The C.n-.ll.n Nur..
D8c:ember 1979 55
THE CANADIAN NURSE
The offtCial /Oumal of the Canadian Nurses
Association published In French and English
editions eleverlimes per year
1979
Annual Author, Subject Index
Vol. 75, No.'s. 1-11
January-December
LEGE'D
A -Abstract
'\ V - Audio ual
E - EdilOnaJ
pon - ponrn..it
ACCIDD/TS
A
e"'y present danger {Post. Langford) 4!fa
Helping preschool children learn to be safe (Eifert) 260
AOOLESCE'CE
Pe"'pective (Wheatley) E.
r.;
.\OOLESCE'TGIRL5-HEALTH ,\'0 H\:GIE"E
The smgle mother: can \o\c help'! (Hlllung-Meyer) 26N
AGED
The loneliness ofthe elderly (Griffin) 23"1)
USH. ArleD<
Not an patients need hOllitiplta)s. 2
'1r
ALBERT A ASSOCIA TIO' OF REGISTERED 'l RSES.
A "'l AL MEETI'G
Ncwsbeat: the provinciaJ scene. 9J/-\
.\LBERT A CHILDRE"S HOSPITAL
Ja -Januar)
Fe - Fcbrua.-y
"h - '-larch
Ap -Apnl
M) - Md)
Jc June
J/.\ -Juh/August
S - September
Oc -October
N - November
D - December
Learning aoom the hospitaJ at home (Ferguson. Park.
Ward).44Ja
ALCOCII.. o.nÏS<
Books can help. 52Ja
ALCOHOLlS'\1
Closeup on physicians at n,k. ION
OccupationaJ hea]th nurses auend akoholism
conference. 14D
ALEMA' \:. Helen
Nursing grand-rounds: femoral a)lograft (Ferguson.
Grice. Stuanl320c
.\LLA:-O. '\Iargam
Nursing: fact and fantasy. 31J/A
ALLE'. ""o
ra
U of -\ hO'ljit
VISlllng pTOfe
,or. &Ja
A'\IBlL.\TOR\: C.\RE
Did you know... the Hea)th Care Cenrfe. 9\1r
A'DER!tO'. "loll)
Bk_ rev., 5:!Fe
^'DERSO:'o. Mona
8k. rev..
:!Fe
ANTISEPSIS
Cross infeclion: a new approach to an old problem
(Cragg) 40Fe
Hands that car<: ar< they sare? (Sklar) 100c
APATHY
Frankly speaking: apathy in nursingfRyanJ J lJe
ASSOCIA nON OF Nl RSES 0
PRJ"CE ED" .\RD
ISLA:-OD. A:-O'LAL MEETI'G
Newsbeat: me provincIa) scene. I
J/A
56 D8c:ember 1979
The C.n-.ll.n Nurse
ASS\X'IATIO" ot RE(;I!>TFRED "I RSFS Ot'
"E\\H)l
DI.A'D
ARNN remembe
pa'\t-Iook!!. to the future. lID
Did you know. . 8N
4.STHMA
Childhood asthma: an outpatient approach (0 treatment
(Ferguson. Webbl '6Fe
A TTITl J)F ot' HE.\L TH P"RSO'
EL
F-nmkly speaking: apathy in nursing (Ryan) 3lJe
A\\ARJ)SA'DPRILES
CNA's annual meeting. 1M}
CNF recei\le
k..ellogggranr. 14Ap
Did you know...SI.John Ambulance, "Ap
Janel "-enny Knox. recipient of the Helen Gibson
Memoridl Schola",hip. 49Fe
The Jud) Hill Memorial Scholal'ihip. 49Fe
Thirteen nurse!!. recel\.e .1wdrd
valued at more than
SJO.OOO. 12Uc
-B-
BAILMENTS
Where does the nurse'" respon'\ibility begin and end in
Cdrlng for a p.1tient"!t. belongmg"'! (
klar) 14S
BA ":'III'G. Judith
^'\si!!otant editor (port) 50c
The nurse in thecommumty: infant stimulation. 36N
BAl "IGART. Alie.
Closeup on nursmg networks. 13J/A
BtL4. 'GER. Anne "Iarie
Servmg Si'iòter. "iO-\p
BESII.\RAII. :\1. Ann.
Closeup on coalition for the prevention of handicap
29N
Commentary (POSI) E. ID
PerOiipective. E. 3Fe
Sinner, or !'taints? E. 4Je
The impo
(hle dream? E. 6Ap
BES\\ETHE:RICK, "Iargarot
StdITmg a"'gnmenl. I
My
BIETTE. M. Ga)le Burns
fhe effects of'ielected factors on the older .1dulfs
managment of treatment for hypertension. 550c
RILLL 'G-"It'\:ER. Jo
fhe'i.1ngle mother: can we: help
::!6N
BOt: ". JaM
Bk. rev.. 480c
Closeup On fetal aJcohol syndrome. 35N
New as
i"itant editor (port) SJ/A
Perspective. E. 5S
BOO" RE\ IE\\ S
Adler. DianeC. AACN organization and management
of crihc.1l-c.1re facditic"i (Shoemaker) 430c
Alhane"ie. Jo'\eph A. Nurses drug reference. 440c
AlexdJ1der. Mar} M. Pedlatnc hillitory taking and
physical diagnosi!'t for nurses (Brown) 450c
Axline. Virginia M. Oibs In search of "ielf. 52Ja
Barber. Elsie. The trembling years. SlJa
Barry. Jeanie ed Emergency nursing. 420c
Blackwell. Marian Willard. Care of the mentally
retdrded.41\Oc
Bretz. H. Lee. Donny and didbetes, 5!1a
Brickhill. Paul. Reach forthe sky, 5lJd
Brown. Molly. ed. Reading!'t in gerontology. 52Fe
Bullough. Bonnie ed. Expanding horizons for nurse.;.
(Bulioughl520c
Burrell.Jr.. Zeb L Critical care (Burrell) S2Fe
Butler. Beverly. Light a single candle. 52Ja
Campbell. Claire. Nursing didgnosi"i and intervention in
nu
ing practice. 52Mr
Canadian Council on Children and Youth. Admittance
restricted' the child as a cItizen in Canada. 53D
Canadian Standards Association. Effective sterilization
in hospÎtaJs by the ethylene oxide process. 53D
Canadian Standards Association. Effectivc stenlization
in hospitals by the steam process. S3D
Chaney. Patricia S. ed. Dealing with death and dying.
4'Oc
Chnstopher, Matt. Sink it. Rusl.Y.
2Ja
Clark. Ann L. Childbearing: a nursing perspective
(Alfonso) S20C
Clark. Bellina, Pop-up going to the hospital. HD
C lark. Carolyn Chambers. Assertive skills for nursc
,
5::!Oc
Clarke. Louise. Can't re.1d. can't write. cdn't t.1lk too
good eIther. "'::!Ja
Dahl. Borghdd. Finding my way.
!la
O'Ambrosio. Richard. No language but a cr). 5!1a
De Angells. Catherine. Pediatric primary care. 450c
Olson. Norma. ClinicaJ nursing technique",. 500c
Dizenzo. Patricia. Why me? 'lilJa
Falk. Ann Man. The ambuldnce. J1D
F.mshawe. Elizabeth. Rachel. 53Jd
Fhnt. 8etty M. New hope for deprived children. 51Ap
fnl"i. 8abbl\. k..risty'o;; courage, 53Ja
Fromer. Margot Joan. Communit} health care dnd the
nursing process.
8Oc
Galton. Lawrence The patienf"i guide to "iurgery. 4:!Oc
G.1rdner. Richard. The f.1mily book about minimal brain
dy...function.53Ja
Garfield. James B. Follow my leader. 53Ja
Gn,
um. M.1rlene Womanpower and health care
(Spengler) 5
Oc
Gunther. John. Dea(h he not proud. HJa
Gydal. M,. When Oily went to hospital (Damelsonl 3JD
Haas. Bdrnara Schuyler. The hospital book. HD
Haber. Judith. Comprehens,ive psychiatric nursing let
aU 480c
Haggard. EliZdbeth. Nobody waved goodbye. 53Jd
Halpern. Susan. Rape. helping the victim. 5::!Fe
Hoffman. Therese Lemire. Into aging, a simulation
game (ReiO 5!1e
HolI.:md. Je.1nne M. C .1rdiova"icular nursing:
prevention. intervention o:\ßd rehabilitation. 430c
Hollowa)'. Nancy Meyer. Nursing and the cntlcally III
patient. 430c
Hudak.. Cðro1yn. ed. Critical care nursing (Gailo. Lohn
S2Je
Jessel. Camilla. Paul in hospi(al (Jolly) '3D
"illilea. Mdrie. "aren. 53Ja
k..lein. Normd. What It', aU about. 53J.1
k..nelsl. Carol Ren. Ment.11 heaJth conceph In
medical-surgical nursing: a workbook (Ameo;;)
k..ramer. Mdrlene. Path to biculturalism (Schmalenberg)
540c
Lasker. Joe. He's my bro(her. S3Ja
Lawrence. Mildred. The shining moment. 53Ja
Laycock. S.R. Family living and sex education: a guide
for pdrent"i and youth IC.1ders. 520c
[edch. Penelope. Your bahy & child: from binh to age
Iive.450c
Leininger. Madeleine. Transcultund nursing: concepts.
theories and pr.1ctices. 3:!Mr
Lewio;;. Clara H. Nutrition. 500c
Litchfteld. Ada. A button in her ear. 53Ja
Litchfield. Ada. A cane in her hand. 5JJa
MdcCracken. M.1ry. A circle of children. 53Ja
M.1
...ie. Roben.Journey (Md......iel 53Ja
'11I1er. Michael H. Current per'\pectlves In nUr",mg
SOCid1 issue"i and trends (t-lynnJ 490c
Neufeld. John, Lisa. bright and ddrk. 53Ja
Neufeld. John. Twink. 53Ja
Park. Clara Claiborne. The seige. S3Jd
Plall. "in. Hey dummy. S4Ja
Rey. H .A. C uriousGeorge goc!'t to the hospital (Rey)
JJD
Robinson. J. ed. Givmg c.1rdiova,çul.1rdru
"i \afely.
440c
Robinson. Veronica. David in silence. 34Ja
Samuels. Gertrude. Run Shelley run. 54Ja
Scipien. Gladys M. Comprehensive pediatric nursing
(et al) 440c
Shaw. Charles R. When your child needs help. S4Ja
Silverman. Peter. Who 'ipeak.s for the children: the
plight of the battered child. 450c
Simon. Norma. All kinds of families. 54Ja
Simon. Norma. Wh) am I different. S4Ja
Stein. Sara 80nnett. A hospital story. J3D
Stewart. Mark A. Raising a hyperactive child tOlds)
S4Ja
VaJens. E.G. The other side of the mountain. 54Ja
Vitale. Barbara. ed. A probiem-solving approach to
nursing çare plans (Laue mer. Nugent) S4My
Waite. Helen E. Valiant çompanions. 54J.1
Warner. Carmen Germame ed. Emergency çare.
assessment and intervention. 48N
Weber. Alfons, Elizaheth gels well. HD
Weller. Stella. Easy pregnancy wilh yoga. 54My
Welzenbach. J.F. Wendy Well and Billy Beller say
.. Hello hospitaJ". Visit the hospital see through
machme. Meet the hospital sandm.1n and A"k a
"mdl-yun" hospital questions (Cline) J3D
West. Paul. Words for a deaf daughter. 54Jol
Wisc.1n. Principle
.1nd practice of psychiatriL: nur...lng
(et all490c
Wolde.Lunilld. Thom.1!!. goeo;; to the doctor, 33D
Wolff. LlI'-erne. F-undamentah of nu
mg IWeltzel.
fuer
u
00c
BOOKS
52Ja.
2Fe. 52Mr. SlAp. S4My. S2Je,
2Oc. 4
N. 5'D
BOR"I..\.:'I/IS. Janis
Your gUide to clinical laboratory proçedure\ (Shepherd.
Hynie) 2
S
DOL RQlE. Jean-Gu)
Admini"itrauve M.1nageroftheCNA Testing Servicc.
7J/A
BRADLEY. Christine
HeaJthiest babies pos
ible(Wdmyca. Ros") 18N
BREAST tEEDlNG
Hea1th professlOnd1s le.1rn more dbout late<;jt in mfdnt
nutrition. 12N
BRETT. Kathleen
See MacMillan-8reu. k..athleen
BRIANT. :'I/ora
Bk. rev.. 5
Oc
Bl CH..\. ". Jan.
The deve10pment of .1 genatnc a!!.<ieO;;lIiment mstrument for
long term care f.1cllitie!!!o. 90
-C-
CAD:\I'\"...... FII.n
Evaluation of Alberta nu
mg in!otructor
. A. 47Je
CAI ENDAR
!Ua. 47Fe. 16Ap. 51My. IbJ/A. I
S. 8Oc. 62N. SID
CA:\IERO
. Sheila
O. B. staff dlert. JON
CAMOLINOS. Francine
The much of love. 3U/A
L..\. 'ADA. ATMOSPHERIC E'\ IRON "IE"T SER\ ICE
Did you know.... 46Je
CA'.\DA. HT:'I/ESS AND A"IAITLR
I'ORT IIRA'CH
Measuring up. 8Je
CANADIAN n:s rRE tUROCCLPATlO,..\L HE.\LTH
A:o.DS4.FE:T\
Occupational heaJth centre holds inaugural meeting.
14Ap
<..A'ADI4.' COl,",CILON HOSPITAL
o\CCREDlT.\ TlO:'l/
Did you kno,," __the Hedhh Care Centre. 9Mr
CA:'I/ADI..\N HOSPITAL L"t'E:CTlO" CO'TROL
ASSOCIATlO:'ll
Infeçtion control practitioners. people in the m
ddle.
14D
CA'ADI.\" I'óSTITl'TEOFCHILD HE.\LTH
Guest ednonal. E (Cochrane) 3Ja
C..\'ADlA' I'liSTITl TEOt'CHILDHEALTH
COAUTlO,," t'OR THE: PRE\ E"TlON UF
HANDICAP
N urscs honor children. HM r
CANADIAN ISTRA\E/liOlS "lRSESASSOClATION
I.V. nurseS meet. IWa
CANADlA' "l'RSE
.. ormer C N F editor educator dies In f1onda. 7N
CANADIA' NL RSES ASSOCIA TIO"
A cataJogue of special interest groups (fltzPoltrick\ 9Je
A meo;;sage from the president (Taylor) IOMy
Claire Me k..eogh is the librarian-Archivist at CNA.
7JIA
CNA - whal's it all about? (Prime) bJ/A
Communication
specialists from the eleven CNA
provincia1/territonaJ as
oci.1tion members met in
CNA House (POrt) 6Mr
Cover photo - CNA House. JJ/A
Directory ofCNA assoclaUOn members. life
f-inancial statements and auditors' report. 49Mr
Have you looked at your association lately? (Prime) E.
SJ/A
Gi
èle Loney has been appointed Liaison Officer. 7J/A
Louise Levesque is Director orCNA projects. 7J/A
Pat W.1llace IS Project Director. de
elopment of nursing
practice st.1ndard
. 7J/A
Prop<>sed amendments to CNA bylaw.. liFe
Submits briefto feder.d commr
sion. CMr
The C8n-.ll.n Nur..
D8c:ember 19711 57
(.A".\D1o\" 'IIl"R'\E:S .\SSOCIATlO'. .\'''l.\L
"tEt:TI'G
IMy
Highlights from the
port of the cxccutive director
f\.lussallem)] ]10.1)
National a
sociation holds annual meeting. 12My
CA....ADlA... 'lR!>t:SASSOCIATlOIlo. AIloIlol'AL
MEt:T1'11G. 1979
RNABC submits election resolution. 8Mr
CAIIo.\D1A:\ IIol RSES ASSOCI.\ no". .\RCHJ\.ES
Nursmg past and present. I Mr
CA'O\D1O\.... 'l K
t.S '''!>UCIATlO:\. COS'\"E:'TIO'
1988
Vancouver. here we cornel :!:!D
C A'ADIA" l\iLRSES ASSOCIA TIO
. LlBRAIU
See Library update
CA"ADlA.... NlRSESASSOCIATlOIlo. TAS" GROl PON
"lRSI'G PRACTICESTA"DARDS .
(portl HOe
CAIloADlA.... Nl
"ES .\"SOCIATIO.... ITSTI"l.
SER\ICE
CNA Testing Senice (Prime. Parrott) 44M)
Examination fees to increase in 1980. ION
Jean-Guy Bourque is Administrative Manager. 7J/A
Newly appointed members orCNA's Testing Service
Nursing Assistants 81ueprint Committee met for the
first time. 8Mr
C A'ADlA' "'l"R!>ES FOL "DATlO!\o
CNF receIVes II.ellogg grant. 14Ap
New CNF board of directors. &Ja
CA'ADlA.... ...lRSES FOL'IIDATIO....-SCHOLARSHIPS
Thlneen nurses recei\'e awards \lalued al mOre than
no.ooo. 120e
CA"'o\DL'\.." ORTHOPEDIC IIoLRSES ASSOCIATIO"
Orthopedic nurses set three-day atlendance record.
12Ap
CA'ADlA" SOCIETY OFDlI\LYSIS P"-RFl!>lO"I!>TS
. End stage renal disease: 1979 and beyond. 8N
CANADlA' l"SIVERSlT\ "'lRSI"G STLDE....TS
ASSOCIATlo"
See CUNSA
CA"CER
Canng for the child with cancer. the nurse practitioner
(Price) 48D
Lifestyle crisis (O'Neil) 12Fe
CAPE BRETO" ISLAJIoD-"'II'11I'11G D1SI\STER. 1979
Emergency (Miller) 4bMy
CAPLI'II. Alice
Bk. rev.. 480e
CARDIOLOGY '79
Currents in cardiology attract record crowd. SSJ/A
CARDIO\ ASCLLAR DI!>EASE:S
WPW syndrome: a case study (Manning/ J4D
CARROLL. Po_I.
Bk. rev.. S2Je
CATHOLIC HEALTH ASSOCIATIOr-; OF CANADA
Rev. Everett MacNeil. executive director. 49Fe
CA "E. Sleole
What a liUIe care can do. 381)
CEREBRO'\ ASCVLAR DISORDERS
Frank's story (Halliian. HunU 2bMr
CERTIflCA T10'l
Occupational health nurses establish certification
program.61a
CHALMERS. KBren
CNF schola",hip. 120e
CHEMOTHERAPY
The IV nurse and the chemotherapy patient: a \'ita) role
in emotionaJ support (MacMillan-Brell) 28Je
CHJLD
Helping preschool chddren learn to be safe (Eifert) 2ID
CmLD. EXCEYTIONAL
A chance to grow wmgs for the spirit. IJe
CHJLD ABUSE:
CNJ talks to Lois Dale. PHN (port) 39Ja
Be it resol\'ed...The role of the nursing association in
the prevention of child abuse (MacLean) 40Ja
Finding and helping victims of chdd abuse (Sklar) I Ua
A team approach to child abu
e (I-nzpatnck) 36Ja
A work
hop on child &tbuse. fJa
CHILD BLHA \ lOR
An exploratory study of the beha\'iors of children in
pain (Macintosh) A, 47Je
CHILD CARl"
The National IndIan Brotherhood. ISAp
Nurses honor chlldren. 8Mr
CHILD HEALTH
Did you know...a study conducled by.... 9Mr
CHILD HEALTH tEDlTORIAL!
The impossible dream' (Besharah) E. bAp
CHILDRE""S HOSPITAL DIAGNOSTIC CElio TRE:.
"ANCOl \"E:R
Early diagnosIs in congemtal heanng loss (OahU 17Ja
CHILDRES'S HO"t'ITAL OF E.\".EK'I O,"T ARlO
Audiology programs: another \'Iewpomt (Smith.
Tataryn. Simser) 2IJa
A team approach to child abuse (Fitzpatnck) J6Ja
CHOI-LI\O. Ag.... T.H.
Bridging the gap between education and service
(Logan) 34Mr
CLAR!\.. Kathio \.I.
New education co-ordinator for the RNAO (port) 50Ap
CLO\\. Caroline
A regIOnal program for the management of hereditary
metabolic disease (Reade) 24N
COCHRA'E. W.A.
Guest editorial. E. JJa
COLLEGE OF NLRSES OF ONTARIO
Ontario nUrse
oppose possible internship program for
studenh.6Mr
CO...I...IISSIO!\o 0' INQLlR\ I'IoTO REDL"\DA"CIES
0\1100 LAY-OtT'S IN CA'o\DA'S LABOR FORCE
CNA submits brief to federal commIS
IOn. 12Mr
CO"'I'\IL 'ICABLE: DISEASt:S
The problem of immunizalion in Canada (LeFon) Z6Ja
CO!\l
1l "ICATION
Did you know.... 7Ja
CO
!\Il NITY HEALTH
l RSI'IG
The nUi30e m the commumty: mfant stimulation
(Banmngl36N
CO:\lGRE:SSliS
Communications specialists from (he eleven l.. NA
pro\lincial/territoriaJ association members melln
CNA House (port) 6Mr
Critical care '78. 8Ja
Did you know.... 7Ja
Health happenings. I5Ap
I.V. nurses meet. IOJa
Measuring up, 8Je
NationaJ association holds annual meeting. 12My
Newly appointed members cfCNA's Testing Service
Nursing Assistants Bluepnnt Comnuuee met for the
first time. 8Mr
Occupational health centre holds inaugural meeting.
14Ap
Onhopedic nurses set three-day attendance record.
12Ap
Spotlight on continuing education. &Je
Time is nOw. nurses decide for selling up doctoral
program.6Ja
U ni\'c:rsity of Moncton to host annual CUNSA
congress. &Ja
A ,,"orkshop on child abuse. 6Ja
CO,,"SL '\fER SATISFACTION
Patient's ad \locate - a new role for the nurse? (Sklar)
J9Je
CONTRACEYTION
Perspective (Wheatley) E. 4N
CORRE:. Gioòle
Officer. SOAp
COTto Jacqueline
Serving Sister. 50Ap
CRAGG. Catherine E.
Cross infection: a new approach to an old problem.
40Fe
CRAIG. Dorothy Marlant
The de\'elopment of a nursing audit tool. S70C
CRAIG. J.:nnifu
SI for you and me (PdgeJ ]bl-e
CRAIG. J
nnifer L"nn
The effect of a self-mstructlon<tl module On the level of
questlon
pos-cd by nur
mg m
tructors dunng
post-chnical conference.... 570c
CRA
HORU. M}J1leE.
Bk. rev.. S20e
LRA
HORD. R_mary
A pre
choolers. health cirçus. l4Ja
CROCMR.I:lUMbeth
Bk. rev.. HU
Cl 'l/NINGHAM. Rosell.
Child abuse program: Scarborough Department of
HeaJth.9U
CL:\ISA
U ni\'ersity of MoncIOn to host annUcll CUNSA
congress. HJa
CY!>,IC FIBROSIS
One bred(h at a time (
ms) 205
-D-
DAHL. Marilyn o.
Early diajnosis in congenital heanng 10
!Þ. I7Ja
o 0\LE:. Lnls
CNJ tdlb to LOIs Dale. PHN (port) J9Ja
DA" EY. Keitha
Bk. rev.. S41Jc
DA \ IES. Borbara L}nn
f.:\ctor.t in\lolved in a mother's decl
lon to
eek
antenata) genetic coun
ehng and have dn
amniocentesIs at an advanced materna) age. 5bOc
1)4. \- .....
. folonÐCr Lornlln
Officer. SOAp
UA\\SO!\o,Joao
Spedking out. a national child hedlth policy' 240
DEATH
Sharing the experience (Willetb-Schroeder) J90c
DEBOI:.R, tiw
Sir. I know. 43My
DELI\"E:RY OF HEALTH CARE
Llfes(yle cnsls (O'Neil) 22Fe
Perspective (Besharah) E. 3t-e
StaJT,ngas.ignment (Be.wethenck) ItiMy
DEN'ISO:\l. Ruth E.
Assistant administrator. Holy Cross Hospital in
Calgary. 491-<
DIABETES INSIPIDlS
Coping with diabetes in
lpidu!o (Moens) 18Ap
D1AGSOSIS. LABORI\TORY
Your guide to climcallaboratory procedures (Bormanis,
Shepherd. Hyme) 25S
DIALYSIS
End stage renal dISease: 1979 and beyond. tiN
DOBBS, CyntIùa
Bk" rev.. 420e
DOHERTY. Gillian
The patient in pain: handling the guilt feelings. 31Fe
DO!>,RO"SKY. J.
Understanding the phYSIology ofpdÌnlHedlinl2til-e
DULCET, SfelJo Burton
The young adult's reported perceptions of the effects of
coDgenitaJ heaII disease on his life style. S70e
DO\\N'S SYNDROME
Diagnosis: down's syndrome (Nixon) 33N
DRUG ABI.:SE
Closeup on physicians at risk. ION
DRUG OVERDOSE
Emergency trealment of drug overdose (Erb) 30My
DKLl\lHELLER MEDIl...1 SECURllY INSTITUTION.
HEALTH CAIU:. CENTRE
Did you know ...the Health Care Centre. 9Mr
DURNFORD. Pbylil
Bk. rev..44Oc
DRYSDALE:, A.....n
Received theJudy Hill Memorial SCholarship. 491-e
58 December 1979
The cenedlen Nur..
-E-
EAGLE. D. Joan
Bk_ rev.. 480c
ECO"OMICS-Nl RSING
Nurses from 64 countries attend ICN meeting in Africa.
120
EDl CATION GRADl ATE
MARN appTOvcs emergency nUT'\ing course. IWa
Time IS now. nur'\e'\ decide forseumg up docwrdl
prog.-am. fJa
EULC\rIO'. ...-LRSI"G
The effect of a self-instrucrional module on the level of
questions posed by nursing instructors during
posl-ciinicaJ conference... (Craig) 570c
RNABC sets up nursing education and re...earch
socle,y. I 'Ap
Bridging the gdp between education dnd service
(Choi-Lao. Logan) HMr
EDlCATIO'l/. Nl"RSI'G. BACCALAlREATE
A follow-up study of graduates from the four year B Sc_
program in nursing. University of Alberta (Field)
570c
Frankly speaking: nur'\ing and the degree mystique. Pt_1
(Hurd) 36Ap
Frankly speaking: nursing dnd the degree mystique.
P!.II (Hurd) 36My
EDl.C.-\TIO'li. NLRSI"G. CONTI"'lING
An assessment of selected continui.ng educdtlon
experiences for professional growth and
competence of nurses (MacI ntosh)
7Oc
Nurses want mOre education programs and paid leave
10 allend. 14Ap
Spotlight on continuing education, &Je
EDI!l:ATION. ". RSI'G. DIPLO"lA PROGRA'\IS
Frank)y speaking: nurCiilng and the degree my")tlque. Pt.1
(Hurd) 36Ap
Frankly "ipeaking: nursing and the degree mystique.
Pt.1I (Hurd) 36M)
EDlCATIO'l/. Nl.RSI..G. GRADlATE-NO'\A SCOTIA
Post graduate maternity nursing program: meeting the
need in the Atlantic region (Steele) 240C
EDlCATIO..... "lRSI'G.STA
DARDS
E"aluation of Alberta nurCiiing mstructors (Cadman) A.
47Je
EDUCATlO:>;AL ME!.SURE'\IÐ,T
CNA Te"ing Service (prime. Parrol\} 44M)
ELFERT. Helen
Bk. rev_. 450c
Helping preschool children learn to be safe. ::!6D
EMERGENUES
Emergency (Miller)
6My
Emergency treatment of drug overdose (Erb) 30My
EMERGE"CY Nl RSING
MARN approves emergency nu.....ing cour<iie. IOJd
F"IPATHY
The I V nurse and the chemotherdpy pdtient: a vit.d role
in emotional support (MacMillan-Brett) ::!RJe
E"IPLO\ 'l.IE"T CO"DITIO,,"S
CNA submits brief to federal commission. I ::!Mr
ERB. Hea'her L.
Emergency treatment of drug overdose. JOMy
ETHICS. Nl.RSI...G
Project Ethics: a code forCanddidn nup.es (Rodchl E.
6My
ETHICS. NL RSI'liG (EDITORIAL!
Sinners or saints? (Besharah) E. 4Je
EXAMI'l/ATIONS
Newly appointed membe
of CNA's Testing Service
NursingA
istants Blueprint Committee met for the
first time. 8Mr
E'\:PLOSIO'liS
Emergency (MIller) 46My
-F-
FELLOWSHIPS
See T rammg I\Upport
See Awards and prize
i'EMORAL NEOPLASMS
Nursing grand rounds: femoral allograft (Alemany.
Ferguson. Grice. Stuart) l20c
n:,\\ ICK. Diana
Recel\ed the Judy Hill Memona1 Schola.....hip. 49Fe
FERGl.SO,,". Faye
Learnmgabout the hospital at home (Park. Ward) 44Jd
FERGl'SON. Patrick
Nursmggmnd rounds: femoral allograft (Alemdny.
Gnce. StUdrt) J::!Oc
FERf;l SO". Roy G.
Childhood dsthmd: an outpatient approach 10 treatment
(Webb) 36Fe
FETAL ALCOHOL S\ "iDRO"1E:
Closeup on fetal alcohol syndrome (Bock) 35N
t IELD. Peggy Anne
CNt scholarship. 120c
CountdownonO.B. nurses.18Oc
^ follow-up study of graduate
from the four year B.Sc.
program in nursmg, University of Alberta. 570c
t1"NEGAN. Marlaine
Bk_ rev_.44Oc
f1T7P.\TRIC". bnda
A catdlogue of special intere't groups. 9Je
A team approach to child abuCiie. JfJa
tOL 'IIDA TlONS
A cata10gue of specid1 interest grQups (Fitzpatrick) 9Je
FRENC H. Susan
("Nt scholarship. 120c
t-RY. Jean E.
8k_ rev..
::!Mr
HTl-ROLOG\
Nursing: nineteen-eighty-floor (Nlghtingown) 17Mr
-G-
GASEK. George
Spoiling and helping the learning disabled child
(Jacobson) IIUe
GENETIC COl.NSELLI'l/G
A regional program for the management of hereditary
metabolic disease (Reade, Clow) 24N
Factors involved in a mother's decIsion to seek
antenatal genetic counseling and have an
amniocentesis at an advanced materna) age (Davies)
560c
GE:o.ETlCS
Early diagnosis in congenital hearing loss (Dahl) 17Ja
GEORGE. Theresa
Bk. rev_. S2Mr
GERIATRIC '1/1 RS....L
Caseload: over seventy-five (Gibbon) 20Mr
GIBBo:lo. Mary
Caseload: over seventy-five. 20Mr
GIBSO... Patricia Lynn
Serving Si'ter.
OAp
GILCHRIST, Joan
Named Flora Madeline Sh
,w Professor ofNurCiimg, 4
N
GOLDE...-BERG. DoD)
Bk. rev.. SOOC
GOODCHILD, Audrey May
Serving SICiiter. 50Ap
GREAT BRITAIN. NATIONAL HEALTH SER\ ICE
Not dll patients need hospitdl
(Aish) ::!3Mr
GREES 9 Florence Grace
Attitudes of registered nUr'\es towards consumer rights
and nursing independence, 560c
GRICE. Jean
Nursing grand rounds: femoral allograft (Alemany.
Fergu
on, Stuart) J20c
GRIFFIN, Amy E:.
The lonehne.. of the elderly. 23My
GROSSMAN. Mary
Here a
d there: a look at nursing in France, JOOc
The LeBoyer Method: what does it mean now? 2HOc
GROVE. Jean E.
The unexpected case of tetanus. 26J/A
-H-
HALLIGAN. Frank
Frank's story (Hunt) 26Mr
H \!liDlL-\PPED
Closeup on coa1ition for the prevention of handicap
IBe.harah) 29N
Handicap: a parent's perspective (RdnkinJ 38N
HARRIS, Jand
When babies cry. 32Fe
HARRIS. Patricia M.
Serving Sister,
OAp
H-\RT. Geraldine Angela
SPinal cord injury: carly impact on the patient's
significdnt others. 570c
HARTLE\'. Bonnie
Hypertensive disorders in pregnancy. 4"2J/A
HASLA:\I. Pam
Hypertension: antihypertensives and how they work. 26Ap
HEALTH
A four-member international nursini[ team.
e
HEARIN(;
Audiology programs: another viewpoint (Smith.
Tataryn. Simser) 2IJa
Early diagnosis in congenital hearing loss (Dahl) 17Ja
HEART DEFECTS, CONGENITAL
The young adult.s reported perceptions of the effects of
congenital heart di<iiease on his life style (Doucet)
S70C
HEBERT, Pat
Bk_ rev_. 490c
HEDUII;. Anne
The immune system. 27J/A
Unde"'tanding the physiology of pain (Dostrovsky)
28Fe
HEGADOREN. Kathy
"Problem children" aren't problems anymore. 3IJa
HENRI"Su
. Carole Lee
See Thomson, Carole Lee
HERE'S HO\\
IOAp. S7JIA. 8S, 8D
HOD:>;ETT, EDen
CNF scholarship, 120c
HOLDER. Elizabeth
Bk. rev.. 500c
HOSPITAL EMERGENCY SER VICE
The ro)e of the family in the emergency department
(Nicklin) 40Ap
HOl RIGAN. Eileen
CNF schola",hip. 120c
HOI'SE. R...alind
A trip to the islandCii. 4::!Mr
HO\T, Bonn)
Executive director of N BARN, 49Fe
Hl.MBER COLLEGE. TORO"TO
Critical care '78. tUa
Hl NT. Lori Whillingtoo
Frank's
tory (Hdlligan) ::!6Mr
HI RD. Jeanne Maric L.
Frankly Ciipeakmg: nursmg dnd the degree mYCiitique.
PLI. 36Ap
Frankly Ciipeaking: nursing and the degree mystlque_
1'1.11. 36My
H\ NIE. Ivo
Your guide to clinical laboratory procedures (Bormanis.
Shepherd) 25S
H\ PERTENSION
Hypenensive disorders in pregndncy (Hanley) 4!J/A
The effects of selected factors on the older adult's
managment of treatment for hypertension (Biene)
5SOC
Hypertension: pediatric hypertension - think about it
(LeFonl32Ap
Hypertension: questions and answers (McCulley) 24Ap
HYPERTENSIO'll-DRl'G THERAPY
H ypertenslon: antihypertenslve
and how they work.
(Haslam) 26Ap
HYPERTENSION-'l/lIRSI'IIG
Hypertension: management m induCiitry - an expanded
role for nurses (Milne. Logan) 21Ap
-
The cen-.llen Nurse
a
December 11171 511
-1-
-"1-
IW\1l 'E TOLERANCE
The immune system (Hedlin) 27J/A
l"I"Il'IT\:
The Immune s\ stem (Hedlin) '!7JI A
l"I'Il'IZ'\T10'
Did you know...a study conducted by.... 9Mr
National advisory committee on Immunization:
recommended immunization schedules for infants
and children. 29Ja
The problem of immunization in Canada (LeFon) ::!6Ja
l'D1o\'S "-"0 ES"I"IOS
ursing north of sixty (Roberts. Ross) 26My
l'U.o\"T
The National Indian Brotherhood. 15Ap
When baNes cry (Hams) 3::!Fe
I'Fo\"T. NE\\BOR"
Healthiesl babIes posSIble (Warnyca. Ross. Bradley) 181'1
I'Fo\:>.T'l-TRlTlO'
HeaJth professionals learn more about latest In mfant
nutrition. I::!N
I"F.\"TSTI"RLATlO' PR(){;RA'\I
The nurse in the community: infant Stlmulahon
(Banning) 361'1
I'FECTIO:>. CO'TROL
Infection control practitioners. people in the middle.
14D
INPl-T
Ja. 4Fe. 4Mr. 7Ap. 8My. 6Je. 56J/A. 9S. 6Oc. 61'1. 6D
I:>'TE
Sl\E CARE
Critical care 078. SJa
I"TESSI\E CARE l:>'ITS
Nutritional assessment of the ICU patient (\1acDougall)
39M)
I'TER"ATlO'AL CO" FERE "CE 0' PRI\L.\R\ CARE
The impossible dream? (Besharah) E. 6Ap
I' TER'A TIOSAL COl
CIL OF:IIl RSES
IC,," supports primary heallh care. 7Ja
Nurses from 64 countries attend ICN meeting in Africa.
lID
Nurses honorchddren. 8Mr
I"TER'ATlO'AL 'l RSES DA \
Nurses honor children. 8Mr
l'IER.....ATlO'AL \:"Eo\R OFTHE CmLD. CA' o\D1A:>'
COM"IISSIO'
The National Indian Brothert100d. 15Ap
I'TER'ATIO'AL \:EAR OF THE CHILD. 1979
CNJ's salute. Ua
A chance to grow wings for the spirit. lJe
Commentary (Besharah. Post) E. 10
Nurses honor children. 8Mr
Guest eØitorial. E (Cochrane, 3Ja
.....TER'SHJP. "O'\fEDICAL
Ontario nurses oppose possible internship program for
students.6Mr
-J-
JACK. !>usanna
It's a bird.lt's a plane, It's supernurse! 34J/A
JAC"SO:>.. Cheryl
CNF schola",hip. HOc
JAC08S0
. Mddrod C.
Spoiling and helping Ihe learning disabled child (Gasek)
l8Je
JOWolSON, F.ye
Neonatal jaundice and phototherapy (Tufts) 450
JO'llES. PbyUis
Appointed dean of the Faculty of Nursing. Uruverslty
of Toronto. 45N
-K-
MLLOGG rol "DATIO:>'. BATILE CREEl\..
MICHIGA....
CNF receives Kellogg grant. 14Ap
Health services division receives Kellogg grant. 8N
KELSEY INSTITL 7E
Did you know.... 7Ja
KID'IIE:\:' DISEASES
End stage renal disease: 1979 and beyond. 8N
"I'll ASH, Rose G.
Experiences and nursmg needç, of spinal cord-lI'uured
patients.
7Oc
KL\:'E. Sandra
That's right.I'ma nune. 35J/A
""'0'\. Janet "enny
Recipient of the S 1.000 Helen Gibson Memorial
Schola",hip.49Fe
"0\\ .o\LCHl..... Bolly
Frankly speaking: a challenge in office nursing, 485
-L-
LABOR.\TOR\ TESTS
\' our guide to clinical laboratory procedures (Ðormani
Shepherd. Hynie) 25S
LA"G. Ga.1
Bk. rev.. 5:!Fe
LA 'GFORD. o\.J.
A very present danger (PosU 42Ja
LASGLOIS. '\farcolle
CNF scholarship. 120c
L.\SOR, lIot5y
Time out! J60c
LE.\DERSHIP
Nurses need leadership skills (Spennra(h. Tlive.) J3Je
LEADERSHJP DE:\ELOP"IE:"T \\ORKSHOPS
Nurses need leade",hip skdls (Spennrath. Tiivel) BJe
LEAR'I...G DISORDERS
Spoiling and helpIng the learning disabled child
(Jacobson.Gasek) l8Je
THE LEBO\:ER '\IETHOD
What does it mean now? (Grossman) :!8Oc
LEEC H. Joan
CNF scholarship. 120c
LEFORT. Sandra
Hypertension: pediatric hypertension - think about it.
32Ap
The problem of immunization in Canada. 26Ja
LEGISLA TIO:>'
Error of jUdgment: is it always negligence? (Sklar) 14Mr
Finding and helping victims of child abuse (SkJar) IUa
On trial'/SkJar) 8Fe
Patient's advocate - a new role for the nurse? (Sklar)
39Je
The coffee-break: pmenua] pitfall for nurses (Sklar)
ISMy
Where does the nurse's responsibility begin and end in
caring for a patient's belongings' (Sklar) 14S
LEGISLATION. MEDICAL
Nurses speak out on legal issues in heaJth. S4J/A
LEGlSLATIO,".!'ol RSJ'IIG
Sinners or saints? (Besharah) E. 4Je
LE VESQl E. Loubo
CNA's Task G roup On Nursing Practice Standards
(port) !JOc
Director of CNA projects, 7J/A
L1BRAR\ lPDo\TE
S4Ja. S2Fe. S2Mr. S2Ap. SSMy. S3Je. S7J/A. SOS. S8OC.
L1'DABlRY. VlrgI.... A.
Former CNJ editor. educator dies in Florida. 7N
WGAN. Alexander
Hypertension. management in industry - an expanded
role for nu",es /Milne) 21Ap
LOGA'. '\far,Dg S.
Bridging the gap between education and service
(Choi-Lao) 34Mr
LO' EY . Gistio
Has been appointed CNA Liaison Officer. 7J/A
LO'llG TERM CARE
Improved care urged by RNABC. 8Mr
WWE. Agatb. Gor1rude
Jomed Project HOPE medica} education program In
Natal. Braz
. SOAp
WYER, Mario d.. A_
Officer. SOAp
"IACCLISH. Barb.ra
Visions. J5Fe
"lacDONALD. Joyce
Closeup on Nova Scotla's reproductive Care program.
270c
I
'I O\COO' 'ELL, Susan
A teenage pregnancy epidemic? 22N
"IACDOlGALL. \"erio
Nutritional assessment of the ICU patient. 39My
MACI'TOSH. Allee R...
An assessment of selected continuing education
experiences for professional growth and
competence of nurses.
7Oc
"I %CI' TOSH. Judith
An exploratory studv of the behavIors of children in
pain. A. 47Je
\f.\CLE'\'.Je_
Be it resolved...The role of the nursing association in
the prevention of child abuse. 40Ja
"IACLEOD. Shlrioy
New CNF board of directors. 8Ja
"IAC\fILLAN-BRETT. Kethl..n
The IV nurse and the chemotherapy pahent: a vital role
in emotional support. 28Je
Mac'JEIL. Re"", E"rrett
Executive director of the Catholic Health Association
of Canada. 49Fe
"I'\LCOLM.IIM
Bk. rev.. 490c
\fALPRACTICE
The coffee-break: potential pitfall for nu",es (Sklar)
I5My
Error of jUdgment: is it aJways negligence
(Sklar) 14Mr
Nursmg negligence in the administration of
medication... Could it happen to you? (Sklar) S U/A
On mal! (SkJar) 8Fe
Sinners or saints? (Besharah) E. 4Je
MA "TOBA ASSOCIA T10'll OF REGISTERED IIIl RSES
\1ARN approves emergency nursing course. IWa
Kathleen Scherer joined office, 49Fe
\fA "ITOBA ASSOCIA TIO'll OF REGISTERED '11I:RSES.
.'\":>'J:AL '\IEETI'iG
Newsbeat: the provincial scene. IIJ/A
\IA"I'G. Coloon
WPW syndrome: a case study J4D
MA"SOlR. Penni
Bk. rev.. SOOC
MATHESON.
tM
y
Commander Sister.
OAp
\fCBRIDE. Bo.....ley Høinl5
Babies with necrotizing enterocolitis: what to watch
for. 410
"IcCL LLE\: . '\fary
H ypenension: questions and answers. 24Ap
"IcDO"ALD. \ida
Commander Sister.
OAp
McEACHER". M.rgaret Mary
Serving Sister. SOAp
McKEOGH. Clair.
Librarian-Archivist at CNA. 7J/A
McKEE\ER. PBtriela
Bk. rev _. 450c
\fcKENZIE. Ruth H.
Analysis of the use of a computer generated staffing
schedule On a nursing unit in a general hospital. S
OC
Mc"lASTER l"NIVERSITY . FACULTY OF HEALTH
SCIENCES
Occupational heallh program launched. 7Mr
MeTA VISH. Maureen
The nurse practitioner: an idea whose time has come.
41S
MEDICAL RESEARCH COI"NCiL
U of A host visIting professor. &Ja
.
60 D8c:ember 1979
The cenedlen Nur..
"IEDIC o\TIO' ERRORS
NUI"I)mg negligence in the ddmml
trdtlon of
medlcdlJon... Could it happen to YOu') (Sklar) 31J/A
"IENTAL RET ARDA TlO;';
o B. stalT alert IC dmeron\ 30N
Our c;,pecial children (Peer) 14Ja
METABOLIC DlSEo\SES
4.. regional program for the management of hereditðry
metabolic di'iicase (Reade. Clow) 24N
METRICS\:STE
SI for you and me (Craig. Page) 16Fe
MIDWIFER\
Nur'ie Midv.-ifery: are we ml,..inlE the boat? (Powi",
210c
"IIGRA"F
Did you kno\\ _..4fJe
MILLER. Dorolh
(;ra)
Emergency. 46My
MIL "E. Barbara
Hyperten'lon: mandßcment in mdu'itry - an expanded
role for nUr'iiC\ (Log.in) 21 Ap
MOE:-OS. Jannelte
Coping with diabetcc;, in'iiipidus. 18Ap
MOII.\" " COLLEGE OF APPI lED ARTS A"D
TECHNOLOG\:
A nurse practitioner in a community college setting
(Nelle'i,25Fe
O()RE. Janel
Bk rev..
:!Oc
MOl :>OTSINAI HOSPITAL. TORO:>OTO
An experiment in innovative "raffing (Stuart) 4
S
Sinners or saints? (Bc'iihdrah) E. 4Je
inner.t or -;aints? The legal pCripective Pt I (Skl.u) 14N
Sinners or saint'? The legd1 per"ipective. Pt.11 'Sklar) 16D
\-U'LLEN. Elaine \-..
Bk rev. "'!Ie
Ml.L TIPLE SCLEROSIS
Health happening'. ISAp
Ml'SSAI LE"I. Helen K.
Highllght!!l from the report of the executive director.
liMy
New CNF bOdrd of direclOr,. KJd
Nur,e, "'dnt more educdtlon programs and pdld ledve
to dllend. 14Ap
-N-
SAMES
49f-e. 50Ap. 45N
NATIONAL AD\lSORY CO"nIITTEE ON
1\1
1'''I.fATlON
Recommended Immunization "ichcdule, for mfdnt, dnd
children. 29Ja
"ATlO'.\L CONt..'Rt:SCE Ot OPFR.\TlN(; ROOM
'lRSES
Cover photo. JS
NATIONAL CON FERESCE0" HE.\LTH A'D LAW.
OTTA"A.1979
NUhe
:"IIpedk out on legal i
,ue
in health. 54J/A
'ATlO'l,AL INDIAN BROTHERHOOD
Among SO group.. to receive fund'ì.. I
Ap
'EGLlGÐ.CE
Hands that care: are they .are' (Skldr) IOOc
NEI LES. Diana
A nur!te practitioner in a community col1ege setting,
:!5Fe
NEVITT. Jovce
Has wnllen a history oflhe nu
mg profe
"\lon in
Newfoundland.45N
'olE" BRl 'l/SWIC" ASSOCIA TIO," OF REGI!>TERED
NliRSES
Appointment of Bonny Hoyt. executive director and
Jacqueline Steward. nursing consultant. 49tc
Jacqueline Steward. appointed nursing consultant for
nursing practice (pon) 50Ap
NEW BRL'l/SWICK ASSOCIATION OF REGISTFRED
"l RSE!>. ASNL 0\1. MEFTISG
New"\heat: the provlncldl "icene. 14J/A
NEWS
6Ja, liFe. IIMr. 12Ap. &Ie. 9J/A. 120e. 7N. lID
'IIIC"L1". "end
McKnight
The role of the f""mily in the emerlEency depanmenl.
40Ap
'IIICHOL. Celia
ThaCs no nur"ie...that'.. my mother! 4
Mr
:-OIGHTlNGO" N. Lawrence
Nursing: nineteen-eighty-floor. I1Mr
"IXO'l/. Linda l,
Diagnosis: down's ..yndrome, J1N
:-OORTHt'R'II Sl.RSING
Nursing nonh of ..i,ty (Robens. Ro
s) 26My
"ORTH" EST TERRITORIES
Nursing nonh of Slxt y (Rohens. RO"isl
6M)
M RSE CLINICIAN TEACHERS
Nurse"i need leadership ..kills (Spennrath. Tiivel JJJe
Nl RSE-PATIENT RELATIONS
Life"ityle crisl' (O'Neil) 22Fe
O,B, "alTalert(Camerom30N
Per
pective (Be..harah) E. 3Fe
The IV nurse and the chemotherapy patient: a vital role
in emotiona1 suppon (MacMillan-Brett) :!8.Ie
The patient in pain: handling the guilt feelings (Doheny)
JIFe
"l RSE-PA TlENT REI A TlONSHIPS
Per'pecti"e (Bock) E.
