterans. I had not, professionally
speaking, successfully re-entered civilian life.
In 1923, Miss Holland, the Director of the
Red Cross Outpost Hospital Service, Ontario
Division called on me. She was resigning from
her position and she wanted me to take her
place. Needless to say I was very flattered:
I accepted the position.
Civilian Life
The Outpost Hospital Service was
concerned with the need for hospital
accommodation and nursing service in the
isolated rural districts of Ontario. It was one of
the largest departments in the Ontario division.
My field work was to be directed by a
representative committee under the
chairmanship of Mrs A. Plumptre.
Miss Holland took it upon herself to
introduce me to the nurses who were directing
other departments. I sensed a^pty,
cooperative spirit among
still the task I was un(
The Canadian Nurse December 1977
considerable and I was worried. Would I be
able to cope with the work?
After a few days in the office, I prepared to
leave to visit the Red Cross's first outpost
hospital. It had been established in 1922 at
Wilberforce in Haliburton County.
I boarded a Grand Trunk Railway train at
Union Station early one morning. I was the
only passenger on the train.
The conductor collected my ticket, noted
the destination and then sat down to talk with
me. I told him that I had been a nurse in the
war. He was an ex-service man himself and
knew I had experienced many ordeals and had
been exposed to great danger.
I was introduced to each passenger as
they arrived and the conductor insisted upon
relating my life history to them. Each time a
new tale was added until even I began to
wonder who he was talking about. I didn't want
to discredit him in front of the people he met
day after day, but I had to stop him when he
told someone that I had received the
highest award in the country, "The Honour of
Merit Medal. "
Of course, no such medal was ever
struck.
Wilberforce
The outpost nurse met me at the
Wilberforce station. We walked through the
village square together until we arrived at a
comfortable looking medium-sized house
proudly proclaiming itself 'The Wilberforce
Red Cross Outpost Hospital."
There was a large room on the right as
you entered the house. It ran the length of the
building and served as a two-bed ward
furnished with hospital beds and two
comfortable chairs. Both units were divided by
a curtain.
There was one patient in the hospital.
When I was introduced to him he clung to my
hand and said "Please matron, don't take our
nurse away. We can't do without her. Until I
was admitted here, she visited me every day at
my home five miles out of town. " I felt sorry for
the nurse, she was a quiet self-effacing
woman and this really embarrassed her.
I couldn't help but notice that everyone
spoke to her on our way from the station and
she called back to nearly all of them by name.
She was warm and friendly — I liked her
manner so much.
A comfortably furnished room in the front
of the house served as the staff sitting room. A
well and a kitchen pump provided drinking
water for the hospital, a cistern provided rain
water for other household needs. A little
outhouse in the back completed the sanitary
unit. , ^ .
for a couple of days
t some of the homes in
/one welcomed us
:nder if I would
nother nurse as
' vgsit with her
I boarded the train in Haliburton, now I
would have time to sort out my ideas before I
returned to the office. I had absorbed a great
deal in those few days. It was an experience
that would prove to be very useful when I was
faced with opening other nursing stations and
outposts.
Home Again
I went back to work realizing I would
always be the Red Cross Representative'
sent to meet those in different places who were
asking for assistance. This would necessitate
my absence from the office frequently. I
decided that I should visit the nursing stations
and hospitals the Red Cross operated just as
soon as possible. My visit to Wilberforce had
shown me just how important it was to find the
right person for the right place.
I had always been interested in hospital
organization and administration. Hospitals like
Roosevelt and Wellesley required large
expenditures in modern equipment and
furnishings to satisfy affluent patients. My
army experience showed me that patients
could be cared for with a minimum of
expensive equipment and still receive quality
care. The success of the hospitals that the Red
Cross established would depend more on
service than on display. The staff must be
selected carefully.
Canoes, Portages and Tents
It would be impossible for me to recount
all of my visits to outpost stations but one
stands out as being of particular interest.
In April, 1926 the Outpost Committee
received a request for nursing service and a
small hospital in the Red Lake mining district of
Northern Ontario.
My first responsibility was to find two
graduate nurses who would be willing to go so i
far away and live a more or less isolated life in
a mining camp. They also had to have the
ability to cope with any emergency.
I was fortunate — two graduates of thp
same training school, two sensible young
women, applied. Together we chose a suitable
uniform — a plain dress worn with an apron
and a Red Cross arm band while they were on
duty.
It took me quite a while to buy all of the
equipment. I wasn't used to the kind of
operation that was proposed for Red Lake.
Three tents were bought — a large one for
hospital purposes, a smaller one for the
nurses' living quarters, and one for storing
supplies. I had to buy folding iron cots, with
good comfortable mattresses, pillows, Hudson
Bay blankets — everything for household
purposes. We had accumulated 7000 pounds
of supplies by the time we left.
There was no electricity at Red Lake so I
included Coleman lanterns, stoves and a
hurricane lamp — my army experience really
helped as I tried to visualize and prepare for
every possible situation.
We left Toronto via C.P.R. the night of
June 25th and arrived in Dryden the following
morning. Dr. and Mrs. Dingwall were ready fo
leave. There was a little man named Papke
with them. I never found out where he came
from or who hired him, but Papke was
indispensable — a strong, wiry little man,
willing to do anything. The six of us took the
train to Hudson where we spent the first night'
— or rather part of the night since we left 11
Hudson at about five a.m. |
Our supplies, 7000 pounds of them, w
loaded into five freight canoes which wer:
The Canadian Nurse DecemDer 1977
111
supphea by the Hudson Bay Conipany and
manned by eight Indian guides. We all
boarded the pointer boat; it had an outboard
motor and towed the canoes.
We reached the Lac Seul Hudson Bay
Trading Post in the evening and met the
managers. Mr. Aldous was in a smart summer
suit — we felt so grubby and bedraggled in
comparison. With great pride he showed us his
miniature golf course. We were able to take
advantage of this opportunity to buy extra
food supplies from the store.
The guides warned us that Lac Seul
became very rough in the late afternoon so we
couldn't stay too long. Leaving the boat at Lac
Seul we walked the first portage to upper Ear
Falls, another portage to lower Ear Falls and
then a longer portage from there to a beautiful
spot where the English River joined another
river.
It was on that last portage that we met
three men returning from Red Lake. One was
evidently a gentleman of some means. He
asked Dr. Dingwall, what four fashionably
dressed white women were doing in this rough
mining district? Dr. Dingwall told him we were
all graduate nurses going to Red Lake to
establish a hospital.
That surprised him — he didn't know what
to say.
We were very tired, our feet ached from
walking steadily since five a.m. — over thirteen
hours. The guides took us to a shallow place
where we could wash and bathe our feet. Thert
they served us cold roast moose sandwiches
(which were delicious) and piping' hot coffee
made over a camp fire. We asked the guides to
make our cedar bough couches' and settled
down for the night. I can picture us even now.
lying five in a row. like five bowling pins
knocked down in an alley. Dr. Dingwall
couldn't help but laugh, what would the
gentleman from Toronto have to say atjout the
four grounded' fashionably dressed ladies
We were roused at four a.m. to cross
Pakwash Lake before it became too rough.
There were three more portages to cross that
day.
The pointer boat was waiting for us at
Pakwash Lake. We got on board very grateful
to sit down. We arrived at Red Lake about four
p.m. June 30th. It had taken us three nights
and four days to reach Red Lake from Hudson.
Two log cabins and some tents were
visible from the lake. Two men came down
from the cabins and introduced themselves;
Dr. Fitzgerald, the mine doctor, and fvlr. James
the assistant manager of the mine. They lead
us through the brush and when we arrived at
the cabins Mr. James took us to the cabin he
stayed in. There we found a basin and pitcher
of water and so we could tidy iMtsel^es. We
were a sorry looking grq
dresses' had been livg
slept in for three
Dr. Dine
go to the otherj
had both gra
The Canadian Nurse December 1977
Medicine at Queen's University. When Dr.
Dingwall reappeared, he was relaxed and
laughing heartily with Dr. Fitzgerald apparently
recalling some prankish university escapade.
Dr. Dingwall seemed quite oblivious to the fact
that the immaculate suit he had left Dryden in
was spotty and wrinkled.
Sherry was offered to the women,
somethirfg stronger for the men, and our
conversation soon became very animated —
yesterday's thirteen-hour pilgrimage was
forgotten. The next day, July 1st, was a
holiday, but still Mr. James detailed eight of the
mine employees to clear a lot, 100 x 250 feet
for our tents. The men seemed pleased to be
helping, they seemed comforted to know they
could be cared for if they were ill. By noon, the
flooring was nailed to the logs, the cracks in the
flooring plastered over and the large tent
securely fastened down — the hospital tent
was up.
Nine other men arrived in the afternoon
and following the same procedure they
finished the nurses' tent. We were able to
move in that night. The storage tent was ready
before noon the next day.
In the meantime. Dr. Dingwall found there
was no trail to the post office which was
located some distance from the camp (the mail
arrived by air every week). With an axe and a
saw he started to clear a path that the nurses
could navigate. It was a slow process, the
brush was thick.
In the evening Dr. Dingwall told us that the
history of Red Lake dated back to the
seventeenth century. He said as he cleared
the path he thought of those early settlers who
travelled by dog team on land and by canoe on
water. What great suffering they had to
endure.
After several days. Dr. Dingwall noticed a
sign nailed to a tree on the trail near our camp
— 'Dingwall Avenue " — his labor had not
gone unrewarded.
The next few days were very busy — as
Papke unpacked the supplies and took them to
the tents, we put everything in its place. Mr.
James arranged for the mine carpenter to build
some shelves and cupboard space for us.
Almost too soon it was time to leave. Mr.
James asked Captain Oake, pilot of the 'Lark'
to fly us out. Dr. and Mrs. Dingwall climbed into
the plane sitting behind the pilot. They had to
wait for me. As a matter of fact, I had to be lifted
up. My heart was in my mouth and I was too
afraid to let go and wave to the nurses I'd left
on the ground.
I had been living out of a suitcase for
thirteen years and I was beginning to think
seriously of leaving the Red Cross. The life of a
traveling salesman was no job for an old lady
of 52.
I was offered the position of Lady
Superintendent of Weston Sanitorium caring
for patients suffering from tuberculosis. I think
it was the opportunity to be a Lady, the
opportunity to settle down and stop rushing all
around the province that made me decide to
accept the position.
I told Dr. Dobbie, the superintendent, that
I had no experience in the care of tuberculosis
and he promised to help.
I discussed the position with Miss Russel,
the Director of the School of Nursing at the
University of Toronto. She thought it might be a
good idea for me to observe the work of some
American Public Health departments. I was
granted a scholarship and I left to travel to
southern Tennessee.
The scholarship allowed me to travel as I
wished. To the amazement of my friends, I
decided to go by bus and return by rail. You
see I really do enjoy traveling.
The district I went to was isolated with a
predominantly colored population. The nurses
were very friendly and I went on all their rounds
with them. Tuberculosis ran rampant in the
community and because of the people's
attitudes to disease, the nurses seemed to be
fighting a losing battle. I didn't envy them in
their work.
When I told them of the position I was
accepting, they agreed with me — my situation
would be very different.
Weston Sanitorium
When I returned to Toronto, I moved into
the nurses' residence at the sanitorium. I had
The Canadian Nurse December 1977
The Canadian Nurse December 1977
never had such an elaborate suite before. My
living room was large enough to take all my
furniture. There were two bedrooms with a
connecting bathroom and at the end of the
living room there was a completely equipped
kitchenette.
It was an apartment designed for a Lady.
There was only one drawback — the lady had
no time to enjoy it.
One of my responsibilities was the
supervision of the nurses. I was lucky because
my staff was made up of nurses I could rely on
to supervise the wards and to provide quality
nursing care.
I was responsible for the feeding of 600
patients and 200 employees. Each morning
the Chef came to my office to discuss the daily
menu and give me the list of supplies he
needed. We both thought that the hospital food
costs were too high and meat seemed to be
our greatest problem. The nurses told me the
patients complained as soon as they received
their trays. 'Stew again ! — Stew again I" — or
mince patties or meat loaf.
I really wanted to work at correcting this
situation, so I started by asking the Chef why
he always ordered carcasses. There was so
much fat and muscle to be discarded and the
result was that only one or two meat portions
could be roasted. I decided to experiment and
buy roasts, rolls for boiling, bones for soup and
some lean meat that could be stewed.
The Chef was frightened. He was afraid
the cost would be high and the doctor (whom
he thought wonderful) would be put out.
Nevertheless. I ordered cuts (roasts and rolled
boiling beef) instead of carcasses for a month.
When we received the bills at the end of
the month, we found the cost was no greater.
Better still the patients were satisfied and there
were no complaints. I noticed the nurses were
enjoying the change too. The Chef was smiling
and best of all. Dr. Dobbie approved.
I think I would have stayed at Weston
longer if Dr. Dobbie had not decided to leave.
The doctor who was going to succeed him told
me about the changes he was going to make
— changes which affected my department and
for a numberof reasons I couldn't accept them.
The Board wrote me a most complimentary
note with an enclosure — a $1000 cheque. I
think I have that letter somewhere ... but not
the cheque.
My Own Nursing Home
I had a few days of leisure to settle into my
new apartment and be with my friends and
then began to think of the future.
Sir William Osier in an address at Johns
Hopkins University on February 22nd, 1915,
spoke of the uselessness of men above sixty
^ears oi_^ejatUh^ incalculable benefit it
lercial, political and
tmatter of course, men
^was this statement
Jrom Anthony
1 suggested it
' chloroform
all men at age sixty, that got me thinking.
I certainly did not wish to be chloroformed
at sixty. I had a thousand dollars to spend and I
wanted to establish and operate my own
nursing home. I would be the lady
superintendent.
I knew the house I wanted to rent. It was
located on the top of a hill overlooking
Davenport Road. The house had been vacant
for a long time and a trust company was trying
to sell it. I went to them and they told me the
owner wanted to sell and not rent. I got in touch
with the owner and arranged to meet him.
I was at the house before he arrived with
the keys. The grass was uncut and the
flowerbeds were full of weeds. Would I ever be
able to restore the garden? As soon as the
owner arrived, we went into the house — it was
absolutely filthy, with cobwebs and crates full
of rubbish everywhere.
I told him that I actually knew the house
very well — friends had owned it at one time. I
would put eight beds in the large living room,
four on each side. I would like to have full
curtains on rods between each bed. If this was
not possible, I would have to buy screens.
We went upstairs. I was planning to put
four beds in the large room there with curtains
or screens. There were also two semi-private
rooms, one small private room and then the
master bedroom which would be the second
private room. In this way I could accommodate
18 patients.
The owner seemed interested. We then
went down to the basement, I was anxious to
see thefurnace and the laundry tubs. I told him
I would have to be assured the furnace and the
stove were in good working order. After
looking everything over — electric fixtures,
sinks, taps, etc. we discussed the situation.
He told me he had wanted to sell but the
Trust Company was not able to find a buyer.
He would rent if the amount agreed upon
covered the taxes, the mortgage costs and a
balance for decorating and repairs. He
suggested a sum which I thought was
reasonable and so accepted.
What a spree! I refused to buy anything
but the best and nothing was to be charged. I
went to the firms I had dealt with when I
furnished the Outpost Hospitals. They agreed
to allow me wholesale prices. Hospital beds,
mattresses, pillows, bedding, linen, blankets,
dishes and china. The thousand dollars were
disappearing rapidly. I had to be careful to
keep enough in reserve to pay the rent for a
couple of months until there would be some
patients. All was in readiness when the first
patient arrived.
My First Patient
A very good friend of mine reserved the
small private room for her brother. He was my
first patient and he was to arrive at eight p.m. I
hired a nurse for the night. She was a graduate
of my own training school. He arrived and
seemed satisfied with the accommodations. I
said goodnight to him and the nurse and I went
to my room — I was too excited to sleep.
In the morning I prepared breakfast and
then called the nurse to take up our patient's
breakfast tray. I didn't know why but I thought
she looked rather glum.
i saw the patient later. He asked me to
phone his sister — he was leaving. He
absolutely refused to stay another night in the
house, the nurse had been impertinent.
Apparently she had told him to be quiet when
he called her the night before. The second time
he called she had slapped him.
What could I say? I was so sorry, I thought
she would be satisfactory. His sister came for
him and they left — so did the nurse.
I realized my patient was a very sick man
and perhaps he had been impatient with the
nurse but I could not, and would not, allow any
of my nurses to treat a patient unkindly. The
man died a short time later. I was glad that he
had not died In my home.
Other patients arrived. Three graduate
nurses living in the district had applied for
work. I hired them and notified them as
patients were admitted. The nurses proved to
be very satisfactory.
Tfie cook, launderers, and part-time
handy man lived outside of my Home and
these employees did not work out as well. The
munition factories were attracting young
women and able-bodied men were in the army
— all in all there were not many people left to
choose from.
The cook would come in one day and not
the next. The woman who did the washing and
cleaning was most unreliable. I do not know
how I would have managed if a practical nurse
had not applied. She soon came to be my right
hand man.
Together we managed the washing when
the launderers did not arrive. She was always
pleasant to the patients and we became quite
fond of one another.
She told me I was working too hard. I
knew she was right and my family was very
worried about me. Finally, my doctor said he
would not be responsible for what would
happen if I didn't sell or give the place away
I was heartbroken. Everything had been
going so well, the beds were nearly always
occupied. I wasn't making a great profit, but
was not in debt.
One evening the night nurse told me that li
I was thinking of discontinuing the home (they
all seemed to think I was done for) she would
like to take it over. I sold her all my wonderful
equipment.... everything butthefurniture I had
brought from my home.
I asked my lawyer to prepare a statement
for me. He was really upset — why didn't I
consult him? I had priced things far too low and
I had made no allowance for the reputation of
the home, its good name. But nothing
mattered to me at that point. I just wanted to
get away. My dream was over.