S
!l.lRSE PRo\CTITlO'ER
A nu
e practitioner in a commumty college setting
(Nelles) 2SFe
The nurse practitioner: an idea who...e time has come
(McTavish) 41S
Nl RSF PRACTlTlO'llERS ASSOCIATION OF 0' T,\,RIO
NPAO Executive. 140c " I Lt.
M.RSI"G
Closeup on nur.tmg nelwurks. IJJ/A
Nu..ing fact and fantasy (Allan) 37J/A
That's nght.I'm a nu",e ("Iyne) 35J/A
Nl RSI"G Al DIT
The development of nur
ing audit tool (Craig) 570c
A meS"iage from the pre
ident (faylor) 10M}
Sl RSING /EDITORIAL,
Perspective (Beshdrah) E. -'Fe
Nl RSI'G-IIRI fiSH COLlMBIA
Nurses review health needs of B.C. Corrections
inmates. 140e
'Ill RSI'IIG-CANADA-STANDARDS
CNA's T ð.skGroupon Nur!ting Practice Standards
(port) HOe
I'ollRSING CARE
Bndgmg the gap between education dnd Itervlce
(Choi-Lao. Logan) 34Mr
It's a bird. if's a plane. if'''i supemurse! (Jack) 34J/A
Perspective (Bock) E. 5S
Sinners O( saints? The legal perspective Pt.l (Sklar) 14N
Sinners or saints? The leg
perspective Pt.11 (Sklar)
16D
The touch oflove (Cdmolinosl JlllA
That's right ('m a nu,-"e (KlyneI3SJ/A
"lRSI"G CARE-
THODS
Staffing assignment (Beswetherick) 18My
Nl.RSING CARE-STANDARDS
Frankly speaking: nursing and the degree mystique. Pt.l
(Hurd) '6Ap
I-rankly
peaking: nur"iing dnd the degree my...tlque.
Pt.ll (Hurd) 'liMy
fhe coffee-hreak: potential pitfall for nur"ies (Sklar)
ISMy
A me..sage from the president (faylor) IOMy
Project Ethics: a code for Canadian nurses (Roach) E,
6My
NURSING EDCCA TIO
See education
Nl'RSI!IoG-FRA"CE
Here and there: a look at nur
mg in France (Gro,sman)
'00c
Nl RSI"'G ST AFF. HOSPITAL
AnalysIs of the U!!le of a computer generated "itafTing
schedule on a nursmg unit in a general hO"ipit.tI
(McKenzie) sSOe
An experiment in innovative staffing (Stuan) 45S
Sinners or saints? The legal pe
pective Pt.1 ,Skldr) I..N
Sinnersorsaints?ThelegaJ perspective PI.II (Sklar)
160
Nl'TRITlOI'o
l-aclOr
Influencing the con"itructlon ofa nutrition
knowled.ge te
t for the elderly IThur..ton) 570c
Nutntion and the chrome "ichlzophrenic (Pyke) 40N
Nutrition counseling. 15Ap
Nutritional a<\<õõessment of the ICU patient tMdcDouga:!1)
39My
-0-
OBSTETRICAl Nl RS"G
Clo..eup on Nova Scotla's reproductive care program
(
acDondld) !JOe
CountdownonO.B nur...e, (tleld) 180c
The LeBoyer Method: whatdoe"\ It mean now
(Grossman) 280e
Perspective (Stainton) E, 50e
Post graduate maternity nur"iing program: meeting the
need in the Atlantic region (Steele) 240e
OBSTETRICS
CIO'
eup on coalition for the prevenllon of hdndicap
( Beshdrah)29N
Healthiest babies pO"i..ible (Warnyca. Ro...s. Bradley)
18N
That's no nursc.__thaC4\ my mother! (Nichol>>4S:\-1r
OCCl'PATIOSAL HEALTH
OccupoilionaJ health centre hold"i inaugural meeting,
14Ap
Occupational health program Idunched. 7Mr
OCClPATIOi'io\L HEALTH Sl RSIN(;
Hypenen"iion: management In Indu
try - an expdnded
role for nU['ô.e
(Milne. Logan) 21Ap
Occupational health nurses attend alcoholism
conference. 140
Occupational heð.lth nurses establish certification
program,6Ja
Oft ICE "l RSI'G
frdnkly speakmg: a challenge 10 office nU
lng
IKowalchukl48S
OLSIA". Mar
.rel T.
Bk. rev.. 5lOe
O'NEIL. Theresa
Lire'\ty1e criM!oo. 22Fe
ONTARIO BLUE CRU""
Nutrition counseling. 15Ap
O"T.\RIO. \UNISTR\"Ot.COLLEGE4."D
l M\-ERSITIES
Ontario nur"ies oppose possible intem..hip program ror
students.6Mr
O'l/TARIO NLRSING HOME ASSOCIA TlOS
Nursing home nurose"i work to improve care. I
D
OOLl p. Pilvi
Bk. rev.. 440e
ORDER Ot' CA,"ADA
Edith May Radley. SOAp
ORDER OF ST. JOH,\;
A number of nurses were honored. 50Ap
ORTHoPEDICS
Onhopedic nUr"ie!!l set three-ddY attendance record.
12Ap
OUTPOST Nl RSI:>OG
A trip to the islands (Hou!ooe) 42Mr
-P-
PAGE. Gordon C,
SI for you and me (Craig\ Illfe
PAIN
An exploratory study of the behaviors of children in
pain (Macl ntosh) A. 47Je
^ holistic approach to nursing the patient in pain
(Vaterlaus) 22Je
The patient in pain: handling the guilt feelings (Doheny)
31F-e
Understandmg the physiology of pain (Hedhn.
Dostrov
ky) 28Fe
PARK. Lillian
Learning about the ho
pitaJ at home (Ferguson. Wdrd)
44Jd
The cenedlen Nuree
3
D8c:ember 1979 61
P/\.RRUTT. Eric G
CN -\ festms Service (Pnmc) 44\1\
P.-\S.h.. EJiaDor Grace
A study of the effects of clinical inve
tlgatlons
conducted in the homes of children with mtt,arohc
disorde",. 550c
PATlE'T .\D\OCAC\:
Atutude
of registered nurses towards consumer nght
and nursing independence (Green)
6Oc
P3uent"s advocate - a new role for the nurse'> (Sklar)
19Je
PATlE'TS
Pallent's advocate - a nev. role tor the nurse
(Sklar)
19Je
Where does the nurse's respon\ibility begm and end in
caring for a patient".. belongìngs
(Sklar) 14S
PATlE'TCARE: PLA!I;'I"G
Nursing care plans: a vital tool (Silvcnhorn) 36Mr
PA TIE' TS-EDl C A TlO'
Currents in cardiology attract record crowd. 3SJ/A
PEDIATRIC 'l RSI"G
The nurse in the community: infdnt ..tlmulallon
(Bannmg) 36N
PEDIATRICS
A preschoolers" health circus (Crawford) l4Jd
A study of the effects of clinical invclliugations
conducted in the homes of children with metabolic
disorder.. CPask/ 550c
A team approach to child abuse (Fitzpatrick} '6Ja
A very present danger (Post. Langford} 41Ja
Babies with necrotIZing enterocolitl
: what to watch for
(McBride, 410
Caring for the child with cancer: the nu
e practitioner
(Price)
RO
Childhood asthma: an outpatient dpproach to treatment
(Ferguson. Webb) 36Fe
Early diagnosis in congenital hearing loss (Dahl) 17Jd
Guest editonal. E (Cochrane) 3Ja
Hypertension: pediatric hyperten\ion - think about it
tLeFort} 32Ap
Learning about the hospital at home (Ferguson, Park.
Ward) 44Ja
Our special children (Peer) 14Ja
Neondtal Jaundice and phototherapy (Johnson. Tufts)
450
Preparation oftoddler.. and preschool children for
ho
pilal procedures (Ritchie. J()[)
"Problem children" aren't problems anymore
(Hegadoren) 31la
Spotting and helping .he learning disabled child
(Jacobson.Gasek) l8Je
What a liule care can do (Cave' 380
WPW syndrome: a ca
e study (Manning) '40
PEER.Brigld
Old you know___3 study conducted by.... 9Mr
Our special children. J4Ja
PERSO'i'EL ST AF"FI!I;G A '0 SCHEDlLL'iG
Old you know... Labour Relations Council. 15Ap
Staffïng assignment fBeswetherick) 18M)'
PERSPECTI\ "E:
3Ja. 3Fe. 3Mr. Mp. 6My. 4Je. 5JIA. 5S. 5Oc.
N. 50
PH\:SICIANS
Closeup on physicians at nsk. ION
PINELLI. Janet May
A companson of mother's concerns regarding the
care-taking tasks of newborns with congemtal hedrt
disease before and after assuming their care. 9D
PI'\S. SCHOOL
Key to cover photo. 3Mr
POETRY
Sir. I know (DeBoer) 43M)
Visions (MacCuish) 35Fe
POST. Shirley
A very present danger (Langford) 42Ja
Commentary fBesharah. E, 10
POWIS. Julianne
N urse-Midwd'ery: are we missing the boat? 21 Ck
PREGNA."CY
That's no nurse...that's my mother! (Nichol) 45\1r
PREGN-\NC\: I" -\J)()I.E:SCE"CE
The '\ingle mother: can we help'l CBillung-Meyer. :!fiN
A teendge pregnancy epujemlc? (MacDonnell) 1:!N
PREG"A"('\: TO"E'II-\S
H
per1ensl\.e disorde" m pregnanc) (Hdnle}'1 41J/"
PRE\ENTI\"E: HE-\LTH SER\ tC"'s
Nutrition coun
eling. 15Ap
PRICE. Barbara J.
Caring for the child with cancer: the nurse practitioner,
80
PRIMAR\: HEALTH CARE
ICN supports primary health care. 7Ja
PRI\IE. Bert
CNA Testing Service (Parron} 44
1y
CNA - ",hat's it all about? WIA
Have you looked at your a....ocidtiOn lately? E, 5J/A
PRISO"S-BRITISH COLl'IBIA
Nurse.. review health needs of B.C. Corrections
inmates. 14Ck
PRI\ ILEGEDCOM'\1l "ICATlO'l,
Patient's advocate - a new role for the nurse? (Sklar)
39Je
PROJECT HOPE
IE:D1C -\1 EDl CA TlO' PROGRAM
AgathaGenrude Lowe.jomed the project m Ndtal.
Braz
. 50.-\p
PS\:CHI..\TRIC "lRSI"G
Behaviour.. of patienh de'icnbed by nurses in
medical-
urgical area.... in the initiation of psychiatric
referrals ([homson) A. 47Je
"Problem children" aren't problems anymore
(Hegadoren) 11la
Time out! (LaSon 360c
Pl BUC HF-\LTH:IIl RSI'I,.
A trip to the Is'ands{Hou<iieJ 42Mr
CNJ talk> to Loi.Odle. PHN (port) WJa
Speaking out: a national child hedlth pohcy ! (Dd\\ \on)
140
Not all patient.. need ho\pltals (Aish) 23Mr
PLBUC RELATlO1l;S
Communications specialists from the elevenCNA
provincial/territoridJ as..ociation member.. met in
CNA House (port) />Mr
P\ KE. Jennifer
Nutrition and the chrome schizophrenic, 40N
-Q-
Ql AUT\: OF HEALTH CARE
Frankly speaking: nursing and the degree mystique. Pt.1
(Hurd) 36Ap
Frankly speaking: nursing and the degree mystique.
I'Ll! (Hurd) 36My
-R-
RADLE\:. Edith '\Ia)
The Order of Canada. 50Ap
RAIN" ILLE. Joyce
CNF scholarship. 120c
RANKIN. H..th.r
Handicap: a parent's perspective. 38N
RAl\I....I". Lorna
Bk. rev.. 43lJc
READE. Terry
A regional program for the management of hereditary
metabolic disease (Clow) 14N
REAUTY SHOCK
Whither nu",ing? 3 iliA
REFERRAL ANDCONSI LTATION
Behaviours of patients de..cribed by nur
e
in
medical-surgical areas In the initiation of psychldtnc
referrals IThom\onl A. 47Je
REGISTERED :IIl'RSES ASSOCIATION OF BRITISH
COLlMBIA
Improved care urged by RNABC. 8Mr
RNABC submits election resolution. 8Mr
Sets up nursing education and research society. HAp
REGISTERED NlR!>"E:S ASSOCIATION OF BRITISH
COLUMBIA. ANNUAL MEETING
New
beat: the provincial scene. 9J/A
REGIS'CERED 'il RSES ASSOCIA TlO:o. OF BRITISH
COil MRI-\. I.ABOl R RELA TlO:-'S cm NCIL
Did \IOU know... Labour Relation.. Council. 15Ap
REGIS.I ERED Sl RSJo.S ASSOCIA TIO" OF SO" A
SCOTI/\.
Be it resolved...The role of the nur\mg a
SOcldtlon an
the prevention of child ahu'\e C MacLean) 40Ja
REGISTERED 'l RSES -\sson"no" O..O"T-\RIO
I\...uhle M. Clark. education co-ordinator (pon) 50Ap
Ontano nurse.. oppo..e pos...ihle Internship program for
studentCii.6Mr
REGISTERED Nl RSF!> ASSOnA TIO' OF 0' T .\RIO.
\NNl. AI
IEETI"'L
Ne
"..beat: the provincial '\Cene. 11J/A
.
RH;J!>....ERED "l R!>ES "SSOCIA TION OF "0\ A
SCOTIA. A':IIl AI 'IEFTI"L
New
beat: the pro\.inclaI..cene. I-1J/A
RFGISTERED:IIl RSES rol 'D.\ TIO' OF B.C.
RN .t\BC ,et!i. up nur'\mg education and research
soclety.ISAp
REHABIUT A nON
J-rdnk's !!.tory (HalligcUl, Hunt) 16Mr
REICHE. Linda
CN. schola",hip. 120c
RE!>EARCH
7Je. 55Oc. 90
A compdrison of mother's concerns regarding the
care-tdking tasks of newborns with congenital heart
di
ease before and after a..
uming their care C Pinelli}
90
Andlysis of the use of a computer generated staffmg
schedule on d nuro;;ing unit in d general hospital
IMc....enzie) 5
Ck
An a.....e"'..ment of ..elected continUing education
experience.. for profesc;.ional growth dnd
competence of nurses (Mdcinto
h) 57Ck
Attitudes of registered nur\es towards consumer rights
and nursing independence (Green) 560c
Behaviou
of patients described by nur'\es in
medical-surgical area.. in the initiation of p'!oychiatric
referrals (fhomson) A. 47Je
Child abuse progmm: Scarborough Depar1ment of
Hedlth (Cunningham) 90
fhe development of a geriatnc a..
e"'mem m..trument
for long term Cdre facilities (Buchan) 90
The development of a nursing audit tool (Craig) 4i7Oc
Old you know.... 46Je
The effect of a ..elf-instructional module on the level of
questions posed by nursing in\tructors during
post-clinical conferences (Craig) 570c
The effect
of selected factors on the older adult"s
management of treatment for hypertension (Biene)
550c
E"dJudlion of Alberta nur\lßg instructor.. (Cadmdn) .t\,
47Je
Expenence
and nur..mg needs of ..pinal cord-lrUured
patienls (Kinash.
7Ck
An exploratory study of the behaviors of children in
pain (Macintosh) A. 47Je
Factors influencing the construction of a nutntlon
knowledge test for the tlderly ([hurston) 570c
Factors involved in a mother'.. decision to seek
antenatal genetic coun..eling and have an
ammocente..is at an advanced maternal age (Davie
J
560c
.t\ follow-up study of gradudte
from the four year RSc.
program in nursing. Univer\lty of Alberta (Field)
570c
RN .t\BC sets up nur..ing educdtion and research
society. HAp
Spinal-cord irUury: early impact on the patient's
significant others (Hart) 57Ck
A
tudy of the effects of clinical investigations
conducted in the homes of children with metaÞolic
disorJe", (pask) S50C
The young adult's reported perceptions of the effects of
congenital heart disease on his life style (Doucet)
570c
RIDEOI T. Ehzabeth
Bk. rev.. 420c
RITCHIE. Judith A_
Preparation of toddlers and preschool children for
hospital procedures. 3(1)
ROACH. Slmo...
Project Ethics: a code for Canadian nur'\es. E. 6My
.
82 Oecember 1979
The Canadien Nurse
New CNF board of directors. 8Ja
ROBERTS, Lence W.
Nursing north of sixty (Ross) 26M)
ROK, Adam
Bk. rev.. 480e
ROLE
Patienfs advocate - a new role for the nurse? (Sklar)
39Je
ROSS. Colin A.
N ur"ng north of "Xly ,Roberts) 26My
ROSS, Susan
Healthie" babies possible (Warnyca. Bradley) 18N
ROSSITER. Edna
14th Canadian nurse to receive the Florence
Nightingale A ward from the I ntemauonal Red
Cro".4SN
ROWAT, Kathleen
C N F schola", hi p. 120e
ROY AL. Joøn
Bk. TeV.. 430e
ROYAL VICTORIA HOSPITAL. '\IONTREAL
Nurses need leade",hip skills (Spennrath. Tiivel) HJe
RY AN. Jessica
Bk. rev.. S30
Frankly speaking: apathy in nu",ing. 3IJe
-S-
ST JOIL" AMBVLANCE
Did youknow...St.JohnAmbulance.ISAp
SA MS. Cheryl Ann
One breath at a time. 2 OS
SASKATCHEWAN I:IISTITUfEOF ARTS AND
SCIENCES
Did you know.... 1Ja
SASKA TCHEW AN REGISTERED Nl'R
E:S
ASSOCIATION. ANNUAL MEETING
Newsbeat: the provincial scene. IOJ/A
SA V ARD. Françoise
Officer. SOAp
SCHERER. Kathleen
Jomed office of the Manitoba Association of Registered
N u",es. 49Fe
SCHILLL"G. Karin voo
Bk. rev.. SlAp
Bk. rev.. S3D
scmZOPHRENIA
Nutrition and the chronic schizophrenic (Pyke) 40N
SCRlTBY. Lynn
Winner of the Helen McAnhur Canadian Red Cross
FellowshIp for graduate study.12Oe
SEARLE, Catherine
Tetanus: the costly CUre. 181/A
!;EX EDUCATION
Pe"'pective (Wheatley) E. 4N
SHEPHERD, Frances A.
Y OUf guide to chmcallaboratory procedures CBonnanis.
Hyme) 2SS
SHIFT SYSTEMS
An experiment in innovative staffing (Stuan) 4SS
SILVERTHORN. Alida
Nursingcare plans: a vital tool, 36Mr
SI'\ION FRASER HEALTH UNIT
A preschoole",' health circus (Crawford) 14Ja
SIM!;ER. Jndy
Audiology programs: another viewpoint (Smith,
Tataryn) 2IJa
SKLAR. Corinne
Error of judgment: is it always negligcnce? 14Mr
Finding and helping victims of child abuse. llJa
Hands that care: are they safe? lOOc
Nursing negligence in the admlmstration of
medication... Could it happen to you' SIl/A
On trial! 8Fe
Patient's advocate - a new role for the nurse? 39Je
Sinners orsaints?The legal perspective Pt.I. 14N
Sinnersorsaints?ThelegaJ perspective. Pt.II.IID
The coffee-break: potemial pitfall for nurses. I5My
Where does the nurse's responsibility begin and end in
caring fora patient's belongings? 14S
r.
N
SMIl H, Andrie DurleuJI:
Audiology programs: another viewpoint (fataryn,
Simser) 2IJa
SMOKI"G
Clo"eup on a generation of non-smokers? 12N
SNIDER. Eleanor M.
Serving Sister. SOAp
SOCIAL ISOLATION
The loneliness of the elderly (Griffin) 23 My
SOCIETIES. Nl'RSING
A catalogue of special interest groups lFitzpatnck) 9Je
SPAIN. Doris
Bk. rev.. SOOC
SPECIALTIES. Nl'RSING
A catalogue of special interest groups (Fitzpatnck) 9Je
SPENNRATH. Susan
Nurses need leade",hip skills ([iivell 33Je
SPINAl CORD INJl
RIES
Experience" and nursing needs of spinal cord-ir\iured
patients (Kmashl 570c
Spmal cord ir\iury: early impact on the patient."
significant othe", (Hart) S10e
STAINTON, M. Colleen
Pe"'pective. E. 50e
STEELE. Rosie
Post graduate maternity nursing program: meeting the
need in the Atlantic region, 240c
STE" ARD. Jacqueline
Appoi.nted nursi.ng consultant for nursing practice of
N BARN (port) SOAp
N u",ing consultant of NBARN. 49Fe
STEWART-HES!;EL, Elizabeth
Bk. rev., 4SOe
Bk. rev.. S20e
STRESS
Hypertension: management in Industry - an expanded
role for nurses (Milne. Logan) 21Ap
Hypertension: questions and answers (McCulley) 24Ap
STUART. AlllsonJ.
An experiment in innovative staffing. 4,SS
Nursing grand rounds: femoral allograft (Alemany.
Ferguson. Grice) 320e
Sl'ICIDE. A TTE1\IPfED
Emergency treatment of drug overdose IErb) 30My
SUTHERLAND. Debbie
Bk. rev.. 48N
-T-
TASK GROUP ON "Il RSING PRACTICE STANDARDS
Canadian Nurses Association (port) 13Ck
TATARYN.Karen
Audiology programs: another viewpoint (Smith.
Simser) 2IJa
TAYLOR, Helen D.
A message from the president. IOMy
TECINOLOGY, MEDICAL
Your guide to clinical laboratory procedures (Bormanis,
Shepherd. Hynie) 2SS
TELLIER-CORMIER, Jeanine
Serving Sister. SOAp
TETANUS
Tetanus: the costly cure (Searle) 181/A
The unexpected Case of tetanus (Grove) 26J/A
THE WORKSHOP. BEACON HILL. MONTREAL
U of A hosts visiting professor, 8Ja
THOMPSON. M.
Bk. rev., S4My
THOMSON. Carole Lee
Behaviours of patients described by nurses in
medical-surgical areas in the initiation of psychiatric
referrals. A. 41Je
THVRSTON. Norma E:.
Factors influencing the construction of a nutrition
knowledge test for the elderly, S10e
TIIVEL. Judy
Nu",es need leadership .kills (Spennrathl HJe
TOO. Louise
TRAINING SUPPORT
WHO to award health fellowships. 1Mr
TRANSPLANT A T10N. ALLOGENIC
Nursing grand rounds: femoral allograft (Alemany.
Fergu..on, Grice. Stuart) 32Ck
TUFTS. Frances
Neonatal jaundice and phototherapy (Johnson) 450
-U-
l'NITED NATIONS
Guest editorial. E (Cochrane) 3Ja
L"11\ ERSITY OF ALBERTA
Health services division receives Kellogg grant. 8N
U of A hosts visiting professor. BJa
UNIVERSITY OF MONCTON
University of Moncton to host annual CUNSA
congress. 8Ja
lNIVERSITY OF WESTERN ONTARIO
Did you know...astudy conducted by.... 9Mr
-V-
\ANCOITVER PERINATAL HEALTH PROJECT
Healthiest babies possible (Wamyca. Ross. Bradley)
18N
VA TERLAUS. Emalou
A holistic approach to nursing the patient in pain. 22Je
\ICTORIAN ORDER OF NUR!;ES FOR CANADA
Caseload: over seventy-five (Gibbon) 20Mr
Closeup on the Victorian Order ofNu
es for Canada.
S4J/A
\ IRVS DI!;EA!;ES
Health happenings. HAp
-W-
WALLACE, Pat
CNA's Task Group on Nursing Practice Standards
(port) HOe
Project Director. development of nursing practice
standards.1J/A
WARD. Vera
Learnmgabout the hospital at home (ferguson. Park)
44Ja
W ARNYCA. Jennifer
Healthies babies possible (Ross. Bradley) 18N
WATSON. Ina
Bk. rev.. 440e
WEBB. Anne
Childhood asthma: an outpatient approach to treatment
(Ferguson) 36Fe
WHEATLEY. Shirley
Perspective. E. 4N
WHITE. Leslie J.
Bk. rev.. S4My
WILLETTS-SCHROEDER. Valerie
Sharing the experience. 390c
WINKLER, Joy
CNF sChola",hip. 120e
W.K. KELLOGG FOUNDATION
Time is now, nurses decide for setting up doctoral
program.6Ja
WOMEN
Women as health care consumers. a change and a
challenge. 130
WORKSHOPS
See Congresses
WORLD HEALTH ORGANIZATION
A four-member international nursing team. 8Je
The impossible dream? (Besharah) E. 6Ap
To award health fellowships. 1MT
-X\::Z-
YOL AND THE LAW
I IJa. 8Fe. 14Mr. I5My. 39Je. SIJ/A. 14S. lOOc, 14N
160
ZANIN. Margaret
Bk. rev.. 430c
. Helping the retarded child in
hospital
. A team approach to child abuse
. Dealing with the problem of
immunization
. Learning about the hospital at
home
. Congenital hearing loss
. Preventing childhood accidents
. A new role for the psychiatric nurse
The
Can ian \
Nune r
3
.
JANUARY
1979
...
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JT' 3
The -,
Canacliðn
\ _ t:
.,,-'-'
-
lose
e
The official journal of the Canadian
Nurses Association published
in French and English
editions eleven times per year.
Volume 75, Number I
..
\to
I,
Guest Editorial 3 You and the law Corinne Sklar 11 md
Input 5 A preschoolers' health circus Rosemary Crawford 14
News 6 Early diagnosis in congenital
hearing loss Marilyn O. Dahl 17 ;1
Calendar 50 Audiology programs: Andrée Durieux. Karen Tataryn, an
another viewpoint Judy Simser 21 I
Books 52 The problem of immunization
in Canada Sandra LeFort 26 .H
"Problem children"
"ren't problems anymore Kathy H egadoren 31
Library Update 54 Our special children Brigid Peer 34
A team approach to child abuse Lvnda Fitzpatrick 36
CNJ talks to Lois Dale, PHN Lynda Fitzpatrick 39
Be it resolved.n Jean MacLean 40
A very present danger Shirley Posr,AJ. Langford 42
.
Learning about the hospital Fave Ferguson. Lillian Park,
at home Vera Ward 44
'R
:--. The Canadian Nurse welcomes Indexed in International Nursing
. suggestions for articles or unsolicited Index. Cumulative Index to Nursing
manuscripts. Authors may submit Literature. Abstracts of Hospital
, finished articles or a summary of the Management Studies. Hospital
. J ... proposed content. Manuscripts Literature Index, Hospital Abstracts,
"" should be typed double-spaced. Send Index Medicus. The Canadian Nurse :e,
F- ...
' original and camon. All articles must is available in microform from Xerox
I
be submitted for the exclusive use of University Microfilms, Ann Amor,
The Canadian Nurse. A biographical Michigan. 48106.
statement and return address should
'\ accompany all manuscripts. Subscription Rates: Canada: one
'" 4 year, $10.00: two years, $18.00.
Foreign: one year. $12.00; two nof
The views expressed in the articles years. $22.00. Single copies: $1.50
This month's cover is a are those of the authors and do not each. Make cheques or money
necessarily represent the policies of orders payable to the Canadian
celebration in two ways. First the Canadian Nurses Association. Nurses Association. red
of all. it introduces an issue
that is CNJ's salute to the ISSN 0008-4581 Change of Address: Notice should be
International Year of the given in advance. Include previous
of
Child. Secondly. it is our way Canadian Nurses Association. address as well as new. along with
ofweIcoming you to 1979 with 50 The Driveway. Ottawa, Canada, registration number. in a
a new cover design in color. K2P IE2. provincial/territorial nurses
Photo courtesy of Studio association where applicable. Not
Impact in Ottawa, and the "responsible for journals lost in mail
smiling children of Les Petits due to errors in address.
Bouts de Choux Day Care Postage paid in cash at third class rate
Centre in Ottawa, Ontario. Toronto. Ontario. Permit No. 10539. - ,
Canadian Nurses Association. 1978.
..
yesterday. . . today. . . tomorrow
Add1son-Wesley is new to nursing publiShing, but its long-standing tradition of pu lishing
excellence in other professions is recogniZed internationalJy. DiStJ..DguiShed as a publiShe lJ
mathematics and physical/life science textbooks, Addison-Wesley has over twenty Nobel IL,ureates
as authors. In 1976 Addison-Wesley formed its Med1caJ/Nurs1.ng Dtv1s1on. The new nursiDg
program is committed to bringing to nursing the Addison-Wesley tradition of publiShing e
cellence.
The liStS of new and forthcoming publications (see below) reflect AddiSon-Wesley's concern
With meeting the needs for expanded nursing education in a profession that is rapidly grotnng and
changing. As yesterday's pioneers in the health care profession, nurses initiated better h th
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professional areas. 'IbmoITow holds even greater promiSe for the nursmg profession.
AddiSon-Wesley's nursing program is dedicated to publiShmg the books that will help tad s
educators and tomoITow's nurses fulfill that promISe.
oeUJ pub\\ca\\oos
AddiBon-Weøley'B
llurøiDg ....Awnhurt ion B.eview
by SaUy L. l8gerqUlst
464 pp. 12.95
Meðica1 Term1DoJ.ogy:
A Text/Workbook
by Alice Prendergast
279 pp. 9.60
*Politics of PaID. MA'ft
ewnent:
by Shtzuko Fagerhaugh and
Anselm Strauss 323 pp. 8.95
B.eview Mathematics
for Ilurøeø 8D4 Health
Profeøs iftftA1R :
A Text-Workbook on Solutions
&Ild Dosage Ca.lcula.tlons
by Lucllle M. Parks 291 pp. 8.25
AgiDg 8D4 Health:
Biologic &Ild Soc1a.l Perspecttves
by Cary S. Kart" Eileen S. Metress
and James F. Metress
339 pp. 13.96
*People in Crisis:
Understanding &Ild Helping
by Lee Arm Hoff 336 pp. 9.60
A Survey of Human Diseases
by David T. Purtllo 453 pp. 16.95
'.rraDøactioDal ADalysis
in Health Care
by Jean Elder 176 pp. 8.95
Shock Syndrome:
Mecha.n18ms &Ild Ma.n1festa.tlons
by Martha Thompson
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The cen-.llen Nur..
..
Jenuery 11711 3
perspective
. .
Guest Editorial emotional problems in the Immunization: There is an opportune time for all those
preschool child to see that evidence that despite the interested in children to
The United Nations has there are many problems yet availability of safe and initiate or expand their
identified 1979 as "The Year to be solved. effective vaccines. interest and in turn meet the
of the Child". In Canada the In 1977. the Canadian immunization coverage is not special needs of Canada's
government has established a Institute of Child Health was adequate. Children still eight million young citizens.
Canadiag Commission - 1979 founded to act as an advocate develop serious complications The Canadian Institute of
International Year of the on behalf of children. It and handicaps from infectious Child Health looks forward to
Child whose many functions functions as an action group to diseases such as measles, a cooperative relationship
will include promoting public improve the health and rubella. mumps, with the nursing profession,
awareness and encouraging welfare and the quality of life poliomyelitis. diphtheria and and all other professional
ideas from and the of Canadian children. from tetanus. In November. the groups who maintain a
participation of children in the conception to eighteen years Institute took part in commitment to the health and
year's activities and of age. Immunization Action Month well being of Canadian
celebrations. It would seem For the coming year. the and has just published a children.
appropriate that all In
titute has decided to focus National Immunization -W.A. Cochrane, M.D.,
organizations and professional its efforts on five priority Survey with a number of F.R.C.P. (C) Chairman,
groups in Canada examine the areas: recommendations. Board of Directors, Canadian
contribution they might make Accident prevention: Nearly Institute of Child Health.
for improvement in the Prevention of handicap: Of the 4.000 children and youth
general well-being of 330.000 babies born in Canada under 19 years of age suffered EDITOR
Canadian children. each year. about :!5.000 will accident or death from ANNE (HANNA) BESHARAH
In 1973 a conference on be low birth weight and as accidents in 1974. Among
the "Unmet Needs of many as 33.000 will be at risk other measures. the Institute ASSISTANT EDITORS
Canadian Children" was held of handicap. It is estimated is promoting the use of car LYNDA FITZPATRICK
by the Canadian Pediatric that at least half ofthese seats. fire detectors and life SANDRA LEFORT
Society assisted by Ross handicaps could be prevented jackets by asking the federal PRODUCTION ASSIST ANT
Laboratories of Montreal. or the risk substantially government to remove sales GITA FELDMAN
Representatives of various reduced with improved tax on these items.
health caring professions. prenatal and perinatal care. CIRCULATION MANAGER
teachers and government That is why the Institute Care of children in hospital: PIERRETIE HOTfE
officials reviewed many published a report in August Because many hospitalized
outstanding problems existing 1978 entitled. Prnention of children are still being ADVERTISING MANAGER
in the Canadian childhood Handicap:A Case for deprived of care that GERRY KAVANAUGH
population. Topics that were Improved Prenatal and considers their special needs, CNA EXECUTIVE DIRECTOR
discussed included caring for Perinatal Care that described the Institute will be HELEN K. MUSSALLEM
the well child. problems of the problems and suggested establishing a Resource
adolescents and migrant ways to prevent handicap. Centre with books and films to EDITORIAL ADVISORS
youth. special needs oflndian Recently, a coalition of be available on loan. In 1979 MATHILDE BAZINET,
!lnd Eskimo children. health related associations the Institute will sponsor, chairman, Health Sciences
problems of the handicapped. (includingCMA. CNA, along with nursing groups in Department, Canadore College,
the inner city child. CPHA and seven other Ontario and B.C., two North Bay, Ontario.
psychosocial problems of groups) was formed to workshops to humanize care DOROTHY MILLER,public
children and the organization recognize and support the for children and their families. relarions officer. Registered
of child health services. concept of prevention of Child health in the next Nurses Association of Nova
Scotia.
Reviewing the conference handicap. The two-year decade: There is a great need JERRY MILLER. director of
recommendations. it is coalition hopes to promote to examine the changing communication services,
evident that while some public. professional and practices in child health and to Registered Nurses Association of
changes have come about in government education. plan for the future. Currently, British Columbia.
the 5-year interval. the needs develop a standard prenatal the Institute is seeking funds JEAN PASSMORE.ediror.
of Canadian children are not record. complete a number of for a two-year study of SRNA news bulletin. Registered
yet being met in a number of papers on related subjects Canada's nine children's Nurses Association of
areas. We have only to look at such as rubella. RH negative hospitals and six major Saskatchewan.
the dramatic increase in sensitization and screening of pediatric teaching centers. PETER SMITH. director of
publications. National Gallery of
adolescent suicides. teenage newborns. Through mutual It is evident that there is Canada.
pregnancies. venereal disease. cooperation. the coalition ml)ch to be done in focusing FLORITA
the need for improved hopes to affect priorities. attention on the care and VIALLE-SOUBRANNE,
maternal-infant care and the policies and allocation 9f problems of Canadian consultant, professional
need for earlier screening for resources for maternal and children. The International inspection division. Order of
physical, mental and newborn health services. Year of the Child would seem Nurses of Quebec.
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The c.nlKllen Nu...
J,,"uery 11171 II
input
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.
Speaking out make a diagnosis of urinary So, in reply to one of the still angry and upset with the
I wish to express a very infection. articles... nurse. They don't want her
emphatic "Bravo" regarding I find myself angry at the "See the nurse...she has solution. Do they know..the
your October 1978 issue on implied criticism ofthe given up her middle class life nurse drinks the same water?
the multidimensional views on northern nurse. Sure. she's with all its benefits to come The nurse is going home
Native Health Delivery!! retreated behind the doors of and live on an Indian reserve discouraged. Families resent
After reading it I felt the station, probably appaHed to try and help the people. See her interfering with their way
challenged,saddened, and frustrated by the enormity the people resent the nurse of life. Her fight to improve
surprised and hopeful. I of her responsibilities and the because she is: child care and public health _
certainly appreciated apparent hopelessness of the (I) white facilities goes unnoticed. No
presentation of both the native task. She went up there, (2) has running water one knows how hard it is to
and non-native viewpoints; probably as a fairly new (3) lives in the nice clinic keep dentists and doctors
insight was gained as to the graduate. to practice building. coming back.
struggle of both parties. NURSING, which she had The nurse sees the poverty the But the nurse's day is not
The perception that I been taught. Indians live in and realizes yet done. She is on
gained was that freedom of Now she finds herself that if they helped themselves 24-hour-call; it is her job to
speech was not censored to a expected to make a dent in a more things would improve. care for toothaches. runny
great extent and I felt good spectrum of social and See the Indian. He is noses and sore throats
about that. Thanks, again! economic problems sitting doing nothing. There is whether it is 3 p.m. or 3 a.m.
-Cindy Bard)', R.N., symptomized by V.D., garbage in his yard. plastic The nurse is not entitled to a
Calgary, Alberta. alcoholism, dental disease, over his windows, a roof that day offbecause she really
malnutrition. despair, which leaks. and water that needs doesn't work hard hauling
Calling all miracle the most elaborate health care hauling. He can't work water or chopping wood.
workers system in large cities has not because he isn't getting paid Non-Indians have indeed
Many thanks for the been able to stem, let alone for it. Welfare, UIC, and infiltrated the northern
interesting and control. family allowance aren't communities bringing with
thought-provoking October Let's face it, Mr. Wenzel, enough to keep his house, his them both good and bad
issue. After reading it. I found we don't need nurses in the car and two skidoos in a state habits. If the natives want the
myself depressed and North; we need miracle of good repair. "white" value system. then
reflecting on the existential workers - a charismatic. Now the nurse is off to they will have to assume
irony of the nursing situation. empathic blend of the Wizard visit these homes. On the way "white" values.lfthey want
In a large urban teaching ofOz, Wonder Woman and she passes a drunk I ndian but to remain "Indian" and have
hospital. surrounded by every Albert Schweitzer! does she stop to chat?No. their own culture, then they
conceivable electronic and How long are nurses why not? If she does she may will have to divorce
human support system, my going to be expected to clean be subjected to physical themselves from the white
graduate nurse students up all the ills of society and/or verbal abuse. culture and quit making
cannot give prescribed single-handed, or continue to See the house the nurse demands on the whites to
medications unless I. the do somebody else'sjob? visits. It has three rooms and support them with free
instructor, am at their elbow. Anyway, thanks for a two families living there. Why medical care, trappers
They must plead for the thought-provoking issue. are they living together? subsidies, schooling, food.
privilege of doing needed -Jean Jenny. R.N.. School of Because they are waiting for etc.
patient teaching or for Nursing, UnÙ'ersity of the government to build them There is room in the
substituting Aspirin for Ottm,,'a, Ottawa. new houses. Why should they Canadian society for many
Oemerol, when the former IS build their own houses if the cultures. I do not foresee great
required. See the nurse government will build them changes for these people but,
Meanwhile. a thousand I am one of the many for free? in decades to come. the
miles away, surrounded by northern nurses working and See the nurse explain that "powers that be" may realize
needy natives and empty living on an Indian reserve. even though there are so many that the old system of
tundra, a lay community This is the second reserve I people they can still be clean if integrating has failed and a
worker is performing medicai have worked on and my they work at it. While she is realistic look at both sides
procedures. and dishing out feelings about these people eXplaining it grandpa hacks up may result in an improved
Ampicillin on the strength of have changed considerably a gob of blood-tinged sputum Indian-white relationship.
having watched an occasional with the experiences I have and spits it on the floor. -Valerie Walker, R.N., Black
visiting nurse or doctor. An been involved in. See the people complain La/..e, Sas/...
urban nurse may expect a I was extremely upset by to the nurse that they are sick
reprimand for initiating a urine some of the articles in the from the water. The nurse has
specimen for C & S. while the October Canadian Nurse and explained time and time again
northern nurse is examining their negative bias regarding about boiling water and water
urine under a microscope to the community health nurse. purification tablets. They are
I J.nuery 11171
The Cen-.ll... NUrH
news
-
Time is now, nurses decide for
setting up doctoral program
If
High priority should be given
to the development of a Ph.D
(N ursing) program in Canada.
nursing leaders from all parts
of Canada decided at a
seminar in Ottawa recently.
Also at the meeting were
national and provincial
officials and leaders from
health care and education
disciplines. It was the first
time the topic of doctoral
preparation for Canadian
nurses was examined
systematicaIly at the national
level.
"The con
ensus of the
meeting and certainly an
almost unanimous feeling of
all nurses present. was that
development of one or more
programs for doctoral
preparation for nurses within
Canada is an immediate and
urgent need," said Dr. Shirley
M. Stinson, project director of
the seminar and
president-elect of the
Canadian Nurses Association.
"At present no university
in Canada offers the doctoral
degree in nursing. Canadians
who wish to pursue higher
education either take their
studies in an allied field and
adapt their learning to nursing
needs or else leave Canada for
study abroad. usuaIly in the
United States. "
I n Canada. the need for
nurses with doctoral
preparation is immediate and
growing. Dr. Stinson said.
These highly prepared nurses
are needed to develop and
carry out research. as well as
for work as educators. top
night clinical practitioners and
administrators.
Dr. Stinson. professor in
the faculty of nursing and the
division of health service
administration, University of
Alberta. said the need in
research is particularly urgent
e
)'
'I
I
and one reason that the
emphasis on a Ph.D (N ursing)
is considered important.
"Research into distinctly
unique nursing science,
including better ways to use
new technologies, is vital if
high quality patient care is to
be given effectively.
humanely and econo01icaIly."
Dr. Moyra Allen, director
of the nursing and health
research unit in the School of
Nursing at McGill University,
Montreal. outlined a number
of areas in which specifically
nursing-oriented research
could be helpful.
. 'N urses often a
e the
first and the most continuing
contacts with families of
patients during an illness and
they are perhaps the best
prepared to investigate the
reactions offamily members
faced by a sudden and
life-threatening illness in one
member. How do the others in
the family react - and how
can they be helped. say in
hospital situations, with a
minimum of time and cost and
yet in human and helpful
ways?"
"As one delegate put it,
perhaps we are fortunate to
have limited finaocial
resources, for it will force us
to be creative and innovative
in our approach so that nurses
from all parts of Canada will
have access to this type of
education. "
The seminar was held
with the assistance of a
$38.250 grant from the W.K.
Kellogg Foundation of Battle
Creek. Michigan. It was
conducted under the joint
auspices of the Canadian
Nurses Association. the
Canadian Nurses Foundation
and the Canadian Association
of University Schools of
Nursing and attended by
approximately 40 nurses.
COI'ies of the procðledings of
the seminar will be circulated
to health-related organizations
as soon as possible in 1979.
A workshop on chikl
abuse
"Do we wait for physicians to
open the door. or do we care
enough to act now - to
examine, discuss and plan a
course of action in carrying
out our responsibilities as
registered nurses throughout
Nova Scotia?" This was the
challenge issued by Brenda
Clements, chairman of the
RNANS Task Force on
Prevention of Child Abuse at a
November workshop held in
Haliiax for nurses in key
positions to prevent child
abuse. Speaking on "The role
of the nurse in identifying high
risk families". she told the
nurses present. "We do not
have to wait for definite abuse
to take place. further
damaging the parent-chrld
relationship. Our most
important role is early
recognition of parents in need
of extra services."
Dr. John Anderson.
Director, Outpatient
Department, Izaak Walton
KiIlam Hospital for Children
pointed out that the focus of
the workshop was on
prevention and that nurses
have an independent and
responsible role. Dr.
Anderson directed the 1973
Study on Child Abuse in Nova
Scotia.
Members of the SCAN
(Suspected Child Abuse &
Neglect) Committee. an
interprofessional group. had a
panel discussivn and
answered questions on the
team approach to identifying
and helping high risk families.
Films such as "Children
in Peril" and "Cradle of
Violence" were used
effectively and there were
numerous graphic displays.
These had been arranged by
the Block Parent Program, the
Poison Control Centre of the
IWK Hospital, the Children's
Dept. of the Halifax Library,
Health Educator. Dept. of
Health; N .S. Commission on
Drug Dependency; the
Canadian Mental Health
Association and many others.
Seventy-five nurses
attended and participated in
group discussions after the
various presentations. An
equal number applied for
registration but could not be
accommodated as space was
limited. The members of the
task force were so heartened
by this response that they
have now made arrangements
to repeat the workshop in
June, 1979.
Occupational health
nurses establish
certification program
Ontario's occupational health
nurses have decided to
establish a voluntary
certification program for its
members, the ftfst time a
special interest group has
done so in Canada.
Approval of the
certification program - which
will include an initial
examination. continuing
education courses and
periodic renewal- was given
by members at the annual
meeting of the Ontario
Occupational Health Nurses
Association (OOHNA) held in
Kitchener, Ontario in late
October. 1978. The
Educational Conference and
Workshop attracted over 400
participants from Ontario.
across Canada. the United
States and the United
Kingdom.
The objectives of the
certification program are to
improve the quality of
The c.n-.llen Nur..
J.nUllry 11711 7
occupational health nursing in
Ontario. to encourage
occupational health nurses to
continue their professional
development and to give due
recognition and a sense of
identity to those nurses who
have met predetennined
standards in occupational
health nursing. The program
design is expected to be
sufficiently flexible to permit
its extension to nurses in
jurisdictions outside the
proVInce.
The proposed certificate
is not intended to endorse the
competence of the holder as a
"nurse or as an
"occupational health nurse".
nor to exclude any nurse not
holding a certificate from use
ofthe title "occupational
health nurse".
At present. the 1200
occupational health nurses in
Ontario. who care for
employees in the work setting,
have little opportunity for
fonnal training beyond their
initial diploma or degree.
Most nurses have to teach
themselves on the job through
on-the-job-training.
According to Dorothy
Clarke. OOHNA board
member. the program will be
"a pilot project in the
province. Ifwe get it going
successfully, ... it could
become a national program."
she stated. A certification
board. made up of
occupational health nurses
and an advisory board will be
set up during the next year
and it is planned that the
certification program will be
fully operational within two
years.
So far. the association's
plans have received the
support of the Ontario
Ministry of Labor. and the
!\linistry of Colleges and
Universities as well as the
College of Nurses ofOntano.
ICN SUpports
primary health care
The I nternational Council of
Nurses (ICN) has vowed its
committment to "making
primary health care an
effective realit} ".
In September 1978.ICN
representatives told delegates
to the Primary Health Care
Conference in Alma Ata.
USSR that nurses are
committed to effecting
"changes in nursing
education. practice. and
management which are
conducive to the
implementation of primary
health care."
While recognizing that
changes in attitude are
necessary before primary
health care can be fully
implemented.ICN's
spokesmen pointed out that it
has long been recognized that
nursing personnel give the
greater part of health care in
most health care systems.
"N ursing is already
structured to promote health
teaching and supervision,"
they pointed out.
ICN representatives at
the Alma Ata meeting were
Syringa Marshall-Burnett
(Jamaica). member.ICN
board of directors. Winifred
Logan.ICN executive
director. and Doris luebs.
nurse advisor.
The conference.
sponsored by the World
Health Organization and
UN ICEF. stimulated
participants to exchange
information and experiences
on the development of
primary health care within the
framework of comprehensive
health services and systems.
Did you know...
The Canadian government
recently licensed Radio
Reading Service. a closed
frequency radio station
broadcasting exclusively to
the blind and otherwise print
handicapped. The station
plans to read books.
magazines and newspapers to
the visually disabled. Special
receivers are required to hear
the station's signal and these
receivers will only be
available to those who are
demonstrably in need of the
service. The service is
non-commercial and
non-profit and is staffed by
volunteers. It is the first
station of its kind in Canada
while there are over seventy
such stations in the United
States . You can write to the
Radio Reading Service at 1247
Rebecca Street. Oakville,
Ontario. L6L IZ2.
Did you know...
A ten year reunion is being
planned for April. 1979 for the
diploma nursing grads '69 of
the l\else} Institute (formerly
SIAAS) in Saskatoon. Sask.
In order to complete a mail inK
list. please send your name
and mailing addres'i to:
Alumni '69, School of
Diploma Nursing. Kelsev
Institute. Box /520.
Sas/"atoon. Sas/".
Nursin. Jftb Fair 1M
NURSES &
NURSING STUDENTS
Looking for a Job Now or Later?
The First Annual Toronto Area
NURSING JOB FAIR offers...
...Over 5.000 nursing posilionsat65 hospitals and medical cenlers
from all over the U.S. and parts of Canada. The NURSING JOB FAIR
nursing employment convention will be held Feb. 22 through 24 at
Ihe Toronto Harbour Castle Hillon Hotel, One Harbour Square
Toronto. Admission is FREE to all in the nursing profession-LPNs.
RNs with diplomas, AS. BSN. MSN. and all students, administralion
and faculty. An open invitation is provided to all.
Come find out whal kind of nursing pOSitions and opportunities
are available. Learn about living conditions, education reimburse.
ment plans. relocalion assistance and nursing innovations.
The NURSING JOB FAIR runs Ihree (3) days. Feb. 22. 23 (Thursday
& Friday) from 10 am. to 7 p.rn.; Saturday. Feb. 24. from 10 am. to 4 p.m.
Come alone or with a busload of friends, but don'l miss this once.
a-year chance to meet represenlalives from 65 hospitals and medical
centers and discuss your long and short lerm nursing employmenl
interesls and needs.
Hospitals and Medical Centers attending from Ihe U.S. are from
the stales of: Alabama. California. Florida. Georgia. Illinois. Louis-
iana. Maine. Maryland. Michigan, Mississippi, Norlh Carolina. Ohio.
pennsylvania. Tennessee. Texas. Utah, Washington, D.C. Facililies
from Canada are from Toronto.
Sponsored as a service of NURSING JOB NEWS monthly
newspaper for the nursing profession. 470 Boston post Road.
Weston, Mass. 02193. For further subscription and convenlion
informalion call (617) 899-2702 9-5 weekdays. C-- "N,-
OVER 5000 .JOBS
8 J.nUllry 11711
The c.nedl.n Nur..
news
Critical Care '78
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The workshop leaders ofC ardioloRV '78 {Jose for a
photoRraph with Marina Heidman. continuing education
coordinator for nursinR of the Health Science Division of
Humber C olteRe in Toronto. (From left to riRht) M arielte
Vinsant, instrllctor of nursinR research and del'elopmeflt at
Jackson Memorial Hospital in Miami, Florida: Marina: and
Theresa Nu<.um. instructor of nursinR research and
del'elopment and coordinator ofnursinR quality assurance
proRrams at Jad.son Memorial.
For tho
e who attended
Critical Care '78. a two-day
workshop on oxygen and
chemical imbalance in the
critically ill. it was a full two
days.
Workshop leaders.
Marielle Ortiz Vinsant and
Theresa Watson Nw:um,
managed to present a
somewhat difficult and
certainly vast topic in an
understandable and
interesting way. They brought
to the workshop both an
impressive list of credentials
and a skillful. systematic and
forthright teaching manner.
Marielle. an instructor of
nursing research and
development atJackson
Memorial Hospital in Miami
Florida. is also an author of
numerous articles and a
textbook. "A commonsense
approach to coronary care: a
program . and has travelled
widely as a lecturer. Theresa
is an instructor of nursing
research and development and
coordinator of nursing quali
y
assurance programs at
Jackson Memorial and has
been a guest lecturer in the
areas of respiratory and
coronary care.
The first day of the
work<ihop was devoted to the
evaluation of oxygen and
chemical imbalance. On the
second day. delegates broke
into two groups to allow them
to attend a lecture of their
choice. centered on either
cardiovascular or respiratory
interests. I n spite of a very
tight schedule. there was
plenty of time for questions
and practice sessions in
problem solving.
The workshop.
sponsored by the Health
Sciences Division of Humber
College in Toronto was held
twice in order to allow a
greater number of nurses to
attend - about three hundred
nurses in all attended over the
four-day period.
New CNF
Board of Directors
Louise T od. executive
director of the Manitoba
Association of Registered
Nurses. Winnipeg. was
elected president of the
Canadian Nurses Foundation
in November 1978. Shirley
MacLeod, Fredericton. N.B.
is vice-president and other
members of the Board are
Barbara Archibald, Ottawa,
Denise Lalancette.
Sherbrooke. Que. and
Margaret McLean. St.
John's. Newfoundland. Dr.
Helen K. Mussallem,
executive director of the
Canadian Nurses Association
is secretary-treasurer.
The Canadian Nurses
Foundation is the only
Canadian Foundation that
deals exclusively in
supporting nursing scholars.
Almost 200 nurses have been
granted CNF scholarships
since 1962 - many of these
scholars have become leaders
in Canadian nursing as
university faculty,
administrators. researchers
and clinical nursing
specialists.
University of Moncton
to host annual CUNSA
Congress
The national conference of the
Canadian University Nursing
Students Association will be
held February 8-11. 1979 at
the University of Moncton.
Over 500 students from 25
Canadian universities are
expected to attend.
The theme of the
conference is . 'The Nurse as a
Preventive Agent" and the
subjects discussed. from child
abuse to school health, will be
approached with prevention in
mind.
CUNSA is the only
association that brings the
student nurses of Canada
together. This annual
congress aims to promote and
stimulate the interest and
participation of students in the
nursing field. Members of the
association will have the
chance to exchange ideas and
impressions about their
profession. through
educational, administrative
and recreational events. This
exchange allows them to find
out about the nursing
programs of various
universities.
Activities during the
three days will include sports,
as well as social and cultural
evenings. There will be
simultaneous translation of all
the meetings and conferences.
U of A hosts
visiting professor
The first nurse ever to receive
a visiting professorship award
from the Medical Research
Council spent one week this
Fall assisting and giving
advice on ongoing research
projects at the Faculty of
Nursing, University of
Alberta.
Dr. Moyra Allen, national
health scientist and professor
and director of a research unit
in nursing and health care at
McGill University shared the
knowledge from McGill
University - a leader in
nursing research - with both
students and faculty at the
University of Alberta.
As part of her visit. Dr.
Allen presented a public
lecture on one of her ongoing
research projects "The
Workshop - a Health
Resource". The Workshop is
an innovative community
health center, just outside
Montreal. The only one of its
kind in Canada. the health
center is designed to help
individuals and families deal
with situations of day-to-day
living in a healthful fashion.
The Cen-.ll.n Nur.e J.nUllry 11711 1
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METAL FRAMED...Slmiiar to above but mounted In
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1 line IF LESS THAN 110
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10 J.nuery 11711
The c.n-.ll.n Nur..
news
I. V. nurses meet
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The third annual convention of the Canadian Intravenous
Nurses Association was an educational experience for those
who attended, and the lectures were not the only reason.
H ere a group of nurses
'isit one of many interesting exhibits
set up by leading manufacturers of intrm'enous supplies.
Over 200 delegates met at
Toronto's Inn on the Park
Hotel for the Third Annual
Convention of the Canadian
Intravenous Nurses
Association (C.I.N .A.) held in
November. 1978. The meeting
addressed some ofthe
concern,> and learning needs
of the nurses who attended
from all parts of Canada.
Trudy De Vries opened
the first day ofthe meeting
with an account of her
experiences starting an I. V.
team at HolyCross Hospital
in Calgary. Alberta. She
emphasized the benefits of
forming a team. both for the
hospital and for the patients,
and underlined the needs for
standards to ensure safe I. V.
practices.
Dr. R.M. Filler.
surgeon-in-chief at the
Ho'>pital for Sick Children and
professor of surgery at the
University of Toronto. talked
about complications in
pediatric intra venous therapy.
both peripheral and central,
from fluid overload to sepsis.
R.L. Ravin. pharmacy
director at St. Joseph Mercy
Hospital in Ann Arbor.
Michigan. discussed safe and
effective intravenous therapy.
pointing out the importance of
ensuring the safe
administration of I. V. fluids
and medications by making
sure
. that intravenous
administrations are
compatible and stable;
. that additives are diluted
appropriately;
. that the rate of
administration is appropriate;
and
. that the risks of
septicemia are minimized.
He stressed the important
role of the pharmacist in
ensuring safe and effective
therapy and gave nurses and a
number of pharmacists who
attended the meeting a good
deal to think about.
C.I.N .A. was founded in
1975 because of a need for
communication, increased
knowledge and idea exchange
between nurses involved in
I. V. therapy. The third annual
convention provided nurses
with an opportunity to meet
these needs. share concerns.
and visit a number of exhibits
pertinent to I. V. therapy.
MARN approves emergency
nursing course
\ .
The Board of Directors of the
Manitoba Association of
Registered Nurses recently
gave its approval to a
post-graduate course for
registered nurses in
Emergency Departments. The
only one of its kind in Canada.
the course is sponsored by the
Health Sciences Centre in
Winnipeg.
The program has been in
operation since September
1976, and at that time served
five Winnipeg hospitals.
However, provincial fiscal
restraints have reduced its
services to two hospitals -
the Health Sciences Centre
(General and Children's) and
the St. Boniface Hospital.
The course is designed to
provide the client with safer.
more comprehensive nursing
care in sudden, unanticipated
conditions. Effective
communication and expansion
oftechnical skills are stressed,
in order that both the client
and his family receive the
highest possible level of care.
Registered nurses
presently working in the
Emergency Department of the
two hospitals involved are the
only nurses eligible to enrol in
the nine-month course.
Approximately 47 eight-hour
class days are spent in
theoretical training on the
following topics: cardiology,
respirology, neurology,
urology, abdomen, pediatrics,
obstetrics, gynecology,
trauma. life crises and
psychiatric emergencies, and
disaster nursing. As often as
possible, specialists are called
in to teach in their area of
specialty.
I n addition to the theory.
at least one day a week is
spent in the actual clinical
setting of the Emergency
Department under the
supervision of a qualified
teacher. In order to gain
insight and experience in a
variety of areas, three days
are set aside for experience
with the Winnipeg Ambulance
Service and two three-week
rotations are arranged with
two Emergency Departments
in other hospitals.
Because of the support
the program has received,
there is a plan to expand the
course to serve a wider range
ofhospitaIs, both urban and
rural. If sufficient interest is
expressed by Canadian and
United States hospitals. and
by registered nurses, the
coordinators of the program
hope to be able to request
additional funding from
governments and other
hospitals to provide improved
instruction and care in
Emergency Departments.
I nquiries about the
course can be made to:
Barbara Duke, Coordinator,
Manitoba Emergency Nursing
Course, Dep(lrtment of
Nursing, Health Sciences
Centre (General), 700 William
A
'enue, Winnipeg, Manitoba,
R3EOZl.
Editor's Note: Immunization
Action Month ended on
November 3D, but its message
that all Canadians need
protection from
communicable disease will
hopefuIly stay with us for
1979. CNJ thanks the Ottawa
Carleton Regional Health Unit
for pointing out that. in
general, adults do not receive
immunization for diphtheria
(as we stated in our November
issue, 1978. p.8). Routinely,
diphtheria immunization is
given up to the age of 14
years.
I
'
The cenlldl.n NUrH
J."...ry 11711 11
YOU AND THE LAW
Finding and helping
victims of child abuse
Corinne Sklar
.,
--
L_ ...
How can the tragedy of child abuse be prevented? What
position does the law take with respect to both the prevention of
abuse and rehabilitation of children and their parents? What
does the law require of the nurse in the matter of child abuse?
Child abuse has been variously defined in the literature.
The term "battered child syndrome" was first coined by Dr. H.
Kempe in 1962 to describe a clinical condition in young children
who have received serious physical abuse usuaIly by parents or
other guardians including foster parents. The injuries result
from non-accidental occurrences and range from minimal to
fatal injury.1 The definition of an abused child has been
broadened to include the emotionally or psychologically
battered child. While physical abuse can be demonstrated by
X-ray film of injuries and by visual evidence of bums, bites,
bruising and general malnutrition. emotional abuse is more
difficult to demonstrate. Obviously, the latter is also more
difficult to recognize so that det
ction and diagnosis on the
emotionalleve\ are often neglected by professionals.
Child abuse can result from outright battery or from
neglect. The results may be physical or emotional or both.
Neglect may be manifested as failure to thrive from physical or
emotional neglect resulting from ignorance, indifference or
inadequacy on the part of parents or guardians.
In legal terms, the a
sed child falls within the statutory
definition of "neglected child" or "child in need of protection"
Ontario'sChild Welfare Act. R.S.O. 1970. c.64 defines â child
in need of protection as foIlows:
(/)In this Part.
(a) "child" means a boy or girl actually or apparently
under sixteen years of age;
(b) "child in need of protection" means,
(i) a child who is brought. with the consent of the
person in whose charge he is. before a judge to be
dealt with under this Part.
(ii) a child who is deserted by the person in whose
charge he is
(iii) a child where the person in whose charge he is
cannotforanv reason care properly for him, or where
that person has died and there is no suitable person to
care for the child.
(iv) a child who is living in an unfit or improper place.
(v) a child found associating with an unfit or improper
person.
(\'i) Repealed
(vii) a child who, with the consent or connivance of the
person in whose charge he is, commits any act that
renders him liable to a penalty under any Act of the
Parliament of Canada or of the Legislature. or under
an\-' municipal by-law.
(viii) a child whose parent is unable to control him,
(ix) a child who, without sllfficient cause, habitually
absents himselffrom his home or school,
(x) a child where the person in whose charge he is
neglects or refuses 10 pro\'ide or obtain proper
medical. surgical or other recognized remedial care or
treatment necessary for his health or well-heinl? or
refuses to permit such care or treatment to be supplied
to the child when it is recommended by a legally
qualif
d medical practitioner, or otherwise fails to
protect the child adequately,
(xi) a child whose emotional or mental de\'elopment is
endangered because of emotional rejection or
deprivation of affection by the person in whose charge
he is,
(xii) a child whose life, health or morals may be
endangered by the conduct of the person in whose
charge he is;
You wiIl note that the definition is very broad and
encompasses a wide range of situations. This statutory
definition is representative of the definitions found in similar
legislation in the other provinces.
Canadian law dealing with neglect of and offences against
children faIls into two categories, each type enacted with
differing intent. The Canadian Criminal Code deals with
criminal sanctions for offences against children. The intent of
the Code is to prohibit proscribed conduct and to punish
wrongdoers for crimes committed against children. The Code is
primarily punitive rather than rehabilitative in nature. Thus,
sexual mis<.;onduct, criminal negligence, and failure to provide
the necessaries of life are all punishable on proof beyond a
reasonable doubt.
Provincial Child Welfare legislation. on the other hand. is
aimed primarily at protecting children from a hostile.
non-nurturing environment. Its thrust is not to punish parents or
guardians inadequate to the task of child-rearing. but to resolve
problems based on the "best interests of the child". In order to
do so. the full range of available community agencies and
professional services optimaIly should be marshaIled. The
12 J.nUllry 11711
The c.n-.ll.n Nur..
"harshest" punishment under these statutes is removal of the
child or children from the parental home either on a temporary
or. sometimes. on a pennanent basis. Remedial treatment may
be required under supervision oflocal agencies, most often the
Children's Aid Society or local equivalent.
Detecting the child abuser
To combat this growing social problem, early detection and
prevention are essential. Nurses have a primary role to play in
this area; they must be aware of the typical characteristics of
the victim of child abuse who may be brought in to the hospital
emergency room, the pediatrician's office, the local clinic, or
the school nurse's office. Nurses must listen and observe
carefully as they fulfill their duties in routine public health
visits. They must have a working knowledge of the general
profile of the child abuser and be alert to emotional strains to
which these individuals are subjected which trigger abusive
behavior. Child abusers are not limited to anyone section of the
socio-economic scale. While problems of financial distress,
overcrowding, alcoholism, etc. are indeed added stressors,
abusive conduct toward children is not limited to those at the
lower end of the socio-economic scale. The potential child
abuser can be found in all walks of life.
Anyone who looks after children has the potential to be a
child abuser. While studies have shown that there are factors
which tend to recur, it is important to realize that the potential
for such behavior toward children exists in all individuals.
Yelaja 2 describes three categories of abusive parents:
. parents who are wilfully and deliberately abusive and
neglectful;
. parents ignorant of child-rearing;
. parents who are burdened with social problems of poverty,
physical and m"ental illness, alcoholism, etc.
Heins'3 profile finds that females tend to be more abusive
than males.
. Fathers tend to abuse older children.
. Child abusers generally are young. have children early and
tend to have many children.
. They tend to be socially isolated and nomadic. to have few
friends and to be separated from their extended family.
. Many child abusers have been abused themselves as
children.
. Their partnerships tend to be highly unstable.
. Some abusive parents tend to have excessively high
expectations of themselves as parents and oftheir children.
. They may be hostile and immature.
. The spouse or partner is usually passive and tends to
abdicate responsibility for the rearing of the children.
Sometimes the parents are simply highly authoritarian and
punitive in their beliefs and childrearing practices. The profile
of the child abuser varies; there is no set formula. All of these
characteristics serve as danger signals warning of potentially
abusive individuals.
It is important to note that not all children in a family are
abused. Generally, one child bears the brunt of the hostility of
the parent. This may be due to some physical characteristic.
some abnormality, the sex of the child, or some personality or
behavior trait.
Raising children is not a simple task; the frustrations.
problems and costs are heavy, the responsibility is enormous.
Today's highly mobile. "independent" nuclear family often
lacks the emotional supports that a less complex, less detached
society of a few years ago provided. Parents in need of support
and guidance often do not know where to turn for help. As well,
parenting is something "one is expected to know how to do
properly". Generally, one is loathe to interfere with the
child-rearing practices operative within a family. Nurses have
to be aware of their own biases and value systems as well as
their general reluctance to intenere.
Reporting requirements
Generally, provincial legislation requires reporting of ill-treated
children to the proper authorities. Some legislation provides
penalties for failure to do so. It is important for nurses to
familiarize themselves with the provincial statute applicable to
them for its definition of children in need of protection and for
the requisite reporting requirement. In Ontario, the reporting
requirement is as follows:
(1) Every person havinR information of the
abandonment, desertion, physical ill-treatment or
needfor protection of a child shall report the
information to a children's aid society or Crown
attorney.
(2) Subsection 1 applies notwithstanding that the
information is confidential or privileged, and no action
shall be instituted against the informant unless the
giving of the information is done maliciously or
without reasonable and probable cause.
Note that no statutory penalty follows on failure to report.
However, this lack of sanction is now under review in Ontario
since it is recognized that the reporting of suspected or clear
cases of abuse is essential to ensure the protection of helpless
children.
The sanction for non-reporting may apply, however, only
to such behavior as physical abuse and sexual abuse. The
concern of the legislation is the condition of the child (physical,
emotional or both) not the conduct of the person which causes
the condition.
Nova Scotia's new Children's Services Act, S.N .S. 1976
c.8 retains the reporting requirements and establishes a child
abuse register. A child who has been found to be in need of
protection. or is believed by members of the medical fraternity
to be subject to abuse, is to be registered. On the report of a
suspected case of child abuse, an agency is required to conduct
an investigation and obtain a medical statement to determine
whether or not abuse has occurred. Conditions for the removal
of a registered name of a child and the transmittal of information
outside the province are specified. 5
Each province has differing requirements. General
penalties for failure to report are found in the legislation of
British Columbia, Manitoba, Newfoundland, Nova Scotia,
Quebec, Saskatchewan. Ontario does not yet penalize failure to
report. New Brunswick and Prince Edward Island do not
require reporting of cases.
Protection of the informant
The responsibility to report usually carries with it freedom from
ci vii action for breach of confidentiality unless the information
is given maliciously or without reasonable and probable cause.
The identity of the informant is protected from publication to
encourage reporting of cases. Thus, a report to the authorities,
in good faith. where there is reasonable and probable cause for
concern will serve to protect the informant from any subsequent
action by the parents or guardians.
In England recently the House of Lords upheld the right of
the National Society for the Prevention of Cruelty to Children
to maintain confidential the name of its infonnant. The Society
had been informed that the 0 family's baby girl was maltreated
On investigation by the Society and the family's physician. the
child was found to be healthy and well-eared-for. However,
Mrs. D. suffered from depression and ill-health as a result of
this complaint and wanted to sue the informant for defamation.
The Court found that it was in the public interest that such
names should not be divulged, else valuable sources of
information would dry up. Information. tendered in good faith,
will be protected at its source.
The c.n-.ll.n Nur..
J.nUllry 11711 15
. Speech assessment is actually done by the parent,
while the expert otTers guidelines.
. Dental examination and brushing methods are
performed with the child's head on the parents' lap, and
the hygienist teaching procedures to be followed in the
home, and with siblings.
. Experiential learning is emphasized in everything
from mental health to nutrition, with the exception of
immunization which is provided for children who will be
entering schoo).
Although it is the public health nurses who do the hard
work of organizing the da} 's activities and carry out the
necessary follow-up procedures, the event itself has become
(
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Having}oureyes ctwckedby the orthoptist can befun when
you're silling on the lap of PHN cum clown. fan SUllon,
during
'ision screening mthe health circus.
a true expression of community cooperation in positive and
preventative health. Local firemen hang street banners;
merchants supply nutritious snacks; volunteer agencies set
up colorful displays; and school children paint posters and
flags to add to the kaleidoscopic etTect. Altogether about
thirty-five groups and agencies participate in this
worthwhile etTort to maintain a healthy environment and
community.
From a small beginning a few years ago in the offices
of the local public health t:nit, the circus has now escalated
to an event that is eagerly awaited by hundreds of local
children and adults each year. .....
Pholostory by Rosemary Crmlford
,
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Unconcerned and unaware of the physiotherapist carefullv
obserdng her acti\'ities. a young participant jo)fully jumps from
springboard to the mat belol\'.
16 January 11711
The can-.llan Nur..
1
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Little sister opens wide to help this preschooler take her polIO
vaccine from Jean Sellers. PHN.
.. Am I tall enough," is the question in the eyes of the young man
hm'ing his height checked by PHN Trudv Phillips at the
health circus.
Acknowledgement: The author would like to acknowledge the
cooperation and assistance offour public health nurses -
Pauline Dunn. Beverley Hills. Betty-Anne Rogers and Rachelle
Siddall- in the preparation of this article. All except the first of
these nurses (who is now a nursing instructor at Douglas
College) are employed by the Simon Fraser Health Unit.
Rosemary Crawford, author of the photostory, "A
preschoolers' health circus", is regional health education
consultant with the British Columbia Ministry of Health. S he is
a graduate of St. Paul's Hospital in Vancom'er, UnÙ'ersity of
British Columbia School of Nursing in Public Health and an
undergraduate in Education at Simon Fraser U nÙ'ersity.
She has been im'oh'ed in community health education for
the pastfour years and recently has specialized in audio-dsual
with emphasis on educational media.
farly diagnosis in
congenital hearing loss
"I had now the key to all language , and I was eager to learn to use it.
Children who hear acquire language without any pa11icular effort; the
words thalfallfrom others' lips they catch on the wing, as it were,
delightedly. while the Iinle deaf child must trap them by a slow and often
painful process. But whatever the process, the result is wondeiful."
Helen Keller
,
"
...-
,
JlllrilYll O. Dahl
J
Children with congenital hearing loss are
most often born to hearing parent!> who
have no kno'o\ledge ahout congenital
deafness.' Since deafness does not seem
to interfere with the initial bonding
process. the mother often remain"
unaware for many months that the infant
cannot hear. The baby cries. smiles,
babbles. reacts to visual. tactile and
kinesthetic stimuli as does any normal
baby. The mother reacts to the infant's
behavior by increasing her attention to
him and social interaction takes place.
The mere fact that the infant responds to
her, increases the mother's
vocalizations. At this stage. there is no
clue that the baby is not responding to
auditory stimuli.
Until the age of six to nine months.
the deaf baby often sounds exactly like a
normal infant. But. vocalizations will
gradually decrease and by the end of the
first year, the child ma} be making only
the primitive sound. "amah" which
many mothers report as ., mama" .!
When the baby fails to respond to sounds
in a normal way and vocalizations
decrease. the parent-child interaction
pattern is altered. The suspicion and
subsequent diagnosis of deafness may
put an added strain on the parent-child
relationship.
Earl
suspicion and detection
In most cases. parent!> are the first to
"uspect that their child is deaf. The more
'ievere the hearing loss. the earlier the
suspicion and the shorter the delay until
diagnosis. Findings in a study of the
Greater Vancouver area published in
1975-' indicate that on the average. a child
was about ten month" old before parents
presented their suspicions to their
primary care physician and even then
there was an average delay of over eight
and a half months until the diagnosis '0\ as
confirmed. In some cases. parental
!>uspicions '0\ ere disregarded as
'overanxiety': in other cases. parents
were advised to 'wait awhile'.
18 January 111711
The can-.llan Nur..
Current findings indicate that
parents are beginning to suspect
deafness in their child earlier - at about
eight months - and that children are
being referred earlier for evaluation.
It
would seem that professionals are
becoming more aware of the importance
of early diagnosis and treatment.
Risk factors
No statistics are available to indicate the
number of infants born with congenital
deafness in Canada: estimates range
from I: 1000 to 5: 1000:' Unfortunately,
there is as yet no simple test to detect
deafness in the newborn and routine
screening in nurseries must be
considered ineffective in detecting
hearing loss." Nevertheless. there are
identifiable factors that increase an
infant's risk of congenital hearing loss. In
1974, the U.S. Joint Committee on
Newborn Hearing Screening
recommended that "infants at risk for
hearing impairment should be identified
by means of history and physical
examination". 7 As a result ofthis
awareness. newborns may be
categorized on the basis of risk. The risk
factors include:
I. family history of hereditary childhood
hearing impairment
2. rubella or other non-bacterial
intrauterine fetal infection
3. defects of ear, nose and throat
4. birthweight ofless than 1500 grams
5. bilirubin level of greater than
20mg/IOO 011 serum.
Using these factors as a possible
clue in the detection of hearing loss. it
has been estimated that about 60 to 70
per cent of congenitally deaf children can
be identified."The committee further
recommended that infants falling into
this category be referred for in-depth
audiological evaluation within two
months after discharge from the nursery.
Even so, deafness may not be apparent
and it is important that periodic
evaluations be repeated.
Acquisition of language
Why is early diagnosis and treatment of
congenital hearing loss so important?
One of the reasons is that language
acquisition is a time-locked function.
connected to early infancy .HThe first
two years oflife are considered to be a
crucial time for language learning that
can never be regained once this time has
passed. It is also suggested that
prelinguistic vocalizations and
intonations similar to the parents speech
are noted as early as eight months. and
are basic to language development. IU A
child learns to talk by hearing the
constant repetition of words. and ifthe
infant has any residual hearing and is
diagnosed early, he can benefit from the
use of hearing aids and/or amplification
devices coupled with other teaching
approaches.
Communication methods
Regardless of the severity of the hearing
loss, the key to a child's intellectual,
social and psychological development is
the establishment of successful
communication as early as possible. But
how is this to be accomplished? Once a
diagnosis of hearing loss is made, the
parents must select the method of
communication best suited to educating
their child. This will probably be one of
the most difficult decisions parents of a
hearing handicapped child will face since
experts themselves are not agreed about
the best approach. This conflicting
advice from experts can rob parents of
support and precipitate a prolonged
conflict. "
There are two fundamental
dPproaches to educating the hearing
handicapped:
Oral communicarion method: teaches
speech training, lip-reading and utilizes
hearing aids and/or amplification units
but discourages the use of gestures and
sign language. The theory is that if the
child uses sign language. he will not fully
develop his verbal
kills.
Total communication method: trains
children in sign-language, finger spelling.
speech and lip-reading, and uses the
amplification of residual hearing through
hearing aids. The theory is that each
child must "learn according to his
capabilities - that learning to
communicate proceeds from the most
primitive to the more complex and
sophisticated symbol systems that
involve all senso"y modalities-
auditory. visual and kinesthetic" .'2
At this early stage, the parent's
greatest need is for counseling. While
some may experience extreme shock and
grief. others may have a more moderate
reaction. Parents with normal hearing
may have difficulty understanding the
implications and limitations of the
handicap for their child. It is vital at this
stage that they understand what the
handicap will mean and that no false
reassurance is given to them to minimize
their concern.
The Vancouver Program
In the Vancouver area, a child suspected
of having hearing loss is referred to the
Children's Hospital Diagnostic Centre.
Here. the infant is evaluated and the
diagnosis is made. Parents are given
counseling and a full explanation of the
two educational programs available to
them. These are:
a) the oral method at the Vancouver Oral
Centre and
b) the total communication method at the
Diagnostic Centre.
Parents are advised to visit both
programs and to choose one of them for
their child. Both programs offer support
for the family and training for the child.
In choosing. parents must consider
which method will help the child achieve
optimal growth. It is important that it be
their choice because they must feel
willing and motivated to participate.
Oral communication method
Many forces playa part in the decision
that parents will make. * They may have
high expectations for their child and
want him to 'pass' in the normal
speaking world. They may be drawn to
the purely oral approach because it
seems to bypass the handicap and
requires less emotional adjustment, since
it does not require the learning of sign
language. '3 Certainly it is natural for
parents to hope that their hearing
handicapped child will develop the
capacity to communicate with the vast
majority of people who hear and speak.
The Smiths** are an example of one
family who chose the oral method for
their hearing handicapped daughter.
Marie, aged 24 months, is the only child
of Mr. and Mrs. Smith. She has
congenital deafness of unknown cause.
When Marie was 12 months old. Mrs.
Smith suspected that something was
wrong with Marie's hearing. While on
vacation that year, she noticed that
Marie did not react at all to a noisy
environment. Through her family doctor
and ear specialist, she was referred to
Vancouver's Diagnostic Centre.
Looking back. Mrs. Smith felt that
there was nothing in Marie's behavior to
make her suspect deafness. She seemed
normal. She slept soundly but would
react to the vacuum cleaner. Probably
she was reacting to the vibration rather
than the noise. She was an "independent
baby". preferring not to be cuddled.
The parents described their reaction
to the diagnosis as "fairly severe". but
overall, they felt that they have adjusted
well. Mr. Smith felt that he had had a
harder time than his wife.
A number of factors affected the
Smiths in their choice ofthe Oral Centre.
Although Marie has a profound loss, she
has some residual hearing and so can
benefit from hearing aids. At age one
year, she WdS babbling and had advanced
developmental skills. The parents' wish
for Marie was that she be as much a part
of the normal world as pos
ihle.
*In other centers across Canada. such as the
Audiology Department al theChildren's
Hospital of Eastern Ontario in Ottawd,
parents do not choose the type of training for
their hearing impaired child. The staff of
CHEO's program feel that parents do not
have the knowledge and are not emotionally
able to handle this decision at the time of
detection. Instead. an evaluative therapy
program will determine and recommend a
suitable method for each child.
** All names are fictitious.
The oral program has continuity-
infant teaching, preschool. kindergarten.
and possible integration into the public
school system. Because the program has
limited grant money. the parents
themselves must carry out continuing
fund-raising activities to support the
program. The program also includes
parent group meetings and bimonthly
in-home visits from a teacher. By this
Fall. Mrs. Smith and Marie will have a
daily 45-minute drive to the Centre for
pre-school classes.
The program emphasizes specific
parent behaviors to treat the child like a
normal child and to talk to him as often
as possible. As Mrs. Smith said.
"Repetition is the name of the game.
Emphasis now is not on teaching the
child to look at you but to make use of
the residual hearing. So when Marie has
her hearing aid on. I talk to her from
behind. try to encourage her to respond
to my voice and she does. "
Marie wears her aid in a red
corduroy pocket on her chest. with cords
running to molds in both ears. It took her
only a few days to accept the aid. When
the aid is on. she uses words with
intonation. But when it is off. she makes
only a monotone cry.
Cost and maintenance of the aid i
another stress. Ear molds must be
replaced every six months as Marie
grows.
In terms of family support. the
Smiths are receiving some help from Mr.
Smith's sister who lives nearby. She
accepts Marie"s handicap and provides
emotional support. Mrs. Smith's family,
during their occasional visits from
another province. express pity for Marie
and this creates tension.
On the whole, Mrs. Smith feels that
they are coping well with Marie's needs.
She hesitates to use the word "deaf' and
substitutes "handicap" instead. But the
Smith's have decided not to have
another baby. Because they cannot trace
their family tree. and thus cannot make
use of genetic counseling. they feel they
could not cope with having another deaf
child.
Total communication method
The total communication program at the
Diagnostic Centre (the only one of its
kind in Canada) has a different approach.
The Centre's aim is to provide families
with an opportunity for extended
participation in the program by providing
sign language instruction and
parent-child training classes. Parents of
deaf infants are also drawn closer
together to exchange interests and
experiences in child-rearing practices in
the home. It allows children in the family
(both hearing and deaf) to interact with
others in a play setting and introduces
the family to deaf adults and
professionals who work with the deaf.
The c.on-.llen Nur..
As well. a deaf adult visits the family in
the home. providing a role model.
Besides educating the child. the total
communication approach helps to
integrate the child into the family unit by
involving the entire family in
"communicating" .
Effect on the famil
The presence of a deaf infant does not
necessarily have a detrimental effect on
family interaction. In some instances,
brothers and sisters express worry and
concern: but in others. the family
members are drawn closer together.
Members ofthe extended family may
wish to enroll in sign language classes in
the community if the child is using the
total communication method.
The effect of a deaf child on the
family will depend on the health ofthe
family unit. If problems already exist,
coping with the handicap may cause
further strain. However, if all members
can be involved in a common program,
learning new methods of communication
and helping one another. family bonds
may be strengthened.
The case of Nancy Moss" and her
extended family gives us an idea of how
all members can become involved.
Nancy. the youngest of three children,
developed deafness at six months of age
after she had meningitis. Again. it was
her mother. Mrs. Moss, who first
suspected that something was wrong
when Nancy was in the hospital for
treatment. She and her parents were
referred to the Diagnostic Centre for
evaluation.
While both parents experienced
severe shock at first, they feel they have
adjusted to the diagnosis fairly well.
In contrast to the Smiths. Mr. and
Mrs. Moss chose the total
communication method for Nancy. Said
Mrs. Moss. "Well. we thought-she's
deaf. We can't change that. Ifwe put her
in the oral program she'll be with people
she can't hear or talk to. She really won't
have any world. If we put her in the other
program she'll have people she can
communicate with in sign language, and
we can learn it with her. At least then
she'll have a place in her world."
The family has a weekly two-hour
drive to the Centre for sign language
classes and group sharing. A teacher
comes to the house weekly. Mrs. Moss
states that Nancy is beginning to use sign
language and both parents are able to
communicate with her by using speech
and sign simultaneously. Nancy's
three-year-old brother has not reacted to
her hearing loss yet but the six-year-old
has questions. Since Nancy will soon be
fitted with hearing aids. he asks if she
will then be able to hear as they do.
Those in the extended family have
mixed reactions. Mr. Moss' father
Jenuery 1171 111
tended to deny the diagnosis at first by
making statements like, "She heard
that". Now. he comes into the house and
signs to Nancy. "Are you Grandpa's
girl". The maternal grandparents are
gradually showing more support. 'The
schools sent out a questionnaire asking
what people would like taught as a
second language," said Mrs. Moss. "My
mother crossed out all the languages
listed and wrote down 'sign language' ."
All of the family speak of Nancy as "cute
and cuddly".
For the future. Nancy's educational
needs will probably require a move into
the city to be near a suitable school. Mr.
Moss will need to find other work.
Helping behaviors
Parents can be taught behaviors that aid
in bonding. encourage the child's
development and meet the child's great
need for visual stimulation and physical
contact. Parents are taught to look at the
child when speaking and to use good
facial expression. But, at the same time.
they should not "overtalk". Some
parents develop a pattern of talking "at"
their child who will soon weary of this
and stop trying to understand." Parents
are taught to use speech before gesture
or speech and sign simultaneously,
depending upon the educational method
followed. Behaviors are oriented toward
helping the baby to develop a watching
habit - to watch people's faces.
especially the mouth and eyes. These
behaviors must be incorporated into the
ordinary, everyday routines. a practice
that calls for much repetition until the
baby understands the message.
Understanding should be rewarded with
evidence of pleasure and praise.
It has been shown that even though
the deaf child does not have verbal skills
he can conceptualize and has cognitive
skills.'s However, if he is deprived of
successful communication with others,
his social and academic skills will be
affected. The greater the lag until his
training is begun, the greater the lag in
his academic learning and the greater the
potential for the development of
emotional problems. Since the handicap
is a hidden one, the child may be
mislabelled as retarded. uncooperative.
dull or inattentive by those who are not
aware of his handicap. With early
diagnosis and treatment most of these
problems can be avoided.
Nursing implications
Nurses have an important role to play in
the detection of congenital hearing loss.
For example. the nurse working with
newborns can bring the five risk factors
to the attention of the family
pediatrician. Public health nurses are in
an especially good position to detect and
follow up on suspected cases. The PHN
who sees the parents and baby at health
20 Jenuery 1171
The c.on-.llen Nur..
clinics and during home visits often is the
only health Care professional involved
with the family until school age.
On the first post-natal visit to a new
mother. the nurse should take a
comprehensive hi
tory and review the
five factors which identify children at
high risk for deafness. Children with a
history of anyone of these factors should
be placed on a "High Risk Registry" and
be followed closely. The PHN can also
ask the mother questions such as:
. Does the baby react to loud noises?
. Does noise awaken him from sleep
when he is in a quiet room?
. By three months. does the baby
turn his head towards sound?
When the infant is between six and
nine months. the age when hearing loss is
usually detected. it is useful to again ask
the mother about the baby's hearing-
does he. for example. turn his head to a
familiar sound such as the sound of her
voice or the ring of a telephone?
Ifthere is any suspicion of hearing
loss. the child should be referred to the
services available in the area. This may
be the family physician or an audiologist.
The PHN'sjob does not end here
however. If the diagnosis has not been
confirmed. the high risk child should be
followed up since deafness may show up
later. If the diagnosis has been
confirmed. the nurse should check with
the parents to be sure they have been
referred to a treatment program and if so.
which program they have chosen.
If the family is involved in a
program. the nurse should learn what
parent-child behaviors are to be followed
so that she can offer support and
encouragement. She should be aware of
parental stresses during this time - the
conflict in choosing an educational
program. possible feelings of
helplessness. guilt or denial and whether
relatives are giving support to the family
or not.
The nurse will also be able to
observe parent's behavior towards their
child- are they being attentive to him.
cuddling him? Both parents and child are
apt to find the 12-month period hetween
the ages of one and two years a
particularly difficult and frustrating time.
as much repetition will be necessary
hefore the child understands what is
being communicated to him. At this
tage. parents can become frustrated and
so. in turn. can the child. Joyful.
reciprocal communication is not easy in
this situation.
Gaps also exist in educational
programs for the hearing handicapped
across Canada. For example. although
the total communication program at the
Vancouver Diagnostic Centre accepts
children up to the age of three. no
program for preschoolers from three to
five exists owing to a lack of funds.
Education is picked up again when the
child enter
school but valuable time has
been lost. 16
In the community. nurses can also
support positive health programs and
promote public education about hearing
loss. There is also a very real need for
integration and cooperation between all
disciplines to ensure the early diagnosis
of hearing loss and continuity of
treatment that is vital if the child is to
have his rightful place in the family unit
and in society.
"I want to say to those who are trying to
learn to speak and those who are
teaching them: be of good cheer. Do not
think ofto-day's failures. but of the
success that may come to-morrow . You
have set yourselves a difficult task. but
you will succeed if you persevere; and
you will find ajoy in overcoming
obstacles - a delight in climbing rugged
paths. which you would perhaps never
know if you did not sometime slip
backward - if the road was always
smooth and pleasant. ..
The Story of My Life
Helen Keller.
References
I Schlesinger. Hilde. Sound alld
sigll: childhood del{fileSS and mental
health. by... and Kathryn P. Meadow.
Berkley. Ca.. U. ofCal. Pr.. 1973. p.3.
2 Downs. Marion P. Guidelines for
hearing screening of the infant.
preschool and school-age child. In
Detection l
fdel'elopmental prohlems ill
children. Edited by M. Krajicek and A.
Tearney. Baltimore. University Park Pr
1977. p.1I1 ff.
3 Freeman. Roger. Psychosocial
prohlems of deaf children and their
families: a comparative study. by... et
aI.Amer.Alln.Deall:!O:4:391-405. Aug.
1975.
4 MacLean. Dr. CD. Personal
communication. March 3.1978.
5 Fisch. L Causes of deafness in
children. Nurs. Mirror, 143:19:48.
NovA. 1976.
6 Downs. Marion P. Joint statement
on neonatal screening for hearing
impairment. by... et al. Pediatrics
47:6:1971.
7 American Speech and Hearing
Association. American Academy of
Ophthalmology and Otoldryngology. and
American Academy of Pediatrics.
Supplementary statemellt o.{joint
committee Oil illjllllt hearillg KreellillX.
Asha. 16: 160. 1974.
8 Gerber. Stanford E. High risk
registry forcongenitLl1 deafness. In
Hearing Ion ill children. Edited hy
Burton F. Jaffe. Baltimore University
Park Pr.. 1977. p.74.
9 Downs. Marion P. Paper
presented. Nm'a Scotia Conference on
Earl\' I dent
fìcation of Hearing Loss.
Halifax. N.S. Sep. 8-11.1974.
Proceedings. Basel. Switzerland. S
Karger. 1976. p.14.
10 Crystal. David. Linguistic
mythology and the first year oflife. An
edited ver
ion of the 6th Jan
son
Memorial Lecture.
Bri.J.Disord.Commun. 8:29-36. Apr.
1973.
II Schlesinger. op cit.
12 Downs. Marion P. Goals and
methods of communication.I n Hearing
loss in children. Edited by Burton F.
Jaffe. University Park Pr.. Baltimore.
1977. p.7:!8.
13 Freeman. Roger. Psychiatric
aspects of sensory disorders and
intervention. I n Epidemiological
approaches in child psychiatry. Edited
by P.J. Graham. London. Academic Pr..
1977. p.:!87.
14 Freeman. Roger. Personal
communication. Feb.17. 1978.
15 Vernon. McCay. Relationship of
language to the thinking process.
Arch.Gell.Psychiatry. Vol. 16. Mar.
1967.
16 MacLean. Dr. CD. Personal
communication. Mar. 3. 1978
Acknowledgement:TlllWhS go to Dr. R.
Freeman. child p,\'\'chiatrist UBC and
Dr. C.D. MacLean, Children's Hospital
Diagno.Hic Celltre for their assistance in
the preparation of this paper. A further
thanh you goes to Elaille Cart\'. UBC
faculty adl'isor for the stud\'.
'-
A ut/wr Marilyn O. Dahl (R.N.) prepared
this paper during the third year in the
B.SeN. program at the Unil'enit\. of
British Columbia. A.I' part ofher stlllf\' on
congenital hearillg loss. she I'isited two
jámilies in the Vancoul'er area. each
with a deajï,!flwt.
Marilyn is a graduate l
f a three \'ear
diploma program, Victoria Ho.lpital,
Prince Alhert. Smh.. ami has nursed in
Sashatchewall. Ontario and B.C. She is
presently .finishing her B .SeN. degree at
U.B.C.
The Cen-.llen Nur..
Jenuery 1171 21
Audiology programs: another viewpoint
A number of centers in Canada like the one in Vancouver, provide diagnostic and treatment services
and educational programs for the hearing impaired child and his family. But different centers have
varying ideas about the benefits of certain communication approaches. To give you a better idea of
how other programs across Canada operate, CNJ contacted the Audiology Department of the
Children's Hospital of Eastern Ontario in Ottawa. The focus of their program is a little different from the
Vancouver approach.
Andree Durieux Smith
Karen Tataryn
Judy Simser
The aims of the Audiology Program at CHEO are the early detection of
hearing loss and the early habilitation of auditory, speech and language
skills in hearing impaired children. Detection is carried out using
behavioral techniques whereby sounds are presented and responses
observed. In cases where results are uncertain. electrophysiological
procedures are used to record changes in brainstem activity as
responses to sound. (Brainstem Electric Response Audiometry). This
latter procedure enables the identification of auditory dysfunction even in
neonates.
Hearing aids are fitted as soon after detection as possible. Prior to
this, an interpretive session is held with the parents. the audiologist. the
social worker of the audiology team and the aural habilitationist who will
be responsible for the parent guidance program. In the interpretive
session. many important factors are discussed with the parents. These
include test results, the implications of the hearing loss. the
recommendation of hearing aids, the description of the parent guidance
program at CHEO together with the various methods used in training
hearing impaired children.
The early detection of heanng loss in children is essential. However,
detection without training defeats its own purpose. The incidence of
hearing loss requiring amplification is approximately 1 in 1000 and of
these. only 2 per cent are totally deaf. Many severely to profoundly
hearing impaired children can learn to listen and develop effective verbal
communication. The development of auditory skills is possibly one of the
most difficult tasks for these children to accomplish. It is also believed
that the early years of life are critical for using auditory input to develop
speech and language skills.
The aural" habilitation program at CHEO, which is available from
the moment of detection till the child is of school age. aims at teaching
parents to work effectively with their child. It is an individually prescribed
program stressing the participation of all individuals involved with the
child. Sessions are held on a weekly basis and include home visits. The
approach used initially is aural, however the therapy is diagnostic in that
the child and his family are continually assessed to ascertain which
method is most suitable for the child. If after a certain period of time. a
child is not progressing sufficiently with the aural approach, signs are
introduced and again the child's progress monitored. If it is determined
that the child would benefit from a total communication approach he is
referred to another program. A close working liaison is maintained with
existing programs in the area and the child continues to be followed
audiologically at CHEO
Parent groups are held on a regular basis for the parents in the
CHEO program. The sessions are educational as well as providing an
opportunity for parents to identify common concerns and discuss
possible solutions.
Regular conferences are held for all children at six month intervals
The child's progress, both from the parent and professional point of
view. short term and long term goals, and upcoming decisions around
the child's future are openly discussed. As a child approaches school
age, the possible educational alternatives are discussed with the
parents. It is our hope that hearing impaired children will be "integrated"
into normal schools with the help of special support services. However,
in some cases. it may be more beneficial for the child to begin school in a
class for hearing impaired youngsters This does not preclude later
integration with hearing children.
As in our initial interpretive session with parents. all professionals
on our team. voice their opinions about appropriate educational
placement. Each child and his family are unique and all relevant factors
must be considered in our recommendation. However, It is ultimately a
parent's responsibility to arrange the chosen school placement for the
child. The ongoing audiological assessment and parallel therapy
program are closely interwoven at CHEO. We are constantly evaluating
each child's progress and attempting to gear our interventions to the
specific needs of each child and his family. At the same time, we
acknowledge that it is not an easy task for parents to become "teachers"
of their hearing impaired child. We are most supportive of parents'
efforts and provide counseling for those who may be experiencing
abnormal stress.
The aim of the CHEO program is the integration of the hearing
Impaired child in a normal environment whenever possible. We hope to
facilitate this goal by responding to the total needs of each child and his
family.
.Aural communication concentrates on developing a child's auditory
skills using a unisensory approach. i.e. training a child to listen for and
distinguish human speech.
Andrée Durieux Smith (Ph.D. in human communication disorders,
McGill University) is Chief of Audiology, Children's Hospital of Eastern
Ontario. Ottawa.
Karen Tataryn, (M. S W University of Toronto) Social Worker.
Audiology, CHED.
Judy Simser (B. Ed.. McGill University; Dip. Education of the Deaf,
Manchester, England) Senior Aural Habi/itationist. Audiology. CHEO
22 Jenuery 1171
The c.on-.llen Nur..