I moved into my small apartment in the
duplex we had built. I did not enjoy resting and
The Canadian Nurse December 1977
relaxing. It only served to nnake me realize to
what a great extent I had neglected myself. I
had been too Impractical.
I sat at home and twiddled my thumbs for
several months. I kept thinking there had to be
something I could do. The longer I sat, the
more frustrated I became.
One day I met a friend of mine (a Sick
Children's Hospital graduate) fortea. She was
still working and was planning to ask for a
month s holiday. She had to find someone to
relieve her.
"Lilly, would you suggest me? I am so
anxious to be doing something."
Lilly arranged everything with the
Superintendent of Nurses at Sick Children's.
I was working in the children s dress
department. Those patients who were well
enough to get around could come in and
choose the dress they liked. The brighter the
material, the more the children liked it —
nothing was too gay.
I loved working with the dear little tots.
Their faces would glow with pride and their
eyes would sparkle brightly as we tried the
dresses on them. I was sorry when the month
was over.
I went to the Superintendent's office to tell
her just how much I had enjoyed the work. She
told me she was planning to have a small room
set apart as a Private Patients' Waiting Room
and she needed a Nurse/Receptionist to
supen/ise the area. Attending physicians were
often very busy men and they were not always
available in their offices. As the receptionist. I
would call the pediatrician and care for the
baby until he came. I accepted the position and
stayed with the hospital for three years.
One day a woman and her husband
appeared at the door, she was weeping over a
frail little babe in her arms. I took the baby from
her and rang frantically for the doctor. I rang
and rang but when he came I handed him a
lifeless little body. The baby had died in my
arms. I was terribly shaken. I have never
forgotten that feeling of the child dying so close
to me.
The Emergency Department was right
next to the waiting room. When I wasn't too
busy I would have coffee with the nurses. They
^ were all very friendly. Before I left they had a
farewell party and, much to my
embarrassment, they gave me a lovely little
gold pin which I value greatly.
When I cashed my final cheque I had
been gainfully employed for 47 years, from
1912 to 1959. I don't think that at 79 years of
age anyone would question my decision to
retire.
I began to be plagued by blackouts early
in 1962. I was repeatedly admitted to the
hospital for a few days and then discharged
only to await another attack.
My doctor advised a move into a guest
home where I would not be alone.
I knew he was right but I did hate parting
with my things, some I had brought from
abroad, some from mother's and
grandmother's home. It's hard to leave things
that have been with you for so long.
It is nearly midnight November 28, 1 972. 1
find myself watching the clock and recalling my
experiences of the past ninety years.
The doctor has tol^me I'll have to return to
the hospital sometime soon. I'm wondering
how I can use the leisure time I will have there?
How can I use it to its best advantage?
Then I'm reminded of a verse in one of
Oliver Wendell Holmes' poems: "If I should
live to be the last leaf on the tree in the spring,
Let them smile, as I do now. at the old forsaken
bough, where I cling."
Mr. Holmes you have helped me solve my
problem.
I will write of those adventurous ninety
years, so many of them spent nursing, and
show that tme adventure knows no age, era or
profession.
My story will be called 'Four Score and
Ten."*
l'24
The Canadian Nurse December 1977
sc
SCREENING
PROGRAM
THAT
WORKS
Between 1974 and 1976, school nurses in Montreal screened 26,947
children in grades seven and eight for adolescent idiopathic scoliosis.
Of these, 4.6% had scoliosis positively diagnosed by radiographic
examination; 4.5% were idiopathic in nature. The nurses were part of
the Shriners School Scoliosis Program — a program that has proven to
be a clinically sound, cost effective way of detecting early scoliosis,
providing consistent follow-up and treatment and preventing
progression of the condition. What follows is a description of how
cooperation and planning among existing health institutions can make
a preventive program work.
I ne K^anauian nurse
Jean F. Gun
Three years ago, medical consultants at
the Shriners Hospital for Crippled Children
and at McGill University along with school
nurses from the Department of Community
Health at the Montreal General Hospital got
together to establish the Shriners School
Scoliosis Program. The program's
objective is to demonstrate the clinical
effectiveness and low cost of an
organization that focuses on early
detection of adolescent idiopathic
scoliosis accompanied by thorough and
consistent follow-up and treatment. The
team of health professionals working in the
program also keeps records of the
incidence of the disease, its natural history
and from these, seeks to demonstrate how
follow-up and conservative treatment can
prevent progression of a curve to 60%
thereby decreasing or eliminating the need
for surgical intervention.
The program requires a well established
community health unit with competent nurses
working In a broad sample of secondary
schools. This must be complemented by a fully
equipped medical center with a coordinated
backup service (medical consultant, nurse,
secretary, radiographer, and physiotherapist).
(See figure 1) Adequate transportation from
the schools to the medical center Is also
Important. All of these requirements were
made available to us In the Montreal area.
The full cycle of the program consists of
four phases:
• Inservlce education
• school screening
• follow-up and treatment
• documentation and evaluation.
Implementation of these phases Is the
responsibility ofthe program's coordinator. It Is
her job to coordinate the diverse functions of
the team (See figure 2). In addition, by
communicating with the various departments
at the medical center, she Is able to obtain
cooperation from other members of the team,
(e.g. radiology, medical records, and
physiotherapy), cooperation essential for the
smooth running of the program.
Inservice education
Small groups of school nurses chosen by
the Department of Community Health are
given inservlce education prior to the
Implementation of the scoliosis screening
program in the schools. The coordinating
nurse helps to organize and prepare the
training sessions while the medical consultant
presents the program and Its objectives. The
training sessions emphasize the Importance of
the nurses' role in the total program and
demonstrates the screening procedure to be
used.
FIGURE 1 ORGANIZATIONAL STRUCTURE
QUEBEC DEPARTMENT
OF SOCIAL AFFAIRS
MONTREAL GENERAL HOSPITAL
SHRINERS HOSPITAL FOR
CRIPPLED CHILDREN
(QUEBEC) INC.
DEPARTMENT OF
COMMUNITY HEALTH
SHRINERS SCHOOL
SCOLIOSIS PROGRAM
TEAM
COORDINATING NURSE
SCHOOL NURSES
MEDICAL CONSULTANT
SECRETARY
RADIOGRAPHER
PHYSIOTHERAPIST
MEDICAL RECORDS
FIGURE 2 COORDINATION CHART
TEAM COORDINATION
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Q.
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03
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LU
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OUTPATIENT DEPT.
X
X
X
ORTHOTIST
X
X
DEPARTMENT OF
COMMUNITY HEALTH
X
X
RADIOLOGY
X
X
X
MEDICAL
CONSULTANT
X
X
X
X
X
X
ADMINISTRATION
X
X
X
X
X
SCHOOL NURSE
X
X
BUS COMPANY
X
PATIENT
X
X
X
X
X
O.R.
X
PHYSIOTHERAPY
X
^
.^jA
1_
The Canadian Nurse December 1977
As an educator, the school nurse is
expected to pass on this information to the
school and the community. She does this
through conferences with school staff, student
groups and information letters to parents.
Obtaining support from the community at an
early stage is important since the success of
the program and its follow-up will in large part
depend on the understanding, cooperation
and acceptance of the program by these
people.
School screening
There are a number of significant features
of scoliosis which we used as the medical
criteria for the development and
implementation of our School Scoliosis
Program:
• Idiopathic scoliosis is structural in nature
and accounts for 65% of the disease
incidence.
• Adolescent idiopathic scoliosis usually
manifests itself before the final "growth spurt"
or at the "modesty age," when parents do not
see their children undressed.
• Scoliosis curves are classified as
thoracic, thoracolumbar, lumbar, and double
major curves. The apex of most thoracic
curves is to the right and the apex of most
lumbar curves is to the left. Scoliosis curves
are further classified as infantile, juvenile, and
adolescent depending on the age of onset.
(See figure 3).
• Rotation of the vertebrae causes a rib
hump which may be observed clinically.
• Small curves (under 15°) usually remain
stable with the establishment of skeletal
maturity.
• Thoracic curves of 45° or more, and
lumbar curves of 36° or more, may continue to
increase at the rate of 1° per year, even after
maturity. This often results in pain, deformity,
possible diminished cardiac output, and
diminished pulmonary reserve.
• Idiopathic scoliosis tends to be a familial
condition.
• Treatment using a brace is prescribed for
curves between 20° and 30° where there are
definite signs of progression and skeletal
immaturity. For curves over 30° where
skeletal immaturity exists, treatment is
prescribed without waiting for progression.
Other data such as age, height, family history,
radiological measurement of ossification of the
iliac apophysis, vertebral rotation, and the
onset of the menarche help to determine the
progression potential of each child.
• A structural curve measuring 6° or more
by the Cobb method was used as the criteria
for diagnosing idiopathic scoliosis.
Using this medical criteria, the most
productive and safe age level for screening is
with 1 2 or 1 3-year-olds, usually grade seven or
eight. (The productivity rate of a trial screening
at the grade six level was found to be low).
Primary screening is carried out by the
school nurse in the school. The technique is
simple and takes only a minute. The child
undresses to the waist and stands in front c
the nurse. The nurse makes her first
observation from the back noting any
asymmetry of the torso such as shoulder, hip
or scapula levels. With scoliosis the shouldei
and scapula on the convex side of the curv(
tend to be higher. Likewise, the hip on the
opposite side of the curve may be more
prominent at the waist. As well, the arm on thi
convex side of the curve will be closer to the
body. Keeping in mind that the apex of mos
thoracic curves is to the right and most lumba
curves to the left, it is sometimes possible ti
see the actual deviation of the spine (See
figure 4).
The nurse then asks the child to bend
forward from the waist with feet together,
knees straight, head and arms falling freely,
and hands clasped together. Keeping her eye
level with the child's back, she looks for an^
difference in elevation of the rib cage (See
figure 5). This "hump" on the convex side c
the curve is the most indicative sign of a
possible scoliosis, and is due to rotation of thi
vertebral bodies toward the concavity of the
curve (See figure 6).
All clinical observations are recorded b;
the nurse. Among the children screened, a
number will be observed to have only a
suspicion of abnormality. The nurse must us(
FIGURE 3
Classification of Scoliosis
FIGURE 4
CLINICAL CHARACTERISTICS
NON-STRUCTURAL SCOLIOSIS: a curve with no fixed rotary components and
totally correctable by bending to the convex side, by lying down or by
traction. The causes are poor posture, a leg length discrepancy, inflammation or
hysteria.
STRUCTURAL SCOLIOSIS: a curve with fixed vertebral and rib rotation.
prominent shoulderf
1 . Idiopathic: about 65%
(a) infantile — 0-3 years
(b) juvenile — 4- 10 years
(c) adolescent — 10-maturity
iinifBinni»H.im»« apex
rib hump
2. Congenital: about 15%
Vertebral anomalies, eg. myelomeningocele, wedged vertebrae,
Extravertebral anomalies — hemi-verlebrae, fused ribs
3. Neuromuscular: about 10%
(a) Neuropathic — eg. cerebral palsy, poliomyelitis, neurofibromatosis
(b) Myopathic — eg. muscular dystrophy
4. Mesenchymal Disorders — eg. Marfan's syndrome, Scheuermann's
disease
, fractures, irradiation, bums
6. I.i ulosis
7. Metabolic Disorders g. rickets
8. Others — nutritional, eno :;rine
arm more proximal
hip elevated
0
k.
l£ciBA
her judgment in such instances, and maintain a
file on these children for follow-up within the
school year. We feel that it is unwise to load the
referral lists with large numbers of suspicious
cases which tax the medical center facilities
and do not benefit the child. Nonetheless, the
nurse has a professional responsibility to
provide for follow-up services if she still
suspects an abnormality during later
observation.
Upon completion of a school screening,
the nurse summarizes her findings and then
contacts the parents of all children she feels
should be seen by the medical consultant. This
is normally done by telephone. She reassures
the parents, and answers all questions about
the disease, follow-up and treatment. The
parents are asked to sign a consent for
radiological examination and are invited to
accompany the child to a secondary screening
clinic.
Follow-up and treatment
The subsequent phase of the program is
carried out at the medical center and consists
of three types of clinics;
1. Secondary screening clinic
2. Regular follow-up clinic
3. Brace clinic
1 . Secondary screening clinic
Secondary screening is carried out by the
medical consultant. The program coordinator
arranges for a bus to transport the children,
school nurse and interested parents to the
medical center for this clinic. The school nurse
participates in the secondary screening and is
therefore able to evaluate her own visual
screening ability. Age, height, weight, arm
spans, and menses onset are documented.
Family history is recorded along with other
clinical diagnostic observations. Radiological
examination, usually an A-P erect spine, is
made at the discretion of the medical
consultant. Using the X-ray, curves are
measured using the Cobb method. Rotation of
the curve is also measured and skeletal
maturation is determined by using the Risser
method to measure iliac cresting.
The children see the X-rays and for the
first time discuss their curve with the medical
consultant and the nurse. They are
encouraged to take a positive view of the
diagnosis and in particular, to assume some of
the responsibility for follow-up and treatment
by remembering to keep further appointments.
Parents who have not accompanied their child
to the medical center receive a letter from the
coordinating nurse outlining the result of the
examination.
2. Regular follow-up clinic
When the diagnosis indicates a need for
follow-up treatment, the parents are once
again encouraged to attend the clinic with their
child ( See figure 7) ; the coordinator schedules
the clinic and advises them of the date and
time. Together, the parents and the child are
shown the X-rays and the medical consultant
discusses and clarifies the implications of the
diagnosis with them (See figure 8).
Further clinic visits are requested by the
medical consultant for those children whose
curves have not yet stabilized. These
follow-up visits are considered a vital part of
the overall program. The coordinating nurse
ensures that follow-up is carried to completion
by tracking down children who miss clinics and
rescheduling their clinic appointments.
FIGURE 5
SCREENING FOR RIB HUMP
FIGURES
A MINIMAL CLINICAL RIB HUMP
FIGURE?
PARENT PARTICIPATION
FIGURE 8
IMPLICATIONS OF DIAGNOSIS
The Canadian Nurse December 1977
3. Brace clinic
Progressive thoracic curves and
thoracolumbar curves are treated with a
Milwaukee brace (See figure 9) while a
lumbar curve is treated with a McEwan
(molded) jacket (See figure 1 0). They must be
worn 23 hours a day until skeletal maturity
develops. These braces as well as others such
as the Boston Orthosis act as holding devices
to arrest the progression of the curve.
Although body braces rarely reduce the size of
a curve, these orthoses when accompanied by
physiotherapy have had highly effective
results. Today the only acceptable treatment
for idiopathic scoliosis begins with the early
detection of the curve followed by prevention
of progression using these orthoses.
When a curve has progressed to a stage
requiring conservative treatment, the medical
consultant immediately talks this over with the
parents and child. Whether the child accepts
or rejects the brace depends largely on how
much support he will receive from his parents.
In turn, their support depends on how well they
understand their child's problem. Both the
parents and the child need a full explanation by
the medical team of the treatment and its
outcome .
All children undergoing treatment return
to a Brace Clinic every three months. This
gives the medical consultant the opportunity to
check that treatment is progressing as
planned. Additional X-rays are taken every six
months to establish the status of the curve and
iliac excursion (an indication of skeletal
maturity). At each visit an orthotist checks the
brace for comfort and fit and provides his
expertise for brace adjustments. As well, the
children visit the physiotherapist who outlines
and supervises a regime of exercises. At
subsequent visits, the importance of activity
and the maintenance of good muscle tone is
reinforced.
Brace clinics are organized so that all
children undergoing treatment meet each
other. The nurse's role during this phase is to
help the children solve personal problems
associated with bracing. Loss of self-image,
dependency, frustration, difficult adjustment to
lifestyle, and changing relationships with
parents and peers are all conditions which can
occur. The nurse is also a source of guidance
for physical problems involving skin care and
personal hygiene.
During our two years of operation,
participation in the clinics have given the
medical team a chance to observe how
children and their parents react to scoliosis
and its treatment. Generally, these
I observ^ons have been confirmed in the
litei^^|y^)t||g|g who have studied
pg conservative
Vv'e ha ^ -)U!!i.i th.T / dren at the
adolesce tween the desire
for indep. ='^(lly
unexpressed need tor parental s ipport. Often,
parents are not sensitive to the ijuctuations
between these needs. Children frequently
come to the clinics by themselves and display
feelings of apprehension or indifference.
Because the coordinating nurse and the
medical consultant recognize these feelings,
they encourage the children to take a positive
outlook by talking with them in a friendly and
supportive way. As much as possible, they are
encouraged to recognize that they are not ill
and are to remain active.
The decision to use a brace is always
upsetting for the parents and the child; most
FIGURE 9
MILWAUKEE BRACE
parents express feelings of guilt and the child a
sense of despair. We have found that young
people either fully accept the prescribed
treatment, adopt a mature outlook and
maintain their self-respect, or they reject it
completely. At this early stage, good
communication skills are required by the
medical team. Children and their parents need
to know that they can talk about their feelings
with the staff. At our clinic, many children
seeking support and reassurance phone the
nursing coordinator "just to talk. "
FIGURE 10
MOLDED JACKET
3 Uj^tacti
The Canadian Nurse December 1977
Evaluation and documentation
At the end of the school screening
program, the school nurse documents her
yearly statistics. From these, she is able to
evaluate her screening proficiency.
Data from a sample of 20 schools, chosen
at random from the program in 1975-76.
showed that the school nurses had an average
screening productivity of 86°b. Of the 3,481
children screened, 352 were referred for
secondary screening at the medical center,
and 65 others selected private referral. Of
those referred to the center. 58 had a
suspicion of scoliosis. 149 had curves
measuring 5'-10', and 89 had curves
measuring over 10". Five of the 89 are now
being treated with braces. Eight had diagnosis
other than scoliosis, such as leg length
discrepancy and Scheuermann's disease
(kyphosis). Forty-eight did not require
follow-up.