Aperfeet
eoJUbiuation. . . you
and Mosby texts.
Your skills in the classroom
and our efIectiye texts can assure
your students of the best
in education.
MEDICAL/SURGICAL
A New Book! MEDICAL-SPRGICAL NURSING:
Concepts and Clinical Practice. By Wilma.J. Phipps, R.:-.!..
B.S.. A.1\1.. Ph.D.; Barhara C. Long. R.:-.!.. M.S.N.; and Nancv
Fugate Woods, R.X. :-1.1\:.. Ph.D. Using both a s'\'stems and
conceptual approach, this new text reflects' the mvriad
changes in contemporary medical/surgical nursing.111
first
two parts discuss such general aspects as socio-cultural
perspectives. the nursing process. stress and adaptation, and
PO:-1R. Part III focuses on specific medical/surgical
problems - each includes an assessment of the in'\'olved
system. followed hy a management/intelTention process.
Chapters seldom seen in other texts explore ecology and
health, health care delivery systems, and an epidemiologic
PI
roach to health care. Febmary. 1979. Approx. 1.600 pp..
13., illus. About H27.75.
Xew 6th Edition' .\1exander's C.\RE OF THE
PATlE:VT IN SURGERY. By MarieJ. Rhodes. R.N., n.S.K;
Barbara ,J. l.mendemann. R.X., B.S., :'-1.S.; and Walter F.
Ballinger. M.D.; witll 21 contrihutors. Long respected for its
accuracy and completeness. ilii!' classic text provides a
comprehensive ovef\;ew of safe. efficient OR nursing. More
than 2.000 superb illustrations (half new) augment
forthright discu!'sions including asepsis, positioning,
wound healing. and surgical procedures., June, 1978.904 pp.,
2.146 illus.. including 2 in full color. Price.
30.00.
A New Bo
k! C \lXCER - PathophysioloJ!y. EtioloJ!y.
Mana
ement: Selected RcadiI1
s. By Louise C. Kmse, R.X,
B.S.:-.!.. :-1.A.; ,Jean Reese. R.N.. B.S.X., :-U\.; and Laura Ilart,
R.X., B.S.N.. :-1.Ed.. M.A., Ph.D.; with 20 contributors. This
collection of articles offers VOlU students the latest
infonnation on cancer pre\'ention, detection. treatment,
rehabilitation - including the rc!e\'ant psychological
aspects. Throughout. discussions emphasize the
commonalities of cancer problems. and provide a practical,
positi\-e pcrspecti\'e of care. ,January, 1979. Approx. 448 pp..
35 illus. About t416.7;;.
Xew 3rd Edition! THE VITAL SIGNS WITH
RELATED CLINICAL MEAsrREMENTS. Bv Bettv
McInnes, RX. R.Sc.X..l\l.Sc.(Ed). Use iliis valuabl
textt
teach yourstudentshow to assess measurements made in the
clinical setting. The programmed fonnat arranges factual
material in small. logical steps - progressing from basic
infonnation to the complex. Two new chapters focus on the
he
rt. and
est and lungfuncyons. Fehmary. 1979. Approx.
144 pp., 3., Illus. About
9.7.,.
Xew 2nd Edition! CLINICAL IMPLIC\TIOXS OF
L\BOR.\TORYTESTS. BySarkoM. Tilkian.l\I.D.;I\1arv H.
Conover. R.X.. B.S.KEd.; and Ara G. Tilkian. M.D.. F.A.é.c.
Give your students the infonnation they need to detennine
the clinical significance of major labordtof\' tests. The hook
begins with a section on routine lab tests. a
d proceeds with
sections on tests used to didgnose specific diseases. This
new edition offers new chapters on rheumatoid and
infectious diseases - and boasts the strongest cardiology
':.c
ion of any similar
cxt. Febmary. 1979. Approx. 272 pp.,
4;) Illus. .\bout
HO.7;).
A Xcw Hook! BASIC PATHOPHYSIOLOGY: A
Conceptual Approach. By Maureen E. Groer. R.N., Ph.D.;
and Maureen E. ShekJeton. B.S.N.. M.S.N. The authors of this
useful new text ha\'e organized the '\'ast field of
pathophysiology into major conceptual areas. Included in
students' study of disease are cellular de\'iation. hodv
defenses. physical and chemical equilibrium, and nutrition
1
balance. Each chapter begins with leaming objectives which
can be used to aid the student in self-evaluation. Febmarv,
1979. Approx. 560 pp.. 423 ilIus. About 819.25. .
ew 2nd Edition! l'ROLOGIC ENDOSCOPIC
PROCEDPRES. B
Alicc :-Iorel. R:\.; and Gilbert J. Wise.
l\1.D.. F.A.C.S. An memhers of the urologic team will benefit
from this unique book. It thoroughly details all important
aspects of the sul
ieet - specific procedures. facilit\. and
equipment requirements, and equipment mainten-ance.
Revised and updated. tllis edition includes a new chapter on
urodynamic procedures. and new infonnation on instmment
cleaning and decontamination. March, 1979. Approx. 224
pp.. 258 iIIus. .\bout 81;;.00.
The c.on-.ll'" Nur..
Jenuery 11171 23
Xl.''' 2nd Edition! PI AXXIXG .
VD I)IPLE
IEX-
TTXG XrRSIXG IXTERVENTIOX: Stress and
.\daptation Applied to Patient Care. By Dolores F. Saxton.
R.N.. B.S.. 1\I.A., Ed.D.; and Patricia A. Ilyland. RX. B.S..:\I.5.,
;\I.Ed.. Ed.D. Help your students learn how to measure
patients' physiological and psychological adaptation to stress
- and use t11is infonnation to plan and implement nursing
interwn tion. Part I descrihes theory and Part II shows how to
apply t11ese concepts. Case studies are used throughout.
;\Iarch. 1979. Approx. 192 pp.. 47 mus. About 810.75.
Xew 4th Edition! :\TRSIXG C\RE IX EYE. E.\R.
XOSE, .-\..'XD TIIRo.\T DISORDERS. l3y William II.
Saunders. ;\1.0.; ,,'il\iam II. IIan..ner. 13..\..1\1.1).; Carol Fair
Keith. R.X.. B.S.X.. ;\1.5.; and Gail Havener. R.X. ll1is new
edition will help students increase their understanding of the
pathophysiology. sign ificant signs and symptoms. treatmen t.
and pre\'ention of EEXT disorders. Discussions emphasi.æ
the nurse's growing role in the health caI"(' system. including
outpatient. inpatient and homegoing preparation situations.
Febmary. 1979. .\pprox. 464 pp., 386 illus. Ahout
20.50.
Xc,," Yolume I! CrRREXT PR\CTICE IX XI'RSIXG
C\RE OF THE ILL ADl'LT: Issues and Concepts. By
;\Iaureen 0. Kennedy. R.X.. 1\1..\.; and (;ail ;\Iolnar. This
contempomry new \'olume examines the e\'eryday prohlems
encountered by nurses in the medical-surgical unit. Three
sections cover current practices (assessment. serious
illness). current concepts (patient-nurse interactions. new
tools for nursing). and current issues (nursing diagnosis.
primary nursing). Key professional issues and their
implications arc discussed t11roughout. and many timely
topics arc featured. Febmary. 1979. .\pprox. 320 pp.. 20 illus.
About 814.50 (llardcovcr):.\hout 810.75 (Paperback).
Xc,," Yolume [! CrRREXT PERSPECTIVES IN
REIIABILIT:\TIOX XrRSIXG. Edited bv Rosemarv
1\lurray. ;\I..\.. R.X.; and Jean r. Kijek. 1\1..\.. R.X. Xurse
.
psychiatrists. physical and occupational therapists. speech
pathologists. and other rehabilitation team professionals-
all join fi)rces toprm;de your sludents with valuahle insights
on all facets of this important topic. Particularly noteworthy
chapters deal with cultural implications. biofeedhack. sexual
therapy. and rehabilitation nursing in the ICU. ;\Iarch. 1979.
.\pprox. 256 pp.. 11 illus. About 814.50 (Hardhaek):.\hout
810.75 (Papcrhaek).
.\ Xew Book!APRACTICALM.
'Xr.\L FORPATIEXT
TE.\CHIXG. Edited b.... Karen 5. Zander. R.X.. 8.5.X., ;\I.S.;\;.;
et ai. This new manua(serves as a model and tool for a svstem
of patient leaching and documentation. It presents te
ching
plans and guidelines foranystage of the educational process.
and describes objecti\'C methods for evaluating the patient's
understanding. Each patient teaching fonn encompasses a
purpose. content outline. learner olliectives and e\'aluation.
Special features include a practical punched and peIforated
fonnat. and sample handouts for patients and families.
Septemher. 1 Y78. 412 pp.. 27 illus. Price. 816.75.
MA'IDWAL/ODLD
HEALnt
NeV.' 3rd Edition! MATERNITY NPRSING. By
Constance Lerch. R.N.. RS.(Ed.); and V. Jane Bliss. R.N:.
B.S.!'\.. M.S.X. Emphasizing t11e family aspects ofbirtb. t11is
comprehensive text provides a broad overview of obstetric
and neonatal nursing. Students will benefit from well
illustrated. detailed chapters on reproductive anatomy.
nonnal and high-risk pregnancy, and alleviation of pain.
Timely new material focuseson male and female responses to
pregnancy and birth. maternal-infant bonding, and
congenital heart defects. 1978. 592 pp.. 269 illus Price,
819.25.
4t11 Edition.
IATERXIn' l\lJRSING: A Self Study
Guide. By Constance Lerch. R.N.. B.S.(Ed.); and V. Jan
Bliss. R.N.. B.S.N.. M.S.X. Stimulate class discussion wit11
this helpful workbook! Beautifully correlated with the
chapters in MATERXI1Y l'\URSIXG. it offers students an
excellent vehicle for self-testing or group study sessions.
Incisive questions probe such topics as: family planning,
high-risk pregnancy. and the nonnal put:rpcriulll and ù1e
recovery nursery. 1978. 228 pp.. 60 illus. Price, 89.00.
A Xew Book! l\TITRSIXG CARE OF INFANTS.AND
CHILDREN. By Lucille F. Whaley. R.I'\., M.S. and Donna
Wong. R.I'\.. M.N.. PXA-P. A comprehensive. practical
approach to pediatric nursing. t11is new book focuses on
distributive nursing care. and uses a systems approach from
the medical model. The authors examine care of the ill or
disabled child, and stress promoting the healt11 of t11e well
child. Among t11e highlights. you'\1 find pertinent guidelines
for action. . . communication with children and families. . .
pertinen t lab data and phannaculogy . . . more than 250 tables
and 400 illustrations.. .andanappendixofnonnalvaluesand
assessment tools. April. 1979. Approx. 1.400 pp.. 744 illus.
\bout
24.00.
A ;\Iew Book! CHILDBEARING: Physiology,
Experiences, Needs. By Jayne DeClue Wiggins.R.I'\., B.N.
1.
This new text will help your students learn how to develop
expectant-parent education programs. It views labor as part
of the much larger process of childbearing - and deals with
the entire pregnancy period. prenatal. the actual birth
experience. and postnatal Almost 200 illustrations amplifY
the discussions. May, 1979. Approx. 144 pp.. 192 illus.
About 89.75.
A Xew Book! MEXTAL RETARDATIOX: Xursing
Approaches to Care. Edited by Judith Bickley Curry, R.X..
M.S.; and Kathryn Kluss Peppe. R.N., M.S.; with 23
contributors. Stressing a family-centered, humanistic
approach. this thought-provoking text explores
contemporary concepts in the care of the mentally retarded
and their families. Students will read definiti\'e. original
articles on: methods for maximum family involvement;
developmental assessment; and quality assurance in
residential settings. April. 1978. 258 pp.. 45 illus. Price,
MIO.75.
IVIOSBV
TIMES MIRROR
24 Jenuary 1971
The Can-.llen Nur..
Put our exPertise
to work in
your elassroolU.
CRITICAL CARE
A Xew Book! MOSBrS
1.-t.'\LTAL OF CRITICAL
CARE: Practiccs and Proccdures. Bv Linda Feiwell Abels,
R.X..
1.
. Offer your students clear. c
ncise instructions on
basic critical care techniques witl1 this useful new text.
Emphasizing systems assessment. it details mtionales and
pnxedures necessary for maintenance ofbody homeostasis.
Practical. comprehensi'\'C tables and useful appendices are
included - and margin indicators highlight significant
material thnHl
hout the hook. ;.larch, 1979. .\pprox. 254 pp..
laO illus. .\hnut
12.00.
A Xew Book! MOSBrS l\L-t.,\TUAL OF EMERGEXCY
CARE: Practiecs and Proccdures, By. Janet Miller Barher,
R.X..
I.S.; and Susan A. Budassi. R.N., M.S.X. This hea\ilv
illustrated new book offers your students a quick reference t
assessment skills and specific techniquestè:)r life supportand
stabilimtion of the critically ill or injured. Arranged in a handy
outlined fonnat, disucssions stress: signs and symptoms;
intenelationships of pathological phenomena; and critical
criteria and decision-making. May. 1979. Approx. 455 pp..
404 illus. .\hnut
lü.75.
Xew 2nd Edition! E
fERGEXCY CARE: Asscssmcnt
and Intcn'cntion. EditedbyCannen Gennaine Warner. R.N..
P.II.X.; with 38 contributors. Emphasizing an
interdisciplinary approach. !be new edition of this highly
acclaimed book shares the insights of authorities in all areas
of emergency care. They first describe underlying concepts,
then focus on specific types of emergencies. Students will
benefit from new chapters on child abuse, sexual assault. and
spinal cord injuries. April. 1978. 556 pp., 226 illus. Pricc.
2().:)().
A Xew Book! HANDBOOK OF E)IERGEXCY
PHAR..\L\COLOGY. By Janet :'-1. Barber, R.X.
1.s. This
practical manual will provide your students witl1 concise.
up-to-date infonnation on frequently used emergency drugs.
Detailed sections - organized according to drug action -
outline generic and tmde namcs. adions. incompatihilities.
administrations. adult and pediatric dosages. contraindica-
tions. and ad\'Crsc reactions. Ocwbcr. 197H. 150 pp_ Price.
R:;O.
.\ Xew Book! .\.\CX ORG.\XIZ.\TIOX .\XI>
M.\X.\(
E
IEXT OF CRITIC\L-C\RE F.\C1U fIES.
Edited hy Diane C. Adler. R.:\:., ;'1..\.. CCRX; and Xonlla. L
Shoemaker, R.x.. BSX.; wilh la contrihutors. This unique
new hook is the first to relate OI-gani.tation and management
concepts directly to critical care facilities. Contrihutors
wcll-known in the field dbcuss how to assess the intensi\'c
care unit. plan k)r optimal function. and manage available
resources. Con Slant attention is given to individual
accountahility and the importance of teamwork in the lCU.
.\pril. 1979. .\pprox. 192 pp.. 32 illus. .\bout f415.10.
FUNDAMENTALS
;\íew 10tl1 Edition! TEXTBOOK OF XXATOMY A.
D
PIITSIOLOGY. By Catherine Parker Anthom'. R.I'\.. B.A.,
:'-1.S.; and Gar
.. Arthur Thibodeau. Ph.D. Depend on the
leading text in the field for a precise. comprehensive. and
up-to-date presentation of human anatom\o. The new 10th
edition has heen thoroughly re'\'ised and no
' includes; more
than 200 full-color illustrations; new chapters on
articulation. the immune system, and the endocrine s'\'stem;
and expanded discussions throughout. January. -1979.
Approx. 672 pp.. 570 illus.. including 211 in 4-color. 20 in
3-color; and 238 in 2-color. About
21.75.
Xew 10th Edition! "-t.
ATO)n' .-t.
D PIITSIOLOGY
L\BORATORY :\L-t.'\"'CAL. B\' Catherine Parker Antl10nv
R.X.. B.A..
LS.; and Garv Arthur 111ibodeau. Ph.D. Th
companion lab manual to-Antl1Ony's TEXTBOOK has also
been ù1Oroughly re\'ised - and is the ideal way to give YOl1\'
studcnts firsthand pmctice in applying the scientific method
to anatomy and physiolo/.,'Y. Highlights indude: measurable
olÜectivcs for each exercise; more emphasis on pathology;
and the addition of 20 new experiments! .January. 19ï9.
"\pprox. 240 pp.. 169 illus. About
9.75.
:\:ew 2nd Edition! THE ;\lJRSIXG PROCESS: A
Scientific Approach to Xursing Care. B\' Ann
larriner.
R.X.. Ph.D. The autl10r has compiled 290ut-;'tandingarticles
dealing with each phase of the nursing process -
assessment. planning. implcmentation. and e'\'aluation. Each
group of readings is prefaced by an insightful introduction
and followed by an cxtensive hihliography. .January, 1979.
Approx. 288 pp.. 6 illus. .\hnut
12.00.
ew 2nd Edition! FUXDA..\IENTALS OF OPERA-
TING ROO)I ;\TRSIXG. Bv Shirle'\' M. Brooks. R.X., B.A
Written especially for studénts with no operating room
experience. this valuable text thoroughly details
fundamentals of preoperative. intraoperath'e, and
postoperative care. The book is specifically designed to be
used by students concunently with their rotation in the
operating room. A photo-re\'iew quiz is pro,\oided to aid the
student in evaluating proficiency.
larch, 19ï9. .-\pprox. 21 G
pp.. 2Hl illus. .\hout
1O.2:;.
ew 4th Edition! CLIXICAL
TRSIXG TECH-
'XIQrES. By !\:"onna Dison. R.X.. B.A.. M.A. Guide your
students through basic and advanced techniques in
medical-surgical nursing with tl1e help of the new edition of
this well-recehoed text. They1lIearn procedures step-by-step
from authoritati\.c discussions. augmented hymore than ï03
original line drawings. Principles and purpose are
emphasi.ted rather than disease orhody systems. A teacher's
guide is included .\pril, 1979. .-\pprox. 432 pp., 703 illus.
"\bout
14.:;O.
The c.on-.llen Nur..
Jenuery 1871 25
Xcw 14t11 Edition! PIL\R.\L\COLOGY IX :\TRSIXG.
By Betty S. Bergersen, R.X.. :'-I.s.. Ed.D.; in consultation with
Andres Got11.
1.D. Trust this classic text to pro....ide your
students witI1 the infonnation the.... need to ensure rational
amI optimal drug thempy. 111e auihor has updated all drug
infonnation - and each chapter has been critically rc....iewed
by Andres GoÙl. renowned authority on phannacology.
Highlights include: expanded cm'eragc on drugs for t11e
eldcrly; new infonnation on enzymes and drugs acting on
gastrointestinal organs; and all new chapter summaries.
January. 1979. Approx. 784 pp.. 100 illus. .\bout
20.:;0.
CO
D
TIT
1ßSING
A Xew Book! IXXOYATIOXS IX CO
nlrXI1T
HEALTH :\LJRSIXG: Health Care Delivery in Shortage
Areas. Edited by Anne R. Warner. B
\.; with 23 contributors.
Offer your students a creative approach to community health
nursing. This timely book bridges the gap between the real
and ideal by presenting first-person accounts of the
challenges inherent in inner city and rural practices.
Inno....ati....e solutions to both timeless and new problems are
described. pro....iding an effecti....e demonstration of the
decision-making process in action. March. 1978. 250pp.. 23
illus. Price,
10.25.
Xew Yolume I! CrRREXT pR.\mrE IX GEROX-
TOLOGIC\L XrRSIXG. Edited by Adm'! :'-1. Reinhardt,
Ph.D.; and :'-lildred D. Quinn. R.X..:'-1.S.; with 19contributors.
The politics of care for the aged . sexuality and aging. . .
growing old in thc Black community .. thelawand t11e elderly
- these arejusta few of the many stimulating topics detailed
in this new book of readings. The contributors are all
knowledgeable and experienced - and together they offer
your students a thorough m'erTiew of the sUQject. :'-Iarch.
19ï9. Approx 304 pp. .\hout
14.:;O (Hardhack): -\bout
1O.7:; (Papcrback).
A Xew Book! THE A..'XTHROPOLOGY OF HEALTH.
Edited by Eleanor E. Bauwens, R.X.. Ph.D.; with 23
contributors. Help students better understand the dÎ'\'erse
beliefs of other cultural groups with this new text. Original
papers apply anthropological principles to health care;
explore the relationship of medicine to culture, society and
health carc; survey changing food habits in \'Rrious cultural
groups; and discuss the sociocultural aspects of aging and
d'\ing. Case studies illustrate major concepts. September.
19ï8. 228 pp.. illustralcd. Price.
12.7:;.
ISSUES
'
nm,rns
A Xew Book! :\TRSIXG: A World View. B'\' Huda
Abu-Saad. Ph.D.. :'-I.X. B.S.X Yourstudentswillenj
y-and
benefit from - this unique new text. It pro....ides a worldwide
historical perspecti....e of nursing. co....ering the growth and
de....elopment of the profession in more than 30 countries.
Useful tables summarize de....elopments in '\'Rriouscountries
for quick comparison. :-larch. 19ï9..\pprox.208pp.,14illus.
About
I:;,OO.
.\ Xcw Book! SPECIAL TECHXIQrES IX
.\SSERTIYEXESS TRAIXIXG FOR WOMEX IX THE
HEALTH PROFESSIOXS. By Melodie Chene....ert, B.A.,
I.s. Written with humor and insight into human nature, this
text focuses on learning to be asserti....e in order to impro....e
patient care. Discussions demonstrate ùle significancc of
de....eloping greater self-esteem and stronger leadership roles.
Examples of specific situations clarify key concepts.
Throughout, the author differentiates between effective
asserti....eness and abrasÎ'\'e aggressÎ'\'cness. Xm'ember.1978.
Approx. 128 pp.. 13 illus. About
9.7:;.
Xew \'olume I! CrRREXT PERSPECTIVES IX
:\TRSIXG
L\XAGÐIEXT. Edited by Ann :'--Iarriner. RX,
Ph.D. Twent\ noted nurse leaders ha\'c contributcd
insightful articles focusing on specific infonnation that
beginning middle managers need to know. Students will
benefit from discussions including use of teams in health
scrvÎCcs. planned change. communication. patient
education. continuing education. and political dynamics.
:-larch. 19ï9. .\pprox. 240 pp.. 8 illus. \bOl1t
14.50
(llardback):.\bout
10.75 (Papcrback).
PRA.cnCAL
TßSING
Xew 3rd Edition! BASIC PEDL-\TRIC XrRSIXG. B'\
Persis ;\Iary Hamilton. R.X.. P.H.X. B.S., ;\I.s. Help you"r
students better understand the special needs of their
childhood patients. This useful text pinpoints the spccific
role of the LP/YX in child care. prm'ides comprehensh'e
infonnation on growth and de'\'elopment,examinesdisorders
common to children, and offers a holistic \'iew of the child in
society. Timely. well-illustrated new discussions explore
neonatal care, immunization. and diagnostic tests. February.
1978. 490 pp., 272 illus. Price,
1 a.25.
Xew4th Edition!
L\TERXAL.-\XDCHILD HEALTH
:\TRSIXG. By A Joy Ingalls. R.X, ;\1.s.; and
1. Constance
Salerno. R.X.. :-1.s.. S.X.P. Well-written and effectively
illustrated. this new edition introduces the LP!\'X student to
major challenges in maternal/child health nursing. It
successfully combines obstetric and pediatric nursing - so
\'our students will know what to do, how to do it, and whv.
Thoroughly re'\'ised. this new edition includes more t11an 200
new illustrations - and updated infonnation in all areas.
:-la
, 19ï9. .\pprox. f)ï2 pp.. f)9:
illus .\bout
1 H.OO.
IVIDSBV
TIMES MIRRDR
THE C. V. MOSBY COMPANY, LTD.
B6 NORTHLINE ROAD
TORONTO, ONTARIO
M4B 3E5
Mosby kno
s nursing.
he pr. blem
· f immunizati · n
in anad ·
Sandra LeFort
,
I
\ , \
I
;, ,...
r - J
. . -.
I
. ,
. J
J I I
,
I '"' p
- -
The Cen-.llan Nur..
Januery 11171 77
Few measures in preventive medicine are of such proven
value and as edsy to implement as routine immunization
against infectious diseases. J Over the last three decades.
widespread acceptance of vaccines has dramatically
decreased the incidence of certain communicable disedses
such as poliomyelitis and whooping cough. According to the
World Health Organization even smallpox. the most
devastating disease in history. has been completely
eradicated from all countries in the world.
But with all this success. there is evidence that
immunization may be lagging in Canada and that some
vaccine-preventable diseases such as diphtheria. may
actually be on the increase. Are you aware. for example. that
in Canada in 1975. nine children died from whooping cough.
two from diphtheria. seven from measles and two from
rubella?" Each year. more than 100 babies are born with
serious defects because their mothers had rubella during the
first three months of pregnancy. Why is this still happening
in a highly developed country such as Canada?
Immunization programs have been going on since the
40's. but most parents. and medical per'\onnel for that
matter. have forgotten the tragedy ofthe polio epidemic of
the 50's. As a result. the recurrent need for immunization for
both children and adults does not seem as apparent as it once
did. As the 1977 annual report of the Canadian Medical
Association's Council on Communit} Health stated:
. 'I t is clear that the public is being lulled into a false sense of
security because of the absence of epidemics of the usual
childhood diseases and is neglecting to have young people
receive the recommended immunizations'"
Which leads us to another question ... What is the
recommended schedule of immunizations'? The debate about
"which schedule is best" has been going on for some time
between medical authorities at all levels - at the local.
provincial and national levels. In 1977. a National Advisory
Committee on I mmunizing Agents agreed not on one but
three immunization '\chedules for infants and children. The
rationale for choosing three schedules was that "no single
set of recommendations for the use of these vaccines is
optimal for all situations." At that time. the committee
believed that there was not enough evidence to support one
schedule unreservedly and that all three are equally
effective.
It sounds good. But. according to a recent editorial in
the Canadian Medical Association Journal. there is still a
problem. Apparently. the provincial health departments do
not necessarily follow the recommended schedules. local
public health authorities at times do not follow their own
provincial programs and finally. some individual physician..
establish their own preference in immunization schedules. If
medical duthorities are openly unsupportive of each other. it
is no ..urprise then that the public is in the dark.
'The public is confused regarding what immunization
they have had. should have had or require. A sizable
segment of the health professions is not much better off.
"Adding to the confusion are an increasingly mobile
population moving to and from areas with varying
immunization record transfer and patients who have no
personal record or idea regarding what they or their children
have been immunized for - or their current immunization
status. ..:t
Part of the sol ution. according to the editorial. is the
acceptance of a single immunization schedule by all health
departments and health professionals. Recently. ajoint
committee of the Canadian Hospital Association. the
Canadian Medical Association. the Canadian Nurses
Association and the Canadian Public Health Association
supported ,his idea by proposing that all these agencies
should accept as a high priority the establishment and
promotion of a basic. single. national immunization schedule
and program. CNA's Board of Directors ha.. given its
support to the recommendation.
At a meeting of the National Advisory Committee on
Immunizing Agents held in late October 1978. this
recommendation and others from various groups were taken
into account and now. a single. immunization schedule has
been adopted. (See page 29)
Even so. the main problem of keeping Canadian
children and adult, protected from communicable diseases
remains with us. Media campaigns are trying to keep the
subject of immunizatIOn in the public eye. A concerned
committee has made November "Immunization Action
Month". Its immediate objective is to promote immunization
against vaccine-preventable diseases for all children in
Canada before the age of school entry.
And so. what is your part in all this? By virtue of your
role as a nurse. whether in a hospital. public health unit or a
doctor's office. you are in contact...... ith a great number of
children and parents. Have you taken the time lately to talk
about immunization to them. ih importance to their health?
Have you encouraged primary immunization of all children.
stressed the need to schedule vaccinations and emphasized
why booster doses are necessary? The following
"Immunization Fact Sheet"" prepared for parents by the
Canadian Paediatric Society and the Canadian I nstitute of
Child Health may be of some help to you as a nurse in
pointing out the whys and ho......s of an immunization program
to clients.
21 Jenu8ry 11179
Th. c.on-.llen Nur..
Immunization Fact Sheet
1. A re ÏI!fectious diseases a prohlem in Canada?
It is astoni'ihing that while notahle results have heen
achieved in the control of whooping cough. measles. ruhella.
polio. tetanus. mumps and diphtheria - the major
preventable childhood diseases - infectious disease'i are
still among the four leading caU'ies of hospitalization of
children (with accidents. respiratory problems and
congenital anomalies being the other three). Many of the'ie
infectious disea'ies could he prevented hy immunization.
2. Do children eI'er die from prel'entahle diseases?
Some children 'itill die each year from these diseases and
others develop serious complications such as encephalitis.
pnl?umonia and hearing loss. One study show'i that ahout one
in ten children who have measles develop complications.
3. Where can I Ret m\' child imllll/1/ized?
In thi'i country many places are availahle to provide
immunization and this varies greatly from province to
province. Your child may be immuni7ed in public health
departments. community clinics. hospital clinics. and
schools or thi'i may he carried out hy family physician'i or
pediatricians.
4. Who should I..eep the record?
As a parent. you should keep a written record of the vaccines
that your child receives and the date of the injection. No one
else is going to do this for you. You", ill need this
information if your child is taken to emergency for treatment
of wounds. for example. In this case. the doctor will need to
kno", if the child's tetanus immunization is ddequate.
Immunization information is al'io required when your child
begins school and if immunization i'i part of the school health
program. you will need to know what has already heen given
and when. I t is al'io needed if you move to another locality or
travel ahroad. Recently. a new immunization health record
wa'i prepareu hy the Infectiou'i Di'ieases Service at the
HO'ipital for Sick Children. It will he extensively used and
distrihuted throughout the province of Ontario as a
permanent record for children. (See page 30)
5. W hell should my child hi' Ïlnm/l/liznland fár what
diseases?
I mmunization should be 'itarted hy two or thl ee months of
age and should follow a schedule as recommended by your
puhlic health clinic or your doctor. Booster shOb. given at
intervals following the primary immunization. are necessary
to reinforce the child's immunity.
6. What should I\'e do
{we plan to trlll'el outside Canada?
Because it may take several weeks. be sure 10 check in good
time with your doctor or puhlic health department. Several
immunizations may he needed depending on the country you
plan to visit.
7.1 s immulli;:.ation a mi/ahle jllr all infe( tious diseases?
No. but re'iearch is in progress to provide protection against
diseases such as chicken pox. gonorrhea and infectious
mononucleo'iis.
8.1 s there a way to protect my child aRainH di.\'ea.\es JÓr
It'hieh there i,\' no ,'accine?
In some instances. temporar} protection may be given or the
disease modified. Check with your pediatrician or local
health duthority.
9. What is the risl.. (!{damage to a hahy ({the mother
del'elop.\. ruhella during the }ìnt three month, of the
{lreR/wncy?
Overall. there is approximately a 50 per cent risk (0 the
baby. The earlier the maternal infection occurs during
pregnancy. the more severe the fetal damage. The most
common problems are heart defects. deafness. blindness
and mental retardation. A pregnant woman should not
receive rubella vaccine.
10. ffmy teena,l!e dauRhter has ne"cr heen immunized'/Ór
ruhdlaand la/11uncertain (fshe e"er Iwd the disease. It'hat
.\JlOuld she do? 1.\ it too late for her to he immunized?
No. it's never too late to immunize against ruhella. A simple
hlood test can he done to determine whether vaccination is
necessary.
1 I. ffm," child JIlI,\' Jwd polio \'accine h,' needle and I\'e mm'e
to a place II'liere polio n/ccille is g;,'en h,'. mouth. is it
nece.Hary ami s(dé for the' child to he renlCcillated?
Regardless of whether the fir'it immunization was by needle
or by mouth. if further dO'ies are needed it i'i perfectly safe to
follow the practice of where }ou are living.
12. What should I do (/1 su.\'pect my child hm all ÏI!féctiOlH
di,\' e a.\(' ?
Keep him at home and contact your physician for further
advice. ..,
References
I Routine immuniz,ttion 'ichedules.Call..'11ed.A.,..\..J.
117:6:705. Sep. 17. 1977.
:! Canada, Statistics Canada. Registrie'i Section. Health
Division. IV ot!lìah/c' Diseases - Vital Statistin ami Disease.
3 Geekie. D.A. Promotion and marketing techniques
could helpCanada's disorganiLed immulllzation 'ichedules.
Call.Aled.A.u.J. 119:
:76()-76:!. Oct. 7. 197K
4 11I/1111l11izat;o/1 Fact S 11('('1. Canadian Pediatric Society.
Canadian Institute of Child Health. 1977.
The Cen-.llen Nur..
Jenuery 11171 211
NATIONAL ADVISORY COMMITTEE ON IMMUNIZATION
RECOMMENDED* IMMUNIZATION SCHEDULES FOR INFANTS AND CHILDREN
Immunization carried out as recommended in the following revised schedules will provide good basic protection for most children against the
diseases shown.
With respect to tetanus and diphtheria, the schedules pertain to use of either fluid or absorbed toxoids. but in view of their superior antigenic
properties. the use of absorbed products is to be recommended when such products become available.
Both live and inactivated polio vaccines have been used in Canada with equal success in preventing the occurrence of paralytic poljo, and
either may be used in the schedules presented below.
Tabte 1
Routine Immunization Schedule For Infants And Children
2 months Diphtheria
4 months Diphtheria
6 months Diphtheria
12 months Measles
18 months Diphtheria
4-6 years Diphtheria
11-12 years Rubella I for girls
14-16 years Tetanus and Diphtheria 2
Pertussis
Pertussis
Pertussis
Mumps
Pertussis
Pertussis
Tetanus
Tetanus
Tetanus
Rubella I
Tetanus
Tetanus
Polio
Polio
Polio
Polio
Polio
Polio
Table 2
Immunization Schedule For Children Not Immunized In Early Infancy
For children 1 through 6 years of age
First visit' Diphtheria
Interval after 1 st visit
1 month Measles
2 months Diphtheria
4 months Diphtheria
16 months Diphtheria
At 11-12 years of age Rubella I for girls
At 14-16 years of age Tetanus and Diphtheria"
For children 7 years of age or over
First visit'
Interval after 1 st visit
1 month
2 months
14 to 16 months
At 11 -12 years of age
At 14-16 years of age
Pertussis
Tetanus
Polio
Mumps
Pertussis
Pertussis
Pertussis
Rubella I
Tetanus
Tetånus
Tetanus
Polio
Polio
Polio
Polio
Tetanus and Diphtheria'
Polio
Measles
Tetanus and Diphtheria"
Tetanus and Diphtheria!
Rubella I for girls
Tetanus and Diphtheria 2
Mumps
Rubella I
Polio
Polio
Polio
Notes:
1. Rubella vaccine is recommended either
a) for all infants over the age of one year or
b) for prepubertal girls at about the age of 12 years.
At the present time. insufficient data are available as to which is the more effective program for preventing congenital rubella syndrome.
2. Tetanus and Diphtheria Toxoid. a combined preparation for use in persons over six years of age, contains less diphtheria toxoid than
preparations given to younger children and is less likely to cause reactions in older persons. If it is not available, other combined preparations of
diphtheria and tetanus toxoids (without a pertusis component) may be used in a dose recommended by the manufacturer for the particular age
group.
3. Although not desirable. measles. mumps and rubella vaccines may also be given at the first visit if it is considered likely that a child will not
return for further immunization.
4. Measles vaccine (live, attenuated) may be given either alone. or in combination with rubella vaccine. mumps vaccine or both. In areas where
special epidemiological conditions exist. and particularly where measles occurs frequenlly in the first year of life. measles vaccine may be given
as early as five or six months of age; if measles vaccine is given before 12 months of age. it is imperative that a further dose be given at about 12
months of age. as persisting maternal antibody may interfere with an adequate immune response to the earlier dose.
5. Where more than one preparation is given. whether they be single vaccines or commercially prepared combinations of vaccines. a separate
injection site should be used for each product.
6. Smallpox vaccination is not recommended.
*These recommendations were issued by the National Advisory Committee on October 27, 1978 and have been
endorsed by the Canadian Paediatric Society.
30 Jenuery 1117V
The C.n-.llen Nur..
The Hospital for Sick Children
IMMUNIZATION
AND HEALTH RECORD
Name of Child
Birth Date
RECORD OF IMMUNIZATION
DPT + Polio Vaccine
:
rn B DT + Polio Vaccine
in B
First Dose Date Booster Date
Second Dose Booster
Third Dose Booster
Fourth Dose
Booster Dose
Measles Vaccine
Mumps Vaccine
Rubella Vaccine
Date
Tuberculin Test
Date
Results
Hemaglobin Date Results
Urinalysis
Vision Test Date Results
Hearing Test
Illnesses & Operations Date Past Infectious Diseases Date
Measles
Mumps
Chicken Pox
Whooping Cough
This Record Should Be Retained And Kept Up To Date
The Cen-.llen Nuree
Jenuery 1117V 31
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aren't problems
anymore
At this hospital, there's a nurse in street clothes that nurses,
patients and their families can turn to for help in meeting the
emotional needs of the "problem child" on the general
pediatric ward.
Kathy He[?ll(loren
32 Jenuery 111711
For the past three years our hO'ipital ha'i
been the scene of an interesting and. we
think. successful. experiment aimed at
making sure that. when a child is
admitted to our general wards. not just
his physical. but also his emotional.
needs are looked after. As the "pediatric
psychiatric nursing coordinator" - a
title suggested by one ofthe staff
members - it is my job to provide
leadership in dealing with psychiatric
patients admitted to general pediatric
wards and a,sistance in handling any
other behavior management problems
encountered throughout ourChildren's
Pavilion.
In recent years the trend at our
hospital. as in many others. has been to
admit an increa'iing number of children
with psychiatric diagnoses to general
pediatric wards. More and more
behdvioral problems manife,ted during
medical or surgical hospitalÌ7ation are
al'io being identified on wards. These
children require a consistent therapeutic
regime to meet their 'ipecialized needs
and. while it is sometime'i easy to
identify what a particular child's needs
may be. difticultie, frequently ari'ie in
providing the neceS'iary nursing hours.
Dealing with emotionally distressed
children can be very time consuming and
'itaff tend to give priority to providing
care for the acute medical and surgicdl
conditions. Then too. some nursing staff
are uncomfortable about being involved
with children admitted for psychiatric
help; others are he...tant due to lack of
e'l.pcrience or previous unrewarding
experiences.
It wa'i in response to these concern'i
that the administrative staff and child
psychiatrist decided to create and till the
position of pediatric psychiatric nursing
coordinator - a nUf'\e who would help
The C.n-.llen Nur..
other nurses to find ways of meeting the
emotional needs of their patients. The
job description made 'ieveral points clear
from the beginning:
. The per'ion Wa'i to be employed at
the general duty level to prevent the
necessity of developing a new nursing
category within the hospital.
. Hours of work were left tlexible to
allow the nurse herself to determine
which days she would work and at what
time her tour of duty would begin.
. This person would be directly
responsible to the assistant director and
supervisor of pediatrics and indirectly to
the head nurses of the pediatric units.
When I accepted the position of
pediatric psychiatric nursing coordinator
late in 1975,1 had already worked for
three years in adolescent psychiatry. The
administrative staff. who predicted that
the succe'iS of the program would hinge
on my acceptance by everyone on staff.
planned a very special kind of orientation
for me. We wanted to make sure that all
levels of staff saw me first as a nurse with
tmditional competencies and second a'i a
nurse who could help with specific
p'iychiatric competencies. 1 had to avoid
being perceived as a suspicious looking
"expert" telling others \\hat to do. With
these ol:iectives in mind I began my tour
of duty as psychiatric nursing
coordinalor in uniform. working general
duty on each ward for varying periods.
Different wards demanded different
involvement. A., most of my work would
be with children between 'iix and thirteen
years of age. 1 spent a \\eek on these
wards. I spent three days on wards with
children between the ages of eighteen
months and six year'i and two day'i on
ward., with infants up to eighteen
months. It was more ditlïcult for staff
caring for infants to see much use for a
psychiatric nurse. except in the area of
dealing with parents.
This orientation period provided me
with an opportunity to appreciate
nursing problems at different levels of
treatment. to become acclimatized to
each unit and to sow seeds of
information about how this consultant
role might develop. The orientation
lasted almost two months. and. as it
drew to a close. I found myself eager to
begin my actual work. My eagerness.
however. was coupled with a twinge of
anxiety: as this was a unique position.
there had been no previous experience
from which performance criteria or
expectations could be drawn. At time'i I
wondered "What am I really getting
into?"
All this wa, three years ago and by
now I feel more comfortable about being
the psychiatric nursing coordinator on
pediatrics. I wear streetclothes which
seem to have been readily accepted by
both staff and patients and. although
there have been times of personal
alienation when I felt a., if I didn't
belong. in general. the demand for
p'ychiatric competencies has increased.
Most of the time I feel that my days are
well 'pent. The work varies: the list of
activities I have been involved in is long
and includes:
· C oordinlltion (
"lI11llspects of the
psychiatric trealmem program:
physiotherapy. occupational therapy.
\chool. parents, etc.
. W eeMy coriferences with \'lIrioll.
stajJ in\'OII'('(1 with the child
psychiarri,ft's patients. This meeting is
primarily for planning short and long
term treatment goals. school planning
and discharge planning. A record is kept
of the discus,ion.
. N lining care planning: team
conferences on a/l of the psychiatrist's
patients frequently includmg other
specific behavior management problems
that have been raised by nursing staff. As
a result ofthe'ie conferences. st.mdard
nursing care plans on some common
psychiatric problems have been
developed including h
perkinesis and
school phobia. A guide for developing
behavioral-oriented nursing care plan
has been posted. In addition. a charting
guide for children with behavior
problems has been developed and is in
the process of being accepted a., pan of
the charting manual.
. I nser\'Ìce education: This aspect of
consultant work is usuallv done through
specific ward ses.,ion
but is also an
ongoing process in team conferences. A
growing collection of re'iource material is
available to all interested staff. Staff are
also invited to attend the weekly student
intern seminars given by the child
psychiatrist.
. Student nurst' education: Student!.
are free to attend team conferences and
inservice to gain understanding in this
panicular aspect of care in pediatrics.
Their interest in helping children\\- ith
psychiatric problems is also reflected
through requests for guest speakers in
their training program.
. Liaison wor/.. with parents: Parents
meet one evening a week with the
psychiatrist and ward staff and often
discover that they are not the only ones
with "problem children". Parents of
babies in the Neonatal Intensive Care
Cnit meet twice a week to share their
fears and questions with unit staff. the
pediatric social worker and myself. This
service is unique in that it is abo offered
to mothers who have gone home without
their babies and wish to share their
anxietie
before and after baby comes
home.
. Group therapy: a dailv. two-fold
re
pon.,ibility in that group therapy is a
well e.,tablished form of treatment for
children with psychiatric problems.
serving to teach communication skills
The Cen-.llen Nur..
and to seek out alternate ways to deal
with life's stresses. It is also a teaching
ground used to instruct staff in various
group techniques and group dynamics.
The after-group sessions with staff
provide more teaching opportunities and
a chance to discuss day-by-day
developments.
. Obsen.ation and .mpen'ision oj a
comhined Rym proKram: This is a
relatively new program where the
pediatric psvchiatrist's patients are
grouped with adolescent psychiatric
patients once a week for various sport'>
activities. Our hope is to use this
program to teach better sibling and peer
group understanding.
. Bi-wee/../yfilm entertainment for
preschool and ScllOol-aKe patients: The
National Film Board is our present
,>ource of films but other sources for
children's films are being looked into.
The hospital has agreed to provide some
monies for film rentals in the next year.
. Teacher-coordinator liai.wn: I\lany
of the problems of children with
psychiatric disorders stem in part from
disastrous school experiences. It
becomes the task of the therapeutic team
to help each child cope with <,chool
stresses. Having a close working
relationship with the hospital's special
education teacher. keeping her informed
of daily de\elopments. has improved
communication between ward and
clas
room staff.
. School-community liaison: The
psychiatrist. his intern. the in-hospital
teacher. m}-selfand. when po'isible.
ward staff meet with the involved
teacher; and the parents at the
community schools. There we discuss
what we have learned about a child and
his family. giving teachers more
background. understanding and help in
devising effective long term school
plans.
Jenuery 1117i 33
The future
To me. one of the most challenging
aspects of this position is the idea that it
is
till evolving. I meet regularly with the
assistant director of pediatrics who
provides guidance and assistance a<; well
as feedback on how the job is going. In
the future the role of pediatric
psychiatric nUßing coordinator can take
many directions. One avenue which ha
been looked at with an eye to future
expansion is t.tJat of parents' groups for
patients with common concerns. The'ie
groups might discu'is the art of parenting
or problems associated with failure to
thrive. a'ithma.leukemia or orthopedic
conditions. Post-discharge group
for
parents and children can be valuable in
the promotion of well-being and
prevention of repeated hO'ipitalizations.
Home visiting is also an area ripe for
expansion. My involvement in the area
of child ahuse is still in a very early stage
of development. An ongoing inservice
program for nursing staff. involving the
hospital's psychologist. i
being
established with the objective of teaching
communication .,kills and basic group
techniques. These are only a few of the
directions that might be follo\\-ed.
The creation of the pediatric
psychiatric nursing coordinator is
evidence not only of the recognition of
the emotional needs of children but of a
positive step in the direction of meeting
the'ie need... '"
A t the time of u'ritinK this paper. author
Kath
Hegadoren II'lIS the pediatric
psychiatric nun-inK coordinator.
Children's P(II'i/ion. Royal Alexandra
Hospital. Edmonton. Alherta. Privr tv
tlris position. she \\ as tire coordinaror of
the adolescent psychiatric proRram at
the R.A.H. As o.fSeplember 1978. Kathy
Iras embar/..ed on a new \'entllre in the
neonatal intensÌ\'e care nursery liS a
matemal-Ì1(fa/lf liaison nune
(Ç)(tJJ
(p
(Çru
(b
(Çooruoo
Caring for the retarded child in an acute care setting
BriKid Peer
. A ten-year-old who drools
constantly and needs help to feed
himself
. An adolescent who reacts to
strange faces and surroundings by
"making strange" like a toddler
. A "self-stimulating"
four-year-old who shows no sign of
hearing or seeing you, who refuses
to establish eye contact and snaps
his fingers instead of talking.
Not all retarded children have behavior
problems as severe as those described
above. but there can be little doubt that
in the eyes of the nurse who assumes
responsibility for their care in hospital.
looking after these special children
presents some very special problems.
Estimates place the number of
retarded individuab in the population at
approximately three per cent. Among
those of us who are fortunate enough to
be excluded from this category, mental
retardation evo"e, a variety of
responses. most of them negative.
Nurses. on the other hand. are "not
supposed" to have negative feelings and
so we are apt to be unwilling or unable to
express the dismay we may feel when
confronted with the prospect of caring
for a retarded child in an acute care
etting.
We are frightened of the temper
tantrums of the physically mature
adolescent: we don't know how to react
to the finger-'mapping youngster who
doe
n't seem to know we exist. We
wonder how we're going to find time to
feed the newly admitted ten-year-old
who needs half an hour of our undivided
attention to finish one meal.
Often. the easiest course is to
confine these children to their beds, to
restrain them if they show signs of
resIsting, and to provide them with few
toys and little or no stimulating
interaction with staff and other patients.
We sigh with rehefwhen a parent wishes
to room-in with his child and, after
treatment or surgery. hurry them back to
the home or institution where we feel
they rightly belong, Ifwe are honest with
ourselves. we admit that we are not
comfortable with these special children
and. as a result, their stay in hospital
becomes a traumatic experience for
everyone concerned - nursing staff,
parents and the children themselves.
Piaget has defined intelligence as the
ability to acquire knowledge which
facilitates the adaptation of the
individual to his environment. I.' I tis
obvious that. according to this definition,
the ability of the retarded child to accept
strange surroundings. painful procedures
and changes in routine will be limited.