Screening proficiency was a large factor
in one nurse's ability to observe a child with a
rib hump, an indication of a possible early case
of idiopathic scoliosis. Radiographically, the
curve was minimal, yet. it progressed rapidly
into the treatable range.
Once the school nurses have
documented their statistics, these are
collected by the nursing coordinator of the
program and the secretarial staff who then
prepare yearly statistics. fVledical records are
kept for each child using a key sort card.
Information from progress notes that includes
data such as family history, curve
classification, rib hump, rotation, cresting,
menses onset, other orthopedic problems and
prescribed treatment are noted on the card.
These cards are updated after each clinic visit.
A cost analysis was prepared by the
coordinator based on data from a sample of
400 school children. This exercise compared
the cost of screening and conservative
treatment against the potential cost of surgical
treatment. Because of our strict criteria for
conservative treatment, we assumed that
most progressive non-treated scoliosis would
ultimately require surgical intervention. The
total cost of all phases of the screening
program for the 400 children was
approximately SI ,700. For the same group of
children, a 2.75 per thousand surgical rate was
calculated to cost some S1 1,000.
Results
From the records covering the two-year
period (1974-1976). in which 26,947 children
were screened under this program, the
following summary of major medical statistics
has been prepared;
• 4.6°o of the 26.947 children screened had
scoliosis; 4.5% were idiopathic, positively
diagnosed by X-ray as structural curves and
over 6°. There was a 2% incidence of
idiopathic scoliosis with curves greater than
10=.
• The female to male ratio of scoliosis was
1.25 to 1, female predominant.
A HAPPY SECURE ATIVIOSPHERE IS SOMETHING
THE MEDICAL CENTER CREATES
• In curves that were 21' or more, girls
predominated by 5.4 to 1 . Over a 24-month
period. 2.75 students per thousand screened
were treated with braces.
• In the first year (1 974-75) of our program,
it was estimated that the provincial health
expenditure was reduced by some S347,000
for the 14.902 children screened. The
aggregate return to the province included this
reduction in expenditure plus the elimination of
extensive shadow costs (e.g. welfare, tax loss,
productivity, workmen's compensation, etc.).
• Over the two-year period, only four of the
75 children who had braces prescribed
refused treatment.
Conclusion
School screening programs, such as the
Shriners, are one means of applying the
concept of prevention to health care. I^ass
screening by a school nurse who provides
early and accurate clinical observations is a
highly effective way of detecting adolescent
idiopathic scoliosis in a significant number of
children. Medical statistics confirm that the
program's performance is consistent with
current medical data, and is capable of
providing new findings.
Because many health professionals are
working together, both the physical and the
emotional needs of the child and his family can
be recognized and met. The use of existing
facilities and institutions permits provincial and
medical services to realize significant cost
reductions over the long term. ^
Author Jean F. Gurr/s a school nurse
employed by the Departmerit of Community
Health at the Montreal General Hospital.
Currently, she is the nurse coordinator of the
School Scoliosis Program. Shriners Hospital
for Crippled Children (Quebec) Inc. Gurr is a
graduate of the Hospital for Sick Children in
Toronto and received her B.Sc.N. from
Queen's University in Kingston, Ontario. She
is a member of the Order of Nurses of
Quebec.
Acknowledgement: The author would like to
thank Dr E.J. Rogala, M.D., FRCS (C)and Dr.
D.S. Drummond, I^.D. FRCS(C) who are
associated with McGill University and with the
Montreal Shriners Hospital for the time and
effort spent in reviewing this article.
References
1 Myers, B.A. Coping with a chronic disability;
psychosocial observations of girls with scoliosis
treated with a Milwaukee brace, by ... et al.
Arrter J. Dis. Child. 20;3:175-181. Sep. 1970.
This is recommended reading for any medical center
contemplating the implementation of a school
scoliosis program.
Bibliography
1 James. John IP Scoliosis. Rev. 2d ed.. by ...
et al. New York. Longman. 1976.
2 Keim, H.A. Scoliosis. Clin. Symp. 24:2-32.
1972.
3 Riseborough. Edward, J. Scoliosis and other
deformities of the axial skeleton, by... an^ames I
Henderson. Boston. Little, Bro
4 Scipien. G. Compre(f^^^^^^/:stHjrsing,
by ... et al. New York,
5 Sells. Clifford J»"
schools, by ... ang
74:1 :60-62. Jan.
ames H^
The Canadian Nurse December 1977
SIN€i ?f J^
The Canadian Nurse December 1977
31
OCCUPATION AND CAREER
PERCEPTIONS OF NURSING STUDENTS
NEW BRUNSWICK'
What reasons prompt young people today to choose nursing as their career? Are
they influenced by the idea of working as part of a highly professional team in the health care
system? Or are they, still, like many generations of nurses before them, attracted to the ideal
of service to others ? If you think the old argument of professionalism versus humanitaria-
nism is dead — read on. Not only is it alive and well in New Brunswick, it is also being
reinforced by the very teaching institutions that educate our nurses.
I
Donald J. Loree
Irene Leckie
The choice of an occupation or career is one of
the most important decisions any individual
makes in the course of his or her life.
In selecting a career, several important
factors are involved. First, young people must
understand their own life situation and the
career chances that are possible for them.
Second, they must have some knowledge of
what the career they choose involves, and
what the practitioners in this profession do.
Third, they must decide by what avenue they
will enter their chosen career.
The prospective nurse in New Brunswick
is confronted with two avenues of entry into the
field. She can enter a Baccalaureate program
in a university, or she can enter a Diploma
program in an educational Institution other
than a university.
We recently undertook a study of the
occupational and career perspectives of
nursing students in New Brunswick. What
struck us particularly about the findings of this
study is that the choice of either the
Baccalaureate or the Diploma program
appears to be based on differing perceptions
of the role of the nurse in todays society. In
other words, the way the potential nurse
defines her future role, whether she sees the
nurse as a professional member of a
professional team or whether she sees the
nurse primarily in a humanitarian role, will
affect her choice of which institution to enter.
The sample
Our questionnaire was administered to all
students enrolled in schools of nursing in New
Brunswick in the Fall of 1976, including
Baccalaureate programs at the Universite de
Moncton and the University of New Brunswick
as well as five independent Diploma schools.
The questionnaire was prepared in both
French and English and distributed according
to the language or languages of instruction at
each institution. Two pre-tests provided
valuable guidance in constructing the
questionnaire and allowed us to eliminate
some problems and also to pre-code answers
to the majority of questions. This was
important to achieve comparability between
the English and French versions.
Demographic factors
A total of 715 nursing students (80.6 percent)
completed and returned the questionnaire.
More than half (60.8 percent) of these were
enrolled in Diploma programs.
The remaining 39.2 percent (280
students) were enrolled in Basic
Baccalaureate programs. Analysis of the
information provided by these students
indicated that:
• 98.5 percent were female
• 59.6 percent considered English their
mother tongue'
• 95 percent were between the ages of 1 5
and 24 and 60 percent were between the ages
of 15 and 19
• 51 .5 percent came from farms or small
towns with populations of less than 5000
persons.
More about our respondents
When we looked at the answers to questions
we had asked about the occupations and
educational attainments of their parents as
well as income of the family head,' we found
an apparent relationship between these three
major socioeconomic variables and the
program that the students were in.
Socioeconomic levels of parents of
Baccalaureate students were consistently
higher for all three variables than parents of
Diploma students, a fact which can be related,
at least in part, to the reported differences in
time and cost between the two programs.
It is interesting to note, too, that for a large
percentage of students the reported education
level of the mothers is considerably higher
than that of the fathers. This reflects the
relatively high proportion of our respondents
whose mothers were either teachers or
nurses.
We wanted to know what other factors
might have influenced these students in their
decision to enter nursing, so we asked several
additional questions. In their responses the
students indicated that:
• Almost three-quarters (73.7 percent of
Diploma students and 74.6 percent of
Baccalaureate students) had at least one
relative in nursing, medicine or a related
occupation.^
• About one fifth of the resDCQdsnl^2(;
percent of Baccalaurealei
percent of Diploma stuc^i^^^^^Bleo that
parents, friends or te§
instance, followed;
'More details conj
article is basedl
University of I
The Canadian Nurse December 1977
^«
care workers, had been most influential in
directing them into nursing programs.
• A small but not insignificant number of
students {6.4 percent) indicated that media
influences were primary.
• Almost exactly half of the students (50.1
percent) reported that they chose nursing
because of the opportunity it offered to serve
others.
Although we found a definite correlation
between the various socioeconomic variables
that we examined and the program that the
student enrolled in, these variables had little
impact on whether the student indicated either
a professional or humanitarian orientation.
Humanitarian versus Professional
The debate on the humanitarian versus
the professional aspects of nursing is an
ongoing one.
However, even a qu \ck scanning of recent
newspaper headlines on the subject of
abortion or nurses' stril<es will make it clear
that, to the general public at least, the
traditional image of the nurse as a caring
person ministering to human suffering is still
very real and very desirable.
If these kinds of concepts are present in
the mind of the public at large, they cannot help
but have an effect on the perceptions and
decisions of those entering or considering
entering nursing. While roles are primarily
learned during the educational and socializing
processes found in both the Baccalaureate
and the Diploma programs, some awareness
of the differences between the two will
certainly be apparent to the observer. The
potential nurse is an observer, and a very
interested one, if she is considering entering
the profession. She sees not only the different
types of nursing education open to her, but
also the different ways nurses approach their
work in different settings. The choice she
makes will be influenced by her observations,
socioeconomic factors and her perceptions of
the nursing profession and nursing roles as
being predominantly humanitarian or
professional.
Several writers have attempted to identify
and classify the role of the nurse vis-a-vis the
other related roles in the health field. In a
study of nursing in Jamaica, Dorian PowelP
identifies the two major images of the nurse
held by the public in general and by those
entering nursing; the traditional one stressing
"humanitarian attributes, " and the
professional image stressing a more
technical" orientation.
Johnson and Martin" put forward the
[tiona! viewpoint of role differentiation in
the'- '• ^tting. They argue that in the
hob !'' of labor exists in which
"instrumerai and express ve functions are not
participaled in equally by nurse and doctor
...The doctor's role is primarily that of the
detached professional and thr nurse's more
expressive and humanitarian it orientation.
Ideally the role of the nurse would integrate
some of the professional aspects so as not to
upset optimum team' effort."
Nurses do, and are expected to, perform a
variety of different functions in their activities.
In the same way, nurses in different areas of a
profession or institution will be expected to
function in a different way from others in other
areas.
In a similar vein, Corwin^ notes that
differing conceptions of nursing were found to
be related to the nature of organizational goals
and occupational settings. The three he noted
were: the employee (basically the
bureaucratic role), the independent
professional, and the public servant in a
humanitarian context. Corwin stresses the first
two, apparently due to a concern with the
administrative-bureaucratic and professional
aspects of the hospital and its internal
occupational relationships.
Although he refers to Diploma schools
that function as part of a hospital (no longer the
case in New Brunswick), Corwin does stress
the differences in the orientation of the two
programs. The Diploma program, he argues,
is more bureaucratically oriented and the
Baccalaureate more professionally oriented.
The New Brunswick Study
For the purposes of our study in New
Brunswick, we delineated these two broad
views commonly held of nurses:
1) the humanitarian concept, based on the
traditional, stereotyped image of nurses, and
2) the concept of the nurse as an objective,
rather detached, professional functioning as
part of the health care system. Both of these
images of the role of the nurse are predicated
on different conceptions of the nurse-doctor
relationship and the nurse-patient
relationship. Each assumes an equal level of
competence in technical nursing skills,
although in each case the stress may be upon
different skills. While elements of both
orientations are probably a part of the general
conceptualization of nursing, one image or the
other will likely predominate and be more
influential in determining attitudes and
behavior in the individual entering nursing, and
especially her choice of Baccalaureate or
Diploma education.
Why Nursing? Image and Orientation
Two questions were of crucial concern in
this study. First, why had the respondents
selected nursing as a career, or, to be more
specific, what facets of nursing had been
instrumental or influential in their decision to
become nurses. Second, were the reasons
cited by the students in any way related to the
school enrolled in? In this, we operated on the
assumption that Baccalaureate and Diploma
programs differed in their orientation and that
this distinction would be reasonably well
known by prospective applicants.^
Respondents to our questionnaire were
asked to select from a list of possible choices
and rank in order of importance those
statements that most closely corresponded
with their own reasons for selecting nursing as
a career. The responses were divided into two
general categories: those that indicated a
more professional conception of nursing and
those that illustrated a more traditional,
humanitarian image of the nurse and nursing.
The former included items such as "the image
of the nurse as a medical professional
appealed to me" and the latter statements
such as "I wanted to help others, especially the
sick and helpless."
The responses are interesting in light of
current debates, trends and changes in the
role of nursing and nursing education. Almost
two-thirds (63.2 percent) of the students
selected one of the humanitarian responses
as being most important in their career choice
decision. Just over a third (34.7 percent) cited
one of the professional reasons first. A
significantly higher proportion of
Baccalaureate students than Diploma
students (41 percent as opposed to 30.8
percent) cited a professional reason as being
most important in their decision to become a
nurse.
Althou gh the d iff erences between the two
grou ps of students were minimal at the level of
their third choice, these findings do indicate a
somewhat greater tendency for those entering
Baccalaureate programs to do so because of a
professional rather than humanitarian concept
of nursing and the nurses' role. Diploma
students, on the other hand tended to have
been much more influenced by the
humanitarian aspects of nursing as indicated
by the fact that two thirds (67.4 percent) of
them cited a humanitarian reason as being
most important as opposed to just 56.8
percent of the Baccalaureate students.
In other words, these findings indicate
that while humanitarian perspectives were
found to be held by a majority of students in
both programs, a greater proportion of
students entering the Baccalaureate program
are oriented towards and hold a more j
professional conception of nursing than those
entering Diploma programs. What the data
also indicate is that Baccalaureate schools
are considered to be more professional in
orientation than Diploma schools.
Career Perceptions
If these differences are important, one
would expect to find that the expectations ano
hopes of the Baccalaureate and Diploma
students about their future career in nursingi
would also differ in similar respects. This
expectation was indeed supported to a
considerable degree by the responses to othe<
items on our questionnaire.
Students were asked to indicate what
nursing positions they expected to obtain or
graduation and what positions they ultimateh
hoped to attain. Far fewer Baccalaureate
The Canadian Nurse December 1977
Students expected to start in that most
traditional beginning position — staff nurse.
Even fewer, when compared to Diploma
students, expected to remain there. The major
steps of expected mobility within the
profession, as seen by Baccalaureate
respondents, were in those areas that could be
defined as having a more "professional"
connotation: head nurse, supervisor,
instructor or administrator. Very few Diploma
students expected to achieve these positions.
Among the Diploma students, the main area of
mobility was in the special area' category,
followed by "community ".
Our f igu res lend su pport to the contention
that students entering Baccalaureate
programs do so with somewhat different
expectations of their nursi ng career than those
entering Diploma programs ... expectations
reinforced by the programs themselves. If the
career possibilities are seen in terms of
"professional" versus traditional "humanitarian'
categories, the expected and anticipated
career patterns of Baccalaureate students
show a marked tendency towards the former
and those of Diploma students towards the
latter In each case, the responses probably
reflect a realistic interpretation of the career
patterns available or apparent to those with
Baccalaureate degrees and to those with
Diplomas in nursing. Part of this is certainly
due to the nursing education and socialization
processes experienced in the two types of
programs. However, part must also be
attributed to a degree of common awareness
of the realities of career patterns within the
nursing profession, by nurses, students and
the public at large.
Summary and conclusion
Our data strongly suggest that
prospective nursing students perceive
Diploma and Baccalaureate programs
differently.
Service to others and an overall
humanitarian perspective was indicated by a
majority of students surveyed but there were
also many who expressed a professional
orientation towards nursing. A significantly
greater proportion of Baccalaureate students
than Diploma students were among the latter
group. The most likely explanation of this lies
in the differing images and role models
presented by the two types of programs and
their graduates.
The relationship between program and
orientation towards the nursing profession
was given additional support by data which
indicated that Baccalaureate and Diploma
students also perceived their future career in
nursing, their nursing role, rather differently.
Occupational and career goals and
expectation patterns, both short and long term,
reflected recognition by students of the
relationship between their preparation and
career possibilities. Although this is
undoubtedly due in part to the socialization
experiences, formal and informal, of the
nursing education process, it must also be
partly dependent upon the images of nurses
and nursing, that the student held prior to
enrolling in a particular program. These
images have, as shown previously,
considerable impact upon the type of program
selected by the individual.
As the nurse's role changes we would
expect to see alterations in images and
orientation of the profession held by fcxjth
nurses and the general community.
The specific direction which will
predominate, will depend very much upon the
type of changes which occur in the nursing role
and relationship with other health
professionals. «
Donald Loree, fS./A., M.A.. McMaster
University, Hamilton; Ph.D., The University of
Alberta, Edmonton) Is assistant professor of
sociology at the University of New Brunswick.
Irene Leckie, (R.N., Provincial Mental
Hospital, Ponoka, Alberta; B.Sc.N., The
University of Alberta, Edmonton; /W.Sc.A/.,
Wayne State University. Detroit), is professor
and assistant dean of nursing at the University
of New Brunswick.
Acknowledgement:
The authors would like to express their sincere
appreciation to Professor R Whalen of the
Department of Romance Languages,
University of New Brunswick, for his
invaluable assistance in translating the
questionnaire; to the directors and faculty of
the schools of nursing in New Brunswick for
their cooperation; and especially to the
nursing students who took the time and effort
to complete the questionnaire.
'In New Brunswick, French Is considered the
mother tongue of roughly 40 percent of the
population.