His needs. however. are the same as
those of the normal child and he is as
sensitive as the normal child to his
environment and to tho'\e who care for
him.
Clearly. what is needed in many of
our acute care settings is a new and more
positive approach to looking after the
hospitalized retarded child.
Admission
Sometimes. when it i.. known thdt a
retarded child is going to be admitted. it
is helpful for the staff members involved
to sit down together and have an honest
discussion about their feelings in canng
for a retarded child. At that time. those
who really do not feel capable of coping
can be identified so that they are not put
into the position of having to care for the
child. One or two ..tatT members may be
chosen or volunteer to be the chief
caregivers for this particular patient.
Since many of the problems
invol ved in caring for the retarded child
in hospital arise out of lack of
understanding. it is important to learn as
much as possible about the child at the
time that he is admitted. Make time to
talk to the parents who. even though
they are undergoing a period of stress,
can often provide real insight and
constructive suggestions. Find out
whether the child likes to be cuddled or
stroked. whether he has a favorite to) or
..pecial feeding or sleeping ritual. I f one
staff member has been chosen to act as
chief caregiver. this nurse should obtain
a very thorough history from the parent
or person who admits the child.
Since the retarded child has
difficulty in adapting to new situations.
all his routines of daily living should be
carefully documented. I n this way. the
only changes that will have to be made
will be those demanded by the medical
regimen and the child will settle more
quickly into the unfamiliar setting.
Whenever possible. a bed should b
chosen for him which is near to the
center of activity. This child needs more
contact with people than a normal child
sincf: he is less able to amuse himself.
His companion in the room should.
preferably. be mobile. able to help his
roommate. and to go for help if it is
needed. If the companion's parents
complain about his being in the room
with a retarded child. an effort should be
made to have them accept the situation.
If they remain adamant. how about
moving the normal child to another
room '? He is better able to adapt to new
The Cen-.ll8fl Nur..
Jenuery 111711 35
surroundings than hi
retarded
roommate. Too often we see the retarded
child shuffled from room to room as
complaints come in. until he ends up
around the corner. down the hall. by
himself. where no one will be bothered
by him.
Nursing assessment
Next. the nurse should make her own
assessment of the child's developmental
level. This should then become her guide
in planning nur
ing interventions. Often.
chronological age has little relation to the
child's capacity to function. In assessing
the retarded child. it is not unusual to
find an irregular pattern of development:
gross motor skills, for example. may be
close to normal while all other areas lag
far behind.
In preparing a retarded child for
surgery or treatments. his developmental
level is again the guide. All children are
entitled to an explanation of what is to be
done to them. Even if you feel you are
'"talking to the wall" go ahead and
prepare him anyway: his comprehension
may far outstrip his expressive ability.
You have nothing to lose and everything
to gain ifhe is prepared. less anxious and
therefore easier to care for. I f one
approach does not succeed. try another.
Sometimes a few extra minutes spent in
gaining the child's confidence before a
painful procedure or new experience can
spell the difference between cooperation
and frustration.
Toys. books and playtime
experiences also must be geared to
developmental level and condition. For
some children. the busy. noisy playroom
may be too confusing and exciting.
leading to seizures. aggressive behavior
or withdrawal. In this case. the child can
be allowed to play in a quieter place. on a
one-to-one basis with an adult.
Volunteers or students can gain much
satisfaction from this type of experience
and the child will certainly benefit. To
leave a retarded child by him
elf for long
periods is to invite non-acceptable
self-stimularory behavior such as head
banging. rocking. masturbation and
finger fluttering. since he is often not
able to use toys in an entertaining
manner.
l'iursing care plan
In an acute care setting. when'the child is
sick or undergoing surgical treatment.
special attention needs to be paid to all
his basic needs.
I. Fluids: The retarded child often
cannot ask for a drink: nor can he obtain
one for himself. He probably does not
understand the need to drink when he is
not thirsty. I t is wise to estimate his daily
fluid requirements and keep an intah.e
and outpllI chart. even when it would not
be necessary for a normal child in similar
circumstances.
2. Respiration: These children are often
very prone to infection. particularly
chest infections. and so pre-and
post-operdtive breathing exercises
become a priority. Here again
pre-operative preparation and practise
will pay off in the post-operative period.
3. Skin care: Skin care i
another
Important area. since many retarded
children have dry delicate skin which can
easily become irritated by contact with
sheets. and hospital gowns. Also these
children tend to be passive and. when
not feeling well. they will not move about
the bed as a normal child will. This
makes frequent turning and skin care
necessary. Incontinence adds anot.her
risk and the diaper area should be kept
clean and dry.
4. Oral hygiene: Mouth care can become
a hassle. as the child is resistant to
intrusive procedures. but it should not be
neglected for that reason. I f you
approach him as though you expect no
trouble you are less likely to run into
difficulties! Many children readily accept
tooth brushing as part of their daily
routine. Others will come to accept it if it
is carried out gently. firmly and
consistently.
Understanding and trust
Often the retarded child is unable to
express pain or discomfort verbally and
it is therefore up to his nurse to recognize
his non-verbal cues. Sometimes the
caretaker can provide a useful
description of behaviors that the child
exhibits to express discomfort. Ifno cues
have been given the nurse should suspect
discomfort in the child who begins to act
out or become increasingly active or
aggressive when this is not his usual
pattern of behavior. The child may also
bang. chew or rub the painful part in an
attempt to remove the pain.
Many parents of retarded children
feel rejected by society. disappointed
and guilty. They are very sensitive to any
suspected criticism or rejection of
themselves or their child. Take time to
establish a trusting relationship with
them. You will need all their help and
cooperation in caring for their child. but
do not let them feel you are opting out
and letting them do your work. Praise
them for what they have accomplished.
and help them to set reasonable goals for
themselves and their child. Accept their
complaints if they are justified and do
something about them. If there are
unjustified complaints. do not just "go
off in a huff': try and find out what the
real problem is. The nur"e does not have
to be all things to all her clients: she
should make full use of services offered
by the hospital, to help her give total care
to the child and his family.
Psychologists. social worh.ers. pa"toral
services. volunteer, and many others
can be called upon for advice and help
with many of the problems you will face
in caring for such a family.
Children are very sensitive to
non-verbal communication and the
retarded child is no different in this
respect. He will sense acceptance or
rejection and behave accordingly.
Because his social controls may not be
well developed. his behavior may be
aggressive if he feels rejected. frightened
or angry. Limits must be set to his
behavior. as with any other child.
'Time-out" in bed or his room may be
effective in helping him regain control.
but the time should be short: in most
cases a few minutes is adequate.
Cuddling. rocking or other physical
contact may be a much more effective
way of consoling a retarded child than
the use of words.
All successful interventions with a
particular child should be incorporated in
his care plan. as should recognition of his
known dislikes. Remember. the staff
must be the one" to adapt since this step
is. for the most part. beyond the ability
of the child.
Our special children are a real
nursing challenge! Each one has his own
special personality and. when you get to
know him. you discover that he can be as
sweet and lovable. or contrary and
mischievous as all the rest. '"
References
I Piaget. Jean. The child and reality:
problems of genetic ps\'chology.
Translated by Arnold Rosin. New York.
Grossman. 1973. p.ll- 13. p.128-133.
2 Mussen.PauIH.Child
de\'elopment alld personality. 3d ed.
New YlJrk. Har.Row, 1969. p.302-306.
Brigid Peer, is assistant professor in the
Faculty of Nursing. U nÌ\wsity of
Western Ontario; affiliate appointmefll
with Children's Psychiatric Research
Institute. LOlldon. She was pre\'iously
coordinator of the Maternal and Child
Health Program at Algonquin College
(Vanier) School of Nursing in Ottawa;
joint appointment with Children's
Hospital of Eastern Ontario.
Born in England. Brigid trained at
St. Thomas's Hospital in London and
worked in Cyprus, Sowh Africa alld
Kenya before joining the RC AF nursing
ser\'Ìce in 1960. She recei,'ed her B .Sc.N
in N ursillg A dmi"ÜtratiOllalld
Educatioll from the U lIi,'ersity ofOttalt'a
a"d her M.Sc.N. in Pedia1ric Nursi"g
from the U ni,'ersity (
/Florida in
G ailles\'ille.
-
.
"
"
.
\,
)
'\'
.....
-
A leam appraach
la child ahuse
Lvnda Fit
patric/..
Jimmy is ten years old. One
evening last summer, he was
brought to emergency with large
bruises on his arms, legs and
buttocks and ahrasions on the left
side of his face. In emergency,
Jimmy remains quiet and
withdrawn, refusing to answer
any questions about what has
happened to him. It is his mother
who answers for him. Jimmy was
beaten by his father as a
punishment for breaking the
zipper on his jacket.
Sharon and Debbie are sisters. ages three
and four respectively. Their mother
calIed the hospital to report that the girls
had ingested some medicine
while she
was napping. The nurse in emergency
instructed the mother to bring her
daughters to the hospital. Instead of
bringing them in immediately. however.
she goes out and buys some beer. The
girls do not arrive in emergency until
some eight hours later. at two in the
morning. Their mother has slurred
speech and smells of alcohol. Sharon and
Debbie tell the nurses in emergency that
they drank the medicine because they
were "hungry".
A young unmarried mother calls the
Children's Aid Society. She is upset and
crying. She says that she is afraid that
she has hurt Bobby. her
two-and-a-half-year-old boy - says she
grabbed him impatiently and roughly as
he was jumping down a flight of stairs.
She seems alarmed at her own rough
behavior and says that she is afraid that
she will hurt her son more. because
. 'things aren't going well" for her. The
case worker talk.; to her for awhile and
tells her to take the child to the hospital
In emergency. Bobby is examined. He is
a healthy. welI-deveioped. and very
active little boy. There are small bruises
on his upper arms where his mother
grabbed him.
The Can-.llan Nur..
Oct_11171 37
Each one of these stories is about a
family in crisis. The details may vary,
but they add up to troubled families and
children at risk. At this point in time,
none of the stories is complete: the
incident that brought each child to
emergency isjust that - an incident.
There is a good deal of searching to
be done before any of these incidents can
be seen in context and plans made to
help the families involved. In many
urban centers in Canada. the work of
searching and of planning is done by a
multidisciplinary group. sometimes
formaJly known as a child abuse team.
One of these operates from Children's
Hospital of Eastern Ontario in Ottawa.
The child abuse team at Children's
Hospital has been in operation for as
long as the hospital has existed. since the
Fall of 1974. For four years now. the
team has been confronted with the kinds
of situations already described and
others. ranging from neglect to beating,
from emotional deprivation to sexual
abu'ie.
Although Jimmy (example one) may
be the only victim of outright abuse.
there are reasons for the child abuse
team to become involved in each of the
hypothetical cases described. The
behavior of the children's mother in the
second example can be seen as neglectful
of their needs. perhaps even dangerous
to their health. At the very least. the
situation needs to be clarified. Bobby's
mom. on the other hand. volunteers that
she needs help. and her desperdtion is
reason enough for knowledgeable and
expert intervention. It is because of a
wide variety of such situations that the
team at Children's uses a broad
operational definition of the term "child
abuse".
Most of the children who come to
the attention of the team do so through
the emergency department of the
hospital. The team at Children's is a
hospital-based team and this is why the
major source of referral comes from
within the hospital itself. Occasionally
the Ottawa Carleton Regional Health
Unit or the Children's Aid Society will
place a child on the agenda for discussion
if they feel:
. that multidisciplinary input is
needed: or
. that coding a child's chart will help
to aJert the hospital staff in case of future
admissions to the hospital.
The children referred to the team
may be abused children or children in
danger of abuse from those who are
re
ponsible for their care. They need
help and their parents also need help.
A team approach
The child abuse team at Children's
Hospital is organized to help families at
risk within the Ottawa-Carleton region.
The team is composed of pediatricians. a
psychiatrist. sociaJ workers and case
workers from the Children's Aid
Society. There are also nurses involved,
from the hospital's emergency
department and from the
Ottawa-Carleton Regional Health Unit.
Each team member comes to the weekly
meetings with as much information as
possible about the cases to be discussed.
The team members personally involved
in an individual case may be limited. but
those who are not directly in touch with
the family in question may add
comments from their own perspective.
As each individual situation is
discussed. the incident demanding
intel vention becomes part of a much
larger picture. Many times. that incident
is not isolated. and there are charts and
records that allow members of the team
to see an evolving pattern. A
multidisciplinary approach ensures that
as much evidence as possible is gathered
from aJl quarters. an approach that helps
in the often difficult task of planning and
decision-making.
Since September of 1974. the child
abuse team at Children's Hospital has
been operating for the purpose of
detection and short-term management of
child abuse in the Ottawa area.
Within the hospital. membe", of the
team are committed to finding. treating
and protecting the child who is the victim
of abuse while investigating the
circumstances that surround the incident
of abuse. The team aims at a plan to
teach and support parents whose care of
their children is less than acceptable.
whose care may, in fact. endanger their
children. Educational efforts are directed
towards the prevention of violence or
neglect of children wherever possible.
and within the hospital. team members
attempt to create an awareness of
children's rights in small ways.
Protecting the children
Child abuse may be reported by a
neighbor. policeman, public health
nurse. teacher or social worker- by any
individual. regardless of whether or not
he serves in a professional capacity. In
fact, Ontario's Child Welfare Act states
that any individual who even suspects
abuse must report it to the Children's
Aid Society. Such reporting is common
in emergency department'i like the one at
Children's. where abused children are
eventually brought for medical
treatment.
What has happened toJimmy is
obvious - there is little doubt that hi'i
injuries stem from a thorough beating.
His mother is in emergency to give a
fairly straightforward account of what
has happened to her son. But not all
cases of abuse are as dramatic or clear
cut and very often parents. afraid of
punishment for their actions. take. pains
to disguise the "reaJ" story from medical
staff. It is therefore important that those
who work in emergency be able to detect
the sometimes subtle signs that sU(!gest
abuse. These signs can be detected
through careful and skilled observation
of the child. his parents and the
interaction between them.
At risk
Eighteen-month-old JiJI was brought in to
the emergency department eight hours
after "she fell out of her crib". The child
is small for her age, remote and detached
from the attentions gi ven to her. Physical
examination reveals a large bruise on the
left side of her forehead and small bruises
on both upper arms; an X-ray shows a
fractured skull. An old chart tells that Jill
is no stran
er to the emergency
department - that she was here three
months ago after another accident.
Jill's mother is in emergency to
describe the accident. Her description of
what happened changes each time she is
asked for information. especially in those
details related to the time oìthe incident
and exactly where the child fell.
Moreover. none of her descriptions
would seem a plausible cause for an
injury as serious as the one Jill has
sutTered. Mrs. M. appears nervous and
uncomfortable, and seems to show little
concern for her daughter's welfare.
At this stage. the evidence is hazy.
but there are indications that Jill' s fall i
more than it seems. The head nurse in
emergency is on the child abuse team;
consequently the nurses in that
department are well aware of the
indicators of a suspicious situation. The
nurse caring for Jill notes the behavior of
both mother and child and fills out the
screening survey used atChildren's
Hospital for children who have
accidents.
She notes that:
. Jill has been in emergency before
\\-ith bruises:
. Jill is below the third percentile on a
standard growth chart:
. the child is detached and
withdrawn:
. Mrs. M. has called this accident and
the trip to hospital "a nuisance";
. Mrs. M. has explained the situation
in a contradictory way - her story
changes each time she tells it;
. Mrs. M. is impatient and seems
detached a'i far as J ill's welfare is
concerned:
. Mrs. M. waited eight hours before
bringing Jill to the hospital.
M rs. M. is also in a great hurry to
leave the hospital. so the nurse quickly
reports her observations to the resident
on call and pages the emergency social
worker. Jill is admitted to the hospital for
observation. a step that is taken in the
event of suspicious accidents regardless
31 Jenullry 111711
The Cen-.llen Nur..
of the extent ofthe child's injury so that
the situation can be investigated and
action taken to protect the child.
Before Mrs. M. leaves, a sociaJ
worker on staff at Children's Hospital
talks to her for a short time to "sound
her out". see how she feels about Jill.
and establish the beginmngs of a
supportive relationship with her. Mrs.
M. repeats that she is anxious to leave:
she tells the social worker that she
doesn't like to leave her other three
children with her husband "who doesn't
know how to take care of them" .
Besides, she confides, she hates
hospitals and wishes thatJill wasn't
"always getting into trouble". At this
stage, Mrs. M. is not confronted with the
suspicions of the hospital staff.
It is also part of hospital protocol to
report suspected cases of abuse such as
Jill's to the Children's Aid Society. A
case worker from the Children's Aid will
normaJly confront parents within 24
hours of the diagnosis of child abuse, but
it will be a gentle confrontation. If the
parents cooperate and accept help from
the Children's Aid Society (as most do).
the case will be opened and CAS will
monitor development in the family and
provide support. If the parents resist,
however, or if the gravity of the abuse
warrants more drastic measures to
protect the child. a court case will
follow. *
Jill's admission gives doctors.
nurses. Children's Aid Society case
workers, and social workers valuable
time. time they need to take a look at the
whole family situation, to document
evidence as it comes together and to find
out the real story. By the time Jill's case
is discussed at a meeting ofthe child
abuse team. members of the team have
been able to reach out to the M. family
and information about the whole
situation has grown considerdbly...
Why Jill?
Jill is the youngest offour children in the
M. family and all the children are under
the age of six years. While she is in
hospital. her mother's visits are few. and
*The Children's Aid Society prefers to
work with the parents rather than in a
climate of adversity. last resort legal
measures of the Children's Aid Society
are:
I order of supervision in which the judge
grants the C AS the power to visit the
family at their discretion:
2 apprehension which grants CAS the
power to remove the child immediately,
with or without warrant, to a place of
safety:
3 temporary wardship in which the
custody of the child usually goes to the
CAS who usually place the child in a
foster home:
4 crown wardship which involves
pennanent removal of parental rights.
during these visits, the nurses notice that
Mrs. M. is gruff and tense. while Jill
remains unresponsive, whiney and
fretful. But it takes more than just these
observations to find out what is really
gomg on.
Ray Helfer. a well-known authority
on the problem of child abuse. has a
great deal to say about its etiology. He
writes, "First there is the potential. then
a particular child and finaJly the
crisis... ". Looking at the M. family and
other families in which abuse occurs, a
recognizable pattern emerges.
First of aJl, there is hardly a case of
abuse discussed by the child abuse team
that does not uncover a revealing story
about the parents' upbringing. So often,
the experiences that they have had at the
hands of their own parents have been
less than satisfactory. It is not
uncommon to hear their growing
experiences described as "horrendous",
involving alcoholism. lack of caring and
outright abuse. The M.'s are no
exception.
Mrs. M. "escaped" from the round
offoster homes she grew up in through
an early marriage. Too soon, she was
also a mother. and lacking effective
guidance on how to be a mother, she had
little to bring to her children but her own
unhappy past experience. The situation
on Mr. M.'s side was not any brighter.
Given their personalities and
experiences, it is little wonder that the
M.'s live fairly isolated lives within their
community. like too many other
families in large urban centers. their
exchange outside an insular family
existence is limited to that which is
absolutely necessary. Mrs. M. admits
that there is really no one that she can
talk to. especially about "trouble".
Within this family, Jill is the special
child. In her first contact with Mrs. M.
the emergency social worker notes the
negative way in which Mrs. M. refers to
her daughter - she is a "nuisance": at
eighteen months, she is "stubborn" and
"always getting into trouble". Further
talk with M rs. M. indicates that Jill
seemed like trouble from the very
beginning. M",. M.'s fourth pregnancy
had been both unwanted and difficult;
then Jill screamed and cried and fed
poorly for months on end - there was
little about the baby that was endearing
in Mrs. M.'s eyes. In a family offour
children. Jill is perceived as different
from her other siblings. as "just plain
difficult" .
What then was the crisis that
brought Jill to the hospital? Although the
family seems to have few resources for
dealing with problems. although Jill is
perceived as a "problem" child. there
are other critical factors that precipitated
Jill's injury. Once Mrs. M. has someone
to talk to. it doesn't take long to find
them out.
Last June, Mr. M. lost his job. For a
few months he remained at home where
he sat, sullen and depressed and drinking
too much. When he found ajob once
more, it was working night shift, so it
was Mrs. M.'s responsibility to keep
everyone quiet while her husband slept
in the daytime hours. Nightwork was
difficult for Mr. M. and grew intolerable
for his family. The strain built up...
Picking up the pieces
The story about Jill as it was known in
emergency has grown. and its details
begin to hint at the ways in which the
child abuse team can help the M. family.
The medical evidence, nurses'
observations and reports of contacts
made by social workers are presented to
those at the Tuesday morning meeting so
that efforts can be made to develop a
helpful plan of action.
In a situation such as this, the
members of the team need to consider
what specific interventions can help the
M. family . Input from theChildren's Aid
Society case worker indicates that the
M. family is willing to accept her help in
dealing with family problems. and so
CAS intervention will continue until
there is no further need. A volunteer
worker is lined up to help Mrs. M. within
her home, giving her someone to talk to
and relieving the isolation that she feels
while her husband is still working night
shift. A plan is also made to introduce
Mrs. M. to a mother's group to give hera
support system and an opportunity to
"get out of the house". A doctor's
appointment is planned to check out her
feelings of chronic fatigue and edginess.
The possibility of helping Mr. M.
consider a more suitable job and aJcohol
counseling is also developed. Through
these plans the M. family is being guided
to better use of the community resources
that can help them in their present
situation.
Outreach
Jill's case is not the 001 y case of abuse to
be discussed at the Tuesday morning
meeting - there may be from four to ten
other cases, and each will tell of parents
who need help and children who need
protection. And there is a meeting every
week. each bringing more families to the
attention of the team. Investigation of
these cases is time-consuming and the
challenge of solving complex problems
requires even more energy. skill and
time.
The work ofthe child abuse team
also involves educational efforts aimed
at the prevention of child abuse before it
occurs. and he early detection of abuse
so that patterns of famil y violence can be
reversed. The team has participated in a
comprehensive inservice education
effort within Children's Hospital itself.
The Cen-.llen Nur..
Jenuery 111711 311
Members have also taken part in
educational programs such as courses at
Carleton and Ottawa universities and
community college refresher programs.
The team has also been instrumental in
training 15 volunteers who will visit local
classes of students in grades II. 12 and
13 and help young people to become
aware of child abuse and what it means.
Service clubs provide another forum
where members of the team can share
what they know about child abuse in
order to create a climate of awareness.
The problem of child abuse is one of
enonnous magnitude and significa'lce.
Professional collaboration - that is,
bringing together the knowledge. skill!>
and perspectives of various involved
disciplines enables the team to begin to
deal with such a problem. The work of
the child abuse team does not end in its
effort to pick up the pieces in those
situations where abuse and neglect has
already begun. 011.
Acknowledgement: The author wishes to
than" the members of the child abuse
team ofC hildren's Hospital of Eastern
Ontario for their assistance in the
preparation of this article. Special
than"-s go 10 Diane Ponee. of the
Departmellt ofS ocial S en'ices. CH EO
(curremly seconded to the C alladian
Commission. International Year of the
Child}. and .....ate Dagg, head nurse ofrhe
emergency department. Borh are
members of the child ahuse team.
References
I Helfer. Ray M. The etiology of
child abuse. I n Symposium on child
abuse. New York University Medical
Center, New York City, June 15,1971.
Pediatrics 51:4 pt 2: 777-779. Apr.. 1973.
Bibliography
I Canada. Parliament. House of
Common!>. Standing Committee on
Health . Welfare and Social Affairs. Child
abuse and neglect. Ottawa, 1976.
2 Helfer. Ray M. Child abuse and
neglect: the family and the community
ed by ... and Henry C. Kempe.
Cambridge, Mass. Ballinger. 197{j.
3 Hepworth, Philip H. Sen'icesfor
abused and battered children. Ottawa,
Canadian Council on Social
Development, 1975.
4 Josten. LaVohn. Out of hospital
care for a pervasive family problem-
child abuse M .C.N. A mer. J. Matern.
Child Nurse 3:2:111-116. Mar./Apr.
1978.
5 Maravchik. Miriam. The child
abusers: the story of one family World
I :8:28-32. Oct. 1972.
6 Ontario. Ministry of Community
and Social Services You and the abused
child. Toronto, 1977.
7 Stainton, M. Colleen.
Non-accidental trauma in children.
Canad.Nurse 71 :10:26-29, Oct. 1975.
8 Symposium on child abuse New
York University Medical Center. New
York City. June 15. 1971. Pediatrics 51:4
pt 2. Apr. 1973.
CNJ talks to
Lois Dale, PUN
What are the ways in \\ hich public
health nurses can be iß\'olved in the
prevention. detection and
management of child abuse? CNJ
talked to Lois Dale. a public health
nurse in the Ottawa Carleton
Regional Health Unit and member of
Children's Hospital of Eastern
Ontario's child abuse team to find out
about the public health perspective on
child abuse.
CNJ:I s there really a role for public
health nurses in the prel"ention of child
ablue?
Løis: Oh yes. there are a number of ways
in which we're already involved. I see a
large part of our preventive role in our
involvement with family planning. After
all. planned children are the lea'it likely
to be abused children. In our prenatal
classes. we are involved with couples.
and I think that is e'ipecially helpful-
we talk about physical and emotional
care of the child and factors that promote
early bonding within the family.
Our post-natal visits also fall into the
category of prevention. At this stage. we
can help the mother to deal with any
fru!>trations that she may have. For
example. ifthe mother is troubled by the
child's constant crying. we help her look
at what is normal for a baby of his age. to
look at why the baby cries so much. and
at the physical measures that she can
take to help her baby and her'ielf too.
We have also established a liaison
with the maternity nurses in all the
hospitals in the Ottawa-Carleton area.
Maternity nurses are in a very good
position to see the early signs of poor
bonding. If they see a high risk situation,
they refer the family to us so that we may
visit them soon after di'icharge from the
ho!>pital. Our weekly conferences with
obstetrical nurses are really paying off-
more sophisticated observations are
being made all the time as we become
more attuned to the indicators of a high
risk situation.
When we visit a family. we try to be
aware of early signs of trouble, to
sensitize ourselves to family dynamics
and be aware of crises - be they
financial. marital. or related to the
family's isolation from the rest of the
community. Because being a public
health nurse means knowing about
community resources, we can also refer
families to helpful services when we
recognize that there are risk factors
involved.
C
J: What do you do if you suspect child
abuse?
Løis: Once we suspect either neglect or
outright abuse. we get involved through
the Children's Aid Society, the Child
Abuse Team. or both. Everybody on the
child abuse team works together to get a
really good grasp of the situation. The
Children's Aid Society case workers are
the key workers once they become
involved. Our specific role on the child
abuse team is con'iultative. We will also
visit families where there is a health
concern that requires nursing
management.
I feel that the public health nurse has
a very special role to play in the area of
child abuse. First of all. we have to
realize that our mandate and expertise
lie'i in the area of health care and not
welfare services. Ifthere is a "health"
reason for our vi!>it, we can be especially
helpful.just because of the way in which
people perceive "the nurse"
C:'oiJ:/s that because you have a
nOli-Threatening role?
Løis: I think so. Ifl visit a family as a
nurse, sometimes just introducing myself
as a nurse allows me to be of !>ervice.
Nurses are seen as helping. caring
people. I feel very strongly that we must
protect that image of being a nuturing
person, because it opens doors and
allows us to use our skills in areas where
the door quite literally is most often
closed. Very often parents aren't abusing
their ch il dren pu rposefull y . . . someti mes
children receive poor care because their
parent'i don't know how to look after
them. or because their situation is very
unstable. They need help. A nurse may
be a non-threatening figure to them.
someone who can be seen as a helping
person.
C
J:That sOllnds li"e a si::.eable job for
\'011.
Løis: It can be. But another good reason
for public health involvement in child
abuse is that the public health nurse
knows her community and its resources,
knows just what is available to a troubled
family in her district- be it the friendly
minister or a formal outreach service.
Sometimes a mother may just need
someone to go shopping with her, or to
take care of her child for an hour or so.
40 Jenuery 111711
The Cen-.llen Nur..
In some communities, these services are
really organized: in others we come to
rely on helpful neighbors. There are
leadership groups being organized in
apartment buildings. There are also
services offered within our city like
marital counseling. credit counseling or
day care services. Ifwe know that the
mother or family wants these !>ervices we
can help by being aware of the services
available and how to get at them.
CNJ: So child ahuse is really a
community prohlem...
Lois: Most definitely a community
prohlem. We're trying to help point that
out too. We have been involved in public
panel discussions - usually with a
multidisciplinary team. Within the Public
Health U nit we also have a lot offormal
and informal discu<;sions about the
problem - we all need to know more. In
high schools we have programs in which
we discuss child abuse. to help students
become aware of the nature of the
problem. People need to know how to
deal with child abuse within their
community; they need to know how
important it isjust to help someone out in
the neighborhood. As nurses, we have
duties as citizens too.
CNJ:As a public health nurse. how do
you see the role of other nurses in
relation to child abuse.
Lois: Since my involvement with the
child abuse team, I've become more
aware that there is hardly any area of
nursing that doesn't have implications
for children. We need to learn to listen to
parents in a defined way - be it during
prenatal classes, during labour and
delivery. or postnatally. in the hospital
or in the home. We can watch for early
signs of bonding. We can help mothers to
care for their young children and help
families when children are ill. We can be
aware as nurses in an adult hospital that
if mom or dad is ill. the children are
affected as well. We have the education
and abilitie<; to take an important
leadership role. We aren't doctors and
we aren't social workers. But we have
developed. and are still developing our
abilities to observe and teach health.
Child abu!>e is one area where nurses can
play an important role by usil1g these
very special skills. 41
.J
"""
Be it resolved...
The role of the nursing association in the
prevention of child abuse
Jcan MacLean
At a time \\hen so many organizations are examining their relevance and effectiveness, is the
prevention of child abuse an appropriate concern for a professional nursing association? Should
organized nursing, in fact, devote some or an
of its scarce resources to the problems of child abuse?
One a'isociation that has answered this question in the affirmative is the RNANS. Here's how Nova
Scotia nurses are meeting this challenge.
The Registered Nurse.. Association of Nova Scotia became
formally mvolved with the prohlem of child abuse in May, 1971,
At that time. Dr. John Anderson. director of Outpatient
Service.. at the Izaa\... Walton "-illam Ho..pital for Children in
Halifax. wrote to the pre..ident ofRNANS reque!>ting the
cooperation of associ.ltion member.. in providing information
fÒr a study on child abuse in Nova Scotia.
In 1973. when the report of the ..tudy' was released. nurses
as well as other group.. were shocked to learn that many cases
of child abu..e. suspected or proven. were not being reported a..
required by law. Indeed, the study indicated that many
physician.. and nurse.. were unaware of provincial legislation
concerning child abuse that hdd been passed in 1968.
Section 19A of the Child Welfare Act reads:
(I) "Erery pen-on hlll'Ù1R Î1!flJr/llation I\'hether cOll..fìdelltial
or pril'ileged (
rthe ahandonml'llt. desertion. phy,Ücal
ill-treatment or need..fÓr protection ofa child shall report the
i,!fÓrmation to a Socien' or the Director.
(2) No action lies aRaÎ11.\1 a penon 1\'1/0 gil'es Ù!(ormation
under suhsection (I) unless the Ril'inR of the i,!fl)mwtion is done
maliciOll.\1v or without reasonable and prohahle cause."
Getting imohed...
The response of our association to the ..tudy findings wa.. ..wift.
Wor\.....hops were quickly organized on the theme of
"Wednesday's children". InfÖrmation about the Child Welfare
Act was communicated to member... At our annual meeting in
June. 1973, a re..olution on child abuse was pas..ed
unanimously:
WHEREAS the result,l' (
rll recent ,\tUl
V indicate that most
cases (
rchild ahuse ami neglect are not reported. and
WH EREAS p1"(
re,Hional nunes are in a ,
trateRic positio/l to
detl'ct ('I'idence of such ahu,le and neglect.
BE IT RESOL
ED 1 HAT thl' memhers (
"the Registered
Nunes A HocÎatio/l ofN (}I'a Scotia use el'ery opportunity to
worh II'ith other conn'1"Iled Rroups in hl'coming Î1!formed ahout
\l'ays to help ami protl'ct children and to help the parents (
r
such children.
The Cen-.llen Nur.e
J.nuery 11171 41
How can 'iuch a re<;olution be translated into meaningful
action'> At a time when Yoe hear murmurs of professional
self-sed.ing and accusations of depersonalized approaches to
nursing care. it has been rewarding to see the response of many
nurses in Nova Scotia to this challenge. Such a response
demonstrates that the caring function which characterized the
early emergence of the nursing profe'i<;ion remains alive and
well.
There ha<; been no difficulty in recruiting bu<;y nurses to
serve on committees and help with projects related to solving
the problems of child abuse. Once the Nursing Service
Committee (one of three major RNANS standing committees)
was well informed about the problems involved. it sponsored
y"orkshops. community meeting<; and seminars to increa<;e the
awareness of other members. A major aim of the Nursing
Service Committee wa<; to help nurses understand their role in
observing. identifying and referring children who were
suspected of needing protection. The term "child abuse" was
taken in it<; broadest possible sense to include neglect and
deprivation. both emotional and physical.
Although most of the activities were taking place at the
branch levels. a good deal of support. including information kit<;
for member'i. was made available through RNA House.
Through its Nursing Service Committee. the association
maintained a close liaison with the professional staff of Family
and Child Welfare. Department of Social Services. and a<;sisted
in developing a standard report form for hospitals and agencies.
In February. 1974. aCentral Child Abuse Registry was
established by the Department of Social Services.
ew
legi'ilation became effective in December. 1976 which stated
that reporting cases of child abuse to the Central Registry must
be done by a "qualified medical practitioner. registered nurse.
or administrator of a hospital or institution".
Within RNANS. special interest groups like the Canadian
Association of Neurological and Neurosurgical Nurses and
Operating Room N ur'ies were including the topic of child abuse
in their own educational ses<;ions.
By this time. it Yo as becoming increasingly apparent that
nur<;es could ta"e a major role in the prel'ention of child abuse.
In 1976 a task force wa<; appointed to stud
possible approaches
to the problem. The Yo or" of the task force. involving nurses
y"ith special expertise in the hospital. the community and
nursing education. has included articles for the RN AN S
Bulletin and an educational display at the as",ociation'<; annual
meeting in 1977.
In October. 1978. the group organized a Yoor"shop for
nurses in key pmitions to prevent child abuse. The goal of the
Yoorkshop was to provide opportunities for nur'ie<; to:
· under<;tand the importance of their role inprel'enting child
abuse .
. improve their ability to identify high-ri<;k familie,,>
. consider the effectiveness of a team approach in helping
high-risk families
. identify needs for additional skills.
Because the workshop could not accommodate all who wished
to attend and the response of the nurses attending wa<; so
positive. the workshop is to be repeated in June. 1979.
-\ speciaJ chaJlenge
l'i it appropriate for our professional a<;sociation to devote
precious re<;ources to the problems of child abuse? Perhap,,> a
statement from One mil/ion children- the C e/dic report is
relevant to this question:
.. Weare c01/l'inced that the "-nowledge and insight!> about
.wcial problem.
. gained through seeing their effects on the Iil'es
of the indiriduaÜ andfamilie.
with whom they 11'01'''-. place a
hem'y responsibility not only on indÏ\'idual professionalJ bllt
also upon the association
of which they are memhers .It i.
not
enough to protect and promote the well-heing qf their own
memhers. or el'en to protect the public from malpractice. The
prq(e.uional associations must alw spea"- out and pro ride
leadership to help bring about the social changes that will
prel'ent the del'elopment ofmany of the problem.
in the first
place. Society hm a right to expect this of its prq(essionals.lf
they prOl'ide this "-ind of leadership. their status and role in
society will remain unchallenged."
Nursing has been de<;cribed a<; ..the major caring
profession". 3 A<; Yo e struggle to define and exert our
independent functions at a time of accelerated change. y"e need
to ensure that this caring function which has been traditionally
ours is retained and adjusted to meet changing needs. We must
also remember that as part of our professional association. we
can be very effective in our influence. hoy,.ever difficult it may
be to measure that influence.
The Registered Nurses A'isociation of Nova Scotia
believes that the prevention of child abuse is a special challenge
requiring the <;pecial skills of nurses. Our definition of nursing.
publi<;hed in 1976. ,>tates that "by collaborating with other
members of the health team. nursing contributes to meeting the
total needs of individuals/families. .., The hard work and
enthusiasm ofRNANS members involved in our child abu,>e
program illu'itrates one important y"ay in which we a'i nurses
may contribute to meeting these health need". ""
References
1 Fra...er. Frederic" :\lurray. Child
ahuse in/VOI'a Scotia: a rðearch project
ahout battered ami maternally depril'ed
children by . . et al. Halifa\. 1973. p.3
.
Commission on Emotional and
Learning Disorders in Children. One
million children. IThe C ELDIC Report
for the Commission) published by
Leonard Crainford. Toronto. 1970.
pp.441-44
.
3 Hall. Catherine. :\1. \\hocontrols
the nursing profession'.' Role of the
professional association Aust. nurses J.
3:
:
9-3
. Aug. 1973.
4 Registered Nurses Association of
Nova ScotiaA framewor"-for the
practice (
( nursing in N ol'a Scotia:
guideline.
and ,Hl",dard.
. Halifa\. 1975.
5 Helfer. Ray. Child abu,
e and
neglect: the family and the communin'
edited by... and Henry C "'empe.
Cambridge. :\lass. Ballinger. 1976.
6 Hurd. Jeanne Marie. Assessing
maternal attachment: first step toward
the prevention of child abuseJ.O.G. \.
.Vurs. 4:4:
5-30. Jul./Aug. 1975.
7 Martin. Harold P. ed. The abused
child: a multidisciplinary approach to
del.elopmental issues and treatment.
Cambridge. :\1ass. Ballinger. 1976.
A uthor Jean :\lacLean i,
currently
,Vursing Sen'ice C onwltant (
(the
Registered Nurses Association ofNOl'a
Scotia. A graduate afVictoria Puhlic
Hospital. Fredericton. Sew Bruns ,,'id
and McGill L' nil'ersin' (8.N.J Montreal.
Québec. Jean has had a ,,'ide range of
erperiences innur.
ing sen'ice and
nursing education. She has also ""(Jr"-ed
closely with the "'ursing Sen'ice
Committee and Tas"- Force on the
Prel'ention o..(Child Ahuse .
t
,
n
e
How do children hurt themselves and what can nurses
_ as individuals and as a profession - do to prevent accidents?
if./ )
.l,1'
.11
f/
,Q;
Shirlev Post
A.J. Lanliford
accounted for 37 per cent of the deaths
among children in this age group. A total
of758.504 hospital days were a direct
result of these accidents.
Is there something that nurses can
do to increase awareness among parents
and the general public of these threats to
the lives of their children? Can nurses
Accident!. are the largest single cause of
death and injury among children under
the age of 19. In 1974 (the latest year for
which complete figures are available)
accidents. poisoning and violence
l -
"\. .'
-
help to prevent accidents through
education? There are indications that
they can.
Nurses are often the first qualified
health person contacted in health care
and service settings: the doctor's office.
emergency wards. health clinics. and
even obstetric wards. All ofthese are
The C.n-.llen Nur..
Jenuery 11171 43
teaching opportunities. Each contact
with a mother. or a future mother. is an
opportunity to inform her of potential
hazards and to gain her support and
cooperation in eliminating them. thus
promoting the well-being of yet another
child.
But. to be successful in educating
others in the means of reducing
childhood accidents. it is essential that
nurses understand the growth and
development of children. know what
accidents are common to which age
group and the preventive measures
required for each age group. By
developing basic teaching skills and
projecting their own feelings and
attitudes toward child safety. nurses can
join physicians in initiating an effective
change in attitudes and influencing
parents to keep their children safe by
means of prevention.
The young child needs constant
supervision and protection. Part of this
protection lies in altering a "normal"
environment to reduce or eliminate
possible hazards. Unfortunately. most
people who care for children need to be
reminded constantly of this and of the
fact that benign items of everyday life.
such as electrical outlets and appliances.
bathtubs. medicines. cleansing agents.
balconies. stairs and cars. can become
dangerous enemies in a child's world.
Toronto's Hospital for Sick
Children. in its 1976 "Causes ofInjury
Report" . pinpoints some of the
problems. In that year:
. 300 children between the ages of
one and four were treated at HSC for
scalds caused by hot liquids (water. tea.
coffee), hot water baths and vaporizers.
. 211 children between two months
and two years of age suffered pulled
arms from being swung or lifted by the
arms.
. 554 children were treated for pedal
cycle i'1iuries; 86 of these youngsters
required hospitalization.
The increased incidence of
accidents occurring while children are
participating in sports or recreation
warrants much closer observation; we
need more accurate data on specific
categories of accidents. such as
skateboard i'1iuries. burns and head
injuries among young children.
Historically. legislation such as the
Hazardous Products Act has proved
beneficial. This act. which controls the
accessibility of certain products to
children and ensures that packages carry
adequate warning to parents of
dangerous contents. was passed in 1969
and since 1970 there has been a steady
decrease in poisonings among children
under four. Under this act. an item can
be judged" hazardous" , not to be
advertised. sold or brought into this
country. Examples include baby rattles
that could choke a child. certain stuffed
animals and a type of baby bottle
propper or holder that permitted the
mother to leave a child unattended while
feeding and could result in asphyxiation
or choking on regurgitated milk. In the
case of this last item. the Canadian
Nurses Association. prompted by
reports from members (especially public
health nurses) of possible dangers
involved in use of the "propper". was
among the groups that pressed for
government action to prevent the sale
and use of the device in Canada.
Under another part of the act the
government may impose regulations to
reduce the probability of accidents.
These regulations may require
child-resistant packaging or specific
labelling; regulated items include toys.
cribs. cots. playpens. pacifiers. rattles.
car seats. matches. flammable materials
used in clothing and a variety of
household items such as turpentine.
polishes and oven cleaners.
Nurses should be aware of this
legislation and make it their duty to
report to the Department of Consumer
and Corporate Affairs (either as
individuals or an organization) any
products that appear to constitute a
safety hazard to children.
One area still requiring legislative
action is the protection of children while
they are passengers in a moving vehicle.
Even though mandatory use of seatbelts
has been demonstrated to reduce
accidents. only four provinces* (Ontario.
Quebec. Saskatchewan. and British
Columbia) have passed seatbelt
legislation. Even in these four provinces.
children under the age of six or weighing
less than 50 pounds, are exempt. A
recent Montreal study found at least half
of all children under ten completely
unr
strained; a further ten per cent were
re:;trained in a manner inappropriate for
the çhild's age and stage of development.
Studies in Calgary. Vancouver and
Toronto have yielded similar results.
The Canadian Institute of Child
Health is presently asking the federal
government to remove the excise tax and
the 12 percent manufacturer's tax from
children's car seats. fire detectors and
life jackets. At the same time. the
provincial governments are being asked
to remove their sales tax on these items.
It is hoped that lower prices on these
items will motivate parents to protect
their children from the three major
causes of death by accident: motor
vehicle accidents. fires and drownings.
*In Nova Scotia. legislation had been passed
but had not yet come into force at time of
wriling.
Accidents can result in permanent
physical and mental impairment: they
can cause social disruptions and
economic difficulties. A child's injuries
bring distress to the entire family.
altering lives and lifestyles. I n many
instances. a heavy emotional and
financial burden is imposed not only on
the family but on the community.
What can nurses do to prevent
accidents? They can make 1979their
Year of Child Safety. As individuals.
they can increase their own awareness of
potential hazards in a child's
environment and use every opportunity
for health education in their homes. their
practice settings. and communities.
As a group. they can act as a strong
political force in influencing
communities to provide safer
environments. businesses to produce
safer products and governments to enact
and enforce regulations that will further
safeguard the lives of our children. 41
Shirley Post, co-author (
f' 'A I'ery
presenr danRer". is I'ice-president of the
Canadian I nstitute (
fChild Health. an
orxani;:,ation she helped to set up in July.
1977. She is a former director ofnursinR
at the C hildren'.
Hospital ofE(utern
Omario in Ottawa.
Audrey Jean Langford, co-author of "A
I'ery present danger", is a graduate of
General Hospital in Calgary, Alberta.
She is presently working part-time ar the
Children's H o.
pital of Ea.
tern Ontario
after a number of years spent in raising
her fil'e children. She is also a I'olunteer
worker with the Canadian lll.
titute of
Child H ealch in Ottawa.
Bibliography
I Canada Safety Council. Accident
fatalitie.
- Canada. Ottawa. 1975.
2 Canada. Laws. Statutes. etc.
Ha;:,ardous products act. RSC 1970
C.H3.
3 Hospital for Sick Children. Causes
o.finjury. Toronto. 1976.
4 Canadian Institute of Child Health.
A ccidents and accident prel'ent;on: 19
year.
and under. Ottawa. 1978.
Unpublished.
I
I
,
44 Jenuary 111711
The Cen-.llen Nur..
Learning about
the hospital at hOllle
Faye F ergu.mn
Lillian Par/...
and Vera Ward
-"
...
"
.:- -1
\
.. ---
'-'=
....,..r-........ .:-
.....
. 1
-..
/'
\
L
-
-
--.:
;
-
"
.'
.
.
-...
-
,
-
.
.
..
III
Pre-admi
sion nurse Lillian Park
("ontacts the parent.
(
r a child
scheduled to be admitted to llOspital.
A.nother member of the pre-admission team,
nurse Vera Ward. receil'es
pre-admission hoo/...ings in her o(fìce.
The Cen-.llen Nur..
Jenuery 111711 45
Mark Taylor is six years old and
ahout to enter Alberta Children's
Hospital to have his tonsils and
adenoids removed. Five days
prior to his scheduled admission,
a nurse who identifies herself as a
pre-admission nurse from the
hospital. contacts his mother.
Since Mrs. Taylor had been given
a letter at her doctor's office
describing this service, she is
expecting this call and is happy to
make an appointment to see the
nurse.
. nursing pediatric history
sheet.
During the completion of this
sheet. the nurse enquires about
recent immunizations or possible
contacts with communicable
disease. She also checks to see
whether there is a family history
of anaesthetic problems or
bleeding tendencies, whether
Mark has been on medication
recently, and whether he has any
physical disability.
...
--
-
-.
assures her that she can stay as
long as she wishes: in fact. she
may even stay overnight if she
wants to.
Following completion of the
various forms, the pre-admission
nurse explains what to expect at
the hospital. She describes:
. the routine admission
hospital tests such as the blood
test and blood pressure and
temperature
. the playroom program
...".
,
-:
-
----"
At the time of the home \isit, the pre-admiuiollllurse helps the
mother to complete the admiuiolls alld cOllsem forms
required b\" the hospital.
listening to the ad\entures of "Emily" . as explailled b,' the
pre-admissioll Ilurse. is a "Jim" way tojìlld oilt more
ahout all impelldillg \'/sit 10 the hospital
In fact. Mrs. Taylor has
many questions about Mark's
hospitalization! They agree that
the appointment ..hould be for
4:30 p.m. so that Mark will be
home from school when the nurse
is there. During her visit, the
nurse completes, with Mrs.
Taylor, the following documents:
. admissions form (name,
address, and other similar
statistical data).
. hospital required consent
forms.
The nurse also takes this
opportunity to ask Mrs. Taylor
whether Mark has any particular
fedrs that might make his
hospitalization more difficult.
Mrs. Taylor tells her that Mark
tends to "get home sick" when
he sleeps away from home and
enquires about whether she can
stay with Mark at the hospital
until he falls asleep the night
before surgery. The nurse
. the visit by the anesthetist
. meals and snacks
. the fasting requirements for
the morning of surgery
. the approximate length of
surgery
. what to expect
post-operatively ("l\lark may
vomit after his operation, but this
is not abnormal. His throat will
be very sore, but it will help if
you can encourage him to
drink" ).
I
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46 Jenuery 111711
The C.n-.llen Nur..