Bibliography
1 Ashley. Jo Ann, This I believe about power in
nursing. /Vurs. Outlook. 21:10:637-641. Oct. 1973.
2 Blishen, Bernard R.. A socio-economic index
for occupations in Canada. In Canadian Society:
sociological perspectives, edited by ... etal. 3d. ed.
Toronto, Macmillan. 1968. Chap. 48. (Reprinted
from the Canad. rev. Soc. Antrop. 4:1 : 41-53, Feb.
1967).
3 Corwin, Ronald G.The professional
employee: a study of conflict in nursing roles. In
Social interaction and patient care . edited by James
K. Skipper and Robert C. Leonard. Philadelphia,
Lippincott. 1965. pp. 341-356. (Reprinted from
Amer. J. Soc. 66:604-615. 1961).
4 Freeman, Ruth, The expanding role of nursing
— some implications, /nt. A/urs. Rev., 19:4:351-360,
1972.
5 Hover, Julie, Diploma vs degree nurses: are
they alike, Nurs. Outlook, 23:11: 684-687, Nov.
1975.
6 Johnson, Miriam M. A sociological analysis of
the nurse role, by ... and Harry W. Martin. In Social
interaction and patient care, edited by James K.
Skipper and Robert C. Leonard. K'hilaoeipnia.
Lippincott, 1965. 29-39. (Reprinted from the Amer.
J. Nurs. 58:3:373-377, Mar. 1958).
7 Keller. Nancy S., The nurse's role: is it
expanding or shrinking. Nurs. Outlook.
21:4:236-240, Apr. 1973.
8 Powell, Dorian L.. Occupational choice and
role conceptions of nursing students. Soc. Boon
Stud. 21:3:284-312. Sep. 1972.
9 Yelverton, Netta M., The role of nursing in a
changing society. Int. Nurs. Rev. 19:4:328-335,
1972.
References and footnotes
1 Occupations were ranked according to
Blishen deciles: Blishen. Bernard R. A
socio-economic index for occupations in Canada.
Education refers to the highest level of formal
education attained and income categories were
those of the 1971 census.
In Blishen. Bernard R. ed. et al Canadian Society:
sociological perspectives, edited by ... et al. 3d ed.
Macmillan. 1968. Chap. 48.
2 Relative was defined as mother, father,
brother, sister, aunt, uncle or cousin. A mother,
sister, or aunt in nursing was the most common
answer.
3 Powell. Dorian L. Occupational choice and
role conceptions of nursing students. Soc. Econ.
Stud. 21:3:296, Sep. 1972.
4 Johnson. Miriam M. A sociological analysis of
the nurse role by ... and Harry W. Martin. In Social
interaction and patient care, edited by ...J.K.
Skipper and R.C. Leonard. Philadelphia, Lippincott,
1965. 29-39.
5 Corwin, Ronald G., The professional
employee: a study of conflict in nursing roles. In
Skipper. James K. op. cit. p. 343.
6 Hover. Julie, Diploma vs degree nurses: are
they alike. Nurs. Outlook, 23:11: 684-687. Nov.
1975.
The Canadian Nurse December 1977
Catching a plane to go to work is all part of the job for the
occupational health nurses who work at the Wollaston Lake
Uranium mine, 446 air miles northeast of Saskatoon.
Working stretches of eleven hours a day (or more) for seven
days at a time provides the nurses with busy, exciting and
unpredictable schedules. Author Janet Mclvor, a nurse who
worked in this setting, shares some of her experiences with us.
Janet Mclvor
The Wollaston Lake open pit uranium mine,
operated by Gulf Minerals Canada Limited, is
typical of what is happening in
Saskatchewan's mineral rich north. Along with
local workers from nearby Black Lake, Fond
du Lac and Stony Rapids, the company
employs workers from the areas around
Uranium City, Prince Albert and Saskatoon
and flies them to the mine site on four weekly
chartered flights.
All 250 or so employees (including the
nurses) work an eleven-hour day, for seven
days and then are flown back to their homes
for seven days off. The work force is housed in
trailers while at the mine site since there is no
town nearby.
Team approach
Since the first days of the mine's
operation, there has been an occupational
health team to serve the health needs of the
workers. The team, whose members alternate
week to week, consists of a nurse, a radiation
technician, a safety officer, and company
physicians in Uranium City, Prince Albert, and
Saskatoon who can be contacted by
telephone at any time. Work shifts overlap to
ensure continuity and ongoing communication
about health matters.
The company physician from Saskatoon
goes to the mine site biannually to do complete
physical examinations. The nurse takes
venous blood samples which are sent to
Saskatoon for hematology, biochemistry and
other tests as prescribed by the physician.
The safety officer is responsible for mill
and mine site safety inspections. There is
on-going communication between him and the
nurse regarding observations they have made
on "formal " and "informal" tours.
The radiation technician monitors
radiation levels by taking air and dust samples.
These levels are calculated and given to the
nurse who charts and calculates cumulative
working levels for each individual employee. If
an employee's radiation working level is found
to be nearing a maximum level, the nurse
alerts the safety officer, and the worker is
pulled from the area until it is safe for him to
return,
A working day
The nurses day starts at seven a.m. and
usually ends at seven p.m. although she is on
24-hour-call for the seven days at site. After
seven p.m., supervisors who have first aid
certificates attend to minor cuts and abrasions,
but the nurse is always on call and available by
telephone or two-way radio.
Nursing in this occupational health setting
is varied, interesting and unpredictable so
there is really no such thing as a typical work
day. However, there are the more routine
tasks to be done: treating frequent ailments
such as colds, gastrointestinal disturbances
and minor cuts; preparing the daily report
which lists information about the health status
of ill workers; and taking preventive health
measures including audiograms, and urine
collection for fluorometric analysis, a test for
uranium in the system. These urine samples
are collected monthly from all the employees.
The nurse tests the urine for protein with a dip
stick and after recording the results, splits and
tags all urine specimens with a sample number
before packing them for air shipment. The
samples are then sent to Mississauga,
Ontario, Pittsburgh, PA., and a laboratory at
the mine site for fluorometric analysis.
As often as possible the nurse goes on
"mill rounds ". These prove interesting to say
the least and provide a good opportunity to do
informal teaching over a cup of coffee with the
"guys " regarding radiation levels, safe
working habits, etc. Besides the teaching
The Canadian Nurse December 1977
I
^s'S?:-^-"'
Nurses Lynda Sallis and Janet Mclvor
discussing working level exposures.
*S,*»S^|-'"-
I
Conversing wan lur
„,L ^r- -fO'^'fi
The Canadian Nurse December 1977
>v
aspects, this is a good time to watch for safety
hazards such as oily, greasy rags left lying
around, slippery floors and catwalks,
improperly blocked equipment in the garage,
improper use of respirators and disposable
clothing. The nurse can then pass on these
observations to the safety officer.
If a worker requ ires emergency care such
as suturing, this is done by the nurse on site.
Employees who are sick in bed are visited at
least twice daily by the nurse and, if necessary,
the physician can be consulted by telephone
for medication orders. IVIedicalion supplies are
kept in the health center and an ambulance is
always available. If an employee should need
further medical attention on days when there is
no charter flight, a plane is called to come to
the site and fly the worker to the nearest
hospital. When a plane is required after
sundown, flares have to be placed on the
gravel runway since there are no runway
lights.
Cancer link
Perhaps the nurse's most important
function is to keep a close watch on the length
of time workers are exposed to radon gas and
radon daughters, the by-products of the mining
and milling process. These by-products are
odorless, colorless, and tasteless and can be
hazardous to the health if proper preventive
measures such as hand washing, proper use
of respirators in designated areas, proper use
of disposable clothing, and limiting of
exposure times are not carefully observed.
Evidence has been put forward linking
lung cancer with these by-products so work
areas are monitored very closely and
erriployee education stressing preventive
rq§jg Important.
I^^erripioy
I*
Counseling
ng takes uj: a iarge part of the
nur„., , . opics often range beyond health
issues and frequently workers visit the nurse to
talk over problems related to separation from
family for seven days and associated worries
levels in control room.
regarding the wife's ability to cope with family
and financial responsibilities during this time.
Other problems discussed include job
stresses, alcoholism, and financial
responsibilities.
On one occasion it was necessary to dust
off an obstetrics text to help allay the anxieties
of an expectant father. Referrals are made to
family physicians and/or community agencies
as necessary.
To help keep the nurses up-to-date,
company-sponsored continuing education
such as courses in audiometries, radiation and
alcoholism are available. The nurses will also
have a hand in instructing courses in radiation
safety and first aid.
Nursing at a mine site in the North is
certainly not for everyone, especially those
who prefer a more conventional lifestyle.
During her time at the site, the nurse must be
prepared for the unexpected — everything
from jumping in a helicopter to attend an
injured man in a bush camp, to keeping an eye
on a hungry bear that stays under her trailer in
the pre-blueberry season.
But in spite of the frustrations, this is one
area in which nursing is playing a unique and
vital role. Much has been done and much more
will be done to ensure the health and welfare of
the workers in this northerly region. *
Janet Mclvor/s a graduate of Lethbridge
Community College, Lethbridge, Alberta. She
has worked in geriatrics and rehabilitation
and has been a staff nurse in a ten-bed acute
care hospital at Lafleche, Saskatchewan. At
the time of writing this article she was
employed by Gulf Minerals Canada Limited,
Wollaston Lake, Saskatchewan. Currently'
she is employed as Clinical Instructor for
Jubilee Residences Limited, Saskatoon,
Saskatchewan.
Pre-au
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LKHiVlUUVT 19/ f
Clinical Wordsearch no. 9
This is another in a continuing series of clinical
wordsearch puzzles relating to different areas of
nursing, by Mary Elizabeth Bawden (R.N.,
B.Sc.N.) who presently works as Team Leader
in the Rheumatic Diseases Unit, University
Hospital, London, Ontario.
Solve the clues. The bracketed number
indicates the number of letters in the word or
words in the answer. Then find the words in the
accompanying puzzle. The words are in all
directions — vertically, horizontally, diagonally,
and backwards. Circle the letters of each word
found. The letters are often used more than once
so do not obliterate them. Look for the longest
words first. When you find all the words, the
letters remaining unscramble to form a hidden
answer. This month's hidden answer has five
words (Answers page 48).
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1 Among other things, it keeps the ears
apart. (4)
2 Pertaining to the outer covering of the brain
and spinal cord. (9)
3 That part of the central nervous system
extending from the foramen magnum to the
level of the third lumbar vertebra. (6, 4)
4 Loss of the ability to move parts of the
body. (9)
5 Junction between two neurons where
transmission of nerve impulses takes
place. (7)
6 Long outgrowth of the body of a nerve cell
which conducts impulses from the body
toward the next neuron. (4)
7 Involuntary and irregular movements seen in
nervous diseases such as Huntington's. (6)
8 Destroying the myelin sheath of nerves. (13)
9 The cutaneous area developed from a single
embryonic somite and receiving the greater
part of its innervation from a single spinal
nerve. (9)
10 A localized infection producing serious
neurological effects. (5, 7)
1 1 Bony brain case. (5)
12 An extravasation of blood beneath the dura
mater. (8, 9)
13 Amyotropic lateral sclerosis. (3)
14 Disease characterized by presence of
fluid-filled cavities in the substance of the
spinal cord with destruction of nerve
tissues. (13)
1 5 Congenital defect in the vertebra of the spinal
column. (5. 6)
16 Pertaining to spasms characterized by
alternating contractions and relaxations of
muscles. (6)
17 An X-ray procedure in which radio-opaque
dye is injected into the subarachnoid space of
the spinal column. (9)
Chronic disease characterized by muscle
weakness probably due to a chemical defect
at the myoneural junction. (10, 6)
Results from banging your head against a
brick wall. (10)
20 Often brought Julius Caesar down to
earth. (8)
21 Pan of the hind brain. (7)
22 Sounds like figures in a chess game. (4)
23 A form of pre-senile dementia. (9)
24 Substance around nerve fibres such as
axons, which speeds the transmission of
impulses. (6, 6)
18
19
25 Disease caused by the chicken pox virus and
characterized by vesicular eruption along the
distribution of a sensory nerve. (6, 6)
26 An automatic response to a given
stimulus. (6)
27 A cordlike structure conveying impulses from
one point of the central nervous system and
some other region of the body. (5)
28 Defect or loss of the power of expression by
speech, writing or signs or of comprehending
written or spoken language due to injury or
disease of the brain centers. (7)
29 A convolution on the surface of the brain
caused by the infolding of the cortex. (5)
30 Anteria portion of the cerebrum. (7, 4)
31 Cerebral vascular accident. (3)
32 Cerebral spinal fluid. (3)
33 Transient ischemic attack. (3)
34 The normal state of slight c^^ctli
skeletal muscles. (5) ^^
35 Partial or nearly compleia unconsdousm
(6)
36 A state of profouna unconsciousnes
37 May be constricted a o)
38 Portion of the nervoL vhich is
functionally indapendent. (9;
A
The Canadian Nurse December 1977
"He was in so much pain, he looked pitiful.
The husband/wife relationship is unparalleled by any other in our society. What happens to
this team when one member is separated from the other and then placed in an alien
environment under the care of strangers? Many spouses experience considerable stress
when a husband or wife undergoes surgery; yet, they receive only minimal nursing care.
Why?
Mary Cipriano Silva
Many books and articles have been written
about the needs and nursing care of surgical
patients; yet. little is known about how surgery
affects families. Recently, as part of a research
study, I talked with 48 spouses (32 nnen and 1 6
women) whose husbands or wives were
scheduled for major general surgery not
expected to be malignant. These spouses
ranged in age from 22 to 70. and in years of
schooling from 10 to 25. Despite these
individual differences, they reported similar
stressful feelings associated with surgery —
feelings of isolation, anxiety, timelessness and
disruption.
"We have never been separated"
One of the first things I found was that, almost
without exception, a sense of isolation
characterized the 48 spouses in my study.
Most of these spouses reported feeling
ignored right from the time of surgical
diagnosis to the patients return to the unit
following surgery. For example:
• Surgeons spoke with only 6 of the 48
spouses prior to the patients hospitalization.
Nurses spoke with none of them.
• The afternoon/evening before the
patient's surgery. 42 of the 48 spouses told me
they had not received any information about
the patient's hospitalization or surgery from
any hospital personnel.
• 3 1 of the 35 spouses who remained at the
hospital while patients were in the operating
and recovery rooms reported that no hospital
personnel talked with them during this period.
"I could run into the surgeon and I wouldn't
know who he was." "My husband has had
surgery before, but this is the first time anyone
has ever paid any attention to me. " Comments
such as these are heard frequently and they
are another indication of spouses' isolation
from the health care system.
Apart from the seclusion imposed on them
by the health care system, spouses
experienced another type of ispjation — lack of
support from (or unavailability of) significant
others. Although several people were
accompanied by family, friends or clergy while
the patient was in the operating room and
recovery room, the majority of spouses waited
alone. Many said they spent their waiting
hours "reading," "unravelling a sweater,"
"trying to watch television," "praying,"
"pretending to write." "whittling a piece of
wire" or "watching the clock."
Fear of separation from, or loss of, their
marital partner was another source of anxiety
for some spouses. One woman, 59 years old
and married for 31 years, stated that she had
never been separated from her husband,
except during childbirth. Another, a
65-year-old retired executive said, "My wife
and I have been married for 44 years. I dont
remember life without her." A third spouse
explained. "My wife is all Ive got. I couldnt live
without her."'
"What If something goes wrong?"
Thirty-six of the 48 spouses in this study were
pretested the afternoon/evening before the
patients surgery with the State Anxiety
Inventory. This is a self-report scale which
measures situational anxiety.' Spouses'
scores on this Inventory suggest that two
commonly held but opposing opinions about
spouses' reactions to surgery may not be
correct.
The first opinion often expressed by nurse
educators is that surgery is always
anxiety-producing for patients and their
families. However, my results show that 1 3 of
the 36 pretested spouses were not particularly
anxious: that is. their scores on the State
Anxiety Inventory were typical of individuals
tested under nonstressful conditions. (Similar
results have also been found with presurgical
patients).
The second popularly accepted opinion
led a variety of professionals to ask me, "Why
are you studying spouses? Theyre not
anxious." However, data from this study
indicate that:
a) the majority of pretested spouses were
anxious (23 of the 36 pretested spouses had
State Anxiety Scores above the established
norms for nonstressful situations)
b) the average State Anxiety Score for
pretested spouses was higher than the
average State Anxiety Score for preoperative
patients as reported in other studies.*-^
In other words, presurgical spouses
appear to be more anxious than presurgical
patients. "^
"Anything can happen at anytime in the
operating room."
It became important for me to find out just
when during the surgical experience spouses
are most anxious. To answer this question I
waited until after the first postoperative day
and then gave each spouse a list of eight time
periods. I asked them to indicate which was
the most anxiety-producing time for them. The
time periods ranged right from surgical
diagnosis to the patient's return to the unit
following surgery.
What I found was that the most
anxiety-producing time for many spouses was
when their husbands or wives were in the
operating room. A 49-year-old government
executive expressed his fears quite simply. It
is the time of greatest danger. Another
spouse said, "Anything can happen —
anything can happen during surgery."
The wait while the patient was in the
recovery room was the most anxious time for
seven of the 48 spouses. "I wasnt sure
everything was O.K." "My wife was in the
recovery room an hour longer than the doctor
said she would be. "
Despite the high anxiety reported by
spouses while patients were in the operating
room and recovery room, these were times
when spouses received little or no nursing
care. Only four spouses reported any contact
with hospital personnel during this waiting
period.
One spouse found the wait prior to
surgery particularly difficult. "The four-week
wait before surgery was terrible. I kept asking
myself, what if something goes wrong? A
spouse who said she was most anxious after
her husband's return from surgery
explained, "He was in so much pain. He
looked pitiful. Other spouses remarked that
had they not been prepared, they would have
been "jolted" by the patient's post-operative
appearance.
Personal experiences also affected
spouses anxiety levels. One man. married for
36 years said. Before surgery my wife was
terrified that she was going to die under
anesthesia. She extracted a promise from me
that if she died I would remarry so that
someone would take care of our five children."
Another man, whose wife was scheduled for a
cholecystectomy confided, "My wife doesn t
know how worried I am. I never told her that my
father had a cardiac arrest when he had gall
bladder surgery."
"A minute seems so very long."
A few spouses mentioned the sense of
timelessness they experience
husbands or wives wer§
said, "I felt as though I
Another rema
knuckles and
father came,
continued to
This cqbmSI 01 timelessness nas
The Canadian Nurse December 1977
received little attention in nursing literature;
yet, it may well be a useful one in
understanding the spouse's perception of tfie
surgical experience. One nurse observed this
phenomenon when her husband was
undergoing major thoracic surgery. While
sitting in the waiting room she soon noticed
that the one question asked again and again
was, "What time is it?"" Another nurse has
described how very long a minute seems when
you're waiting for a loved one's return from
surgery.^
"My husband is home caring for the children."
It soon became obvious to me that surgery and
disruption of family life go hand-in-hand for
many spouses of surgical patients. One
70-year-old man who had retired early in order
to care for his sick wife was unable to be
admitted for surgery until after he had placed
her in a nursing home. Several wives who did
not drive expressed concern about their
dependence on others for transportation to
and from the hospital. Many patients were not
visited by their spouses the afternoon or
evening before surgery because their
husbands or wives were home caring for their
children.
Endress has studied this concept of
disruption in family life.'* In interviews with 20
spouses of hospitalized medical-surgical
patients, she found that all of them reported at
least one disruption in their family's daily
routine. The activities most frequently
disrupted for spouses were preparing and
eating meals, returning from work, doing
housework and buying groceries. The
routine most frequently disrupted for children
was bedtime.
The Problem
I looked at the data and concluded, quite
simply, many spouses experience
considerable stress when a husband or wife
undergoes surgery; yet, they receive only
minimal nursing care. Why? Certainly nurses'
attitudes toward families affect their view of
whether they see families as legitimate
^recipients of nursing care. Unfortunately,
"" fr.^|ueri^ly regard the family as an
[•hii*rii-3nce, a nuisance or an
imbi,
C, i.^ IC3U' ;i ..untnbuting to the negative
litude some nurses have towards families is
only held belief that the patient — not
It — is ill. This belief immediately
"establishes a set of priorjtiesiut^hich families
can be easily, and justifiably, excluded from
receiving nursing care.
Yet, there is considerable evidence to
indicate that illness of one family member
frequently impairs the physical or mental
health of others. ' ^'"' In this study, for example,
one wife told me she had a knot in her stomach
for several days before her husband's surgery.
A patient told me that her husband was
unusually quiet and had tears in his eyes the
day before her hospitalization. Two other
women said their husbands were so "terrified"
of hospitals they were unable to visit them the
evening before surgery. These examples
support Anthony's assertion that, "To some
extent, the family is always sick along with its
sick member — sometimes physically,
sometimes psychologically and often
empathically. "'^
Another factor contributing to lack of focus
on the family is their inaccessibility — spouses
of surgical patients are very busy people. For
example, of the 102 spouses who met this
study's criteria, 51 were not available for
discussion the afternoon or evening before the
patients surgery. In addition to this spouses
were frequently not available after the first
postoperative day. Over a seven-month period
of data collection, it became aoparent ihat,
because of the inaccessibility of spouses and
their transient visiting patterns, nurses and
spouses quite often occupied the same space
— they just never met.
A Solution
In an effort to lessen the burden of
isolation and anxiety for the spouses of
patients undergoing surgery I developed a
preoperative orientation program. This
program described:
• the general pre-, intra- and
postoperative nursing care of patients
• the role of the spouse and other
health team members in caring for the
patient
• the orientation of spouses to the
hospital environment.
This information was laid out in a 1 0-page
script and a 20-minute tape recording. Each
spouse (and anyone else who was interested,
including the patient) received the tape/script
presentation simultaneously. They were also
given a copy of the script to keep.
The preoperative orientation program
included talking with spouses individually. It
was at this meeting that I talked to them about
procedures unique to their husband's /wife's
surgery and answered their questions. The
sessions were held the afternoon or evening
before the patient's surgery. Each session
averaged approximately 40 minutes,
depending on the number and nature of the
questions raised.
In order to give you some idea of the
content and tone of the orientation program
here are a few examples of information I
presented to spouses in our tape/script
production. (Intheseexamples, "you "refers to
the spouse).
— You may visit the patient at any time the
day of surgery and accompany him to the
doors of the operating room if you so
desire.
— You should not judge the seriousness
of the surgery by the time the patient is in
the operating room. It is customary to
send for patients some time in advance of
the operation and preparations by the
anesthesiologist take time.
— Following the operation, patients are
transferred to the recovery room. The
ratio of nurses to patients in a recovery
room is high so that patients can be
carefully and frequently observed while
awakening fron, the anesthetic.
Obviously there is an overlap between
this information and preoperative teaching
information for patients, but there are also
areas of difference. For example, although
spouses are given an overview of how the
patient is prepared for surgery, they are not
given detailed explanations about how
patients are coughed, deep breathed and
turned. Rather, the focus is on letting the
spouse know just how they can participate in
the surgical experience and how they can
communicate with health team members.
Evaluation
How did spouses respond to the
orientation program? Of 48 spouses who
participated in this study, 44 of them received
the tape/script presentation. I asked these
people how helpful they thought the
presentation was.
Extremely helpful — 28 spouses
Considerably helpful — 12 spouses
Slightly helpful — 4 spouses
Not helpful — 0 spouses
The Canadian Nurse December 1977
Those spouses who found the tape/script
"slightly helpful" said they had prior
experience with surgery and felt most of the
information offered was already familiar to
them.
Others reacted more positively,
• "This is a terrific idea. You should mail the
script to families ahead of time."
• "This information is very reassuring. It
should be available to all spouses."
Several people told me that after they had
seen the presentation they gave the script to
others. Those others' included brothers,
sisters, sons, daughters, parents, in-laws and
even other patients and their families. One
script turned up safely in the hands of a newly
admitted patient a month after it had been
given to a spouse in my study.
When I asked people what they found
most helpful (or not helpful) about the program
they told me it let them know what to expect
and gave them an opportunity to receive new
or review old information.
Specific information that spouses said
they found most helpful included the patients
visiting hours on their day of surgery, how and
where they could meet the doctor after surgery
and how patients are cared for through a
systematic team effort. Spouses who received
the tape/script orientation program reported
less anxiety and more favorable attitudes
toward hospitalization and surgery than those
who did not receive the program.
Some Practical Considerations
I found that this preoperative orientation
program for spouses is neither time
consuming to initiate nor costly to implement.
In my case less than eight weeks passed from
the time the program was first presented to the
hospital administrator to the time the first
spouse participated in it. During this period I
received permission to conduct the study,
wrote the script and produced the tape. The
script was reviewed by 12 nurses, an
administrator, a chaplain and an admitting
supervisor before it went into production. The
hospital already owned tape recorders,
cassettes and copiers so the primary expense
was the cost of reproducing the script for each
spouse.
After the study was completed I shared
the results with administrators, nurses and
physicians. The primary concern expressed
by all was, "How do we implement the program
so that we reach the most spouses?"
The method that was selected included
the following;
• Videotaping the preoperative orientation
information and showing it on closed circuit
television at 7 p.m. each evening.
• Telling spouses about the program by
attaching a notice to each patient's dinner
menu.
• Placing a copy of the written script on
each unit for handy reference by patients,
spouses and hospital staff.
• Informing all nursing staff about the
objectives of the program and their role in
helping spouses.
To date, spouses have reacted positively to
the program, saying that it has helped them
in coping with their patients.
If a concerted effort is made by
administrators, nurses and other health team
members, the family of the surgical patient
can become actively involved in the surgical
experience, and consequently, feel less
afraid and alone.*
Acknowledgement: The author would like to
thank the administration, staff and patients at Holy
Cross Hospital in Silver Spring, MD., for helping to
make this study possible.
References
1 Spielberger. CD. STAI /Manual for the
State-Trait Anxiety Inventory, by ... at al. Palo Atta,
Ca. Consulting Psychologists Press, 1970.*
2 Spielberger, CD., Emotional reactions to
surgery, by ... et al. J. Consult. Oin. Psychol.
40:33-38, Feb. 1973.
3 DeMonbrun, Marguerite R. Effects of
preoperative teaching upon patients with differing
modes of response to threatening stimuli. (Thesis -
Catholic University of America. University
Microfilms No. 74-7, 028).
4 Hoelter, Barbara Anne. Those who wait.
AORN J. 13:2:237-239, Feb. 1971.
5 Travelbee, Joyce. Interpersonal aspects of
nursing. 2d ed. Philadelphia, Davis Co., 1971,
p. 88
6 Endress, M.P. Effect of hospitalization on
the nuclear family. Seattle, Wa. 1971. (Thesis
(M.A.) - Washington).'
7 Frost, Monica. Talking and listening to
relatives. Nurs. Times 66: Suppl. 129-132, Sep. 3,
1970.
8 Portman, Ruth. Who cares for the relatives?
Nurs. Times 70:29:1125, Jul. 18, 1974.
9 Campbell, Genevieve W. Letters (to the
editor). Amer. J. t\lurs. 75:3:393,395, Mar. 1975.
10 Schorr, Thelma M. It's vent-my-spleen time.
Amer. J. hJurs. 75:8:1287, Aug. 1975.
1 1 Golden, Stella M. Letters (to the editor).
Amer. J. Nurs. 76:5:746. May 1976.
12 Baudry, F. The family of the surgical
patient, by ... and A. Wiener. Surgery 63:416-422,
Mar. 1968.
13 Klein, R.F., The impact of illness upon the
spouse, by ... et al. J. Chronic Dis. 20:241-248,
Apr. 1967.
14 Kemph, J. P.. Kidney transplant and shifts in
family dynamics, by ... et al. Amer. J. Psychiat.
125:1485-1490, May 1969.
15 Anthony, E.J. The impact of mental and
physical illness on family life. Amer J. Psychiat.
127:138-146, Aug. 1970.
* References not verified by CNA Library.
"Spouses need nurses too" is an outgrowth
of a doctoral dissertation by author, Mary
Ciprlano Sllva (R.N., St. Rita's Hospital
School of Nursing, Lima, Ohio; B.S., M.S.,
Ohio State University: Ph.D., University of
/Maryland). At present, she is an associate
professor of nursing at George Mason
University, Fairfax, Virginia. Her previous
experience includes teaching
medical-surgical nursing at Stanford
University School of Nursing and Frances
Payne School of Nursing, Case Western
Reserve University, Cleveland, Ohio.
The Canadian Nurse December 1977
Laura Hall
As a social worker, Mr. Duncan had seen
a lot but now his six-foot frame was
hunched dejectedly over his desk, bony
fingers combing his iron gray hair.
I shuffled the thick file in front of me,
gathering it into my briefcase as I rose to
leave. We had just concluded discussing
another crisis in the Murphy family.
^tseparatethem," Mr. Duncan
you know why, ' he
^n surfacing in his Oxford
accen;
Six months previously as a fledgling
Public Health Nurse assigned to a rural
district I had inherited the Murphy case
file.
Members of the community termed
the Murphy residence "a dirty fire trap"
and an eyesore. Teachers at the local
school presented a long list of complaints
that included truancy, lack of adequate
clothing and personal cleanliness, poor
lunches, facial sores and other defects all
attr ibutabi e to the fou r sch ool-age Murphy
Chi Idren between the ages of five and ten.
The bulging file I held spoke volumes
in unresolved problems with continued
Health Nurse assistance.
On my first visit, as I came in sight of
their residence my mind registered,
"write-off." With difficulty I manoeuvered
my small car down the winding, rutted
lane to the tar-paper shack.
I knocked at the dilapidated screen
door which opened into their narrow,
cluttered porch. Beyond the porch lay the
main room containing a large round table.
I
The Canadian Nurse December 1977
rickety chairs and a shabby couch piled
high with clothing. A crowded, dingy
bedroom could be seen to the left of the
main room. The cramped attic room was
accessible only by a steep, narrow
stairway. The entire house had a "certain
air," namely stale food mixed with
woodsy smoke from an old stove.
Looking round, I chose the chair that
offered the least porridge remains. As I
had suspected from neighborhood
rumors, Mrs. Murphy was pregnant, about
seven months I judged. Mr. and Mrs.
Murphy had been assessed as slow
learners and my enquiries met with typical
unconcern.
As a practical gesture we made plans
for a visit to the doctor and wrote out some
simple meal plans. Evidence of
accumulated soft drink bottles and empty
potato chip cartons made the success of
this exercise dubious.
My predecessor had instructed Mrs.
Murphy in the use of a wringer washing
machine donated to the family. On her
next visit she had found the wash dutifully
pinned to the line, wrinkles and all, just as
it had rolled through the wringer — totally
unshaken.
I limped along with the family until the
Christmas surprise arrived — a new baby
girl, born a week prior to Christmas day.
Mr. Duncan was now doling out food
vouchers to Mr. Murphy, whose seasonal
employment had hit a lull. "Make sure
they buy some canned milk for the baby,"
Mr. Duncan advised before leaving the
city for his vacation. He knew that the next
food voucher might be diverted for
admission to a movie or other family
entertainment.
Three days following delivery,
including a post-partum hemorrhage,
Mrs. Murphy discharged herself from the
hospital. "See if you can get a consent for
sterilization and have her readmitted," the
clinic doctor bellowed at me over the
phone.
The next day, fighting my way along
the snow-plugged roads enroute to the
Murphys, I though wryly of the doctor's
orders. I knew that Mrs. Murphy would put
off the sterilization until her next
pregnancy, so I'd better concentrate on
the baby.
The Murphys all gathered around the
table as I produced the donated baby tub
for a demonstration bath. The heads of
the two pre-school tots bobbed curiously
above the magazines and papers at one
end of the table. Mr. and Mrs. Murphy sat
on the couch holding hands, a glow
suffusing their faces.
Just as I finished demonstrating the
baby bath, emphasizing the virtues of
cornstarch as a good, cheap dusting
powder, the door flew open and the
children tumbled in from school.
They were met with hugs and kisses.
Immediately, the lesson was forgotten
while school work was admired and
pinned to the wall. Each event of the
school day was recounted in detail and
listened to with rapt attention. Plans for
supper consisted of a free-wheeling
discussion about which can to open. The
frozen bread, dropped at the lane
entrance, was brought in by the children
and put in the oven to thaw. A pail of jam
plunked in the middle of the grubby table
made an effective centerpiece. "We'll
play Chinese Checkers after supper," I
heard the children saying as I closed the
door.
"It's futile, disgusting and hopeless," I
thought, driving back to the city in the
descending dusk. "The only remedy for
that mess is a bomb. '
Dimly in the back of my mind I
thought of Mr. Duncan's words at our last
meeting. "We can't separate the family
and you know why " ... but was it enough ? I
could not dismiss the happy, enthusiastic
faces of the children above their unkempt
clothing and sensed in the choking,
smokey atmosphere a warmth not
generated by wood and fire.
Returning from my Christmas
vacation a memo topped the litter on my
desk. "Fire destroyed Murphy house,
check with Mr. Duncan re placement of
children."
It was the unanimous conclusion of
all the organizations and individuals
involved in looking after the Murphy
family, that the fire was the best thing that
could have happened — a blessing in
disguise. The family had escaped
unharmed and the children had been
placed in district foster homes. We had a
new lease in resolving our problems.
The new lease lasted about a month,
until the first interview with the primary
teacher and the principal at the local
school took place.
The Murphy children simply were not
blossoming as we had been sure they
would. They were pale, not hungry for
their "Canada Food Rule " lunc. es, and
unimpressed by their new clothii g. One
or two were showing behavior problems
undreamed of in pre-fire days.
Frustration and resentment
characterized the reports I received from
the foster parents in the homes where the
Murphy children had been placed. They
cried for their real parents and for each
other. They did not appreciate the bright,
clean decor of their new homes or their
stiff new clothes. "What more can we give
them?" was the repeated cry.
The new house that Mr. Duncan and I
found for them was the "more" we settled
on. Nevertheless, disgust was evident in
my voice when I returned from my first
visit to their new home and recounted the
latest Murphy saga to Mr. Duncan. "I
discovered an odorous Murphy baby in a
basket on the floor — oiled and dusted,
not with cornstarch, but with cake flour.
They are hopeless and you are not very
popular in the community for getting them
back together."'
"The house has one more room, " Mr.
Duncan countered, grinning at me.
"You are asking for a whole new string
of problems, " I replied.
"I didn't get them together," he said
seriously. ""It"s the Murphy glue. We can"t
separate them, they care about each
other. They love each other and it shows.
It is the one thing that holds hope for them
when nothing else does.
Murphy's glue, I thought, was pretty
sticky stuff, stronger than good intentions
and cornstarch.*
Laura Hall, the author of our "Christmas
Story," Murphy's Glue, is a freelance
writer and member of the Canadian
Authors' Association who describes
herself as "a registered nurse on the
inactive list." This story, one of several
she has had published since she began
her writing career, is based on her own
experience while she was still
practising.
A graduate of Brantford General
Hospital School of Nursing in Brantford,
Ontario, she also attended a three-year
course in Christian Education in Illinois,
U.S.A. before completing her graduate
work at the University of Western
Ontario. After working as an assistant
and head nurse in emergency and
surgical nursing, she spent four years
as a public health nurse in northern On-
tario.
Now married to a high sa|
teacher and living in Winnj^eg,
the mother of three childi
The Canadian Nurse December 1977
Resumes are based on studies placed
by the authors in the CNA Library
Repository Collection of Nursing
Studies.