Mrs. Taylor is also advised as
to the time ofMark's admission and what
articles to bring to the hospital. The
nurse tells her about the various
amenities available for her use at the
hospital such as the cafeteria and parent
lounge. Mrs. Taylor is instructed to give
Mark a bath and shampoo the morning of
admission and to collect a urine
specimen.
While she is talking. the nurse gives
Mrs. Taylor plenty of opportunity to ask
questions or express concerns. She gives
Mark a coloring book called "Emily
Goes To Hospitar'. After the nurse and
Mrs. Taylor have finished talking. the
nurse looks at this book with Mark.
explaining each picture and going over
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the experiences of"Emily". a whimsical
kitten who goes to hospital to have her
tonsils out. Mark can keep the coloring
book to show his friends. When he
comes to the hospital. he will see Emily
in a puppet show and after his surgery he
will receive a badge with a picture of
Emily and announcing in large letters "I
had an operation" .
At the end of her visit. the
pre-admission nurse leaves a hospital
pamphlet with Mr!oo. Taylor on which ..he
notes the nurse's name. the date and
time of admission. and reminders about
the.urine specimen. bath and shampoo.
She tells Mrs. Taylor to contact her
physician if Mark develops cold
symptoms. fever. etc.. prior to the
admission.
As ..he leaves. the nurse encourages
Mrs. Taylor to call ifshe has any further
questions. When she says goodbye to
Mark and his mother she leaves them
with the promise that "I'll see you at the
hos pital" .
Admission day
On the big day. Mark and his mother
arrive at the hospital at the agreed upon
time. They are met at the reception area
by the pre-admission nurse. who takes
them to the laboratory. then to the
nursing unit. After a brief tour of the
unit. introductions to the nurses. taking
of blood pressure and temperature
readings, Mark is able to go to the
playroom. The entire in-hospital
admission procedure takes about 15
Admission dav arrhes and the nur.
e
who l'isited th
m in their home Rreets
the child and his mother in the
reception area o/the ho.
pital.
At the start of his hospital visit,
the child and his mother ta/...e
the time to learn ahout the facilities
and ser\'ices thc hospital prm'ides.
minutes and Mark spends the majority of
his first hours m the hospital playing with
other children in the spacious. toy-filled
playroom.
A wa) of coping \\ ith stress
Nurses who work with young children
undergoing a period of hospitalization
are very much aware of how stressful
this experience can be. both for the
children involved and for their parents.
They know that while they are in hospital
many children ..how signs of regressive
or disturbed behavior. These
observations are borne out by research
studie.. which indicate that. in addition to
these obvious problems. hospitalization
has adverse results that may not become
obviou.. until after the child returns
home. The serious nature of these effecto;
has recently been noted in two studies
conducted in Britain"" which provided
strong evidence that one hospital
admission of more than a week's
duration or repeated short admissions
before the age offive years are
associated with behavior disturbances
and learning difficulties as late as
adolescence.
Several authors have provided clues
as to the reasons that hospitalization is
so stressful to children. One important
factor is the idea that the hospital is a
totally unfamiliar and unpredictable
environment for the child. The need to
know and predict one's environment
seems to be a universal human trait. In
health care settings it is becoming
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increasingly evident that the degree of
anxiety an individual experiences is a
function of the accuracy of his
expectations. The old adage of "being
afraid of the unknown" certainly holds
true. I n other words. an individual.
whether child or adult. who knows what
to expect in an unfamiliar o;ituation will
be hetter able to cope and will not feel
helpless.
A second factor involved in the
anxiety-provo\...ing effects of
hospitalization on children is the strong
influence of maternal stress on the child.
For a mother. the hospitalization of a
child is always stressful: her degree of
stress will depend on the amount of
adequate and accurate information she
received about the hospitalization before
The Cen-.llen Nur..
Jenuery 11171 U
it took place. The more predictable the
experience is for her. the better she will
be able to cope effectively and. thus. to
maximaJly support her child. A study of
hospitaJized children conducted in 1968"
provided strong evidence that the
anxiety level of the mother has an effect
on the anxiety level of the child: mothers
who received adequate. accurate
information about the hospitalization and
were encouraged to verbalize fears and
ask questions displayed a lower level of
anxiety. In addition. the children of these
mothers displayed lower anxiety levels.
made more rapid recoveries and
experienced fewer after-effects of the
hospitalization.
\
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I
period of time before the actual
admission to prepare for the experience
in accordance with the infonnation they
have been given.
2. To eliminate the lenRthy admissiom
procedure at the hospital.
By completing admissions documents in
the home. the in-hospital admission
procedure can be shortened
con'iiderably. thereby eliminating what
was often a hurried and unpleasant first
contact with the hospital.
3. To encouraRe mothers to effecti\'ely
support their child durinR
11O.
pitali::.ation .
Through the transmission of accurate
information. it was felt that the mother
would cope more effectively with the
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of Calgary chIldren who are scheduled
for elective admission to Alberta
Children's Hospital will receive a visit
from one of these nurses. Out-of-lOwn
admissions are contacted by telephone.
Effectheness of Pre-Admission \ isiting
Since its introduction four years ago. the
pre-admission program has been
enthusia'itically received by the mothers
whose children were admitted under it.
Nurses. too. have been pleased to
relinquish the "harried" admissions
procedure for which they had originally
been responsible.
The positive effects of the program
on the mothers and children have always
been suspected but it is only recently
that we were able to document them. In
,
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A "3rd nurse ta/...e
the child's admission hlood pressure, one of the \'eryfew
procedures that must be carried out before he is allowed to \'isit the playroom.
Objecthes ofthe PA \ P
It was recognition of the fact that
children and many mothers are not
familiar or comfortable with nonnal
hospital routines. that caused the nursing
department at the AlbertaChildren's
Hospital to set up a Pre-Admission
Visiting Program in 1974. The initial
objectives of the program were as
follows:
I. To pro\'Ïde the child and his mother
with accurate information about the
hospital process in em em'ironment that
is comfortable to them.
We felt that both the mother and child
would be most relaxed in their own home
and therefore better able to absorb the
infonnation. express concerns and ask
questions. A'i well. they would have a
hospital and feel more willing to assist in
her child's care. As well. the
pre-admission visit would be a time to
assure the mothers that their presence in
the hospital is welcomed.
4. To lessen the number of children
admittedfor .wrgery which 't'{I.
later
cancelled because of e>;posure to
communicahle disea.
e or other iIIne.H.
Children who have had such an exposure
would be identified during the
pre-admission visit. thus their surgery
could be cancelled before they ever
reached the hospital.
Over the past three years. the
pre-admission program ha'i striven to
meet these objectives. Two registered
nurses and a clerical assistant comprise
the Pre-Admission Team. The majority
order to do this. we undertook a
controlled evaluative study' of some of
the effects of the program on a group of
8:! children between the ages of three and
seven. All the children were coming to
hospital for tonsillectomies: one half of
them received a pre-admission visit.
while the other half were admitted
directly to the hospital. All were given
exactly the same infonnation by the
same admitting nurse: only the location
and time were different. Ba'iically. the
children all had a very similar hospital
expenence.
The results of the various measures
taken on the children and their mothers
indicated that:
· Mothers who received a
pre-admission visit expressed
41 Jenuery 111711
The Cen-.llen Nur..
considerably more satisfaction with the
care and health teaching they and their
child received in the hospital. Basically.
the pre-admitted mothers were happier
and more satisfied about the whole
experience than were the hospital
admitted mothers.
. All the mothers displayed a high
level of an xiety on the day of admission.
but the mothers who had been
pre-admitted showed a greater decrease
in anxiety. At a post-operative contact.
the pre-admitted mothers displayed a
very low level of anxiety. while the
hospital-admitted mothers showed a
considerably higher level.
. The children who had experienced
à pre-admission visit reported less fear of
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hospital-related thmgs than did the
hospital-admitted children. This
difference in the level of hospital fears
was apparent at the time of admission
and at the pmt-opeHltive contact
(u",ually 7 - 10 days after the ..urgery).
. The children who had experienced
a pre-admission visit displayed a marked
reduction in negative post-hospital
behavior as compared to the
hospital-admitted children. I n other
words. the pre-admitted children showed
fewer behaviors indicative of sleep
disturbances. eating disturbances.
aggression. withdrawal. separation
anxiety and general anxiety following
their hospital experience.
The results of this study have been
very satisfying and have supported what
many nurses have intuitively felt to be
true. One unexpected benefit of the
pre-admission program has heen it,;
effect on the nurses involved in it. The
pre-admission nurses have become
increasingly skilled at interviewing and
have developed new levels of sensitivity
to the concerns and anxieties of the
mothers they talk to. In their constant
evaluation of the information needs of
children. these nurses have observed
that they are becoming more sensitive to
developmental and learning capabilities
of children. The pre-admission nurses
never lose sight of the family as a unit.
and have become appreciative of familial
differences including ethnic and cultural
effects. As well. the continual need for
In the pla
room.
wearing her hero hutton
awarded followillg completioll
o( lahoratory hlood te.
t.
,
is Emi!\'. star ofhoth
the color;"g hoo/..
alld a puppet .
/ww
hlued Oil her Iw.
pital
adl'ellture,
.
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open channel.. of communication
between parent. child and health care
professionals has become an important
goal of the program.
In short. pre-admission visiting is
one way to effectively prepare children
and their mothers for hospital admission.
I t provides both mother and child with
information that may assist them to cope
effectively with what otherwise could be
a strange and frightening experience. OW
References
I Douglas. J. W. Early hospital
admi",sions and later disturbances of
behaviour and learning. Del'. Med.child
Neurol. 17:4:456-480. Aug. 1975.
2 Quinton. David. Early hospital
admissions and later disturbances of
hehaviour: an attempted replication of
Douglas' findings by... and Michael
Rutter. Del'. M ed.C hild N euro.
18:4:447-459. Aug. 1976.
3 Skipper. James K. Children. stress
and hospitalization: a field experiment.
by... and RobertC. Leonard.J. Health
Soc. Behm'. 9:275-287. Dec. 1968.
4 Ferguson. Barbara Faye.
Preparing young childrenfor
/wspitali:ation; a comparisoll o(two
methods. Calgary. 1978. Thesis' (M.Sc.)
-Calgary.
Faye FergusonrR.N., HolyCm.u
Ho.
pital. Calgary; B.Sc.N., The
U Ilil'ersity of Alherta. Edmollton; M.Sc.,
U nil'ersity l
rC algaT}') is education
coordinator at Alherta C hi/dren's
Hospital, Calgary. The study cited in this
article was part of her thesis research
leadillg to a MaHer's degree in
Educatiollal Psychology.
Lillian Park (R.N.. Killgston General
Ho.
pital. Killg.
toll, Ontario) i.
a Ilurse
011 the pre-admi.uion team at Alherta
Childrell's Hospital. Calgary. Prior to
hecomillg a pre-adminion Ilurse she
wor/..ed lU asÚ
tant head Ilursefor a
numher ofyear.
on the .H1rgicalullit at
Alherta Children's Hospital.
Vera \'\ard rR .N., Holy Cmu Hospital.
C algary) i.
a memher l
(the
pre-adminioll team. She was one of the
origillal Ilurses Oil the team alld has been
illtimatel\' ;'lI'oll'ed ill the del'elopmellt of
the Pre-l;dmission Program. She also
performed the admissionsfor all the
childrell examined in the study described
in this article.
,
butter is really the villain responsible
for various common pathologies. . .
,
these very illnesses continue to occur frequently despite
a dramatic decrease in butter consumption over the past thirty years?
.
And did you know that. during this same period
of time. there has been a marked increase in the
consumption of margarine in Canada?
COMPARATIVE DAILY CONSUMPTION RATES OF BUTTER
AND MARGARINE FROM 1948*-1978** IN GRAMS PER PERSON
c
,296 112 I
,
I,
O
18 C I
V V
1948 MARGARINE 1978 1948 BUTTER 1978
For more facts about dairy foods. write to:
Canadian Dairy Foods Service Bureau.
30 Eglinton Ave. E.. Toronto. Ont. M4P 186
*Statlsbcs Canada
** 1978 estimated
consumption
I
J
I
When you look at the facts
you can see the good in butter.
50 J8nu8ry 111711
The Cen-.llen Nur..
calendar
January 1979
Continuing education courses
offered at the Faculty of
Nursing, University of
Toronto:
Curriculum refinement and
revision -Jan. 25-26. $50.
Writing workshop: are you
getting your message across?
-Jan. 31. $25.
Family therapy principles for
nurses-Feb. 7. $25.
The problem of skin disorders
for the adolescent. Feb. 12,
$25.
Care of the disturbed elderly
patient-Feb. 15-16. $50.
Nursing process in mental
health and psychiatric nursing
- Mar. 1-2, $65.
The community as client:
assessing levels of community
health - Mar. 28, $25.
Contact: Dorothy Miles.
Director. Continuing
Education Program, Faculty
of Nursing , University of
Toronto. 50St. George St.,
Toronto. Ontario, M5S IAI.
Continuing Education
Programs offered at the
University of Alberta.
Edmonton: Del'elopment of
political sl..ilIsfor
organi:.atiunal change. Jan.
25-26. $45.
Anatomy and physiology for
nur.
es, Feb. 8-Mar. 22 (7
Thurs. evenings). $35.
CommunicatÙ'e disorders in
children: identification and
referral. Feb. 8-9. $40.
Writing sWlsfor nurses. Feb.
13-14. $60.
Control female
inCClntinence,
naturally
Eschmann Female
Incontinence Device
naturally and discreetly controls stress
incontinence in patients awaiting corrective
surgery and over long-term periods.
Worn internally. the device controls the
opening - naturally - of the bladder neck
The device is comfortable. easily
inserted and removed by the
patient after a simple
demonstration.
--=
Available from leading
surgical supply dealers
or directly from
@ESCH
advancing the cause of good health
Eschmann Canada Limited
Barclay Avenue Toronto, Ontano M8l5S6
(416) 252-2281
Geriatrics symposiumfor
health care professionals.
Mar. 12-14.
Quality assessment of
mother-child relationship.
Mar. 16-17. $45.
Performance appraisal for
nurses. Mar. 22-24.
Nursing aspects of
intrm'enous therapy. Apr. 16.
S elf care framework applied
to nursing practice. Apr.
19-20
Management of pain. April.
Competency analysis profile:
application to nursing. Mayor
June.
Nursing pharmacy workshop.
May 25.
ECG interpretation. June
25-28. $80.
Tests and measurements for
nurses. Aug. 13-14, $45.
Contact: Millie Pasemko,
Faculty of Extension , The
University of Alberta, Corbett
Hall. Edmonton, Alberta.
T6G 2G4.
February
The Canadian Orthopaedic
Nurses Association Second
Annual Meeting to be held
Feb. 6-9. 1979 at the Hotel
Toronto in Toronto. Fee:
members - $20 per day. or
$50 for 3 days: non-members
- $25 per day or $60 for 3
days. Contact: Cheryl
McCulloch, R.N., CONA, 43
Wellesley St. E.. Toronto,
Ontario. M4Y IHI.
Annual Pediatric Seminar-
"Rights of Children in
Hospital". Sponsored by
Calgary Health Agencies and
the Chinook Affiliate of the
Association for Care of
Children in Hospital. To be
held on Feb. 8-9. 1979 at
Foothills Hospital. Calgary.
Fee: $25. Contact: Pat
Powers, Seminar
Chairperson, 6301 Larl..spur
Way, Calgary. Alherta.
T 3E 5P9.
48th Annual Meeting of the
Royal College of Physicians
and Surgeons and the Medical
Surgical Exposition to be held
February 6-9, 1979 in
Montreal, Quebec at the
Queen Elizabeth Hotel.
Contact: Dr. James H.
Graham, Secretary, Royal
College of Physicians and
Surgeons of Canada , 74
Stanley Ave., Ottawa,
KIN IP4.
March
Primary Cancer Care - The
Role ofthe Nurse. A two-day
workshop to be held March
22-23. 1979 at the University
of Calgary. Contact: Faculty
ofC ontinuing Education,
University of Calgary. 292024
Al'e. N.W., Calgary, Alberta,
T2N IN4.
April
Post diploma maternity
nursing course for registered
nurses to be held at the Grace
Maternity Hospital. Halifax,
N .S. A 12-week course
beginning April 2 - June 22 and
Sept. 10 - Nov. 30. 1979.
Contact: Margaret Power,
Director of Nursing
Education. Grace Maternitv
Hm.pital, Halifax, N.S.,
B3H IW3.
Did you know...
The Canadian Lung
Association has a Nursing
Fellowship of $8.500 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 Albert Street,
Suite 908, Ottlll\'a, Ontario.
KIP 5E7. Application
deadline: February 15. 1979.
Clinical .
I I
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order titles on 3O-day approval, enter order number and auth or: Please Print:
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in England: 1 St. Anne's Rd., Eestbourne. East Sussex BN21 3UN
In Auslrella: 9 Wallhem StreeI. Artarmon N.S.W 2984
'\ Drain & Shipley
.J The Recovery Room
i Two leading experts in the field provide clear, accurate coverage
of the recovery room in this valuable new, one-of-a-kind book.
Topics include the physiology of anesthesia, the effects of
various anesthet+c agents. specific care after all types of
operations, and factors that affect recovery from anesthesia in
particular patients.
By Cecil B. Drain. RN, CRNA. BSN. Univ. of Arizona. Tucson, AZ; and
Susan B. Shipley, RN, MSN. Nurse Researcher, Nursing Research
Service. Walter Reed Army Medical Center. Washington. DC. Aboul
350 pp. lIIustd. Ready soon. Order
3186-X.
Sorensen & Luckmann
Basic Nursing:
A Psychophysiologic Approach
The authors of the popular Medical-Surgical Nursing now offer a
comprehensive textbook on basic nursing concepts for the
practitioner. Twenty-eight contributing experts provide special
coverage of important topics such as biomechanics; nutrition;
bowel, bladder, and catheter care; vital signs; respiratory care;
the therapeutic nurse-patient relationship; blood administration
and much more. Particular attention is paid to the role of stress
and adaptation in illness, understanding the existence of the
patient, therapy and rehabilitation, the nursing process, and
the changing role of the nurse.
By Karen Creason Sorensen, RN, BS. MN, Formerly Lecturer in
Nursing, Univ. of Washington; Instructor of Nursing, Highline
College; Nurse Clinical Specialist, Univ. Hospital and Firland
Sanitorium. Seattle. WA; and Joan Luckmann, RN, BS, MA, Formerly
Instructor of Nursing. Univ. of Washington, Highline College, Seattle,
Oakland City College, and Providence Hospital College of Nursing.
Oakland. CA. About 1185 pp.. 435 ill. Ready soon. About $23.00.
Order *8496-X.
Conn
Current Therapy 1979
Current Therapy 1979 will be off press in R!bruary-and this new
edition of Conn offers more clinically usable datd than ever
before! Completely revised by over 335 leading authorities. it
provides Quick access to the most-up-to-date, proven treatment
methods available. Here are just a few of the topics: Leish-
maniasis. Plague, Toxoplasmosis, Bagassosis, Farmer's Lung and
other forms of hypersensitivity. Newer agents in therapy of
bacteremia. and much more!
Edited by Howard F. Conn, MD. With 14 contributors. About 1000 pp
IIlustd. $31.05. Re.wy Feb. 1979. Order *2.64-5.
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Krause & Mahan
Food, Nutrition and Diet Therapy
6th Edition
A strong revision of an already excellenttext, the new 6th edition
of Krause & Mahan is even better suited to your students' needs.
New material includes stress responses, nutrition and cancer,
and the low-birth-weight infant. Assessment of nutritionå
problems and the importance of nutrition throughout the life
cycle is emphasized. Many new iIIust
ations, graphs. and tables
highlight and enhance better understanding of all aspects of
nutrition.
By Marie Y. Krause, BS. MS. RD, Formerly Dietitian In Charge of
Nutrition Clinic and Assoc. Director of Education. Dept of Nutrition.
NY. Hospital; Therapeulic Dietitian and Instructor in Dieletics, Mount
Sinai Hospital. Philadelphia, PA; Therapeulic Dietitian and First Asst.
to Instructor in Nutrition. Dept. of Medicine. Univ. of Chicago Clinics;
and L. Kathleen Mahan. RD, MS, Lecturer, School of Nutritional
Sciences and Textiles, Nutritionist, Child Development and Mental
Retardation Center. Univ. of Washington; Consulting Nutrilionist,
Seattle, WA. About 935 pp. 295 ill. About $19.55. Ready soon.
Order *5513-{).
Keane
Essentials of Nursing:
A Medical Surgical Text
4th Edition
This is a compact textbook for students beginning the study of
medical-surgical nursing. From the more general concepts
related to illness (such as adaptability and immobility and
homeostasis) and those related to nursing, it goes on to discuss
medical-surgical nursing care problems with emphasis on the
nursing process throughout. Student aids include; learning
highlights (similar to objectives); vocabulary lists; summary
tables; and a student study aid section consisting of learning
activities, additional reading, and a study outline.
By Claire Brackman Keane, RN, BS. MEd. Formerly Director of
Nursing Education and Instructor in Medical-Surgical Nursing, Grady
Memorial Hospital School of Nursing, Atlanta. GA. About 600 pp.
lIIusld. About $16.10. Ready soon. Order *5313-8.
--------
CN 1/79
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Signature
All prices differ oUls,de U.S and subject to change
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Philadelphla,pa.19106 _ _ _ _ _ __
52 Jenuary 111711
The Can-.llen Nur..
books
BOOKS CAN HELP
Denise Alcod.
The experiences or sensitive observations of others when shared in the literary form can educate, enhance the reader's insight
and be therapeutic by offering hope and encouragement. This is an annotated bibliography of books which should help the
reader gain a better appreciation of the hardships and realities of living with certain disabilities, both from the personal and
family points of view. Although many of the books are written for school age and young adult readers - with the exception of
picture books - we as professionals can gain valuable insight into the reality oflife for some of our patients and their families.
Also included are some books that deal with the complexity oftoday's social life with its resulting emotional and social
problems for the child or adolescent. The books have been chosen because they can lend a helping hand.
Denise Alcock is the Director of the Child
Life Department. Children's Hospital of
Ew,tern Ontario, Ottawa, Ontario.
Axline, Virginia M.,DIBS In search 0/
self, Boston, Houghton \liffiin Co., 1964.
186 p.
With the hel p of play therapy and Dr.
Axline. a severely disturbed and
withdrawn child discovers his own
potential as an exceptionally gifted
person. The book is based on actual
recordings of weekly therapy sessions
and is an absorbing account ofDibs'
struggle for identity.
Barber, Elsie, The trembling years, N. Y.,
Macmillan, 1949,237 p.
At the age of 17 when life is full of
excitement, Kathy is stricken with
paralytic polio. Her relationship with
people changes, she rebels against her
handicap and feels very sorry for herself
The story deals with how Kathy
struggles to live with her problem and
comes to lead a fulfilling life.
Bretz, H. Lee, Donny and diabetes,
Vancomer, B.C., Tad Publishin
Ltd.,
1973, 55 p.
A pictorial educational guide for children
with diabete!>.
Brickhill, Paul, Reach/or the sky, N. Y.,
Norton, 1954,312 p.
The incredible true story of Douglas
Bader, who lost both legs in a plane
crash yet continued to golf. swim, drive a
car and fly a plane. During World War I[
he was taken prisoner and twice
escaped. A remarkable story of
inventiveness and determination.
I
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disability and the family's struggle as
well. Most informative regarding
problems. treatment methods, resources
and impact of dyslexia on the individual
and the community.
D' Ambrosio, Richard (M.D.), No
language but a cry, Dill Publishing Co.
Ltd., 1970,314 p.
The true story of a physically and
mentally scarred twelve-year-old who
had been abused as an infant by her
parents. It is a story of her rebirth as a
functional human being as a result of the
patience and wisdom of remarkable nuns
and Dr. D'Ambrosio.
Dahl, Borghild, Finding my way, N. Y.,
Dulton. 1962. 121 p.
The autobiography of a determined,
independent woman. who though blind.
maintains her own apartment. travels,
and shares practical ways for blind
people to stay in the mainstream of life.
Butler, Beverl). Light a single candle,
Arch"ay paperhack, 1970,217 p.
About a teenager's acceptance of and
adjustment to blindness which occurs at
14 due to an unsuccessful glaucoma
operation. The fact that the author,
Butler. lost her sight at the same age
contributes to the novel's sensitivity and
authenticity.
Christopher, Matt, Sink it, Rusty, Boston,
Little, Brown & Co., 1963, 138 p.
Rusty uses his handicap as a crutch.
With the help of a former basketball
player whose career was interrupted by
the loss of his left hand, Rusty learns to
adjust and make the most of his
capabilities. Deals with attitudes toward
handicap!>.
Clarke, Louise, Can't read, can't write,
can't talk too good either,N. Y., Walker &
Co., 1973. 2HO p.
A mother's personal document revealing
her child's struggle with severe language
The C..-.llan Nur..
J8nUllry 111711 5.1
Dizenzo, Patricia, Why me' N. Y., Avon
Books, 1976, 139 p.
Examines the loneliness, fears and hurt
of a 15-year-old rape victim.
Fanshawe, Elizabeth, Rachel, London,
England, The Bodley Head, 1975, 29 p.
A picture book which illustmtes how
Rachel who is in a wheelchair is able to
go to school, help at home and at school,
go to Brownies, learn to swim and ride
and choose a career.
Friis, Babbis, Kristy's courage, N.Y.,
Harcourt, 1965, 159 p.
Seven-year-old Kristy is struck by a car.
She has facial scars and her speech is
impeded. Upon return to school,
children laugh at her and tease her. Her
mother is in hospital with a new baby. It
is the story of how a 7-year-old deals
with these problems and how insensitive
people can be to visible handicaps.
Gardner, Richard, (M.D.), MBD The
family book about minimal brain
dysfunction, N. Y., Jason Aronson Inc.,
1973, 185 p.
A two part guide book: part I for parents
and part II for children, dealing with the
most common concerns regarding brain
dysfunction. For parents the book deals
with signs and symptoms, adaptive
reactions, social problems and the
child's future. The second part. with the
help of drawings and clear wording,
gives the reader (or child being read to)
an explanation of brain dysfunction. help
available and most important, a feeling
that somebody understands the problem.
Garfield, James, B. Follow my kader,
N.Y., Scholastic Book Services, 1957,
187p.
A firecmcker thrown by a friend causes
blindness. With the help of a guide dog.
Jimmy learns to become an active social
and happy person instead of the hostile
and dejected person he was just after his
accident.
Gunther, John, Death be not proud, N. Y.,
Harper & Row, 1965, 161 p.
A father's memoir of his teenage son's
battle with a brain tumor and his son's
maturity, courage and good humor in the
face of his terminal illness. It is written
so that others "may derive some
modicum of succor from the unflinching
fortitude and detachment with which he
rode through his ordeal to the end."
Haggard, Elizabeth, Nobody waved
goodbye, N. Y., Bantam Pathfinder, 186 p.
Peter, 16,
annot cope with the discipline
of schoolwork or with responsibility.
This novel reveals the thought processes
and feelings of a rebellious adolescent
who creates unhappiness for those who
love him as well as for himself.
Killilea, Marie, Karen, N.Y.,
Prentice-Hall, 1952,314 p.
Karen. the author's first child, has
cerebml palsy. Much shopping takes
place before Karen's parents are able to
find encouragement and medical help.
Obstacle after obstacle is overcome until
Karen can walk. talk. read and write.
Klein, Norma, What it's all about,
Archway Paperback, 1978, 146 p.
Life for an eleven-year-old with an
adopted Vietnamese orphan for a sister.
a stepfather that her mother fights with a
lot and finally leaves. a father who has
just remarried and whose new wife is
pregnant. and a young gmndmother who
has just remarried. is complex indeed.
The story is a reflection of modern day
family instability and its bewildering
effect on children.
Lasker, Joe, He's my brother, Toronto.
George J. McLeod Ltd., 1974,36 p.
Through excellent illustrations and a
simple story, this book helps young
children understand a sibling or friend
who has a learning disability.
Lawrence, Mildred, The shining moment,
N. Y., Harcourt, 1960, 187 p.
A car accident facially scars a pretty
university student. She drops out of
university, moves in with her
grandmother, and virtually goes into
hiding. Eventually as the scar fades and
she finds ajob, she becomes interested in
local community projects and a young
man. The story emphasizes that intellect,
friendship and interesting work are
better assets than facial beauty.
Litchfield, Ada. A cane in her hand,
Toronto, George J. McLeod Ltd., 1977,
30p.
A picture book about Valerie who is
visually impaired. The story is "intended
to create feelings of understanding and
acceptance toward visually impaired
persons."
Litchfield, Ada, A buUon in her ear,
Toronto, George J. McLeod Ltd., 1976,
28p.
A picture book with a story that helps
children understand the problems and
abilities of their deaf friends who must
wear a hearing aid.
Massie, Robert and Suzanne,Journey,
N.Y., Warner Books, 1973,462 p.
Alternate chapters are written by Robert
and Suzanne Massie whose only son has
haemophilia. It is a compelling story
which deals with the anxieties and the
hardships of the first eighteen years of
Bobby's life. It is also a factual
handbook on haemophilia and a history
ofthe progress and non-progress of
treatment techniques and facilities.
MacCracken, Mary, A circle of children,
Philadelphia, J.B. Lippincott Co., 1973,
221 p.
. 'This is the story of a teacher with a
listening heart who learned how to
understand her children's private hells of
anger. confusion, hurt and tragic
loneliness". (backcover)
Neufeld, John, Twink, N. Y., New
American Library, 1970, 127 p.
Twink has cerebral palsy. The whole
family is affected and involved.
''Twink'' portmys the anxiety, fear,joy,
set-backs, love and survival ofa family
with a member who has cerebral palsy.
Neufeld, John, Lisa, bright and lÙlrk,
N. Y., New American Library, 1969,
143p.
A 16-year-old cannot convince her
parents she needs psychiatric help. Her
teachers are afmid to interfere. Her three
teenage friends offer understanding and
amateur therapy until they can obtain
professional help for her. Lisa's mother
reacts to her hospitalization by hiding
from neighbors in shame.
Park, Clara Claiborne, The seige,
Toronto, Little, Brown & Co., 1967,
280p.
A mother's account ofthe family's
struggle to teach their autistic child to
love and to respond during the first eight
years of the child's life. Some ofthe
incidents this family encountered show
that the helping professionals can be
rude, self-important and insensitive
people.
54 "'nuery 111711
The Cen-.llen Nur..
Platt, Kin, Hey dummy, N.Y., Dell
Publishing, 1971, 171 p.
--
A pamfully sensitive novel about Neil. a
twelve-year-old. who befriends a
thirteen-year-old brain-damaged boy.
The novel portrays the cruelty of the
peer group. the fears of misinformed
adults and the pain such a friendship can
bring. The ending is unexpected but very
real.
Robinson, Veronica, David in
silence,Philadelphia, Lippincott, 1966,
126 p.
The new boy in the neighborhood is deaf.
He laugh<; inappropriately and his words
are unintelligible. Sometimes it is very
difficult for the other children to accept
him but slowly they learn ofDavid'<;
fears and his need for acceptance.
Samuels, Gertrude, Run Shelley run,
N.Y.. New American Librar), 157 p.
Shelley is a teenager who has had a
lifetime of trouble - an alcoholic
mother. a stepfather who tries to rape
her. a neighborhood where sex and drugs
have to be avoided and a training school
which is a prison. Run Shelley run!
Sha
, Charles R. When your child needs
help. l'o. Y., William !\torro
and Co.,
1972, 309 p.
Discusse
the major emotional disorders
of children. Written by a psychiatrist for
parents and teacher!> to enable them to
better understand the disturbed child.
Simon.
orma, All kitrds offamilies,
Toronto. George J. \1cLeod Ltd., 1976,
36p.
With the help of excellent illu<;tration<;
this book enables children to explore in
words and picture... what a family is and
how familie<; vary in makeup and
lifestyles.
Simon, Norma, n hy am I different,
Toronto, George J. McLeod Ltd., 1977.
31 p.
Situation
in this picture book help
children explore differences in growth.
hair color. physical abilities. cultural and
religiou<; background<; and family
structures.
Stewart, Mark A. (M.D., and Sail}
\\'endkos Olds, Raising a hyperactive
child, 1'i.Y., Harper and Row, 1973,
299 p.
The purpose of the book is "to restore
parents' confidence in themselves by
explaining the nature of the problems
presented by hyperactive children and
by describing practical ways to deal with
them. ..
Valens, E.G., The odrer side of the
mountain, N. Y., Warner Books, 1966,
301 p.
The story of Jill Kinmont who in her last
qualifying race before the 1955 Olympic
tryout crashed and was left permanently
paralyzed from the shoulders down. It is
a true story of incredible struggle and
victory.
\\,'aite, Helen E., Valiant companions,
N. Y., Scholastic Book Services, 1964,
279p.
A biography of Helen Keller and also to
some extent. a biography of Anne ,
Sullivan who. as Helen's teacher opened
the door to a full and rewarding life for
the blind. deaf and mute Helen.
West, Paul, Words for a deaf daughter,
"I.Y., Harper & Ro
. 1968. 188p.
Paul West is a professional writer and the
father of a deaf child who describes how
he brings the world to his daughter and
has as a result come to know and
appreciate the world better. Mandy's
presence has become ajoyful celebration
of the richness oflife itself. He
articulately brings to the reader an
awareness of many kinds of
communication apart from words and
also points out the vacuum between the
harassed parent and austere
professional.
library update
Publications recenlly received in the
Canadian Nurses Association Library a.ce
available on loan - with the exception of
items marked R -10 CNA members. schools
of nursing. and other institutions. Items
marked R include reference and archive
material that does nor go out on loan. Theses.
also R, are on Reserve and go out on
Interlibrary Loan only.
Requests for loans. maximum 3 at a rime,
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 ór the publisher.
Books and Documents
I. Bou\'ier, G. Le nursing en neurologie et
en neurochirurgie. par...Juliana Pleines et
Jacques-CartierGiroux. St-Hyacinthe. P.Q..
Edisem; Paris. Maloine cl978. 313p.
2. Brown, Joan C. Prevention of handicap: a
case for improved prenatal and perinatal care.
A background paper. Ottawa. Canadian
Institute of Child Care. 1978. 57p.
3. Canadian Hospiral Associarion Annual
general meeting. 1978. Ottawa. Iv. (various
pagings)
4. Conférence infernationale sur les soins de
santé primaires, Alma-Ata, URSS 6-11, sept.
1978 Documents. Genève. 1978. 5pts. in \.
5. C onférence sur [' enseignement dans
['administration des services de santé au
Canada, Ottawa. 1977 Les besoins à
satisfaire; enseignement dans I'administration
des services de santé au Canada. Compte
rendu d'une conférence parrainée par la
fondation W.K. KelIoggde Battle Creek,
Mich. Ottawa. ColIege canadien des
\ I directeurs de services de santé. 1978. 144p.
6. Dickason, Elizabeth J. L'infirmière et la
périnatalité. Édité par...et Martha Olsen
Schult Montréal. HRW. cl978. 542p
7. Gougeon, J. L Ïnfirmière en
rhumatologie. Paris, Expansion scientifique
française. 1978. I39p.
8. International Conference on Primary
Health Care, Alma-Ata, USSR. 6-11 Sept.
1978 Non-governmental organizations and
primary health care. Halifax. 1978. A Position
paper prepared for the International
Conference... Sponsored by WHO/UNICEF.
Washington. World Health Federation of
Public Health Associations. 1978. 93p.
9.-.Papers.Geneva. 1978. 5pts. in I. R
10. I nternational Labour Conference. 63rd
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.
CONTRAINDlCATlONS
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.
Ð HQRflfR
"
session, Geneva, 1977 Draft programme and
budget 1978-79 and other financial questions.
Second item on the agenda: programme and
budget pmposals and other financial
questions. Geneva. International Labour
Office. 1977. 83p. (/ts Report 2)
II.-.Provisionalrecmd. Sixth item on the
agenda: employment and conditions of work
and life of nursing personnel. Geneva.
International Labour Office. 1977. 3pts. in I.
12.-.Committee on nursing personnel
Pmceedings. Geneva. International Labour
Office. 1977. 9pts. in I.
13. International Labour Organization
Conditions of work and employment of
professional workers. Tripartite
meeting.. .Geneva. 1977. Geneva.
International LabourOffice. 1977. Hip.
14.-Director-General's programme and
budget proposals for 1978-79.Geneva,
International Labour Office. 1976. Iv.
(various pagings)
15. Kesterton, Wilfred H. The law and Ihe
press in Canada. Toronto. McClelland and
Stewart in association with the Institute of
Canadian Studies. Carleton University.
'- cl976. :!4:!p. (fheCarleton Library no. 1(0)
16. MacStrm'ic, Robin E. Determining
health needs. Ann Arbor. Health
Administration Press. cl978. :!68p.
17. N eh' Democratic Party of Ontario.
Health Policy Planning C ommitree Health.
not illness: A green paper for Ontario.
Toronto. 1978. 74p.
18. Organisation mondiale de la Santé
Répertoire mondial des écoles d'agents
d'assainissement. 1973. Genève. 1978. 81p.
-
.,
,. \
. .
I. . '.
....
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.....' I .
L
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/'
THE
LAST
THING HE
NEEDS
IS GAS.
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The Cenedlen Nur..
19. Primary health care. A joint report by
the Director-General of the World Health
Organization and the Executive Director of
the United Nations Children's Fund. Geneva.
World Health Organization; New York.
UNICEF. 1978. 49p.
20. Public Services International Report.
1973-1976. Feltham, Middlesex, 1977. Iv.
(various pagings)
21. Smith, Janet Saskatchewan registered
nurses' perceptions of quality of care. A study
undertaken by Dept. of Social and Preventive
Medicine. Univ. of Saskatchewan...under
contract with Saskatchewan Registered
Nurses' Association. Regina. Reprinted with
a foreword and summary by Sask. Registered
Nurses' Assoc. and with permission of the
Dept....Saskatoon. 1978. 133p.
22. Les soins de santé primaires. Rapport
conjoint du Directeur général de
"Organisation mondiale de la Santé et du
directeur exécutif du Fonds des Nations
Unies pour I'enfance. Genève, Organisation
mondiale de la Santé; New Y mk. UNICEF.
1978. 54p.
23. Teaching and evaluating the affective
domain in nursing programs. Editor Dorothy
E. Reilly. Thorofare. N.J., Charles B. Slack.
cl978. 76p.
24. Vanier Institute of the Family The new
life. Ottawa, 1977. 51p.
:!5.-.Varieties offamily lifestyles: a selected
annotated bibliography. phase I. Ottawa.
197? 98p.
:!6. World Health Or1!anization World
directory of schools for auxiliary sanitarians.
1973. Geneva. 1978.8Ip.
(fiD
eP'"
K!!!!!!i
'" .,,-=
'I',
,
.
..
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 antifiatulent
tablets that work fast to
relieve trapped gas and
bloating.
,
Jenuery 11171 55
Pamphlets
27. A ssociation des infirmières et infirmiers
du Canada La direction des relations de
travail de I'A.l.I.C. et vous. Ottawa, cl978.
brochure.
28. Canadian Labour Congress By-Laws
governing chartered local unions. Rev.
Ottawa, 1975. 31p.
29.-.Constitution. Rev. Ottawa. 1976. 47p.
30. Canadian NursesAssociation You and
yourCNA Labour Relations Department.
Ottawa. cl978. pam.
31. Congrès du Travail du Canada Statuts
Édition revisée. Ottawa. 1976. 50p.
. 32. L'lnstitut Vanier de lafamille
Déclaralion sur les styles contemporains de
vie familiale. Ottawa. 1977. Iv. (pagination
multiple)
33. Levêque, 8. Comment faire pour que
notre enfant soit vite propre la nuit. par...et C.
Dilain. Paris. Expansion scientifique
française. c1978. 24p.
34. McMurray, David Current economic
and industrial relations indicators. Kingston.
Ont..lndustrial Relations Centre. Queen's
University, 1978. 38p.
35. Munro, John A statement by....Minister
of Labour to the sixty-third session of the
International Labour Conference. Geneva.
Switzerland. Monday. June 13, 1977. 15p.
36. National League for Nursing. Division
of Baccalaureate and Higher Degree
Programs Doctoral programs in nursing.
1978-79. NewYof'k. 1978. (NLN pub.no.
15-448) 5p. R
37. Queen's U niversiry.1 ndusfrial Relations
Centre Collective bargaining and white collar
Ovol"
80
r rGas
C<Itre
IesGaz.
9 HQBJl..sR
a-=..
Product mODOp"'ph
evailable OD req.-t.
!Ie Jenuery 111711
,..- ""'II
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this
patient
needs
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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-
liable sourCe of skilled nursing
and home care specialists you
can recommend with confidence
for private duty nursing and home
health care.
All of our employees are carefully
screened for character and
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pendable. professional care.
Each is fully insured (including
Workmen's Compensation)
and bonded to guarantee your
patient's peace of mind.
Care can be provided day or
night, for a few hours or for as
long as your patient needs help.
For complete information on our
services, call the Health Care
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.HaJ
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HCS ee23 1
The Cen-.llen Nur..
employees; a bibliography 1970-1977. municipalities. Ottawa. Minister of Supply
Compiled in the Research Reference Section. and Services Canada. 1978. 80p. Catalogue
Kingston, Ont.. 1977. lOp. no. 94-803.
38.-.Collective bargaining in education in 57.-.Census of Canada. 1976. Vol. 9.
Canada: a bibliography 1970-1977. Compiled Supplementary bulletins: housing and
in the Research Reference section. Kingston, families. family composition. Ottawa.
Ont.. 1977. 6p. Minister of Supply and Services Canada,
39.-.Health care sector unionization and 1978. (various pagings) Catalogue no. 93-831.
collective bargaining; a bibliography 58.-.Health manpower registered nurses,
1970-1977. Compiled in the Research 1976. Ottawa. 1978. 116p. Catalogue no.
Reference Section. Kingston, Ont.. 1977. 9p. \ j!3-220.
40.-.lndex of industrial relations literature j9.-.Nursing in Canada: Canadian nursing
1976-. Compiled in the Research Reference statistics, 1977. Ottawa, 1978. 137p.
Section. Kingston, Ont.. 1977. Iv. 60p. Catalogue no. 83-226.
41.-.Job evaluation; a bibliography 60. Statistique Canada Main-d' oeuvre
1970-1977. Compiled in the Research sanitaire infirmières et infirmiers autorisés.
Reference Section. Kingston. Ont.. 1978. 4p. 1976. Ottawa. 1978. 116p. Catalogue no
(Its Compensation Bibliographies series no.l) 83-220.
42.-.Pay for performance; a bibliography 61.-.Recensement du Canada, 1976. Vol. 5,
1970-1977. Compiled in Ihe Research Activité; taux d'activité selon I'âge et Ie sexe
Reference Section.
ingston. Ont.. 1978. 9p. Canada. provinces et divisions de
(Its Compensation Bibliographies series no. 3) recensement. Ottawa. Ministre des
43.-.Performance appraisal; a bibliography Approvisionnements et Services Canada.
1970-1977. Compiled in the Research 1978. 4Op. Catalogue no. 94-802.
Reference Section. Kingston.Ont., 1978. 16p. 62.-. Recensement duCanada, 1976. Vol. 5.
(Its Compensation Bibliographies series no.2) Activite; tau x d'activité selon I'âge et Ie sexe
44. Vanier Institute of the Family A agglomérations de recensement et
statement on contemporary familial lifestyles. municipalités. Ottawa, Ministre des
Ottawa. 1977. Iv. (various pagings) Approvisionnements et Services Canada.
Government Documents 1978. 8Op. Catalogue no 94-831
Canada 63.-.Recensement du Canada. 1976. Vol. 9,
45. Health and We/fareCanada Summary Bulletins supplémentaires: logementset
of projects approved January 1974 to March families, composition de la famille. Ottawa.
1977. National health research and Ministre des Approvisionnements et Services
development program. Ottawa. 1978. Iv. Canada, 1978. (pagination multiple) Catalogue
124p. " no 93-831.
46. Labour Canada Working:conditions in 64.-.Soins infirmiers au Canada: statistique
Canadianinduslry.1977.0ttawa.1978. 136p. des soins infirmiers. 1977. Ottawa. 1978.
47. Tra
'ail Canada Conditions de travail 137p. Catalogue no 83-226.
dans I'industrie canadienne, 1977. Ottawa. 65. Tramil Canada Grèves et lock-out au
1978. 136p. Canada. 1977. Ottawa. Ministre des
48. Shillington. E. Richard Selected Approvisionnements el Services Canada,
economic consequences of cigarette smoking. 1978.80p.
Ottawa. Dept. of National Health and New Brunswick
Welfare. 1977. I v. (various pagings) 66. Task Force on New Brunswick Health
49.-.Quelquesconséquenceséconomiques Care. Report. Fredericton. 1978. 69p.
de I'usage de la cigan:tte. Ottawa. Ministère Chairman: S. Cassidy
de la Santé nationale et du Bien-être social, 67. Comité d'Étude sur les soins de santé
1977. Iv. (pagination multiple) Rapport. Frédericton. 1978. 69p. Président: S.
50. Lois,statuts etc. Lois sur les stupéfiants. Cassidy
Codification administrative. S.R.. c.N-1 Ontario
modifiée à 1972, c.17 1974. 75-76c.48 etle 68. Ministry of Labour. Research Branch
Règlement sur les stupéfiants établi par C.P. Life insurance and accidental death and
1961-1 \33 modifié àC.P. 1977-2012. Ottawa dismemberment insurance plans in Ontario
Approvisionnements et Services Canada. collective agreements. Toronto. 1977. 12p.
1978. 47p. (Bargaining information series. no. 24)
51. Conseil national de recherches du 69.-.0.H.LP. major medical, prescription
Canada Rapport. 1977/78. Ottawa. 1978. and dental plans in Ontario collective
128p. agreements. Toronto. 1977. 16p. (Bargaining
52. National Research Council of Canada information series. no. 25)
Report. 1977/78. Ottawa, 1978. 128p. 70.-.Paid vacations and paid holidays in
53. Sante et Bien-être social Canada Ontario collective agreements. Toronto. 1977.
Planification familiale; inventaire des 24p. (Bargaining information series. no. 23)
ressources. Ottawa, 1977. 274p. 71.-.Part-time work in Ontario: 1966 to 1976.
54.-.Protection de la Santi Les maladies Toronto. 1976. 24p. (Employment information
liées à I'usage du tabac au Canada: les series. no. 20)
tendances de la mortalité-Ies maladies 72. Ontario Council of Health
ischémiques du coeur. Ottawa. 1976. \3p. Hypertension. Toronto, 1977. Iv. {various
(Son Rapport technique no 5) pagings)
55. Statistic s Canada Census of Canada. Saskatchewan
1976. Vol. 5. Labour force activity; labour 73. Dept. of Continuing Education. Policy
force participation rates by age and sex Planning and Management Information
Canada. provinces. census divisions. Ottawa. Systems Branch First follow-up of the 1977
Minister of Supply and Services Canada. certified nursing assistant. diploma nursing
1978. 40p. Catalogue no. 94-802. and psychiatric nursing graduates from
56.--.Census of Canada. 1976. Vol. 5. Labour Kelsey and Wascana Institutes: Results ofthe
force activity; labour force participation rates special nursing questionnaire. Regina. 1978.
by age and sex census agglomerations and . 25p. R
The Cen-.llan Nur..
'I
Jenuary 11171 57
74.-. Second follow-up of the 1976 certified
nursing assistant. diploma nursing and
psychiatric nursing graduates from Kelsey
and Wascana Institutes: Results ofthe special
nursing questionnaire. Regina, 1978. 3Op. R
75.-.Second follow-up ofthe 1976 graduates
of Kelsey and Wascana Institutes health
science programs. Regina. 1978. 45p. R
76.-Research and Planning Branch First
follow-up of the 1977 health science program
graduate. Regina, 1978. 67p. R
United States of America
77. Dept. of Health. Education and Welfare.
Bureau of State Ser....ices. Tuberculosis
Control Dil.;sion Tuberculosis in the United
States. 1976. Atlanta.Ga.. 1978. 55p. (DHEW
pub. no. (CDC) 78-8322)
78. Dept. of Health, Education and Welfare.
Public Health Sen-ice National Library of
Medicine Classification; a scheme for the
sheIfarrangement of books in the field of
medicine and its related sciences. 4th ed.
Bethesda. Md.. 1978. 390p. (DHEW pub. no.
(NIH) 78-1535)
79. National Institute on Drug Abuse
Research on smoking behavior. Washington,
Superintendent of Documents. 1977. 383p.
(DHEW pub. no. (ADM) 78-581) (NIDA
Research Monograph 17)
Studies in CNA Repository Collection
80. Brooks. Faye Marybelle A study of the
expressed concerns of multiparous mothers.
four weeks after the delivery of an infant.
Toronto, c1977. 93p. Thesis (MScN)- Toronto.
'\
:1. Canadian Conference on Nursing
I Diagnosis I, Toronto. Nov. 24. 25.1977
Proceedings. Toronto. Faculty of Nursing,
University of Toronto. 1977. lOOp. R
82. Cleyle. Theresa Helen Patient's
identification of home care needs. Halifax,
1977. 92p. Thesis (M.N.)-Dalhousie. R
83. Dufour, Nan-Michelle A study of
self-actualization. Vancouver. B.C.. 1978.
55p. Study (M.Ed.)-UBC R
84. Field, Peggy-Anne A follow-up study of
graduales from the four year B.Sc.
programme in nursing. University of Alberta.
1971-1974. Edmonton University of Alberta.
Faculty of Nursing. 1978. 153p. R
85. Ford. James Ellsworth Doing obstetrics:
the organization of work routines in a
maternity service. Vancouver. 1974. 332p.
Thesis-British Columbia. R
86. Herbert. Pearl The relationship between
prenatal classes and care of the newborn.
Halifax, 1978. 98p. Thesis (M.S.)-Dalhousie.R
87. Jackson. Marion Ruth Study of the
modification of a workload index staffing tool.
Vancouver. 1973. 82p. Thesis
l\ (M.S.N.)-BritishColumbia. R
88. Kerr. Janet Catherine Ross Financing
university nursing education in Canada:
1919-1976. Ann Arbor. 1978. 277p.
Thesis-Michigan. R
89. Pine/li. Janet May A comparison of
mothers' concerns regarding the care-taking
tasks of newborns with congenital heart
disease before and after assuming their care.
Toronto. c1978. 127p. Thesis
(M.Sc.N)-Toronto. R
90. Registered Nurses' Association of
British Columbia. Steering Committee to
Identify Essential Manual SJ.ills Essential
manual skills for a new graduate. Report.
Vancouver. Registered Nurses' Association
of British Columbia. c1978. Iv. (various
'\..pagings)
",91. Workshop on Research Method%gv in
Nursing Care, O"awa. 9-11 Nov. 1977
Working papers. 1976-1977. Iv. R
92. Funke-Furber. Jeanette T. Reliability
and validity testing of indicators of maternal
adaptive behavior. Edmonton. University of
Alberta. Faculty of Nursing. 1978. t29p. R
93. Gibbon. Mary Nurse influence on the
quality oflife of elderly patients with chronic
illness, by...and Ellen Stevens. Hamilton,
Victorian Order ofN urses for Canada.
Hamilton-Oundas Branch. 1977. Iv. (various
pagings) R
94. Hart. Geraldine Angela Spinal cord
injury: early impact on the patient's
significant others. Vancouver. 1978. 112p.
Thesis (M.Sc.N.)-British Columbia. R
95. Kleiber. Nancy Caring for ourselves: an
alternative structure for health care. by.. .and
Linda Light. Vancouver. School of Nursing.
University of British Columbia, 1978. 184p. R
96. McRae. Bradley C. A survey of smoking
education given in prenatal classes in Canada,
by. ..et al. Ottawa. Canadian Council on
Smoking and Health. 1977. 35p. R
97. Money. Sheila Student nurses' death
anxiety. death education. evaluation anxiety
and clinical penormance. Toronto. 197'.'. 29p. R
98. Travaux du colloque sur la méthodologie
de la recherche infirmière, Ottawa. 9 au II
novo 1977 Méthodologie de la recherche
infirmière. Ottawa. Association des
infirmières et infinniers du Canada. 1978.
273p. R
99. Tremblay, Marthe Le marriage
encounter (Étude exploratoire d'un service
aux couples). Ottawa. 1978. 145p. R
100. Wells, Thelma Toward understanding
nurses' problems in care of the hospitalized
elderly. Manchester. Eng.. 1975. 370p.
Thesis-Victoria University R
Audio "ïsual Aids
101. Association des medecins de langue
française du Canada Sonomed. série 4, no.
10. Montréal. 1973. I cassette. Contenu:-Côté
A. Bureau, Jules. La place du sexologue en
médecine générale.-Côté B. I. Camerlain,
Monique. L 'Arthrite rhumatoidejuvénile. 2.
Viens. Pierre. Le trichinose. 3. Séguin.
Fernand, L'instinct des saumons.
102.-.Sonomed. série 4. no 12. Montréal.
1973. I cassette. Contenu:-Côté A. Jobin,
Françoise. Principes et pratique de
I'Anticoagulo-thérapie.-Côté B. I. Viens,
Pierre. La toxoplasmose. 2. Séguin Fernand,
Du nouveau sur robésité.
103. Hennes: Ie satellite technologique de
télécommunications son fonctionnement et
ses applications. La Société royale du Canada
de concert avec Ie Ministre des
Communications Canada et I'Administration
nationale aéronautique et spatiale. États-Unis
d'Amérique. Ottawa, La Société royale du
Canada, 1978. 3v.
104. National Library of Medicine
audiovisuals catalog. 1977. Bethesda. Md.,
U.S. Dept. of Health. Education and Welfare.
Public Health Service. National Institutes of
Health. 1978. Iv. (DHEW Publication no.
(NLH) 78-1102)
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51 Jenuary 11171
The Cen-.llan Nur..
Classified
Advertisements
Alberta
DIrector of Nursing required immediately for SG-bed
nursing home in Bonnyville. 165 miles North-East of
Edmonton. Alberta regislration required. An in-
terest in geriatrics. and experience in supervision is
essential. Salary negotiable. Please send resume to:
Mrs. H. Masterson. Parkland Nursing Homes Ltd..
13210-114 Street. Edmonton. Alberta, T.5E .5E2.
The University of Alberta Faculty of Nursing invites
applications for a Cllnlelll Nunr Researeher position.
A senior tenure-track position. Major respon-
sibilities for developing an active clinical research
program; some teaching in M.N. or senior under-
graduate courses; possibility of joint appointment
with clinical agency. Requiremenls: Ph.D. in nursing
or related field. recent clinical experience: research
and/or graduate teaching experience. The University
of Alberta is an Equal Opportunily Employer. Dead-
line for application: I March 1979. Appointment to
be made: I July 1979. Apply to: Dr. A.E. Zelmer,
Dean. Faculty of Nursing, The University of Al-
berta. 3rd floor - Clinical Sciences Bldg.. Edmon-
ton, Alberta. T6G 2G3.
The University of Alberta Faculty of Nursing invites
applicalions to fill full-tIme or part-time teaching p0s-
Itions In undergraduate progrem. ([hese positions
are contingent on funding for an expanded Post-R.N.
baccalaureate program). M
or responsibilities for
teaching senior undergraduate courses in all fields of
nursing. Some opportunities for selected teaching in
M.N. program and clinical jomt appointments to ap-
propriately qualified individuals. Requirements:
Master's degree completed. Preference will be given
to those with university-level teaching expenence
and/or recent clinical experience. The University of
Alberta is an Equal Opportunity Employer. Deadline
for application: I March 1979. Appointment to be
made: I July 1979. Apply to: Dr. A.E. Zelmer. Dean,
Faculty of Nursing. The University of Alberta, 3rd
floor - Clinical Sciences Bldg., Edmonton. Alberta.
T6G 2G3.
The Big Country Health Unit requires a l>lrector to
commence work February I, 1979. Applicant with
Public Health experience required. This is a super-
visory position and applicant should be knowledge-
able in that field. Salary negotiable based on qualifi-
cations and experience. Apply to: Director. Big
Country Health Unit. Box 279. Hanna, Alberta. TOJ
IPO.
British Columbia
Rqlltered and Graduete Nunes required for new
41-bed acute care hospital. 200 miles north of
Vancouver. 60 miles from Kamloops. Limited
furnished accommodation available. Apply: Director
of Nursing. Ashcroft & District General Hospital,
Ashcroft. British Columbia. VOl< IAO.
Challenge and opportunity await the nurse prepared
to accept a position In a 1000bed accredited acute
care hospital in a booming northern city. We will
help the beginning practitioners to expand their
knowledge and skills. Write to: Nursing Director.
Dawson Creek and District Hospital, 1l100-l3th St..
Dawson Creek. British Columbia. VIG 3W8.
British Columbia
Gnera1 DuI, N_ for modem 41-bed accredited
hospital located on the Alaska HiPway. Salary and
penonnel policies in accordance with the RNABC.
Temporary accommodation available in residence.
Apply: DireClor << Nursin.. Fan Nelson General
Hospital, P.O. Boll 60. Fan Nelson. British Colum-
bia, VOC tRO.
Generlll Duty Registered er Graduate Nu....,. -
needed for 2.5-bed acute care hospital in North
Central B.c. Salary and working condition
according to the RNABC CotltraCl. Apply: Director.
Stuart Lake Hospital. Fort St. James. British
Columbia. VOJ IPO or call collect (604)
996-8201/996-730.5 .
Experienced Nunes (eligible for B.C. Registration)
required for full-time positions in our modern
300-bed Extended Care Hospital located just thirty
minutes from downtown Vancouver. Salary and
benefits according 10 RNABC contract. Applicants
may telephone .52.5-0911 to alTange for an interview.
or wrile giving full particulars 10: Personnel Direc-
tor, Queen's Park Hospital. 31.5 McBride Blvd.,
New Weslminster. British Columbia. V3L .5E8.
Eaperiftced Nllww. (B.C. Keaistered) required for
upansion to 463 bed acute. teachina, reaional
referTaI hospitllliocated in Fraser Vlllley, 20 minutes
by freeway from Vancouver, and within easy access
of various recreationlll facililies. Euellent orienta-
tion and continuina education proarammes. Salary:
S 1184.00-S 1399.00 per month (1977 rates). There is
an immediate need tn coronary care. intensive care,
operatina rooms and hemodilllysis because 0(
increased services. OIher clinical areas include
medicine. sUl'lery. obsletrics, pediatrics. emeraency
and rehabililation. Apply to: Personnel, Royal
Columbian Hospital. New Westminster. British
Columbia. VJL JW7.
General Duty Nurses (eligible for B.C. registration)
required for 12.5-bed hospital in the South Okanagan.
RNABC contract in effecl. Reply in writing to:
Director of Nursing. South Okanagan General
Hospital. Box 760. Oliver, British Columbia. VOH
ITO.
Experlencrd ICU/CCU and Operatl", Room General
Duty Nunes required for full-time and summer relief
in a 230-bed accredited hospital in the Okanagan
Valley. Must be eligible for B.C. registration. Salary
$1,30.5 to SI..542 per month, with differential for
special clinical preparation of not less than 6 months.
Apply to: Director of Nursing. Penticton Regional
Hospilal, PenticlOn. British Columbia. V2A 3G6.
Registered Nunes - Required immediately for a
340-bed accredited hospital in the central interior of
B.C. Registered Nurses interested in nursing posi-
tions at Ihe Prince George Regional Hospital are
invited to make inquiries to: Director of Personnel
Services, Prince George Regional Hospital. 2000-
l.5th Avenue. Prince George. British Columbia V2M
IS2.
Wanted Immediately. R.N.'. Generlll Duty. Perma-
nent full-time and part-time. Apply to: R. Billerlich,
Nursing Director, Queen Charlotle Islands General
Hospital, Box 9. Queen Charlotle City. British
Columbia. VIJf ISO. Phone: (604) .5.59-4411, Local
2.5.
British Columbia
Faculty - New Position (I) in 2-year post-basic
baccalaureate program in Victoria. B.c.. Canada.
Generalist in focus. clinical experience is provided in
gerontology in community and supportive exlended
care units. and in community nursing.
Highly-qualified and motivated studenls in a
dynamic academic environment stimulate teaching
creativilY which. with research, is strongly
endorsed. Master's degree. teaching and recent
clinical experience in geronlology/med.-surg./reha-
bilitation preferred. Salaries and fringe benefits
competitive: an equal opportunity employer for
qualified persons. Appointment effeclive July I.
1979. Contact: Dr. Isabel MacRae. DireClor, School
of Nursing. University of Victoria. P.O. Box 1700,
Victoria, B.C.. Canada. V8W 2Y2. Telephone (Area
Code 604) 477-6911 - Local 4814.
Nova Scotia
Teaching Posh Ion Available: Nurse clinician with
master's preparation to teach in the Bachelor of
Science In Nursing program in the area of children
and/or adult nursing. Program enrolment: 100.
Salary commensurate with preparation and experi-
ence. Write to: Chairperson, Department of Nurs-
ing. St. Francis Xavier University. Antigonish.
Nova Scolia. B2G ICO.
Quebec
Cemp Nurses required for childrens summer camp in
beautiful Quebec Laurentians. Mid-June to end of
August. Resident M.D. Contact: Mr. Herb Finkel-
berg. Director of Camp B'nai B'rith. .51.51 Cote SI.
Catherine Rd., Suite 203. Montreal. Quebec. H3W
IM6, or lelephone (.514) 73.5-3669.
Nurses for Children's Summer Camps In Quebec. Our
member camps are located in the Laurentian Moun-
tains and Eastern Townships. within 100 mile radius
of Montreal. All camps are accrediled members of
the Quebec Camping Association. Apply to: Quebec
Camping Association. 2233 Belgrave Avenue,
Montreal. Quebec. H4A 2L9. or phone 489-1.541.
United States
RN'S-CalifornlL Registered nurses interested in a
career in California working in skilled nursing
facilities. Salary is comparable to Canadian wages.
Moving expenses provided. No California examina-
tions are required. Write: M. Cameron. 12.54 Prin-
cess Street. ApI. 17. Kingslon. Ontario, K 7M 3C9 or
telephone (613 1.544-0 170-Evenings or weekends.
Nursing Opportunity - Mississippi Baptist Medical
Center, a ma,jor 600-bed hospital. has immediate
positions available for experienced RNs and recent
nursing school graduates in a variety of specialilies
and medical/surgical areas. Competitive salaries.
liberal benefits. Visa, licensure and relocation
assistance provided. Located in Mississippi's capital
city of Jackson (population 300,(00). MBMC is the
state's largest and most modern privately operated
hospital. For further information write: Mrs.
Johnnye Weber, Nurse Recruiter, 122.5 North State
Street. Jackson. Mississippi 39201; or call collect
601/968-.513.5.
The Cen-.llen Nur..
..
Januery 11171 511
United States
United States
RNII- Aa Exdtlaa Career Awaits You In Las Vqas.
Join Valley Hospital and realize your nursing
potential while e
oying the unique lifestyle of sunny
Las Vegas. Valley Hospital is a progressive,
fully-accredited 277-bed facility nNed for providing
higfl quality personalized medical care. We offer an
excellent salary and benefit package. For more
information, write or call collect: Kalene Ryan,
Nurse Recruiter. CN-I, Valley Hospital. 620
Shadow Lane. Las Vegas. Nevada 89106, (702)
385-3011.
Nanes - RNII - Immediate Openin,lI in
California-Florida-Texas-Mississippi - if you are
experienced or a recent Graduate Nurse we can offer
you positions with excellent salaries of up to 51300
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 U.S.
thaI you are interested in. We will call you upon
receipt of your application in order to alTange for
hoSpital interviews. You can call us collect if you Brf
an RN who is licensed by examination in Canada or
a recent graduate from any Canadian School ct
Nursifli. Windsor Nurse Placement Service. P.O.
Box 1133, Great Neck. New York 11023. (516-487-
2818).
"Our 20th YearofWorJd Wide Service"
The Best Location la the Nation - The world-
renowned Cleveland Clinic Hospital is a progres-
sive, 1020-bed acute care teaching facility committed
to excellence in patient care. Staff Nurse positions
are currently available in several of our 61CU's and
30 departmentalized med/ surg and specialty divi-
sions. Starting salary range is 513.286 to 515,236,
plus premium shift and unit differential. progressive
employee benefits program and a comprehensive 7
week orientation. We will sponsor the appropriate
employment visa for qualified applicants. For
funher information contact: Direclor - Nurse Re-
cruitment, The Cleveland Clinic Foundation. 9500
Euclid Avenue, Cleveland, Ohio, 44106 (4 hours
drive from Buffalo. N.Y.); or call collect 216-444-
5865.
NuninB Opponunities - ProJVessive SOO-bed Medi-
cal Center in West Texas city of Abilene with
population nearly 100.000 is Iookifli for aew
,ndulllft and experienced R.N.'s for positions in
O.B.. Pedialrics. SurBery. E.Jt... ICU. CCU. plus
surJicai and medical floors. Good compelitive salary
and Benerous benefils are provided. Contact: Per-
sonnel Office. Hendrick Medical Center. 19th and
Hickory. Abilene. Texas. 79601.
A....13.
.,
MEDICAL
RE'CRUITERS
OF AMERICA
INC.
MRA recruIts Regls.ered Nurses and recen,
Gradua.es tor hosp"al pOSItions In many
U S clloes We provide comple'e Work V,sa
and Sta.e licensure .ntormaloon
ARLINGTON. Tit. 76011
6" Ryan Plaza Dr SUlle 531
(811) 461-1451
CHICAGO. ILL 60607
500 So RaCine 51 SUile 3.2
13121942."46
FT. LAUDERDALE. FL. 33309
800 N W 62nd 51 SUite 510
(305) 172.3680
FOUNTAIN VALLEY. CA. 92708
17400 BrOOkhurst SUile 213
1714) 964.2471
PHOENIIt. AZ. 85015
5225 N 19th A.ve. SUlle 212
(602) 249-1608
TAMPA. FL. 33607
1211 N Wesishore Bivd. SUI1e 205
18131872.0202
ALL FEES EMPLOYER PAID
lfh
GENERAL
ST AFF NURSES
Operating Room
We require general staff nurses for Ihe
Operating Room of Calgary's largest general
hospital. The successful applicants must be
eligible for registration in Albena and have
experience and or a post graduate course in
Operating Room technique.
The salary range is 51123-51341 per monlh
plus educational allowances and shift
premiums. There is a comprehensive
employee benefit program included.
Please apply with resume of qualifications
and experience to:
Director 01 Personnel
CALGARY GENERAL HOSPITAL
1141 Centre Avenue East
Calgary, Alberta
T2E lOA
Unit Co-ordinator
Reponing to the Assistant Executive Director.
the incumbent will be responsible for managing:
a) Spedal Care unit (4 beds)
b) Emergency Department
c) O.R.. Recovery. N.F.A.
area'of an accredited 100 bed. acute Care hospital
in Nonhern !vIanitoba. These units normally
operate wilh a lotal staff of20-25 people.
We require a nurse who is eligible for
registration with M.A.R.N. as an active
practising member. A nurse who has 3-5 years
clinical experience in a critical area and who has
graduated from a recognized program in I.C. U.
as desired. A BSc. degree in nursing would be a
definite asset. The candidate should also be an
instructor in C.P.R. or be willing to obtain same
and be willing to co-ordinate and participate in
clinical teaching in the critical care area.
This position offers an excellent range of
benefits. including free denlal plan. accident and
health insurance. four weeks annual vacation.
group life insurance and nonhern allowance.
The initial salary will be in excess of 5 16.000 per
year.
Interested parties are asked to submit a complete
resume in confidence to:
R.L.lrvlne
Direc10r 01 Personnel
Thompson General Hospital
Tlaompson Drive South
Thompson. Manitoba R8N OC8
Canadian Nunes - Our 350+ bed full service
community hospital in a city of 70.000 in the piney
woods and lakes of beautiful East Texas wishes to
extend an invitat,C'n to you to practice nursing in a
progressive hospital while you and your family enjoy
the good life atmosphere of smaller city living. Our
special visa sponsorship and licensure program may
be what you have been seeking. We plan a trip to
several cities in Canada to interview and hire soon so
don't delay your response. For more information.
please write or call Jack Russell. 611 Ryan Plaza
Drive. Suite 537. Arlington. Texas. 76011. (817)
461-14S1.
CeDe to Tn.. - Baptist Hospital of Southeast
Texas is a 400-bed growth oriented ol'Janization
lookifli for a few Bood R.N.'II. We feel that we can
offer you the challenge and opportunity to develop
and continue your professional jp"owth. We are
located in Beaumont, a city of 150,000 with a small
town atmosphere but the convenience of the IlU}Ie
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 fringe package. We will provide your immig-
ration paperwork cost plus aiñare to relocale. For
additional intonnation. contact: Personnel Ad-
ministration, Baptist Hospital of Southeast Texas.
Inc.. P.O. Drawer 1591. Beaumont. Texas m04. Aa
amrmlllive adIoa employer.
Excltemeat: Come and join us for year around
excitement on the border. by the sea. an unbeatable
combination. Enjoy the sandy beaches of So. Padre
Island or the unique cultures of Old Mexico. Our
new 117-bed. acute care hospital offers the experi-
enced nurse and the newly graduated nurse an array
of opponunities. We have immediate openings in all
areas. Excellent salary and fringe benefils. We invite
you to share the challenge ahead. A"istance with
travel expenses. Write or call eoUect: Joe R. Lacher.
RN. Director of Nurses. Valley Community Hospi-
tal, P.O. Box 4695. Brownsville. Texas 78521; I
(512) 831-9611.
Primary Cbildren's Medical Center in Utah has A
Place lor You. RN's - interested in new born
intensive care-We want you! We've opened our
new 22-bed intensive care center and have positions
available. RN's for Medical. Surgical. Semi-
Intensive Care Units and Nursery. Primary Chil-
dren's Medical is located in a beautiful residential
seclion of Salt Lake City. only minutes from
recreational and skiing areas in the Rockies.
Excellent benefits package include tuition reim-
bursement. Temporary housing Can also be ar-
ranged. For personal interview write or call collect
now: Beverlee Aaron. RN. Nurse Recruiter, 320
121h Ave.. Sal. Lake City. Utah 84103. Phone
1-801-328-9061. Ext. 3S1. E.O.E. M/F.
Switzerland
Wintenhur Can.on (n5 bed) hospital near Zlirieh
needs Operating Room Nurses for the surgery clinic.
Required for immediate or future openings. We offer
pleasant workifli conditions. equitable hours of
work and leisure. Salary and benefi.. in accordance
with the regulations of the Canton of Zürich.
Five-day week. accommodation available. cafe'ena.
Apply in writing to: Sekretariat Pflegedienst. Kan-
tonsspital Win.enhur. CH-1I401 Wintenhur. Swit-
zerland.
Miscellaneous
Africa - Overland Expeditions. London/Nairobi 13
wks. London/Johannesburg 16 wks. "'enya Safaris
- 2 and 3 wk. itineraries. Europe - Camping and
hotel tours from 16 days to 9 wks. duration. For
brochures contact: Hemisphere Tours. 562 Eglinton
Ave. E.. Toronto. Ontario. M4P IB9.
í
10 J.nuery 11171
The C8n-.ll.n Nur..
Wish
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.. .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
nonnalload 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
financial support for educational leave.
For further infonnation on any, or all. of these career
opporttmities, please contact the Medical Services
office nearest you or write to;
ø........,
I Medical Services Branch I
Department of National Health and Welfare
Ottawa. Ontario K1A OL3
I Name I
I Address I
I City Provo I
I . . Heallh and Welfare Sanfe el B'en-elre socIal I
Canada Canada
..........,
Associate Director - Nursing Service
To be responsible for a number of clinical areas
within Nursing Service of a 1000 bed active
treatment hospital.
Qualifications:
Master's Degree in Nursing preferred, with at least
three years of top nursing management experience.
Skills in day-to-day departmental operations
including staffing.
Experience with various nursing care modalities
highly desirable.
Apply with curriculum vitae to:
Director of Personnel Services
Royal Alexandra Hospital
10240 Kingsway A venue
Edmonton, Alberta
T5H 3V9
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 8 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
KlPIE2
.
The Can-.llen NUrH
Nursing Opportunities in Vancouver
Vancouver General Hospital
If you are a Registered Nurse in search of a change and a challenge -
look into nursing opportunities at Vancouver General Hospital. B.C.'s
m
or medical centre on Canada's unconventional West Coast. Staffing
expansion has resulted in many new nursing positions at all levels.
including:
General Duty ($1231-1455.00 per mo.)
Nurse Clinician
Nurse Educator
Supervisor
Recent graduates and experienced professionals alike will find a wide
variety of positions available which could provide the opportunity
you've been looking for.
For those with an interest in specialization. challenges await in many
areas such as:
Neonatology Nursing
Intensive Care
(General & Neurosurgical)
Cardio- Thoracic Surgery
Burn Unit
Inservice Educatiun
Coronary Care Unit
Hyperalimentation
Program
Renal Dialysis & Transplantation
Paediatrics
If you are a Nurse considering a move please submit resume to:
Mrs. J. MIIC:Phail
Employee Relations
Vancouver General Hospital
855 West 12th Avenue
Vancouver, B.C. V5Z IM9
Perinatal Nursing
Specialist
For
Neonatal Nursery
Are you looking for a challenging opportunity where you can use your
clinical expertise. educational and managerial skills? Are you interested in
being a leader in the development of our Neonatal Program working
closely with nursing, medical and paramedical personnel? Would you like
to be involved in the planning of a 60 bed SpecIal Care Nursery in a new
Pediatrics/Obstetric hospital complex and the development of a Family
Centre Perinatal Care Program?
lfyou are. you might be the person we are lookmg for. This IS a newly
created position in which you will help us develop our current Tertiary
Program and plan for its move into the new facilities. Future plans also
involve the development of Regional Program and Perinatal Care. Salary
negotiable, commensurate with experience. Excellent benefits.
Preparatiou Desired: A minimum of at least three years of
Neonatal Intensive Care Nursing and alleasllwo years experience and
preparation as aN urse Educator. Previous experience in administration
desirable but not essential. A Baccalaureate or Master's Degree reqUIred.
Qualified applicants please send your curriculum vitae and names of three
referees to:
Mrs. J. MIIC:Phall
Empioyee Relations
Vancouver General Hospital
855 West 12th Avenlle
Vancouver, B.C. \5Z IM9
Januery I tl7I 111
The Province
of British Columbia
Community Nurses
Applications are invited from qualified persons to form an
EligibiJity List (valid for six months) of community nurses from
which vacancies occurring at various locations in British
Columbia will be filled.
Duties wiJl include providing general public nursing. counselling
and crisis intervention services in the area concerned: to liaise
with health professionals and others providing care. and
encourage appropriate use of available facilities.
Qualifications - University degree in nursing. including public
health training. or equivalent combination of educalion and
experience: preferably some general nursing experience.
including some in directly related duties: registered. or able to
obtain registration. in the RegisteR:d Nurses Associat,ion of
British Columbia: use own car, or government. on mileage basis.
Salary - $16.322 - $19.296 Quote Competition 78:2619-38
Closing Location - Victoria Closing Date - immediately
POSlhooS are open to bOlh men and women
ObtalO and return applicatIons at addres< below unle,s nlherwlse Indicated
Province of British Columbia
Public Service Commission
544 Michigan Street. Vlclona. Be V8V 1 S3
a ;
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Nurses
Applications are invited for appointment on a permanent or
short term basis to the nursing staff of the Cottage Hospi-
tal" Burgeo and Harbour Breton, Newfoundland.
Salary and bonus in accordance with Nurses Collective
Agreement.
Living-in accommodations available at reasonable rates.
also laundry services provided.
Public service benefits apply with annual and sick leave
with pay. provincial statutory holidays and contributory
pension plan.
Applications should be addressed to:
Director of Nursing
Cottage HospitaJs Dh ision
Department of Health
Confederation Building
St. John's. Ne\\foundland
AIC 5T7
112 Januery 1179
UNITED STATES
OPPORTUNITIES
FOR REGISTERED NURSES
A V AILABLE NOW
ARIZONA
CALIFORNIA
TEXAS
WE PLACE AND HELP YOU WITH:
STATE BOARD REGISffiATION
YOUR WORK VISA
TEMPORARY HOUSING - ETC.
A CANADIAN COUNSELLING SERVICE
Phone: (416) 449-5883 OR WRITE TO:
RECRl'ITING REGISTERED NURSES INC.
1200 LA WHENCE A VENUE EAST. Sl;ITE 301,
DON MILLS, ONTARIO M3A ICI
IN
FLORIDA
OHIO
NO FEE IS CHARGED
TO APPLICANTS.
@
Foothills Hospital
Calgary, Alberta
The Department of Nursing and the
Department of Pediatrics. Neonatology.
are offering a five month clinical and
academic programme for Graduate
Nurses:
Advanced Course in Neonatal Nursing
Applications are being accepted for clas-
ses enrolIing each March and September.
Participation in the programme is limited
to eight.
For further Information pt_ write to:
Mr. B. Wrlghl
Coordinator of Eduutional Srrvlc:rs
FoolhlUs Hospital
t40
l9SI. N.W.
Calgary. Alberta
T2N 2T9
Director of Nursing
and
Home Care Services
Poshion A senior management position in
Communily Health Nursing and Home Care
Services.
Location Mount View Heallh Unit - includes
the M.D. of Rocky View. County of Mountain
View and I.D. #8.
Duties Responsible for planning. organizing.
co-ordinating. directing and evaluating all
nursing and co-ordinated Home Care programs.
QualIDcations Minimum qualifications - a
Bachelor of Science in Nursing and
demonstrated administrative skills. This nurse
should have a minimum of 5 years experience in
a supervisory capacity.
Salary Negotiable and dependent on
qualifications and experience_
Appllcallons Send resume to Medical Officer of
Health. Mounl View Health Unit #101. 5421
II th Street N. E. Calgary. Albena T2E 6M4.
The Can-.llen Nur..
Clinical Nurse Specialist -
Psychiatry
required for
Medicine Hat & District Hospital
Applications are invited for the position of
Clinical Nurse Specialist - Psychiatry. for a 247
bed aclive trealmenl and 100 bed extended care
hospital located in southeastern Albena.
Accountable to the Assistant Execulive Director
- Patient Services.
Responsible for continuing development of
psychiatric program.
Master'sDegree preferred Will consider
Baccalaureate Degree with minimum three
years' clinical expenence in psychiatric nursing.
Salary - negotiable.
Submit ResumeTo:
Mrs. Shirley NeWlon
Nursing Director - Slamng
Medicine Hat lit District Hospital
666 FIfth Sireet. Soulh West
Medicine Hat. Alberta
TIA 4H6
Director
School of Nursing
Reponing direclly to the Executive Director.
assumes Ihe responsibility for Ihe organization
and administration of ongoing accrediled
diploma nursing programs.
Quallftutlollll:
Appropriate Master's Degree preferred, but
applicants possessing a Baccalaureate in
Nursing will be considered.
Previous experience in the adminislration of an
accrediled nursing education program a
necessily
Please forward. in confidence. a complele
resume of experience and qualificalions.
including expected salary to:
Mr. T.I. Bartman
Executive Dlrect(,r
Misericordia General Hospllal
99 Cornish A venue
Winnipeg. Manitoba
RJC tAl
High Risk Obstetrics and
Neonatal Intensive Care
Nurses
McMaster University Medical Centre is a
progressive teaching hospital with a
multi-disciplinary team approach to patient care.
M&,jor specialties include Obstetrical Intensive
Care and Neonatal Intensive Care unils. When
openings occur in these areas for Registered
Nurses. we require experienced staff. Inquiries
are welcomed at any time from mature.
responsible individuals who wish to work in a
stimulating environment on a 12 hour shift
system. Preliminary interviews can be arranged
for out of lown nurses with current Ontario
registration if written requests are accompanied
by detailed resumes.
Please apply to:
Ms. Nora Prosser
Personnel Interviewer
McMaster Unive.-si1y Medical Centre
1200 Main St. W.
Hamlhon. Ontario
L8S 4.19
Assistant Nursing Dira:tor
- Operating Room
required for
Medicine Hat & District Hospital
Applications are invited for the position of
Assistant NursingDirector for a six room O.R.
suite and six bed Recovery Room. The hospital
is a 247 bed active trealmenl and 100 bed
exlended care facility located in southeastern
Albena. A new facility is presently being
planned.
Baccalaureate Degree preferred. Post-Graduale
course with minimum of three years' experience
will be considered.
Salary - negotiable.
Submit Resume To:
Mrs. Shirley NeWlon
Nursing Director - Stamng
Medicine Hal lit Dlslrict Hospital
666 flfth Sireet. Soulh West
Medicine Hal, Alberta
TtA 4H6
The Religious Hospitallers of Saint Joseph
of the Hotel Dieu of Kingston
Hotel Dieu Hospital Kingston
requires
Director of Nursing
Applications are invited for the position of
Director of Nursing in a fully accredited 219 bed
general teaching hospital.
Reponing to the Administrator. the Director of
Nursing will be responsible for managing the
Nursing Depanment and maintaining an
excellent standard of nursing care in a leaching
environment. This vacancy is due to the
promotion of the present incumbent.
Extensive experie..ce administering a complete
nursing program. a B.Sc.N. degree and
eligibility for Ontario registration are minimal
requirements. Preference will be given to
applicants possessing a Master's degree in
nursing or administration.
Please forward your resume to:
Sister K. KHvII
Hotel Dleu Hospital
Kingston, Ontann
K 7L 3H6
Applications are invited for
Faculty Positions
in the following areas
Medical-Surgical Nursing
Parent-Child Nursing
Qualifications:
Preference will be given to advanced
preparation in the clinical specialties
Salary and Rank:
Commensurate with education and ex-
perience
Applications Deadline: February 15. 1979
Fot" further information contact:
Miss Kathleen King
Dean
Faculty of Nursing
llniversity of Toronto
50 St. George Street
Toronto. Ontario
'\15S fA f
The Central Registry of
Graduate Nurses
411 Eglinton Avenue East
Suite 500
Toronto, Ontario M4P IM7
A non-profit organization welcomes
candidates for membership in this
prestigious group of nurses specializing
in general and private duty nursing in
hospitals and homes.
Telephone for appoimment 483-4306
Registered Nurses
Louisiana
(two locations)
California
(close to Los Angeles)
Active care accrediled hospitals each
have a requirement for four Canadian
RN's experienced in crilical care. As
the hospilals are only interesled in
persons becoming registered aliens of
the USA. these positions would be of
inlerest to the married RN whose
spouse could not obtain a work permit
under the regulalion covering the H-1
temporary permit. Candidates must,
under Louisiana and California licens-
ing, have written AN's in Canada and
received marks of 350 in all five discip-
lines 10 obtain license by reciprocity.
Apply in confidence to W. P. Dow
& Associates lid., (a Canadian
company), 361 Tenlh Street W..
Owen Sound. Ontario N4K 3A4
(519) 376-6809.
Nurses.. .
Are you interested in rural
extension nursing? There are
openings for you in Africa. Or
would you like to teach in nursing
colleges in Africa, Papua New
Guinea or Latin America?
Qualifications: B.Sc.N. or R.N.
with Public Health or broad
general nursing experience.
Inquiries are welcome at:
CUSO Health-D Program
151 Slater Street
Ottawa, Ontario
K1P 5H5
as an alternative. . . _ . . CUSO
Th. Cen-.llen Nur..
Jenuery 111711 13
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You the Nurse.
Hermann the Place.
Houston the City.
...
Imagine This. The kind of nursing you've always wanted to do.
Nursing the way it should be.. .planning and implementing patient
care in a primary nursing framework that lets you exercise optimum
freedom to carry out your professional goals.
You've Got The Talent It Takes. Hermann Hospital has im-
mediate openings, especially for those of you with specialty train-
ing in surgical areas. We'll assist you financially with your reloca-
tion expenses. You'll find the salary program for RNs is more than
competitive and we offer a comprehensive benefits package which
includes three weeks vacation, nine paid holidays, tuition and rent
assistance, fully paid hospitalization, and more. It's an offer you
can't refuse!
Put Yourself In Our Place. We're in the heart of Houston, where
the excitment of the arts, outdoors, and nightlife abound in the en-
vironment of the city of the future. Compare Houston's cost of liv-
ing with other major cities-it's considerably lower, and the state
of Texas doesn't have a state income tax. All things considered,
Hermann Hospital and Houston are where you've always really
wanted to work and live, so now do something about it.
Pnmary Teaching Hospital lor the
University 01 Texas Medical School at Houston g
HERMANN HOSPITAL
HOUSTON'S LIFE _.. .
FLIGHT HOSPITAL '-:,-
,
:I
An equal opportunity employer, mIl-handicapped
Please contact us for more
information about our ex-
cellent salaries and com-
plete benefits package. Ms.
Beverly Preble, Nurse
Recruiter, (713) 797-3000.
AU: Nurse Recruiter
1203 Ross Sterling Avenue
Texas Medical Center
Houston, Texas 77030
Name
Address
City
State Zip
Phone
Specific Area of Interest
(Circle) RN LVN Student Nurse
&4 Jenuary 1179
The Cen..sJen Nur..
Nursing Consultant,
Occupational Health:
$19,400- $22,100
The MINISTR Y OF LABOUR, occupational health branch. seeks
energetic individuals to: provide consultant services in occupational
healln nursing to Ontario industries. employees. health and safety
personnel. educators. professional and lay groups and government
agencies to ensure quality care for employees at their place of work; assist
in developing standards and criteria through interviews. research and
surveys. Locations: Sudbury (LB 208/78). Hamilton (LB 209178) and
London (LB 210/78).
Qualifications: registration as a nurse in Ontario: recognized cenificate in
occupational health nursing or public health nursing. preferably with a
B.Sc. in nursing: at least three years experience in the field of
occupalional health and nursing with some supervisory experience: good
communication and interpersonal skills: abilily to work independently:
willingness to travel.
Please submit application or resume by January 26. 1979. indicating area
of preference and quoting appropriale file number. to: Personnel Branch,
Ministry or Labour, 400 Unlverslly Avenue, 2nd Floor. Toronto. Ontario.
M7A IT7
'["his position Is open eejUlllly to men and women.
Ontario
Ontario
Public Service
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 IZip
Please complete appropriate category
o I hold active membership in provincial nurses' assoc.
reg. no./perm. cert./lic. no.
o I am a personal subscriber
Mail to: The Canadian Nurse, 50 The Driveway, Ottawa,
Ontario K2P I E2
Index to
Advertisers
January 1979
Addison-Wesley (Canada) Limited
Canadian Dairy Foods Service Bureau
The Canadian Nurse's Cap Reg'd
Career Dress (A division of White Sister
Uniform Inc.)
The Central Registry of Graduate Nurses
Equity Medical Supply Company
Eschmann Canada Limited
Famolare, Inc.
Health Care Services U pjohn Limited
Frank W. Horner Limited
Mont Sutton
2
49
13
Cover 2
63
9
50
4
56
54,55
9
TheC.V. Mosby Company Limited
NursingJob Fair
Pentagone Laboratories Limited
W. B. Saunders Company Canada Limited
22,23,24,25
7
57
51
Wellcome Medical Division!
Burroughs Wellcome Limited
Westwood Pharmaceuticals
Cover 4
CoverJ
Adt'ertising Manager
Gerry Kavanaugh
The Canadian Nurse
50The Driveway
Ottawa. Ontario K2P 1 E2
Telephone: (613) 237-2\33
Advertising Representatives
Richard P. Wilson
:!l9 East Lancaster Avenue
ArdmOl;e, Penna. 19003.
Telephone: (215) 649-1497
Jean Malboeuf
601. Côte Vertu
St-Laurent. Québec H4L lX8
Téléphone: (514) 748-6561
Gordon Tiffiri
190 Main Street
Unionville. Ontario UR 2G9
Telephone: (416) 297-2030
Member of Canadian
Circulations Audit Board Inc.
mEE1
Before you try the
Alpha Keri *jKeri * Lotion Moisture System
on your patients, try it on yourself.
Experience for yourself the soothing.
moisturizing qualities of Alpha Keri.
Bath Oil or Keri' Lotion. Simply place two
capfuls of Alpha Keri in your evening bath.
and feel the difference the emollient oil
makes to your skin. Alpha Keri cleanses
without the need for harsh drying soaps. In
the morning. massage super-rich Keri
Lotion into hands. legs. and problem dry
areas. Your skin will feel softer. suppler.
more resilient. and initating itching will be
relieved for hours.
The same benefits apply to your
patients. of course. Alpha Keri and Keri
Lotion are indicated for all dry. pruritic
skin conditions and may help prevent
skin breakdown and the possible
fonnation of decubitus ulcers. And bed
bathlOg's never been simpler. Just add
Alpha Ken to water and gently wash the
patient. Soaping and rinsing are
unnecessary. so you save time and steps.
Actions speak louder than words, and
we'd like Alpha Keri and Keri Lotion to
speak for themselves. In a special offer
to the profession only, a 56 ml size of
each will be sent to any nurse who
sends her name and address, and 25(;
to: The Moisture System,
P.O. Box 1538,
Belleville, Ont. K8N 5J2
J
"r.. A In UN<
WESTWOOD
PHARMACEUTICALS
BELLE\.' LLIE ONTA"'O KeN SEI
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Nature gives it. "
Zincofax* keeps it that wa
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.
\Vhat's more, Zincof.n.. is economical, even more
important now with a new baby at home.
,- ,
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FOR BABV'S SIC,II
keeps a family's
smooth skin smooth
----
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5111
...----
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....Zincofa)(
FO
ø
.
Contains Anhydrous Lanolin and 15% Zinc Oxide.
Available in 10 and 50 g tubes and 115 g and 450 gji\cs.
I Wellcome Medical Divisio
Burroughs Wellcome ltd.
laSalle. Qué.
. Helping mothers when babies cry
. How to make sense of the metric
muddle
. Understanding the physiology of
pain
. Preventing cross infection on a
pediatric ward
. Nurse practitioner in a community
college setting
The
Canadian
Nune
FEBRUARY 1979
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The "
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Quality from "T I e Hou ;. · f
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"J
Style No. 42364 - Pant suit
Sizes: 5-15
"Impact Plus" 100% textured
Dacron' polyester with Zelcon
finish
White, Champagne. . .
about $35.00
Style No. 42307 - Dress
Sizes: 3-15
"Impact Plus" 100% textured
Dacron' polyester with Zetcon.
finish
White, Apricot. . . about $34.00
.
,
.
Siste
-......-
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Available at leading department stores and specialty shops across Canada
...
The
Canadian
Nurse
February 1979
The official journal of the Canadian
Nurses Association published
in French and English
editions eleven times per year.
Volume 75, Number 2
Input 4 You and the law Corinne Sklar 8
News \l SI for you and me Jennifer Craig. Gordon Page 16
.
Calendar 47 Lifestyle crisis Theresa O'Neil 22
A nurse practitioner in a
Names 49 community college setting Diana Nelles 25
Understanding the Anne Hedlin.
Books 52 physiology of pain Dr. J. DostrOl'sky 28
The patient in pain:
Library Update 52 handling the guilt feelings Gillian Doheny 31
When babies cry Janet B. Harris 32
Visions Barbara MacCuish 35
Childhood asthma:
an outpatient approach RoyG. Ferguson
to treatment Anne Webb 36
Cross infection: a new II
approach to an old problem CatherineE. Cragg 40
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I
The Canadian winter certainly
provides us with many
opportunities for exercise.
February is heart month-
and what better way to
celebrate than cross country
skiing?This month's cover
photo comes to us courtesy of
the National Sport and
Recreation Centre Inc. in
Ottawa. Ontario.
4"
"
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-spaced. Send
original and camon. All articles must
be submitted for the exclusive use of
The Canadian Nurse. A biographical
statement and return address should
accompany all manuscripts.
The views expressed in the articles
are those of the alJthors and do not
necessarily represent the policies of
the Canadian Nurses Association.
ISSN 0008-4581
Canadian Nurses Association.
50 The Driveway, Ottawa. Canada.
K2P IE2.
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
I University Microfilms, Ann Arbor,
Michigan, 48106.
f
Subscription Rates: Canada: one
year, $10.00; two years, $18.00.
Foreign: one year, $12.00; two
years. $22.00. Single copies: $1.50
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
Toronto, Ontario. Permit No. 10539.
Canadian Nurses Association, 1978.
2 Februery 1171
The c.n-.ll.n NUrH
1
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Number one...and still gro""ing!
THE
ELINIU
I
..... ua .A" o".c....oa -"CII.U.
SHOE
k
ÍI\,UJkÄti.@
SOME STYLES ALSO AVAILABLE IN COLORS... SOME STYLES 3Y2-12 AAAA-EE, ABOUT 33.00104800
For a complimentary pair of while 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
The Cenedlan Nu...
February 1171 3
perspective
Who took the nurse Nor was the "take a deep realized I had been mistaken worry. It doesn't matter
out of nursing? breath and don't move" lady in assuming that she was an whether it's a new baby or an
in the X-ray room which was RN. Her official title was operation like this, we all get
For the past five and half the next stop on the route. registered nursing assistant. the blues sooner or later. You
years nurses have been at the The pleasant, middle-aged During the ten days of my just climb back into bed and
center of my working life. I lady who showed me up to my hospital stay, I did get to meet have a real good cry. I'll shut
talk with nurses in my office, room reminded me of a several bona fide RN's. There your door and when I come
at meetings, on planes and bellboy in a hotel. She even was the nurse who visited me back in an hour I can
I trains and on the street. I offered to carry my suitcase. the night before the operation guarantee you'll feel better. ..
correspond with nurses, I read "Just push this button to and assured me that she would And, you know what?
the letters. articles and even make your bed go up or down; be looking after me in the She was right. Now, a
poems that they write for here's your radio and phone recovery room. But I never do month later, I can claim to
publication in their journal. I and the bath is right here." remember seeing her again. have some sketchy idea of
write for nurses, I collect The label on her orange smock There were also, I am sure, how patients are treated in
news about them and for them said "Volunteer". plenty of highly qualified hospitals these days, but just
and much of my reading Pretty soon, I thought, as nurses in the OR but I must don't ask me to help you
consists of nursing journals. I puttered around unpacking admit it was the reassuring pat define nursing practice as it
That's why, when I found my toothbrush and notepaper, of my doctor's hand on my relates to patient care.
that I could no longer put off I'll see a real nurse. Finally, shoulder as I was rolled into -
I.A.B.
the surgery that had been even though it was only a little the theatre that comforted me
hanging over my head, I after noon, I put on my nightie most as I waited. EDITOR
decided to look on my hospital and climbed upon the bed. There were RN's on the ANNE BESHARAH
stay as a learning experience. The voice that made me open floor when I began to be
Eight out of every ten nurses, my eyes was friendly. She conscious of my surroundings ASSISTANT EDITORS
I knew, still work in hospitals wore a uniform, carried a set again back in my room. It was LYNDA FlTZPAllUCK
of one kind or another and my of scales and said her name an RN, for example, who SANDRA LEFORT
experience with these was Marcie. Her shave prep, a announced firmly once when I PRODUCTION ASSISTANT
institutions was limited, to say hospital procedure I finally worked up the nerve to GITA FElDMAN
the least - consisting mostly remembered and dreaded. push the buzzer beside my
of a short stay when each of was carried out casually but bed: "No, you can't have CIRCULATION MANAGER
my three children, now carefully and was over before anything for the pain - not PIERRElTE HOTrE
teenagers, was born. I had time to think about it. for another 15 minutes." And
Things have changed a lot While she worked, it was another RN who ADVERTISING MANAGER
since then I reasoned: my ten Marcie confided that just a complained, after three futile GERRY KAVANAUGH
days in hospital would give me year ago she had had the same and painful attempts to CNA EXECUTIVE DIRECTOR
the chance [ always wanted to operation [ was scheduled to re-start my IV, that "all you HELEN K. MUSSALLEM
see for myself what it is that have. "I was so scared," she ladies have difficult veins."
nurses really DO at work, said. "All the old wives tales It was an RN, too, who EDITORIAL ADVISORS
what nursing practice consists I'd heard, working in a switched on the light above MATHILDE BAZINET,
offrom the viewpoint of that hospital and all, and, in the my bed at ten every night just chairman, Health Sciences
all-important person - the end. there was nothing to it. as I was dozing off, handed Department, Canadore Colleje,
patient. I chose a smaller It was Marcie who helped me my sleeping pill and North Bay, Ontario.
hospital this time and, from me fill in the three-page antibiotic and walked out DOROTHY MILLER,public
the first, it seemed friendlier, nursing assessment form. without asking whether I relations officer, Registered
more welcoming I wore an "How do you feel about your needed water to swallow them Nurses Association of Nova
Scotia.
identity bracelet. yes, but I operation?" "Why, of course, and without waiting to turn off JERRY MILLER,directorof
was never left with the feeling you're glad to be here so you the light which was just communication services,
that I had been reduced to a can get it over with and get beyond my reach. Registered Nurses Association c(
disease or a room number. better," was Marcie's breezy Yes, there were RN's but British Columbia.