Research
, ,. care
jUi^regis
I
• Patient Classification
The Development and Testing
of an Instrument for
Assessment and Classification
of Patients by Types of Care.
Saskatoon, Sasl<., 1976. Thesis
(M.H.S.A.), University of Alberta,
by Mavis £ Kyle.
The study was undertaken to
develop and test an instrument
for assessment and classification of
patients by Types of Care. The project
was initiated by the f\/ledicine Hat and
District Health Planning Committee as
one method of identifying the needs of
the community for health care
programs and facilities, as well as
describing the characteristics of the
study population to show the
appropriateness of present patient
program-placement. The major
objective of the investigator was to
identify the degree of reliability and
validity of data obtained by use of the
instrument.
Using the Types of Care
classification and related patient
characteristics as defined in the
Report of the Working Party on Patient
Care Classification as the criterion
measure, an assessment and
classification instrument and User's
Manual were developed. Assessment
items were related to the demographic
characteristics, medical status, and
physical and psycho-social
functioning of each patient.
Classification items included the type
of care, the site where needs could
best be met, and program
requirements.
Following a pilot test and pretest,
a clinical analytical survey was carried
out on a specific day on the study
population of 490 patients in an acute
care hospital, auxiliary hospital, two
nursing homes and individuals
awaiting placement in the long-term
care facilities. The assessors were
registere^urses in the institutions
lity, providing care
o!'"' onals, the
encouraged
A stratified random sample of 1 00
patients was used for an inter- rater
reliability study and another sarrp'" of
1 00 patients was randomly chosei jr
an empirical validity study. Statisti.;al
procedures were undertaken to
identify the degree of reliability and
validity of the instrument items and to
produce descriptive frequency
distributions.
It was concluded that the
instrument possessed an acceptable
degree of reliability and validity. The
major recommendation is that
additional research be undertaken to
determine predictive validity and
further refine the instrument and
User's fvlanual. Other
recommendations relate to the
experimental use of information
gained by studies of this kind for
planning, administrative and patient
care decision-making.
• Education for Teacliers
Orientation and Inservice
Programs for Teachers in
Canadian Two- Year Schools of
Nursing and Sources of
Satisfaction and
Dissatisfaction as Perceived
by these Teachers. Fredericton,
N.B., 1976. Thesis (M.Ed.)
University of New Brunswick by
eeffy Carol Field.
Nursing education in Canada has
experienced a definite change in the
last ten years. Many traditional
three-year hospital based nursing
schools have been replaced by
two-year educationally controlled
schools of nursing. Orientation and
inservice education programs for
faculty members are in an early stage
of development and no previous
studies could be found concerning
such programs in these schools.
This study was designed to obtain
information concerning the orientation
and inservice education programs
provided for teachers in the two-year
nursing schools across Canada. It
was also designed to explore sources
of satisfaction and dissatisfaction
among faculty members in 'hese
schools, and to identify significant
relationships, if any, between certain
teacher characteristics and
expressions of satisfaction with
various aspects of their teaching
positions.
Two questionnaires were
constructed by the investigator to
gather data for this study. The first
questionnaire, designed to obtain
information about faculty members,
the orientation, and the inservice
education programs provided for
faculty members, was completed by
23 of the 40 directors of two-year
educationally controlled nursing
schools across Canada. The second
questionnaire was designed to obtain
information from faculty members
about their qualifications, perceptions
regarding their orientation and
insen/ice education programs, and
sources of satisfaction and
dissatisfaction. It was completed by
1 02 of a random sample of 1 50 faculty
members in these schools.
The content of responses to
open-ended questions was analyzed
by the investigator. Frequencies and
percentages were tabulated on
numerical data. It was found that:
• a period of orientation is general ly
provided for new teachers in the
two-year programs
• these programs include various
topics and range from under 1 0 hours
to over 120 hours
• faculty memtsers generally were
not satisfied with the orientation they
had received and specified areas they
would have found helpful
• inservice education programs
were provided for teachers in most of
the schools
• various topics were covered in
the past year and faculty involvement
ranged from under one hour to over
ten hours per month
• the majority of teachers
expressed dissatisfaction with the
inservice education programs and
listed topics they would like included in
future programs
• the majority of teachers were
satisfied with working relationships
with other faculty members, student
contact, philosophy and objectives of
the school, the clinical area used for
student experience, salary, fringe
benefits, library facilities, teaching
aids, relationships with the school's
director and assistants, teaching load,
student teacher ratio, and freedom to
schedule their own wori< time.
• in addition to orientation and
inservice education programs, faculty
members expressed dissatisfaction
with the leadership and administration
of the schools and methods of faculty
evaluation.
Recommendations based on the
findings in this study included the
following:
1. The feelings of present faculty
members regarding orientation and
inservice education programs should
be assessed and existing programs
should be revised or supplemented in
accordance with the expressed
needs.
2. More extensive orientation should
be provided for new teachers in
relation to teaching methods,
evaluation techniques, test
construction, and faculty expectations
for student performance at various
levels.
3. Inservice education programs on
educational topics, techniques of
teaching and evaluation, curriculum
development, and wori<ing with
students should be available in the
schools for faculty members.
Teachers should be encouraged to
attend available conferences on
educational topics outside their own
schools.
4. The areas of leadership or
administration and methods of faculty
evaluation (areas of dissatisfaction for
many faculty members) should be
explored.
5. The areas of curriculum, physical
facilities, clinical areas, salary and
fringe benefits (sources of satisfaction
for some teachers and sources of
dissatisfaction for others), should be
evaluated in individual schools; steps
should be taken to improve these
areas or the understanding of these
areas as applicable.
Implications for further research
would include the following:
1. A similar study should be
undertaken at a time when financial
restrictions and the employment
situation would be less likely to be a
factor in influencing responses.
2. Similar studies should be
conducted in regions or provinces at
Canada to identify more clearly any
regional trends and reasons for sucti
expressions of satisfaction and
dissatisfaction.
3. Further information should be
obtained on the relationships between
on-the-job preparation ( in terms of
orientation and inservice education
programs) and (a) feelings of facultyi
satisfaction and (b) effectiveness of '
faculty memtiers.
The Canadian Nurse December 1977
Books
Did you know?
Nursing in Canada: Canadian Nursing Statistics
1976 is now available wherever government
publications are sold. The publication presents basic
distributions and cross-classification of
socioeconomic characteristics of the nursing
profession in terms of work setting, salanes, and
education as well as related information. (A
Statistics Canada publication, catalogue number
83-226, price $1.40 per copy.)
Community health and nursing practice by
Evelyn Rose Benson and Joan Quinn
McDevett. Englewood Cliffs, N.J. Prentice-Hall.
1976.
Approximate price $11.50
Reviewed by Jean E. Innes, Associate
Professor. Community Nursing, College of
Nursing, University of Saskatctiewan.
The content of this hard cover text with its
purpose to focus on family health, will
disappoint the concept-process oriented reader and
practitioner of community nursing.
The book is organized into five units. In the first
three units the authors attempt to lay the foundation
for the practice of community nursing by setting out
some concepts fundamental to community health
and tracing the development of present day practice.
Traditional concepts of health and prevention are
presented and some consideration is given to
community health science concepts.
Definitions and discussions concerningthe role
of community nursing, nurse practitioners and
nursing as a positive force in community health
appear shallow, sketchy and misleading in terms of
complexity unless the reader earnestly pursues the
content of the bibliographies and glossaries listed at
the end of each chapter of the unit. The first three
units lack an overall conceptual framework to give
the reader a feeling of continuity and wholeness.
Perhaps the authors would have achieved this
purpose better had they included concepts of
systems and community as basic concepts to
community health rather than introducing them later
in the text as concepts related only to nursing
intervention. Discussion of health problems, trends
and populations at risk would have formed a more
natural outcome from these units and lead directly
into nursing intervention theory and method.
In the units set out to describe nursing
intervention, the emphasis is on content rather than
process. There is an absence of the quality of
completeness in the discussions of the community
and the family as a system, outcomes of crisis theory
and intervention, and models for health education.
The accomplished reader will question the
superficiality of the presentation and the sequencing
and integration of the concepts in these units.
The final unit deals almost entirely with the
problem oriented system and nursing process. Ttiis
unit may be useful to some readers in community
nursing who are looking for a method for the
compilation of a family data base and a method to
formulate a problem list. Other readers will argue the
illness oriented base of the problem oriented record
system as it is presented in this text. The community
nursing process again gets quick overview without
note of the complexities involved with each step of
the process, particularly as it relates to family
centered community nursing.
The sample forms that appear throughout the
text may attract some readers and be quite useful in
applicability. The bibliographies are comprehensive
and supportive of concepts presented in the text and
must be read if the reader is a novice to the field.
Some readers may find the simultaneous use of
the terms public health and community nursing
puzzling: however, the sophisticated reader will
have no problem making the necessary transition of
terms.
This text might be used as a reference text by
experienced readers and practitioners who are
already familiar with the basic concepts, content and
process of community nursing. I cannot agree that
the authors have achieved their purpose of
producing a book that focuses on family health or
presents an approach that is family-centered.
In my opinion the book fails to present the basic
concepts in sufficient depth to achieve the objectives
of the book.
Community health nursing by Kathleen M.
Leahy, Marguerite Cobb and Mary C. Jones. 3d
ed. Scarborough. McGraw-Hill, Ryerson, 1977.
Approximate price $13. 75
Revievi/ed by Jennifer Carryer, Lecturer,
Sctiool of Nursing. University of Manitoba,
Winnipeg, Manitotm.
"Community Health Nursing" is intended as a
comprehensive introduction for nursing students in
the area of community health. The text is very
readable, with simple cartoons and diagrams as well
as current bibliographies accompanying each
chapter.
One chapter outlines ways that theories of
developmental process, learning process and
socialization process can form a frame of reference
for application of the nursing process with
individuals and families. Another chapter deals with
Students & Graduates
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The Canadian Nurse December 1977
ISooh.s
therapeutic communication skills, and the
teaching-learning principles most necessary in
community nursing.
The book explores the application of the nursing
process with families as well as communities and
continually emphasizes the aspect of mutual goal
setting with clients. Not only does it provide a
conceptual framework and overview of community
health nursing, but it also aids the beginning student
In dealing with very practical situations such as case
finding, consulting, referring, and recording client
interactions.
Other chapters cover the topics of working with
groups, preventive health care, aging and trends in
health care delivery. This edition includes a vastly
updated chapter on epidemiology, elementary
statistics and research. It integrates these concepts
in a manner that would be meaningful to a student or
beginning practitioner in a community setting.
Part II of the book includes a case study of
program planning, from identification of the need to
initiation of the program. Also included are case
studies to demonstrate the application of various
theories including the social learning theory,
Mastow's hierarchy of human needs etc., in specific
client situations. There are 10 situational exercises
on family visiting and three on community
assessment that would benefit nursing students.
Although many references are made to
American organizational structure and resources,
these do not detract from the principles that they
illustrate.
The Mentally Retarded and Society ; A Social
Science Perspective edited by Michael J.
Begab and Stephen A. Richardson, Maryland,
University Park Press, 1975.
Approximate price $17.50.
Reviewed by Anne Marie Kelly, Instructor in
Nursing, Halifax Infirmary School of Nursing,
Halifax, Nova Scotia.
This book originates from a conference
sponsored by the National Institute for Child
Health and Human Development and the Rose F.
Kennedy Foundation Center for Research in Mental
Retardation and Human Development. It addresses
"some of the major issues of social concern and
policy posed by the mentally retarded in our
society." In the preface, the editors speak of mental
retardation " ... as a social problem that vanes from
tur^lflM^m^..." and they state that " ... society
. iSSBfefded those who fall to measure up
to its norms, expectations and demands because of
(presumed intellectual inadequacies."
It is around these statements that the book is
organized into 22 articles, background papers and
discussions. Because of the nun jer of articles, it is
easier to discuss the book by dt ilmg with the six
topicgroups under which the arte s are presented.
• Historical and Contfimnorarv sues: This topic
_ societ
^^ retard
^^^^uri
deals with the status of the mentally retarded in
present day society, a historical perspective of their
status throughout the past, and briefly, some
contemporary issues. Stein and Sussers article
deals specifically with the incidence and prevalence
of mental retardation in society today.
• The section on Attitudes and Values includes
Gottleib's public; peer and professional attitudes
toward the retarded and Mercer's pointed article
about the erroneous assignment of lower I.Q. scores
to children of a minority group.
• Three articles under the topic of Social
Competence and Socialization deal mainly with the
language and social skills necessary for integration
of the retarded in society.
• Forms of Family Adaptation : The presence of a
mentally retarded family member adds stress to
normal family roles. Fartser's article deals with the
phases a family goes through in order to cope with
the situation. This section includes discussions on
deinstitutionalization and its effect on the family, and
foster family care — its benefits, problems involved,
and the type of family best suited to foster care.
Garber's account of the Milwaukee project — a
study of children with low IQ's and the
socioeconomic class in which they are raised — also
appears in this section of the text.
• Emerging Patterns of Service for Young People
and Adults: Most of the articles in this secton deal
with residential vs. hospital care and with vocational
adjustment of the mentally retarded as, through
public advocacy and other means, full human rights
are sought for these people.
• Social Change — Problems and Strategies:
includes discussions of the legal, technical and
bureaucratic problems occurring with the change of
status of the mentally retarded. Also included is a
discussion of how attitudes of teachers, nurses and
media can be changed. Etzioni and Richardson's
article pleads the case of planned and guided
change, change that has tieen prepared with a view
to prevention of suffering for the mentally retarded.
This book is an excellent resource for those
interested in the role of the mentally retarded in
present day society. The articles are pertinent and
up-to-date, the authors knowledgeable, and the
material interesting. The book, however, contains
very little clinical data, being, as the title indicates,
psychosocial in make-up — ' a social science
perspective.'
Because of this, the book would prove of little
value to students in a diploma program, because of
the depth of subject matter and the way it is
presented. Many of the articles are deeply couched
in psychological and sociological terms. Therefore
those lacking a good background in statistics —
means, modes and standard deviations — would not
be able to property interpret the data presented. It is
an excellent tsook for tfiose involved in the field of
mental retardation and for those who have a strong
psychosocial and statistical tjackground needed to
property understand and interpret the articles.
Adult and child care; a client approach to
nursing 2d ed. by Janet M. Barber, Lillian
Stokes and Diane McGovern Billings. 1036
pages. St. Louis, Mosby, 1977.
Approximate price $18.95
Reviewed by Eileen Burrows, coordinator,
diploma nursing program, Centennial College
of Applied Arts and Sciences, Scarborough,
Ontario.
The authors have devoted considerable
thought and effort to the revision of their nursing
text. In this second edition, the integrated approach
to the nursing care of adults and children has beer
maintained and improvements have been made ir
relation to several areas of content which were
incomplete in, or missing from, the first edition.
The content is organized in a manner which is
compatible with the approach to the teaching of
nursing inherent in many basic nursing piograms.
The focus is on basic human needs throughout th<
life cycle, and the common health problems resultinc
from stress and stressors, of clients of all ages.
Assessment, intervention and instruction, as
components of the nursing process, are presented
in relation to normal needs and the common healtf
problems. This integration of content makes it easiei
for the learner to understand how the nursing
process is utilized in a wide variety of situations.
Several areas of this edition have been
significantly expanded from the first edition. Greate
emphasis has been placed on explanation of
pathophysiology and rationale for nursing
interventions. Sections on pathophysiological and
psychosocial considerations have been added to
the discussion of each need. Additional content ir
areas such as tumors, fluid and electrolyte
imbalance and shock provide the type of informatior
required to make sound nursing judgments.
Perhaps the most beneficial addition to the text is th(
greater emphasis placed on the assessment phase
of the nursing process. Client assessment is
emphasized in all areas, and several useful
assessment guides have been included.
The area of the text pertaining to the child client
has not been significantly altered. Perhaps this area
might have benefited from the same thoughtful
revisions given other aspects of the text. Applicatior
of concepts of growth and development, and the
rationale for nursing care related to some health
problems particular to children might be presented i
more detail.
The authors state that this text has been
developed for the basic undergraduate student wh
is learning about the nursing care of adults and j
children. This text would be very appropriate if thj
client were an adult; additional basic resources
would be necessary in some cases if the client wer
a child. However, the manner in which the content isj
integrated to emphasize the utilization of the nursinij
process, and the quality of much of the material i
presented, makes this an excellent resource book'
The Canadian Nurse December 1977
Library Update
Did you know?
World Health Organization (WHO)
publications are now available from
the Canadian Public Health
Association. There are over 3,000
titles related to the health care field to
choose from with over 20,000 volumes
in stock. For a free catalogue, write to:
Canadian Public Health Association,
1335 Carting Avenue, Suite 210,
Ottawa, Ontario, KIZ 8N8. (613)
725-3769.
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, al.50
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 lettergiving author, title and item number in this
list.
If you wish to purchase a book, contact your
local bookstore or the publisher.
Books and documents
1. Aguilera, Donna C. Crisis intervention; theory
and methodology, by... and Janice M. IVIessick. 2d.
ed. St. Louis. tVlosby, 1974. 153p.
2. American Academy of Orthopaedic Surgeons.
Committee on Allied Health. Emergency care and
transportation of the sicl< and injured. 2d. ed. rev.
Chicago, III., 1977. 480p. ((Workbook 245p.)
3. American Society of Association Executives.
Who's vi/ho in association management.
Washington, DC, 1977. 396p. R
4. Bailer, Warren Robert. Bed-wetting: origins and
treatment. Toronto, Pergammon Press, c1975.
124p.
5. Behavioral approaches to children with
developmental delays, by Sally M. O'Neil, Barbara
Newcomer McLaughlin and Mary Beth Knapp. St.
Louis, Mosby, 1977. 210p.
6. Canadian Council on Hospital Accreditation.
Appraisal of long term excellence of care, Toronto,
1976. 1v. (unpaged)
7. Canadian medical directory, 1977. Don Mills.
Seccombe House. 1977 848p. R
8. Chapman, Christine M. Medical nursing. 9th ed,
London, Baillidre Tindall. 1977. 390p. (Nurses' aids
series)
9. Commission on Education for Health
Administration.fleporf. Ann Arbor, Mi., Health
Administration Press, 1975. 2v.
10. Dealing with death and dying. 2d. ed.
Jenkintown, Pa., Informed Communications, 1976
189p. (Nursing 77 Skillbook Series).
11. Deloughery, Grace L. History and trends of
professional nursing. 8th ed. St. Louis, Mosby,
1977. 277p.
12. Freour, Paul. Fumeurs en question, par... et
Paul Coudray. Paris, A. Leson, 1977. 190p.
13. Grant, Marcia Moeller. Case studies in clinical
pharmacology, by... et al. Philadelphia, F.A. Davis
Company 1977. 169p.
14. Health Organization of the United States,
Canada and internationally. A directory of voluntary
associations, professional societies and other
groups concerned with health and related fields.
4th ed. Paul Wasserman, Managing editor. Ann
Arbor. Mich.. Anthony T. Kruzas: c1977. 327p. R
1 5. History of Vancouver General Hospital. 75th
anniversary souvenir edition. Researcher/writer
Claire Marcus. Editor Faye Cooper. Vancouver,
Vancouver General Hospital. Public Relations
Department, 1977. 1v. (not paged)
16. International Council of Nurses. National
reports of member associations 1977. Geneva,
1977. 1v. (loose-leaf) R
17. Langebartel, David A. The anatomical primer;
an embryological explanation of human gross
morphology. Baltimore, Md., University Park Press,
C1977. 51 Op.
18. Manfreda, Marguerite Lucy. Psychiatric
nursing, by... and Sydney Diane Krampitz. 10th ed.
Philadelphia, Davis. 1977. 525p.
1 9. National League for Nursing. Stress —making it
work for you. New York, 1977. 85p. (NLN
Publication no. 16-1674)
20. — . Council of Associate Degree Programs.
Preparing the associate degree graduate. New
York, C1977. 71p. (NLN Publication no. 23-1661)
21 . — . Council of Baccalaureate and Higher Degree
programs. Cultural Dimensions in the
baccalaureate nursing curriculum. New York,
C1977. 114p. (NLN Publication no. 15-1662).
22. Pediatric nursing, by H.C. Latham et al. 3d. ed
St. Louis. Mosby. 1977. 605p.
23. Pediatrics. 16th edition. Edited by Abraham M.
Rudolph. New York, Appleton-Centry-Crofts, c1 977.
2198p.
24. Popiel, Elda S. Nursing and the process of
continuing education. 2d. ed. St. Louis, Mosby,
1977. 249p.
25. Street, Margaret M. The tvlargaret M. Street
Papers. Research papers and edited manuscript of
Watch-fires on the mountains: the life and writings of
Ethel Johns... Inventory, by... in the library of the
University of British Columbia. Special Collections
Division. Vancouver, 1977. 50p. R
26. The surgical patient: behavioral concepts for
the operating room nurse, by Barbara J.
Gruendemann et al. 2d. ed. St. Louis, Mosby, 1977.
27. Tinkham. Catherine W. Community health
nursing; evolution and process, by... and Eleanor F.
Voorhies. 2d. ed. New York,
Appleton-Century-Crofts, c1977. 299p.
28. Western Council on Higher Education for
Nursing. Newly initiated and completed research in
WCHEN schools of nursing; vol. 3 September
1974-December 1976. Boulder, Colorado, June
1977. 1v. (loose-leaf) R
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 lend me the foltowing publications, listed in the
or add my name to the waiting list to receive them when available.
Item Author Short title (for identification)
No.
. issue of The Canadian Nurse,
Request for loans will be filled in order of receipt.
Reference and restricted material must be used in the CNA library
Borrower
Registration No
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The Canadian Nurse December 1977
29. Wood, Luate A.Techniques de nursing , sous la
direction de... traduction Louise L. Berger.
Montreal, HRW, 1977. 2v.
30. World Conference of the International Women's
Year, 19 June-2 July, 1975, Mexico City. Report.
New York, United Nations, 1976. 199p.
31. Benedikter, Helen. From nursing audit to
multidisciplinary audit. New York, National League
for Nursing, c1977. 45p. (NLN Publication no.
20-1673)
32. Castonguay, Ther^se. Looking back: a five
year descriptive study of Grant MacEv/an
Community College nursing program, by... and
Myrna Maquera. Edmonton, Grant MacEwan
Community College, 1977. 30p.
33. International Labour Conference. 63rd session,
June 1-22, 1977 Geneva. Memorandum. Geneva,
International Labour Organization. 1976. 17p.
34. Lodge, Mary P. Initiating a master's degree
program in nursing: Asking the essential questions.
New York, National League for Nursing. c1977. 17p.
(NLN Publication no. 15-1672).
35. New York State Nurses Association. Selected
references outlining the development of New/ York
State Nurses Association's 1985 proposal. Albany,
NY., 1977. 12p.
36. The Operating Room Nurses of Greater
Toronto. Standards of practice of operating-room
nursing. Toronto, 1976. 15p.
Government documents
Algeria
37. Minist^re de la Sante publique et de la
Population. Direction de la Sante publique. Guide
de la circonscription sanitaire pilote. Alger, 1966.
221p. R
Canada
38. Handbook; the annual handbook of present
conditions and recent progress, prepared in the
publishing section, Information Division, Statistics
Canada 1960-1977. Ottawa, Ministry of Supply and
Services, Canada, 2v. R
39. Health and Welfare Canada. Health Programs
Branch. Working Group on Program evaluation.
Final Report to the Federal- Provincial Sub
Committee on Quality of Care and Research and
the Federal Provincial Advisory Committee on
Health Insurance. Ottawa, 1977. 2v.
40. — . Health Economics and Statistics Division.
Health Programs Branch. Salaries and wages in
Canadian Hospitals 1962-1975. Ottawa. 1977. 8 5p.
41 . — . I^edical education in geriatrics: report of a
working party convened by the Health Standards
and Consultants Directorate, Health Programs
Branch, Department of National Health and
Welfare. Ottawa, 1977. 43p. (Health Manpower
report no. 1-77)
42. Labour Canada. Strikes and lockouts in
Canada 1976. Ottawa, Supply and Services, 1977.
93p.
43. Law Reform Commission. Project description:
Protection of life project. Ottawa, 1977, 20p.
44. Medical Research Council. Grants and awards
guide 1977. Ottawa, 1977. 95p.
45. Conseil de Renherches m^dicales. Guide de
subventions et bourses, 1977. Ottawa, 1977. 95p.
46. La revue annuelle des conditions actuelles et
des progres recents, preparee a la section des
publications, division de I'information, Statistique
Canada, 1960-1977. Ottawa, Ministre des
Approvisionnements et Services Canada. 2v. R
47. Conseil des Sciences du Canada. Rapport
annuel 1978-1977. Ottawa, Approvisionnements et
Services, 1977. 62o.
O^
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BSE/
breast self-
examination
48. Science Council of Canada. Annual report
1976-1977. Ottawa, Supply and Services, 1977.
58p.
49. Statistics Canada. Hospital morbidity:
Canadian diagnostic list, 1974. Ottawa, 1977, 103p.
50. Statistics Canada. Nursing in Canada:
Canadian Nursing Statistics 1976. Ottawa, 1977,
139p.
51 . Statistique Canada. La morbidity hospitali^re:
liste canadienne de diagnostics, 1974. Ottawa,
1977. 103p.
52. — . Soins infirmiers au Canada: statistique des
soins infirmiers, 1976. Ottawa, 1977. 139p.
53. Travail Canada. Grewes et lock-outs au
Canada, 1976. Ottawa, Approvisionnements et
Services, 1977. 93d.
Clinical Wordsearch
Answers
Puzzle no. 9 (appears on page 37)
11 Skull
25 Herpes Zoster
12 Subdural Haematoma
26 Reflex
13 A.L.S.
27 Nen/e
1 Head
14 Syringomyelia
28 Aphasia
2 Meningeal
15 Spina Bifida
29 Gyrus
3 Spinal Cord
16 Clonic
30 Frontal Lobe
4 Paralysis
17 Myelogram
31 C.V.A.
^■■1
18 Myasthenia Gravis
32 C.S.F.
19 Concussion
33 T.I.A.
7 Cho-ea
20 Seizures
34 Tonus
8 Demyelinating
21 Medulla
35 Stupor
9 Dermatome j||^
22 Pons
36 Coma
1 0 Brain Abscess iB
23 Alzheimer's
37 Pupils
mm
24 Myelin Sheath
38 Autonomic
Hidden Answer; Keep your he
.d, buckle
up.
54. Conseil du Tr6sor. Directive du Conseil du
Tr^sor sur la reinstallation. Ottawa, Information
Canada, 1975. 8 pts in 1. (Catalogue no
BT46-4/1975)
55. Treasury Board. Guide on EDP administration
for departments and agencies of the government of
Canada. Ottawa, Information Canada, 1974. 10 pts.
in 1.
56. Treasury Board. Treasury Board relocation
directive. Ottawa. Information Canada, 1975. 8 pts.
in 1. (Catalogue no BT46-4/1975)
United States of America
57. Department of Health Education and Welfare. A
summary of studies of interviewing methodology,
1959-1970, by Cannell, Charles F. Rockville, Md.,
1977. 78p. (DHEW Publication no. (HRA) 77-1343)
58. — . Survey of registered nurses employed in
physicians' offices, September 1973. Bethesda,
Md., 1975. 98p. (DHEW Publication no. (HRA)
75-50)
59. — . Women and their health research
implications for a new era, by Virginia Olesen.
Rockville, Md., 1977. 104p. (DHEW Publication no.
(HRA) 77-3138)
60. — . Public Health Service. Division of Nursing. A
rewew and evaluation of nursing productivity.
Bethesda, Md,, 1976. 3v. in 1. (DHEW Publication
no. (HRA) 77-15)
61. International Conference on Women in Health,
Washington, D,C., 1975. Proceedings of the
International Conference on Women in Health, June
16-18, 1975, Washington, D.C. Sponsored by
Health Resources Administration. Washington,
U.S. Dept. of Health Education and Welfare, Public
Health Service, 1976. 204p. (DHEW Publication no
(HRA) 76-51)
62. Public Health Service. The British national
health service. Conversations with Sir George E.
Godber. Rockville, Md., 1976. 159p. (DHEW
Publication no. (NIH) 77-1205)
63. Public Health Service. Division of Nursing.
Immigration of graduates of foreign nursing
schools; report of the conference. Bethesda,
Maryland, June 23-24, 1975, Bethesda, Md, 1976.
38p. (DHEW Publication no. (HRA) 76-84)
64. Department of Health, Education and Welfare.
Public Health Service. Division of Nursing. Survey of
foreign nurse graduates. Bethesda, Md., 1976.
112p. (DHEW Publication no. (HRA) 76-13)
65. Preventive and community medicine in primary
care. A Conference sponsored by The John E.
Fogarty International Center for Advanced Study in
the Health Sciences and the Association of the
Teachers of Preventive Medicine. National
Institutes of Health, Bethesda, Md., edited by
William H. Barker. Bethesda, Md., National Institute
of Health 1976. 125p. (DHEW Publication no. (NIH)
76-879)
Studies in CNA Repository Collection
66. Chisolm, Doris Avril. An investigation of
premature infants' responsiveness to the Brazelton
Neonatal Behavioral Assessment Scale. Seattle,
Wash. 1975. 41p. Thesis (M.N.) — Washington. R
67. Synmoie, Gloria Lorraine. An investigation of
premature infants' responsiveness to the Brazelton
Neonatal and sic. Behavioral Assessment Scale.
Seattle, Wash., 1975. 40p. Thesis (M.N.) —
Washington. R
68. Tremblay, Adrien. Les plans de soins infirmien^
et leurcontenu en 6l6ments de soins individualises. '
Montreal, 1975. 128p. Th6se (M.N.) — Montreal. R
Audio-visual Aids
69. The health sciences video directory 1977.
edited by Lawrence Eidelberg, New York, Shelter
Books, 270p.
Th« Canadian Nurse December 1977
(la.s.sirkHl
Advert i80incMit.s
Alberta
Ontario
United States
A Supervisor of Nurses is required by January 1st. 1978 tor a prog-
ressive public hearth nursing program with a nursing staff of 15 North
Eastern Aiberta Health Umt serves a population of 36.000 persons tn
rural north eastern Alberta with 5 sub-offices located throughout
Wages are negot)aWe but comparable with AARN recommendations
Qualifications BSc- m Nursing plus relevant experience Please ap-
ply. sencSng resume to Execut)ve Director, North Eastern Alberta
Health Unit. Box 1468. St. Paul. Alberta. TOA 3A0.
Head Nurse for Neonatal Intensive Care Nursery — Applicant must
have knowledge and experience m neonatal intensive care as well as
managenal competency B.Sc N. prefene<3. Apply in wntmg to: Per-
sonnel Recruiter, St- Joseph s Hospital, 268 Grosvenor Street. Lon-
don. Ontario. N6A 4V2,
Quebec
British Columbia
General Duty Nurses for modem 41 -bed hospital located on th(»
Alaska Highway Salary and personnel poiiaes in accordance with
RNABC. Accommodation available m residence. Apply Director of
Nursing. Fort Nelson General Hospital. P.O. Box 60, Fort Nelson.
British Columbia. VOC IRO.
Registered Nurses — Full time positioris for general duty graduate
nurses m 41 -bed hospital Must be wilting to become B.C. registered.
Submit applications to: Mrs. N.W Baker, Director of Nursing. Golden
& Distnci General Hospital, P O. Box 1 260. Golden, Bntish Columbia.
VOA 1H0.
General Duty Grads required for 1 30-bed accredited hospital. Previ-
ous experience desirable Staff residence available Salary as per
RNABC contract with northern allowance included. For further infor-
mation please contact the. Director of Nursing, Krtimat General Hospi-
tal. 899 Lahakas Boulevard. Kitimat, British Columbia. V8C 1E7.
ExperierKed 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
vanous recreational facilities Excellent orientation and continuing
education programmes Salary: $118400 to S1399.00 per month
Chnical areas include: Medicine, Surgery. Obstetncs, Pediatncs.
Coronary Care. Hemodialysts. Rehabilitation, intensive Care,
Emergency. Apply to Nursing Personnel, Royal Columbian Hospital.
New Westminster. British Columbia, V3L 3W7.
Required Immediately — Co-ordnalor o( the degree programme in
Community Nursing Education. Loyola Campus of Concordia Univer-
sity. Administrative abiSties: knowledge of community nursing; teach-
ing and curriculum experience: eligible for registration as a nurse in
the Province of Quebec. Ph D preferred Master in nursing with
suitable experience maybe considered Send resumes to; Director,
Community Nursing Programme, Concordia University. 7141 Sher-
brooke W , Montreal, Quebec. H4B 1R6
United States
Registered Nurses — A variety of nursing openings m all services
including iCU-CCU are available at the University Hospital. This
300-bed teaching hospital located with the University of Arizona Col-
lege of Mediane m the Arizona Health Sciences Center offers a
vanety of challenging professional assignments. En)oy the dry, sunny
climate and pleasant way of hte m the attractive Southwest Contact.
Staff Employment Center, Untveraty of Arizona, 1 101 Babcock. Tuc-
son, Arizona 85721 . 602/884-3668. An Equal Opportunity. Affirma-
tive Action. Title IX Employer,
TEST DEVELOPMENT OFFICER
The Canadian Nurses Asscx;iation invites applications for the position of Test
Development Officer to work in the French-language section of its test
development program.
The successful applicant will assist committees in developing test blueprints,
conduct item-writing sessions, prepare test items for committee review, compile
test forms, and carry out other functions related to the development and
preparation of tests.
Applicants should have a nursing background, a master's degree or equivalent in
education or psychology with specialization in tests and measurement.
Experience in test construction desirable. Mastery of French essential;
knowledge of English would be an asset.
Position available immediately.
Interested applicants are asked to reply, In confidence, stating salary
expected and Including curriculum vitae, to:
Director of Testing Service
Canadian Nurses Association
Testing Service
Suite 400, 220 Laurier Avenue West
Ottawa, Ontario K1P5Z9
Challenge Awaits You at our dynamic community medical center
Huntington Memor«ai Hospital is a 565-t>ed general care hospital
located in a beautrfui sutxjrban area of Los ArKJeles The emphase is
on excellence in patient care and m maintaining the t^est possible
nursing staff through exceptional onentation and in-service training
programs, continuing education, ar>d professional involvement with
innovators m many fields of medtcine Were presently seekir>g ex-
perienced RN's as well as riew grads for many of our outstanding
units If you d fike to enjoy the rewards of more challenge from your
career, plus the many benefits our hospital and Southern California
offer, please contact Unda Chavez. RN. (collect} at (213) 440-5400.
Huntington Memonal Hospital, 747 S Fairmount. Pasadena, Califor-
nia. 91105 An equal opporlunrty employer m/\.
Nurses for United States — Hospital openings lor Registered Nur-
ses and recent graduates tor Florida. lllir>ois, Texas. Louisiana and
Arkansas. Openings in all specialties. — Cntical Care, Operating
Room. Recovery Room, Medical/Surgical. Emergency Room and
Pediatrics We will provide necessary work visa No fee to applicant
For more information write to Medical Recruiters of America, Inc. at
one of the followtng addresses 800 N.W 62nd St , Suite 510. Ft
Lauderdale. Rorida. 33309, 611 Ryan Plaza Dnve. Suite 537.
Arlington. Texas. 76011: 1443 W Fargo. Chicago. Illinois 60626
Nurses — RNs — Immediate Openings in California — Florida —
Texas — Mississippi — If you are expenenced or a recent Graduate
Nurse we can offer you positions with excellent salanes of up lo S1300
per month plus all benefits Not only are there no fees to you what-
soever for placing you. but we also provide complete Visa and Licen-
sure assistance at also no cost to you. Wnte immediately tor our
aopticatton even if there are other areas of tlie US. that you are
interested in We will call you upon receipt of your application in order
to arrange for hospital interviews Windsor Nurse Placement Service.
P.O. Box 1133, Great Neck, New York 11023, (516-487-2818)
Our 20th Year of World Wide Service"
Come to Texas — Baptist Hospital of Southeast Texas >s a 400-bed
growth oriented organization looking tor a few good R.N.'S We feel
that we can offer you the chalter^e arxJ opportunity to develop and
continue your professional growth. We are located in Beaumont, a City
of 1 50,000 With a small town atmosphere but the conventerKe of the
large city We re 30 minutes from the Gulf of Mexico and surrounded
by beautiful trees and inland lakes. Baptist Hospital has a progress
salary plan plus a liberal frir^e package. We will provide your immigra-
tion paperwork cost plus airfare to rekxate For additional information
contact Personnel Administration, Baptist Hospital of Southeast Te-
xas, Inc.. P O. Drawer 1591. Beaumont. Texas 77704, An affirma-
tive action employer.
UNITED STATES
OPPORTUNITIES
FOR REGISTERED NURSES
AVAILABLE NOW
IN CALIFORNIA
FLORIDA
MISSISSIPPI
NEW ORLEANS
TEXAS
WISCONSIN
WE PLACE AND HELP YOU WITH;
STATE BOARD REGISTRATION
YOUR WORK VISA
TEMPORARY HOUSING
A CANADIAN COUNSEL^
Phone: (416) 449-588i.C
RECRUITING REGISTERED NURSES WC.
1200 LAWRENCE AVENUE EAST, SUITE 301
DON MILLS. ONTARIO M3A 1C1
j^/^/\r
NO •
TO
OPEN 7 DAVS A WEEK.
The Canadian Nurse December 1977
RN
s . . .^.
^lENCEANDSKILLSI
YOUREXPERI
CAN MAKE A VALUABLE
CONTRIBUTION TO THE
EDUCATION OF OUR
POPULATION
NOW INTERVIEWING . . .
FOR ASSOCIATE DEGREE
NURSING FACULTY
"Nursing Fundamentals — the basics
'Maternal-Newborn Nursing — total maternity cycle
•Pediatric Nursing — care of children
"Medical-Surgical — health care, teens to geriatrics
"Psychiatric Nursing — total scope of mental health
Northeast Wisconsin Technical Institute
IS regionally tax supported for the educa-
tion of adults. We are currently forming a
faculty for an Associate Degree Nursing
program with opportunities available for,
5 individuals with Masters Degrees, Ad-
vanced Practice and Current Employ-
ment m one or all of the above areas. Pro-
grammed to begin in September 1978,
but openings exist immediately for those
interested in establishing curriculum, etc.
We are located in an attractive 9 build-
ing, multi-level structure in the heart of
the upper Midwest's transportation/
vacation/health hub. We can provideyou
with convenient access to a 4 year uni-
versity, bustling shopping communities,
excellent housing facilities and a 4
season recreational environment.
Our positions include attractive salaries,
excellent working conditions and a com-
prehensive fringe benefits program sub-
stantially paid for by the Institution. If you
are interested, please direct your resume
or CALL COLLECT to:
Miss Marjorie Snyder,
A.D. Nursing Director
(414) 497-3202 or
(414)497-3434
Convenient Appointments
G«ife6e Arranged For
IntS'"'. .ew^ Jn Your Area
Northeast Wisconsin Technical Institute
'/i^
1
Northeast Wisconsin Tectinical Institute
2740 W. Mason Street
Green Bay, Wisconsin 54303
.3' Opportunity .Employer M/f
Royal Hobart Hospital
Hobart Tasmania
Nurse Educators
Applications are invited from the above for positions in the
Nurse Education Department. Diploma in Nurse Education
desirable.
The Royal Hobart Hospital is a training School for
approximately 300 student nurses, and has a bed capacity of
600. It is the major teaching hospital attached to the University
of Tasmania.
Salary — with Tutor Diploma $A1 0,652 — $A11,515
depending upon experience.
Full board and lodging is available in a modern nurses' home
at the rate of $18.43 per week. An allowance of $2.00 per week
is payable if applicant wishes to be non-resident.
Further information may be obtained from:
The Director of Nursing
Mrs. Jean M. lUloore, FCNA.
Royal Hobart Hospital
Box 1061L, G.P.O.
Hobart, 7001
Tasmania
NURSING COORDINATOR
OPERATING ROOM
(CARDIO VASCULAR THORACIC)
The above position is available at one of Canada's leading
teaching Hospitals, providing the highest quality of care to
patients and of service to the community.
Responsibilities will include:
Planning and organizing daily work schedules.
Assessing and evaluating departmental requirements for
future needs. Directing and supervising all nursing and
auxilliary staff.
Qualifications:
Demonstrated supervisory ability. Extensive knowledge and
practise of Cardio Vascular nursing and operating room
experience essential. B. N. Desirable. Eligible for registration
with the Manitoba Association of Registered Nurses.
Please apply in writing to:
Mrs. Phyllis McGrath
Director, Nursing Service
ST. BONIFACE GENERAL HOSPITAL
409 Tache Avenue
Winnipeg, Manitoba, R2H-2A6
Canada
The Canadian Nurse December 1977
Hermann
i:v
part of
avery
team!
Nurses, join us and Cathy in a course toward leadership in progressive total patient care
Located in the famed Texas Medical Center, we are the primary teaching facility for the University of Texas Medical
School at Houston This vibrant teaching environment will allow you the freedom to be the nurse you want to be.
Join us as we grow We re expanding from 500 beds to 1.000 beds opening career opporlunilies at all levels and in all
Nursing specialities
Discover Houston . . a city with an unlimited future. A city alive. We are now the 5th largest city in the U.S.. the largest
city in the South! . and growing. The non-stop nightlife, culture, sports, year round recreational activities on nearby
beaches, inland lakes and rivers— are all an easy drive away You'll find the lower cost of living and no local or state
income taxes make it more than comfortable to pursue your profession
In addition to excellent salaries, our comprehensive benefits package includes 3 weeks paid vacation and tuition
reimbursement up to 100% We also offer relocation assistance and one month free rent If you are an experienced
professional nurse, we would like to discuss the opportunities now available for you in our Primary Nursing programs
For more infoimation about Hermann Hospital, mail the coupon to or call collect Ms Beverly Preble. Nurse Recruiter
1203 Ross Sterling Avenue. Houston. Texas 77030. (713) 797-3000
An Equal Opportunity Employer M/F
Name
Address.
City
Phone
State-
Zip _
Specific Area of Interest
(circle) RN
LVN
NURSE INTERN
CN 12/77
^lOVtOf ^ Attn: Nurse Recruitme
Hermann
Hospital
1 ■■-■ m
1203 Ross Sterling
Texas Medical Center
Houilori. Texas 77030
The Canadian Nurse December 1977
DIRECTOR
OF SURGERY
SERVICES
Large progressive Southern Cali-
fornia Hospital, located within
view of beach, is seeking a man-
agement-oriented RN to direct
surgery services, 12 rooms includ-
ing laminar flow and expanding
cardiovascular service. Nursing
staff includes Clinical Supervisor
charge nurses and in-service in-
structor.
The qualified applicant will have
demonstrated administrative a-
bility and clinical experience. An
excellent opportunity. Salary
negotiable. Exceptional benefits.
Send resume and salary history
to
Attn: L. Bertrand,
Personnel Department
1680 N. Vine - Suite 406
Los Angeles, CA 90028
equal opportunity employer m/f
McMaster University
School of Nursing
Nurse faculty members required for the
1978-79 academic year for a School of
Nursing, within a Faculty of Health
Sciences. The School is an integral part of
a newly developed Health Sciences
Centre where collaborative relationships
are fostered among the various health
professions; some joint appointments
possible.
Requirements: Master's or Doctoral
degree, with clinical specialist preparation
or experience and/or preparation in
teaching preferred.
Application, with a copy of curriculum
rvitae and two references to:
ur. D Kergin
Associate Oean (Nursing)
Faculty of Health Sciences
McMaster University
Health Sciences Centre
1200 Main Street West
Hamilton, Ontario L8S 4Jd
Applications for the
position of
Supervisor
Operating Room and
Recovery Room
are now being accepted by this
300 bed fully accredited hospital.
We offer an active staff
development programme.
Salaries and fringe benefits are
competitive, based on
educational background and
experience. Temporary
accommodation available.
Apply sending complete
resume to:
The Director of Personnel
Stratford General Hospital
Stratford, Ontario
N5A 2Y6
WATERFORD
HOSPITAL
REGISTERED
NURSES
Openings exist for Psychiatric
Nurses and Staff Nurses prepared
to undertake Post Basic Education
in Psychiatric Nursing.
Benefits are in accordance with the
Nurses' Union Contract, including
substantial allowances in addition
to the basic salary.
For further inquiries please direct
in writing to:
The Personnel Director
Waterford Hospital
Waterford Bridge Road
St. John's, J^ewfoundland
Canada, A1C5T9
Co-Ordinator
Obstetrics, Gynaecology, Nursery,
Delivery and Pediatrics
Applications for the above position are
now being accepted by this 300-bed
accredited general hospital.
Baccalaureate Degree in Nursing and
experience in these areas preferred.
We offer an active staff development
programme, competitive salaries and
fringe benefits based on educational
bacl<ground and experience.
Apply sending resume to:
Director of Personnel
Stratford General Hospital
Stratford, Ontario
N5A 2Y6
This
Publication. . . .
is Avadlable in
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cancellation is 6 weeks prior to 1st
day of publication month.
The Canadian Nurses Association
does not review the personnel
policies of the hospitals and agencies
advertising in the Journal. For
authentic information, prospective
applicants should apply to the
Registered Nurses' Association of
the Province in which they are
interested in working.
Address correspondence to:
The Canadian Nurse
50 The Driveway
Ottawa, Ontario
K2P 1E2
4f
The Canadian Nurse December 1977
The Province
of British Columbia
ASSOCIATE DIRECTOR
OF NURSING
Responsible for total nursing care services at
Valleyview Hospital; to develop programs at ward
level and act for Director of Nursing when necessary.
Quote Competition No. 77:2150-38
NURSE SUPERVISOR
AFTERNOONS
Responsible for directing/co-ordinating administrative
and clinical nursing activities from 1600 — 0010 at
Riverview Hospital.
Quote Competition No. 77:1160C-38
Qualifications — Degree in Nursing, specializing in
psychiatric/geriatric nursing; must obtain license to
practise nursing in B.C. under Registered
Nurses/Registered Psychiatric Nurses Acts; extensive
related experience, including supervision.
Salary — $19,188 — $22,476
Positions at ESSONDALE, Ministry of Health
Closing Date — IMMEDIATELY
Obtain and return applications from Valleyview Lodge,
Essondale, B.C. VOM 1J0.
COMMUNITY NURSE
For Ministry of Health, Nelson, to provide general
public health nursing service in area and
identify/interpret conditions affecting health of
individuals, families and community groups; to assist
with various programs (communicable/special
disease control), overall health care material to
geriatric, and validate applications for
extended/intermediate care; to liaise with community
agencies.
Qualifications — Appropriate university degree (or
acceptable equivalent of education and experience),
and some general/directly related nursing experience;
registered or become registered in Registered Nurses'
Association of British Columbia: use own car on
mileage.
Salary — $16,332 — $19,296
Quote Competition No. 77:1108B-38
Closing Date — IMMEDIATELY
Obtain and return applications to Public Service
Commission, 544 Michigan St., Victoria, B.C.
V8V1S3.
Province of British Columbia
Public Service Commission
544 Michigan Street. Victoria, B C V8V 1S3
CHI]
NURSING
FACULTY
5 POSITIONS
1 IMMEDIATELY, 4 FOR 1978
Why not move into a dynamic young city in the heart of Interior
B.C. ? We're looking for experienced nurses to join our teaching
facu Ity . We're a young college that can offer you career opportu-
nities as we grow. Our diploma program is new and demands
creative, innovative teachers that can help us in the further
development of the program. If you have a baccalaureate
degree and are registered or eligible for registration in B.C. . we
want to hear from you.
The 1977-78 salary range is $17,051 to 529,687. In addition,
we offer a full benefit package including moving expenses
Please write us. Send along a full resume and three references
to:
Dr. F.J. Speckeen, Principal
THE COLLEGE OF .NEW C.'VLEDONIA
2001 Central Street
Prince George, B.C.
V2N 1P8
OPPORTUNITY Ahrj\n
NURSES
Several positions are now available in Red Deer. Alberta, at the Miche-
ner Centre, a facility for the care, training and rehabilitation of the
developmentally handicapped. Responsibilities include general duty on
nursing units, participating in residential programming, and providing
supervision for non-professional staff.
Qualifications: Graduate from an approved School of Nursing and eligi-
ble for nursing registration In Alt)erta.
Salary $1 1 ,748 — 513,812 (Currently under review)
Competition No. 91 84-9 To remain open until suitable candidates have
been selected.
Please submit completed application forms to:
Mr. H.L. Maki
Personnel Administrator
Michener Centre
Box 5002
Red Deer, Alberta, T4N 5H1
4
Wish
you were
here
...in Canada's
Health Service
Medical Services Branch
of the Department of
National Health and Welfare employs some 900
nurses and the demand grows every day.
Take the North for example. Community Health
Nursing is the major role of the nurse in bringing health
services to Canada's Indian and Eskimo peoples. If you
have the qualifications and can carry more than the
normal load of responsibility. . . why not find out more?
Hospital Nurses are needed too in some areas and
again the North has a continuing demand.
Then there is Occupational Health Nursing which in-
cludes counselling and some treatment to federal public
servants.
You could work in one or all of these areas in the
course of your career, and it is pt^ssible to advance to
senior positions. In addition, there are educational
opportunities such as in-service training and some
financial support for educational leave.
For further information on any, or all, of these career
oppt)rtunities, please contact the Medical Services
office nearest vou or write to:
Medical Services Branch
Department of National Health and Welfare
Ottawa. Ontario K1A0L3
Name
Prov.
'are Sante et Bten-etre social
Canada
The Canadian Nurse December 1977
Index to
Advertisers
December 1977
^
The Canadian Nurse's Cap Reg'd
The Clinic Shoemakers
45
Cover 2
Equity Medical Supply Company
15
Hollister Limited
International Development Research Centre
11
Miller-Stephenson
13
Posey Company
Procter & Gamble
13
Cover 3
W.B. Saunders Company Canada Limited
Standard Brands Canada Limited
Cover 4
Advertising Manager
Gerry Kavanaugh
The Canadian Nurse
50 The Driveway
Ottawa, Ontario K2P 1E2
Advertising Representatives
Richard P. Wilson
219 East Lancaster Avenue
Ardmore. Penna. 19003
Telephone: (215) 649-1497
Gordon Tiffin
2 Tremont Crescent
Don Mills, Ontario M3B 2S1
Telephone: (416) 444-4731
Member of Canadian
Circulations Audit Board Inc.
VICE PRESIDENT - NURSING
Applications are invited for the position of
Vice-President Nursing, Toronto General Hospital.
The Position:
As a member of the Hospital's top-management team this
position requires a nurse with innovative qualities and
ability to organize, delegate and direct the work of others
within the Hospital's Nursing Service.
The applicant we seek will be prepared to carry forward
advanced concepts of nursing administration now in place
and add new initiatives based upon sound research and
planning.
Qualifications:
Ability to register in the Province of Ontario is required.
Preference will be given to candidates with advanced
post-graduate preparation in nursing administration
and/or equivalent. Demonstrated success In previous
senior management posts is an essential pre-requisite.
Apply in writing to:
President
Toronto General Hospital
101 College Street
Toronto, Ontario
M5G 1L7
@
Parnpers
ives
you both
ahieak
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.
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
l:)ed 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
c are of babies have
more time to spend oiy"
other tasks.
PROCrCR A OAWSLC
A
• nil
move for cholesterol
concerned patients.^
,is to Fleischmann's Margarine and Egg Beaters.
Egg Beaters, the anti-cholesterol
eggs.
The average large egg contains 275 mg
of cholesterol. It's the single highest source
of cholesterol in man's diet. By replacing
egg yolks with corn oil and a vitamin/
mineral fortified nutrient, we've reduced
the cholesterol content of eggs by 98% . Yet
Egg Beaters look, cook and taste like fresh
farm eggs. They're versatile and delicious.
Egg Beaters. Even cholesterol patients
can eat them every day.
In your grocer's freezer
j^^
Special give-aways to help
your patients.
Please send me at no extra charge:
. Eng. copies
/
"Cooking with Egg Beaters'
. Ejig. copies
Tell your patients about
polvnunsaturates.
Because Fleischmann's Margarine is made
from 100% corn oil, it has a very high poly-
unsaturate level — 40%, and only 18% saturates.
A very sensible choice for patients with
cholesterol problems. Incidentally, when you
recommend Fleischmann's for its health
benefits, they'll thank you for the
taste! Fleischmann's. We make all
our margarine with 100% corn oil.
Name;
Address: .
City:
Postal
. Code: .
^
"Cholesterol, Calorie,
Sodium Calculator"
. copies
Province:
CN-77-I2
Fleischmann's, Consumer Service Division, The Business Center, Toronto Eaton Center,
P.O. Box 504, Suite 104, 220 Yonge Street, Toronto, Ontario, MSB 2H1
La BA.btioth^que.
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