I knew the chatty lady answer when my doubts it was my husband who said, JEAN PASSMORE,editor,
behind the desk who sorted surfaced again. "Take my arm and we'll walk SRNA news bulletin. Registered
out the details of what I was Her reassurance was also as far as the lounge and Nurses Association of
doing there, where I lived, comforting in a couple of back." It was the Saskatchewan .
worked and was born, etc. other areas: no enema, onl y physiotherapist who said PETER SMITH. director of
was not a nurse. And I was suppositories and, as for the "Have you been coughing and publications, National Gallery of
Canada.
pretty sure, even before I got scar, why you can wear a taking deep breaths today?" FLORITA
a look at the label on her bikini next summer if you And it was Marcie, the RNA, VIALLE-SQUBRANNE,
uniform. that the lady in the want to. It was only when who took one look at me on consultant, professional
lab who was after my blood Marcie called in a nurse to the evening of my fifth day inspection division. Order of
was not a nurse. check her shave prep that I postop, and said, "Don't Nurses of Quebec.
4 Februery 1171
The Cen-.llen NUrH
input
The Canadian Nurse invites your
letters. AU correspondence is
subject to editing and must be
signed. although the author's
name may be withheld on request.
Dear Sir/Madam
My concern is the way in
which the careless use of
language in professional and
other journals can further
entrench women in
stereotyped jobs.
I have searched through
six issues of The Canadian
Nurse and find countless
examples of the unconscious
assumption that a nur.5e is a
female person. It is
undeniably true that at the
beginning of this decade,
approximately 96 per cent of
all graduate nurses were
female and this figure may not
have appreciably diminished
- but is this an irreversible
situation?
I noted many instances
where the problem was
avoided by referring to
"nurses" in the plural,
thereafter using the pronoun
"they". In certain editorial
notes, such as in the "Here's
How" articles, when the
editor suggests "Every nurse
has practical ideas gathered
from his or her
experience...", it is evident
that you are conscious of the
problem, but could the rigid
enforcement of greater
concern in this matter not
become a criterion for
acceptance of material for
publication?
Certainly it is disturbing
to note reference to the doctor
as "he", but equally so is the
use of this pronoun when
speaking of a hypothetical
patient. Even babies and very
young children are assumed to
be male.
Nurses are in the
unenviable position of
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appearing to serve both the
patient and the doctor. An
uncaring society perhaps
considers the nursing
profession to be one of
subservience. Is it not
possible that this unhappy
state will continue to exist as
long as nurses themselves
unconsciously perpetuate the
myth that they are women and
that those whom they are seen
to serve are men?
-Sandra Conrad, A.R.T.,
Montréal, Québec.
Spiritual forgotten
Thank you for the very
well written and helpful
articles on the care of the
dying. (November 1978)
Not once, however, was
the name of God mentioned.
Is this the great "no-no" of
our profession? In our fear of
offending this or that church,
have we abandoned every
expression offaith in the
Creator oflife, the Father of
us all?
We are agreed that a
loving touch, or a cup of tea
with five minutes sharing, is
worth more than a thousand
words. But we surely do need
a holy hope in the life to come,
to offer along with the service
of our hands. Otherwise the
despair in our own hearts will
be only too visible in our eyes.
-Jean M. Heard, R.N.,
Vernon, B.C.
1977 Nobel Peace
prize winner
There are hundreds of
thousands of men and women
around the world who are in
prison because of their race,
religion or political beliefs.
Amnesty International works
for all of them - the sick, the
tortured, the forgotten.
Please help the Canadian
section of Amnesty
International in this work
through your membership or
your financial contribution.
Contributions are tax
deductible. Write today to:
Amnesty International, 2101
Algonquin Avenue, P.O. Box
6033, Ottawa. Ontario.
K2A ITI.
-Rob Robertson, National
Director, Amnesty
International.
N.S. emergency nurses
Members of the
Association of Emergency
Nurses of Nova Scotia were
particularly interested in the
account of the first
interdisciplinary meeting of
emergency personnel in
"News" in the November
1978 issue ofthe Canadian
Nurse.
The AENN S was formed
early in 1977 and now
numbers nearly ninety nurses
from allover Nova Scotia.
Plans are now being made to
hold the annual educational
seminar in June of 1979.
Current president of the
Association is Valerie
Wiggans ofthe Izaak Walton
Killam Hospital for Children
in Halifax.
-Dorothy Miller, Public
Relations Officer, RNANS,
Halifax, N.S.
S.L.E. group
Again, congratulations
and thanks to Bonnie Hartley
for her excellent article
"Systemic Lupus
Erythematosus - a patient's
perspective", and "Now
you're on cortisone"-
February 1978 issue. Not only
interesting, they were most
informative, helpful and
reassuring.
We now have a S. L. E.
group (as yet un-named) in
Montreal, which met for the
first time at the Montreal
Children's Hospital,
November 19,1978. Anyone
interested (S. L.E. not a
prerequisite) may contact:
Margaret Duffy N, 140 - 4th
Ave., Dorion, Quebec, J7V
2Z7. Monthly meetings are
planned.
-Margaret Duffy, Dorion,
Quebec.
The Cenedlen NUrH
....
Febr\lll['L 1979 II
A WISE INVESTMENT FOR
TO DAY'S NURSING PROFESSIONAL
Barnard. Clancy & Krantz
Human Sexuality for Health
Professionals
This multi-disciplinary approach to the field stresses the need
for sex education and sexual counseling, and the importance of
knowledge on the part of all health professionals, with emphasis
on the nurse. Many nursing programs offer courses on the sub-
ject now. Contributions include material from 28 leading author-
ities including physicians, professional counselors, clergy,
psychologists, and nurses.
By Martha Underwood Barnard, RN, MN, Facully-Nurse Clinician.
School of Nursing; Barbara J. Clancy, RN, MSN, Assoc. Prof.,
School of Nursing; and Kermit E. Krantz, MD, Prof. and Chairman,
Obstetrics and Gynecology and Dean of Clinical Affairs; all of Univ
of Kansas Medical Center, Kansas City. 301 pp. lIIustd. Soft cover.
$11.45. April 1978. Order ff1544-9.
Sorensen & Luckmann
Basic Nursing:
A Psychophysiologic Approach
They've done it again! The authors of the popular Medical-
Surgical Nursing now offer a comprehensive textbook on basic
nursing conæpts ofr the practitioner. Twenty eight contributing
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ship; blood administration and much more. Particular attention
is paid to the role of stress and adaptation in illness, under-
standing the existence of the patient. therapy and rehabilitation,
the nursing process, and the changing role of the nurse. You'll
find special features like many new and original illustrations,
important information boxed off in each chapter. key points
highlighted with arrows, an overview and study guide preceed-
ing each chapter, and a two-<:olor format for easy reading.
By Karen Creason Sorensen, RN. BS, MN, Formerly Lecturer in
Nursing, Univ of Washington; Instructor of Nursing, Highline
College; Nurse Clinical Specialist, Univ. Hospital and Firland Sani-
torium, Seattle. WA; and Joan Luckmann, RN, BS, MA. Formerly
Instructor of Nursing, Univ. of Washington, Highline College, Seattle,
Oakland City College, and Providence Hospital College of Nursing.
Oakland, CA. About 1360 pp., 435 ill. Ready soon. About $23.00.
Order ff8498-X.
Keane
Essentials of Nursing:
A Medical-Surgical Text
4th Edition
This is a compact textbook for students beginning the study of
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homeostasis) and those related to nursing, it goes on to discuss
medical-surgical nursing care problems with emphasis on the
nursing process throughout. Student aids include: learning
highlights (similar to objectives); vocabulary lists; summary
tables; and a student study aid section consisting of learning
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By Claire Brackman Keane, RN, BS, MEd. About 720 pp., 125 ill
About $16.10. Ready soon. Order ff5313-8.
I '
Stryker
Rehabilitative Aspects of Acute and
Chronic Nursing Care
2nd Edition
This book will help you implement rehabilitative steps in both
acute and long-term nursing care. Psycho-social aspects of
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with the brain damaged patient.
By Ruth Stryker, RN, MA, Asst. Prof.. Long Term Care Administra-
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$11.50. June 1977 Order ff8637-0.
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Over 1500 drugs are included in this easy to use softcover
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and contraindications.
By Mary W. Falconer, RN, MA; H. Robert Patterson, PharmD, MS;
Edward A. Gustafson, PharmD; and Eleanor Sheridan, RN, BSN,
MSN. 312 pp. Soft cover. $8.60. March 1978. Order ff3568-7.
II
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II Februery 1171
The Cen-.llen NUrH
input
-
Medical care can't do it all Focus on health have both a direct and indirect Concern for continuing ed
I read with much distaste For the last 25 years I influence on the standard of Would it be possible for
your October issue which have worked very closely with health (and employment etc.) The Canadian Nurse to
dealt with native health care. the native people in our of the people. Although the introduce a continuing
Why not tell it like it is, not hospital. I cannot agree with Native Peoples of Canada do education program similar to
just how it looks from an you we white nurses don't indeed live surrounded by one the "Accreditation of
Indian viewpoint. understand the native people of the world's richest Continuing Education in
When I came to"this area and the way they live. economies, they must be Nursing" frequently
to work, I had worked with I drive through the considered a third world presented in the American
and been employed by Indians Reserve of .... , districts of people. Journal of Nursing?
and found them to be fair, new lovely homes with On another point, my Surely C.N .A. can
hard working people. Since fridges, stoves, carpets, collection ofCNJ of the past develop some type of
coming to a town that delivers almost everything in them. two years has been well correspondence instruction
health care to a nearby How does the outside look? received by my Spanish for RN 's in areas not easily
reserve my outlook has Weeds are high, plenty of speaking colleagues. First accessible to major teaching
changed. young energetic teenagers they had me translate different centers.
It's difficult to help around, nothing to do. But articles, then they got to work It is fine to talk of nursing
people who won't help why work?There is oil with the scissors to make good competency, but sometimes
themselves - regardless of money, also easy welfare to use of the many excellent quite difficult to require the.
race. It's hard to see culture in get. Middle-aged men have photographs in teaching up-dating knowledge
lice-infested, drunken, told me, why work? sessions. They've even had necessary to retain it.
tuberculous humanity. Often I go out on their uniforms made from the I look forward to reading
When will people realize ambulance call to the reserve. latest models! my Canadian Nurse each
that medical care can't do it It makes me cry when I see -Alice PurdeyCulbert, month and I am sure it could
all? If there is no pride in a the beautiful homes run down (BSN,UBC 1967), be used more positively for
group of people that inspires in no time. Also I get very Fusagasugå, Cund., continuing education
them to achieve something, frustrated when the call Columbia. purposes with accumulative
even if it is only good health, wasn't even necessary. But credit recognition for nurses
the medical profession can't the Band pays for it. And who Native health in remote areas.
do it for them. Personally I"m pays the Band? The working I would like to comment -JoanE. McLaren, R.N.,
tired of hearing about the poor people and the taxpayer. on the well-published October Iroquois Falls, Ontario.
misunderstood Indian and -FA. Wagner, R.N., 1978 Canadian Nurse Journal
would like to see more articles Wetaskiwin, Alberta. featuring the health of What it's all about
like that by Lucy Chapman Canada's native people. Input I found the article on
which told of trying her Right on from the National Indian Primary Care Nursing by
hardest with the natives, her The October 1978 issue Brotherhood, Indian students, Marlene Medaglia (May, 1978)
failures and frustrations and on Native Health has just held Indian health representatives very stimulating. Although I
how she dealt with them. me completely absorbed. The and Indian nurses (6 out of 12 am currently enrolled in the
-Fran McWilliam, R.N., article "See the nurse" by authors) showed a real Post Basic Program at the
Maple Creek, Sask. Patricia Floyd had most cultural sensitivity. University of Western Ontario
impact. One concern I did have I have had the privilege of
Valued team members She's right. How can a was with the lack of input working with Marlene in her
Thank you for the person of social conscience from community health nurses capacity as a staff nurse and
excellent articles in categorize problems? All are working on reserves. The 1978 head nurse in the c.c. U. at
October's issue regarding inter-related and in order to Health and Welfare statistics the Montreal General
Community Health better the living conditions of show approximately 760 Hospital.
Representatives. the majority of people on this nurses working in Indian and The purpose of my letter
Not .only did the articles earth. we have to look at the northern health facilities, yet is to commend Marlene and
portray the warmth and social origins of these not one of the twelve authors her stafffor the superb care
capabilities of the CHR's but problems (poor housing, were actually practicing they are giving their patients.
recognized their many unemployment, abandoned community health nurses in The nurses seem to work
valuable contributions to the families, alcoholism, poor native settlements. extremely well together and
health care team. health etc.). Apart from that, I felt the are all very knowledgeable
The recognition you As aCUSO volunteer in a general presentation on native and competent in their field.
have given these individuals third world environment, I health was well done. They care for and about each
is richly deserved. have experienced and -Christopher Lemphers, patient who passes through
-Margaret Gauthier, observed at first hand how R.N., Halifax. the unit and that is what
Instructor CHR Program, decisions by governments and nursing is all about.
Alberta Vocational Centre, their representatives, and by -Barbara Lee, London,
Lac La Biche, Alberta. multinational corporations Ontario.
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. Februery 1171
The tan-.llen NUrH
YOU AND THE LAW
On Trial!
..
--
L- ....
Corinne Sklar
No one likes the idea of becoming personally involved in -
litigation proceedings. In spite of our superticial acquaintance
(mostly through the medium of TV) with the trappings of
courtroom dramas - the black gowns of the lawyers. the
stylized ritual of the proceedings and the language - our official
courts oflaw are strange and awesome places for most of us.
Nevertheless. the possibility exists that some day. whether
we like it or not. we may find ourselves caught up in some
aspect oflitigation. Maybe we receive ajury summons in our
mail: maybe we are subpoenaed to serve as a witness or.just
maybe. we find ourselves called upon to defend our
competency to practice as a nurse before ajudge or jury of our
peers.
. - Nurses can be and. in fact. have been named as defendants
in legal actions in courts ofIaw in this country. That's why it is
important that they acquire a degree offamiliarity with their
legal responsibilities in the area of administering patient care.
- . The nurses in the case that is recounted below represent a
variety of areas of nursing: the office nurse. the general duty
nurse, the special duty nurse and the nurse supervisor.
The case I
When the events surrounding this case took place. the plaintiff.
a little girl whom we will call Teresa*. was just five and a half
years old. Some time earlier. her mother had made an
appointment with the family physician forTeresa to receive her
immunization (quad) booster. The office nurse. knowing that
Teresa was frightened of needles and in consultation with the
physician. supplied her mother with a nembutal** suppository
to be administered to the child one hour before their visit to the
doctor's office for the D.P.T. and P. booster. The appointment
was postponed for one day because Teresa was suffering from
the effects of a head cold.
*Although the names of the nurses, physicians and hospital involved in
this case are on record, in my opinion no purpose is served by citing
them here. For this reason, no surnames are included in this account
and the name of the child, "Teresa", is fictitious.
**A registered trade name of Abbott.
The caMdien .......
...
FeÞruery 1171 I
On their return home. Teresa became feverish and
complained of a sore throat. At the insistence of her mother. the
physician made two housecalls: he found his patient to have a
mild fever, a slight reddening ofthe throat with small vesicles
on the soft palate. Her breathing was slightly resonant but there
was no rasping. barking, or wheezing nor were there symptoms
of dyspnea or obstruction.
Later, Teresa was admitted to hospital. Her mother was
upset and worried and while the child's condition had not
deteriorated. neither had it improved. Her mother hired a
special duty nurse. one who knew Teresa personally. even
though the physician, when asked, felt it unnecessary.
While in hospital, Teresa's condition remained the same
until about 2:00 a.m. when her special duty nurse heard her
make a "grunting sound" and then her patient voided
involuntarily. The nurse decided to summon the physician to
the hospital because there had been no improvement. While her
respirations were somewhat more labored. Teresa was not
mouth-breathing. nor showing signs of air hunger or
obstruction. The physician instructed the nurse to prepare for a
tracheotomy; he would come Sf AT.
Shortly thereafter. Teresa awoke and thrashed about.
There was marked air hunger and she became cyanotic. A
convulsion was followed by a period of apnea. Mouth-to-mouth
resuscitation by the physician was begun immediately and
Teresa began to breathe again. Oxygen was given by catheter
and an endotracheal tube was inserted without difficulty. The
physician then performed a traecheotomy and Teresa's
breathing was restored.
Unfortunately, however, the period of anoxia had resulted
in brain damage. Teresa was permanently physically and
mentally disabled. Why had this happened? Was anyone to
blame?
Teresa's parents sued on their own and on their daughter's
behalf. Because they were unable to say whose negligence had
caused their daughter's condition. they named the physician,
the hospital, the clinic and all the nurses. Thus, it was the task
of the Court to determine from the evidence:
. How and why had this tragedy occurred?
. If the result was due to negligence, which ofthe defendants
had been negligent and in what respect?
. The amount of the plaintiffs damages to be paid by the
negligent defendant(s).
The decision
It is important to note the fourteen-year delay in the hearing of
this case. The events related occurred in 1960: the decision of
the trial judge was delivered in 1974. The parties themselves
were not responsible for this delay.
The passage of time "fades memories, and impairs the
ability of witnesses to recall the events of the time with
complete accuracy" .2The trial judge noted the assistance and
value obtained from the use of the notes made
contemporaneously with the events or shortly thereafter:
nursing notes would have provided such assistance. The value
of clear. accurate, concise but descriptive nursing ñotes is
inestimable .1
In this case. the chart would have provided the judge with a
picture ofthe events as they occurred. The record would have
been most helpful especially where conflicting evidence was
gIven.
The triaIJudge found that the plaintiff had failed to prove
that there bad been any negligence on the part ofthe physician.
the nurses or the hospital. The action was dismissed. The Court
of Appeal of Alberta upheld the trialjudge's decision. In their
view, the evidence supported the trialjudge's conclusion.
The law
I 'ln order to support a finding of negligence against a physician,
nurse or hospital. the evidence must show that the care given
the patient was below the standard of care the patient ought to
L have received. The standard of care t(' which nurses are held is
that of a reasonable prudent nurse of like training and
experience:The test applicable to physicians is similar.
"The-test ofreasonable care applies in medical malpractice
cases as in other cases of alleged negligence. As has been said in
the United States, the medical man must possess and use that
reasonable degree of learning and skill ordinarily possessed by
practitioners in similar communities in similar cases. "J This
test, stated in the Supreme Court of Canada in 1956, continues
to apply nearly 30 years later. In Johnston v. Wellesley
Hospital, 4 earlier judgments containing the following statement
of standard are cited with approval:
I
"Every medical practitioner must bring to his task a
reasonable degree of skill and knowledge and must exercise
a reasonable degree of care. He is bound to exercise that
degree of care and skill which could reasonably be
expected of a normal. prudent practitioner ofthe same
experience and standing, and if he holds himself out as a
specialist, a higher degree of skill is required of him than of
one who does not profess to be so qualified by special
training and ability. ..
I
,
,
A hospital is charged with the duty to take reasonable care
in selecting a properly qualified staff to care for its patients and
to provide adequate facilities for the treatment of patients.
In assessing the quality of care delivered to Teresa, the
standard of medical and nursing practice applicable was the
standard that prevailed in 1960, not the standard at the time of
the trial in 1974. some 14 years later.
The evidence of the medical expert witnesses was
significant in this case in order to determine the cause of
Teresa's ultimate condition. Epiglottitis was deemed to have
been the probable cause of her dyspnea and anoxia. In 1960.
however. epiglottitis was not considered by the medical
profession to be a separate clinical condition as it is today.
Thus, the diagnosis of laryngotracheitis made in 1960 would
have embraced what was then known about epiglottitis and a
prudent physician or nurse in 1960 would not have been aware
of the greater danger epiglottitis posed to the patient. Today's
medical personnel would be expected to be cognizant of this
hazard.
Two of the expert witnesses stated that while. in their
opinion, Teresa would have been suffering from a degree of
epiglottitis, probably the cause ofthe convulsion and
subsequent brain damage was not epiglottitis. In their view, the
most probable cause of the convulsion was encephalitis. This
conclusion was consistent with the evidence given of the
observations recorded by the physician on his examination of
Teresa. Even if encephalitis had been diagnosed, there was
nothing that the defendants could have done to prevent the
injuries Teresa sustained.
Supporting the conclusion that epiglottitis was not of a
severe degree, was evidence of the lack of difficulty the
physician had in inserting the endotracheal tube and the fact
that mouth-to-mouth resuscitation almost immediately restored
Teresa's breathing, indicating that the airway was not
completely obstructed. The nursing notes would be most
important here as a record of what was done in response to
Teresa's sudden altered condition. the time at which measures
were taken. and all observations of the patient at the relevant
times.
II
'I
1
,
,
I
10 Febru.ry 1179
The Cenedlen NUrH
\f\\@
u 1follister ostomy pouches
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The Court did not find any evidence substantiating the
allegations of negligence against the nurses. There was an
allegation that the nurses had not properly observed the patient
and that there were delays in summoning the physician. The
evidence did not support this claim. Again, the nursing notes
would have been of value in answering such an allegation.
Where witnesses give conflicting evidence, as in this case,
it is the duty of the trial judge to assess the credibility of the
witnesses and decide which evidence he will believe. When
faced with conflicting oral (viva voce) evidence, supporting
documentation again is most helpful in assessing the truth ofthe
statements made. The trial judge here clearly stated that he was
fully aware of the human frailty ofrationalization and
reconstruction of the events especially given the passage of
time. He was also cognizant ofthe effect of hindsight on the
opinions, especially where the final outcome was known to the
witness.
Conflict arose chiefly over the condition of Teresa at
various times as described by her mother and reported in
telephone conversations and instructions. Generally, the
evidence of the office nurse, the hospital nursing staff, and the
special duty nurse was preferred to that of Teresa's mother.
. A lawsuit is an unpleasant experience for professional staff
at any time; it is particularly tragic when, as in this case, a child
is permanently disabled. For the plaintiff and her family the
results were devastating. The Court's task was to discover
whether it was the conduct of the medical personnel that caused
the child to be injured and, ifso, to fix blame, apportion the
fault and assess the damages to compensate the patient.
The Court found that the defendants had discharged their
duty to the patient without negligence. The case shows that
--nurses can be named as defendants. It reminds us also how
'. important it is to keep complete, accurate records; memories
fade but recorded observations and orders do not. The chart
remains a "living" record ofthe course of care given to a
patient. While the record may serve to indicate fault, it may
also, as in this case, show that there was no negligence in the
quality of care given.
References
I The evenrs which led up to this lawsuit occurred in 1960,
but it was not until 14 years later (1974) that the decision ofthe
Alberta trial court was reported (Tiesmaki et al. v. Wilson et al.,
19744. W. W.R. 19 (Alta.S.C.). One year later, the Alberta
Court of Appeal affirmed the earlier decision 19756 W. W.R.
639 (Alta.C.A.).
2 Id p. 640.
3 Wilson v. Swanson, 1956S.C.R. 804 per AbbottJ., p. 817.
4 19712D.R.103.pp.IIl-Il2.
.....
. --
"-
t ..
"You and the law" is a regular
column that appears each month
in The Canadian Nurse and
L'i'1firmière canadienne. Author
Corinne L. Sklar is a nurse and
recent graduate of the University
ofT oronto Faculty of Law and is
currently articling with a Toronto
law firm.
Th. Cen-.llen Nur..
F-..ery 18711 11
PROPOSED AMENDMENTS TO CNA BYLAWS
The following proposed amendments to CNA Bylaws wllJ be presented to membership at the 1979 annual
meeting, 29 March 1979.
Present
BOARD OF DlRECrORS
Section 8
The affairs of the Association shall be managed by a board of
directors which shall be composed of:
(a)l"he president, the president-elect, the first vice-president
and the second vice-president;
(b) five members-at-Iarge elected to represent respectively
the fields of nursing administration, nursing education,
nursing practice. nursing research and social and economic
welfare;
(c) the representative of each association member elected by
and from that association member.
Section 13
Tenn of Office: Directors under paragraph 8 (a) and 8 (b) shall
be elected for a term of two years. Directors under paragraph
8 (c) may similarly hold office for a term of two years
concurrent with the term of office of the other directors. No
director of the board shall hold the same office for more than
four (4) consecutive years.
Proposed
BOARD OF DIRECTORS
Section 8
The affairs of the Association shall be managed by a board of
directors which shall be composed of:
(a) The president, the president-elect, the first vice-president
and the second vice-president;
(b) five members-at-Iarge elected to represent respectively
the fields of nursing administration, nursing education,
nursing practice. nursing research and social and economic
welfare:
(c) the representative of each association member elected by
and from that association member;
(d) three public representatives appointed by the board of
directors.
Section 13
Tenn of Office: Directors under paragraph 8 (a) and 8 (b) shall
be elected for a term of two years. Directors under paragraph
8 (c) may similarly hold office for a tenn of two years
concurrent with the term of office of the other directors.
Directors under paragraph 8 (d) shall be appointed as soon as
possible following the biennial election of new directors
under paragraph 8 (b) and shall hold office for a term
concurrent with a tenn of office of such directors elected
under paragraph 8 (b). No director from 8 (a), 8 (b) and 8 (d)
shall hold the same office for more than four (4) consecutive
years.
I
II
DIRECTORY OF CNA ASSOCIATION ME
BERS
Registered Nurses Association of British Columbia 2130
West 12th Avenue, Vancouver, B.C. V6K 2N3.
Executive Director - Marilyn Carmack
Alberta Association of Registered Nurses, 10256-1 12th
Street, Edmonton, Alta. T5K IM6. Executive Secretary
- Yvonne Chapman
Saskatchewan Registered Nurses Association 2066
RetaJlack Street. Regina, Sask. S4T 2K2. Executive
Director- Barbara Ellemers
1\1anitoba Association of Registered Nurses, 647 Broadway
Avenue, Winnipeg, Man. R3C OX2.Executive Director-
M. LouiseTod
Registered Nurses Association of Ontario 33 Price Street,
Toronto, Ontario. M4W 1Z2. Executive Director-
Maureen Powers
Ordre des innrmières et innrmiers du Québec (Order of
'\Iurses of Quebec), 4200 Dorchester ouest, bd, MontréaJ,
Québec, H3Z IV 4. Executive Director and Secretary of
the Order - Nicole Du Mouchel
! I
New Brunswick Association of Registered Nurses, 231
Saunders Street, Fredericton, N .B. E3B 1N6Executlve
Secretary - Marilyn Brewer
Registered Nurses Association of Nova Scotia, 6035 Coburg
Road, Halifax, N .S. B3H IY8. Executive Secretary -
Joan Mills
Association of Nurses of Prince Edward Island 41 Palmers
Lane, Charlottetown. P. E.I. CIA 5Y7. Executive
Secretary-) Registrar - Laurie Fraser
Association of Registered Nurses of Newfoundland 67
LeMarchant Road, St. John's, Nfld. AIC6AI.Executh'e
Secretary - Phyllis Barrett
,I,
I\orthwest Territories Registered Nurses Association, Box
2757, Yellowknife, N.W.T. XOE IHO.Executive
Director-Registrar - Mary Lou Pilling.
II
12 Februery 111711
The Cen-.llen Nur..
Why
Spend All
Semester
Looking for
The Right
Texts?
A New Book APPLIED DECISION-MAKING IN NURSING. Give
your students a realistic look at decision-making theory with this
innovative text. Using a step- by- step approach. it slresses the relationship
between values. values clarification and decision-making. Examples of
specific nursing situations provide an excellent opportunity 10 practice
important skills. By JoAnn Garafalo Ford. R.N.. M.S..etaLJanuary: 1979.
Approx. 144 pp.. I iIIus. About $ 9.75.
New I Oth Edition
TEXTBOOK OF ANATOMY AND PHYSIOLOGY
Through 9 successful editions. you and your colleagues have
depended on thiS text for an accurate. comprehensive presentation of this
subject. The new 10th edition retains the features which have made it a
leader in the field: a precise. readable approach: meaningful correlation of
illustrations with discussions: and numerous leaming aids - chapter
outlines. tables. diagrams. outline summanes and challenging review
questions. Extensively revised and updated. this edition offers these
valuable new highlights:
. features more than 500 superb illustrations - over 200 in full
color. Throughout. the use of color is functional.
. reflects an increased emphasis on physiology. expanding
coverage of the endocrine. reproductive. urinary and
cardiovascular systems:
. incorporates a timely new unit on defense and adaptation - with a
new chapter on the immune system and more material on stress:
. features a new chapter on articulations:
. provides a succinct review of chemistry in the first chapter.
By Catherine Parker Anthony, R.N.. B.A.. M.S. and Gary Arthur Thibodeau.
Ph.D. January. 1979. Approx. 672 pp.. 570 iIIus. including 211 in
four-color. About $21.75.
New 10th Edition
ANATOMY AND PHYSIOLOGY LABORATORY MANUAL
Students need to apply the generalized knowledge gained from
lectures and reading to direct laboratory experience. This lab manual is the
ideal way to give students firsthand practIce In applying the scientific
method to anatomy and physiology. The revisions made in this edition
correspond to the extensive changes in the text For example:
. measurable objectives are provided for each laboratory exercise.
Students can now proceed independently to explore scientific
principles and concepts with a minimum of instructor assistance:
. stronger emphasis on physiology now provides a more balanced
coverage between structure and function;
. more than 20 new experiments provide increased flexibility.
. up-to-date new appendixes cover: metric conversion factors,
physical constants; blood types, normal adult blood values;
nutrition data; and solution preparation.
By Catherine Parker Anthony. RN., B.A., M.S. and Gary Arthur Thibodeau,
Ph.D. January, 1979. 270 pp.. 169 iIIus. Pñce. $ 9.75.
A New Book. RESPIRATORYTHERAPV: Basics forNursingand the
Allied Health Professions. An effective synthesis of theory and practice,
this handy guide details therapeutic procedures, specific equipment and
appropriate nursing actions. Noteworthy features include: a
comprehensive chapter on pediatric therapy; an extensive glossary; and a
useful appendix of conditions that alter normal breathing pattems. By
Dennis W. Glover, M.S., RRT. and Margaret McCarthy Glover, B.S., RN.
October, 1978.232 pp., 148 ilIus. Pñce. $10.75.
A New Book
NURSING CARE OF INFANTS AND CHILDREN
A comprehensive. practical approach, this contemporary text
focuses on the care of well, ill and handicapped children. Emphasizing
aspects of growth and development, the authors not only examine care of
the ill or disabled child. but also stress promoting the health of the well
child. Among the many student-oriented highlights, you'li find:
. "Summaries of Nursing Care" which include pertinent guidelines
for action:
. strong emphasis on - and guidelines for - communicating with
children and their families;
. key concepts are clarified with a wealth of tables and illustrations;
. pertinent lab data and pharmacology are integrated throughout;
. an excellent chapter on caring for the terminally ill child;
. an extensive appendix outlines normal values and assessment
tools.
By Lucille F. Whaley,RN., M.S. and Donna Wong,RN.,M.N., PNA-P.April,
1979. Approx. 1.408 pp., 744 ilIus. About $ 24.00.
Th. Cenecl'en Nur..
New Volume II CURRENT PERSPECTIVES IN ONCOLOGIC
NURSING. A broad scope - stressing the nursing process - offers
students a contemporary view of oncologic nursing. Fascinating original
papers focus on professional awareness. therapy. maximizing the quality
of life and rehabilitation. Students will particularly value papers on
nUlritional support. oncology self-help groups and hospices. Edited by
Carolyn Jo Kellogg. R.N.. B.S.N.. M.S.N.. N.P. and Barbara Pelerson
Sullivan. CR.N.. B.S.N.. M.S.N.. N.P.: with 22contributors.April. 1978.204
pp.. 26i11us. Price. $14.00 (C), $10.25 (P).
New 9th Edition. ORTHOPEDIC NURSING. You and your students
can relyon this superbly illustrated classicfor acomprehensiveoverviewof
modern orthopedic nursing - both basic principles and specific nursing
interventions. This edition incorporates a totally new chapter on
emergency nursing care in the orthopedic unit; and current information
on bone tumors. amputations. care of the cerebrovascular accident
patient, and anatomy/physiology of joints. By Carroll B. Larson. M.D..
FACS. and Marjorie Gould. R.N., B.S.. M.S. April. 1978. 508pp.,466illus.
Price. $18.00.
New 7th Edition. CARINI AND OWENS' NEUROLOGICAL AND
NEUROSURGICAL NURSING. Revised to reflect advances in this field
and the nurse's expanded role. this well known text focuses on holistic
nursing care and the rationales for specific nursing actions. Youllfind new
chapters on embryology, functional physiology. sexual integrity. trophic
changes and rehabilitation: an expanded chapter on pain discusses pain
assessment, pharmacologic control. biofeedback. acupuncture and
hypnosis. By Barbara Lang Conway, R.N.. M.S.: with 3 contributors. July.
1978.656 pp., 307 iIIus. with 2 color plates. Price, $ 20.50.
A New Book. PLANNING AMBULATORY SURGERY FACIUTIES.
This long-awaited textservesas both aframeworKand a practical g uide for
planning and maintaining a walk-in surgical facility. Using a clear.
step-by-step approach. it deals with all facets of this subject - including
budgeting. scheduling, personnel, ethics and necessary equipment
Helpful suggestions and guidelines are readily adaptable to meet the
particular needs of any institution. By Reba Douglass Grubb. B.S. and
Geraldine Ondov, R.N.: with 2 contributors. February. 1979. Approx. 240
pp., 62 iIIus. About $ 21. 75.
New 2nd Edition
REVIEW OF PHARMACOLOGY IN NURSING
When you're preparing students for important examinations. tum to
this clinically-oriented text In challenging question/answer fonnat, it
provides an understanding of basic pharmacologic actions. .. emphasizes
major drug categories. . . examines nursing's responsibility for correct
drug administration... and offers a conceptualapproachforfurtherstudy.
The authors have carefully updated and revised all material. and integrated
contemporary research findings and new drugs. Students will particularly
appreciate:
· an outstanding new chapter on drugs that affect sexual response.
the fetus and the nursing infant;
· essential new material on special implications of drug therapy for
the elderly;
· the latest infonnation on CNS drugs, psychotropic drugs. and
drugs affecting the cardiovascular system.
By Betty S. Bergersen, R.N., M.S., Ed.D. and Jurate A. Sakalys. R N.. M.S.
July, 1978. 312 pp. Price. $12.00.
A New Book. lEADERSHIP IN NURSING: Theories. Strategies.
Actions. Centering on nursing leadership as a social process. this
innovative text is organized around the common themes of behavioral
science theory, process. models, concepts, data analysis, research,
education and the future. The author presents a leadership behavior
measurement tool and demonstrates its application in a major study. By
Margaret M. Moloney, RN., Ph.D. May. 1979. Approx. 250 pp., 11 illus.
About $ 9. 75.
A New Book. MCN ORGANIZATION AND MANAGEMENT OF
CRITICAL-CARE FACIUTIES. Noted authorities share their expertise
with all aspects of operating a critical care unit Major sections focus on
initial planning... analyze design and equipment needs... review policies
and procedures . . . discuss staffing and inservice education . . . and
consider factors in patient care. Throughout, the authors stress optimal
patient care and the most efficient use of resources. Edited by Diane C
Adler, R.N.. M.A.. CCRN. and Norma J. Shoemaker, R.N..B.S.N.; with 13
contributors. April, 1979. Approx. 192 pp., 32 iIIus. About. $15.10.
FebrValry 1171 13
New 4th Edition. COMPREHENSIVE CARDIAC CARE: A Text for
Nurses. Physicians. and Other Health Practitioners. Thoroughly revised
and updated. this popular text reflects current advances in cardiac
research/technology and the resulting new approaches to patient care.
Revised discussions of the data collection process. pacemaker therapy
and new technology in patient care highlight this edition: a concise
appendix incorporates data on investigational and experimental drugs. By
Kathleen G. Andreoli. R.N.. B.S.N.. M.S.N.. et al. March. 1979. Approx. 384
pp.. 694 iIIus. About $13.25.
A New Book. MOSBY'S MANUAL OF CRITICAL CARE: Practices
and Procedures. Organized according to a needs approach to
homeostasis. this practical book presents procedures, techniques and
rationales needed for effective intensive care. Initial chapters examine
general considerations and patient assessment. Subsequent chapters
describe and depict such procedures as airway establishment,
hemodynamic monitoring. temperature control and assistance/control
of breathing. More than fifty informative tables summarize key concepts.
By Linda Feiwell Abels. RN.. M.N. March. 1979. Approx. 254 pp., l30illus.
About $ 12.00.
I
ANew Book HOME HEALTH CARE. Home health care - what it is.
who the clients are. and how it is organized and delivered - is the main
focus of this unique text. Using a multidisciplinary approach, it defines
home health care as care of the client at home - not just home nursing.
Topics include professional and support services, methods of financing.
continuity of care and the futureofhome health care. Students will find this
resource particularly helpful for discharge planning. By Jane Emmert
Stewart. B.S., M.S.N. March. 1979. Approx. 208pp.. I Oillus.About $9.75.
A New Book. MOSBY'S MANUAL OF EMERGENCY CARE:
Practices and Procedures, This generously illustrated manual describes
and depicts advanced skills needed to effectively handle classic
emergency problems. For each. students will find flow charts for initial
management along with convenient cross-references to procedures and
drugs. Dental emergencies. cardiac life support, neurological
emergencies. human bites and chest pain are just a few of the
potentially-grave situations explored. By Janel Miller Barber. R.N., M.5.N.
and Susan A. Budassi. R.N.. M.S.N. May. 1979. Approx. 455 pp..493 iIIus.
About $16.75.
New 3rd Edition. NURSING MANAGEMENT AND LEADERSHIP IN
ACTION: Prindples and Application to Staff Situations. This highly
successful text has enlarged its focus from leadership to the broader
spectrum of leadership and management in nursing - whether practiced
in team, primary, functional or case nursing. h delineates a conceptual
frameworK of administrative principles needed by the nurse-Ieader-
manager and demonstrates their application in everyday practice. Atimely
new chapter on management highlights this edition. By Laura Mae
Douglass, R.N., BA, M.S. and Em Olivia Bevis, R.N.. B.S., MA. F AA.N.
April, 1979. Approx. 304 pp., 16 iIIus. About $12.00.
Prices subject to change.
IVIOSBV
TIMES MIRRDR
THE C. V. MOSBY COMPANY, L TO.
B6 NORTHLINE ROAO
TORONTO. ONTARIO
M4B 3E5
14 FeÞruery 111711
The Cen-.llen NUrH
Why
Spend AU
Semester
Looking for
The Rigþt
Texts?
New 2nd Edition. A GUIDE TO NURSING MANAGEMENT OF
PSYCHIATRIC PATIENTS. Bridge the gap between learning clinical skills
and applying them with this valuable workbook! Updated throughout, it
covers all major aspects of psychiatric nursing - providing definitions,
answers and rationales for all questions. This edition features: a new
chapter on the expanded role of the nurse; a rewritten chapter on
substance abuse: succinct chapter overviews; a clinical evaluation tool;
and an instructor's manual. By Sharon Dreyer. RN.. M.A.. M.S.N.. et aL
April, 1979. Approx. 288 pp. About $11.50.
A New Book. STRESS AND SURVIVAL: The Emotional Realities of
Ufe- Threatening OIness. A timely. comprehensive presentation. this text
analyzes stress and survival for caregivers working with patients and
families facing life-threatening illness. Noted contributors explain optimal
ways of providing emotional support and show how that support can
promote quality of life, longevity and. at times. survival. Students will
especially want to read material on psychotherapy, biofeedback and
therapeutic touch. Edited by Charles A. Garfield, Ph.D. March, 1979.
Approx. 400 pp., 9 iIIus. About $15.75.
A New Book. BASIC PATHOPHYSIOLOGY: A Conceptual
Approach. This conceptual approach presents the basic b.iology of
disease from the perspective of alterations of normal phYSiology -
regarding the human organism as an open system in continuous
interaction with the environment. Theauthorsdiscussdiseasesintennsof
models of major concepts, rather than as a compilation of signs and
systems. Each chapter begins with helpful behavioral objectivesand ends
with a detailed glossary. By Maureen E. Groër. RN., M.A., Ph.D. and
Maureen E. Shekleton. RN.. B.S.N., M.S.N. February. 1979. Approx. 560
pp.. 423 iIIus. About $19.25.
A New Book. A PRIMER OF CARDIAC ARRHYTHMIAS: A
Self-Instructional Program. A challenging. programmed fonnat offers
students "hands-on" practice in interpreting cardiac arrhythmias.
Following lucid chapters on such general aspects as cellular physiology
and cardiac monitoring. the core of the coverage focuses on specific
arrhythmias - sinus arrhythmias. atrial arrhythmias. A Vblocksand more.
A useful appendix of practice rhythm strips is excellent for class
discussions. By Cecelia C. Harris, RN.. M.S.N. February, 1979. Approx.
144 pp., 100 iIIus. About $ 9.75.
A New Book. BEHAVIORAL CONCEPTS AND THE NURSING
PROCESS. This incisive text delineates specific behavioral concepts -
e.g. stress. depression, aggression - within the framework of the nursing
process. Detailed case examples following each chapter clarify key
theories and show students how the nursing process can be utilized in
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Trygstad-Durland, RN.. M.S. February, 1979. Approx. 192 pp., 7 iIIus.
About $9.75.
A New Book. GROUP PROCESS FOR NURSES. This valuable text
offers students assessment, intelVention and evaluation tools to assist in
therapeutically using small groups to meet the biopsychosocial health
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and disadvantages of using groups . . _ provide helpful guidelines for
developing and structuring successful groups. . . analyze leadership roles
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Maxine E. Loomis, RN., Ph.D. March, 1979. Approx. 176 pp., illustrated.
About $9.00.
New 2nd Edition. PRIMARY NURSING: A Model for Individua6zed
Care. Explore primary nursing with this comprehensive text. It discusses
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report pertinent research results. This edition provides new data and
guidelines for implementation. altematives for staffing, and comparisons
of primary nursing with other methods. ByGwenMarram, RN., M.S.. Ph.D.,
et aL May, 1979. Approx. 200 pp., 25 iIIus. About $10.75.
A New Book. DEPARTMENT OF EMERGENCY MEDICINE
GUIDEUNE MANUAL: Po6cies and Procedures. This practical manual
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retrieval - to stress management, treatments and responsibilities of
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users to specific information. By Jeffrey R Mac Donald, M.D. and Pat
Kinder, RN. May, 1979. Approx. 400 pp.. 11 iIIus. About $24.80,
New 3rd Edition. CARE OF PATIENTS WITH EMOTIONAL
PROBLEMS. How well can your students meet the emotional needs of
their patients? This authoritative text can help as it studies the roles
emotions play in the human life span - including emotional
development. physical illness, emotional disorders and functional
psychotic illness. This edition features an informative new chapter on
remotivating the emotionally disturbed patient through the use of groups.
By Dolores F. Saxton. RN., M.A., Ed.D. and Phyllis W Haring, RN.. M.S.,
M.Ed. March, 1979. Approx. 144 pp.. 8 iIIus. About $ 7.25.
3rd Edition. COMMUNITY HEALTH. Designed for introductory or
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complete study of the field - emphasizing community health
maintenance, environmental health and health services. You'll find new
infonnation on maternal and infant health. cardiovascular disease,
venereal disease, alcoholism and cigarette smoking. New charts and
graphs augment the text. By C. L Anderson. B.S., M.S.P.H.. Dr. P.H.. et al.
1978. 384 pp., 106 iIIus. Price. $18.00.
A New Book. FETAL MONITORING AND FETAL ASSESSMENT
IN HIGH-RISK PREGNANCY. Questions on fetal monitoring? Students
will find concise answers in this well organized text. It examines all fetal
monitoring methods - biophysical. biochemical and electronic - and
outlines the progression from possible fetal difficulty to intelVention for
fetal distress. Numerous case studies and fetal monitoring strips illustrate
appropriate nursing care. By Susan Martin Tucker, RN.. B.S.N.; with 1
contributor. July. 1978. 172 pp.. 128 iIIus. Price. $12.00.
Th. Cenedl.n NUrH
Februery 11171 15
A New Book PRINCIPLES AND PRACTICE OF PSYCHIATRIC
NURSING. Using a nursing-oriented, conceptual approach, this
well-organized text describes man's adaptation to illness, and explains
nursing diagnoses and specific nursing intelV'entions. Part I discusses
specific nursing diagnoses - anxiety, grief, disruptions in the
communication process. Current therapeutic modalities are the focus in
Part II. Selected bibliographies and the latest research findings assist
students with further study. By Gail Wiscarz Stuart, R.N., M.S., CN. and
Sandra J. Sundeen. R.N.. M.S.; with 15 contñbutors. t-'-.ay. 1979. Approx.
736 pp., 24 iIIus. About 5 17.25.
New 2nd Edition. THE PROCESS OF STAFF DEVELOPMENT:
Components for Change. t-'-.any states are instituting legislation making
license renewal contingent on continuing education efforts. This valuable
resource can help students learn the essentials of designing,
implementing and evaluating the staff development process. New and
updated discussions examine the budgetary process and the relationship
of staff developmentto the overall continuing education effort. By HelenM.
Tobin, R.N., M.S.N., F AA.N. and Pat S. Yoder Wise, R.N., M.S.N. April,
1979. Approx. 224 pp., 26 iIIus. About 5 14.50.
New 2nd Edition. HUMAN SEXUAUlY IN HEAL TIf AND Iu.NSS.
This new edition again explores all facets of the complex phenomenon of
sexuality. Three major units examine the biopsychosocial nature of
human sexuality. . . analyze sexual health and health care. . . and define
clinical aspects of human sexuality. Case examples - presented in review
questions - offer an effective demonstration of theories, principles and
research findings. By Nancy Fugate Woods, R.N.. M.N., Ph.D.; with a
chapter by James S. Woods, Ph.D.; and 7 contñbutors. t-'-.arch, ] 979.
Approx. 320 pp., 11 iIIus. About 5 12.00.
A New Book. FATHERING: Participation in Laborand Birth. Explore
the father's role as an active nurturing participant in the birth process with
this unique book. The authors first examine the father's role in labor and
delivery and provide physicians' feelings on the subject. In section II,
students will read fascinating interviews with the fathers who shared in the
birth experience. By Celeste R. Phillips. R.N.. M.S. and Joseph T.Anzalone,
M.D. t-'-.arch. 1978. 164 pp., 73 iIIus. Price, 5 10.25.
2nd Edition. THE-GROUP APPROACH IN NURSING PRACTICE. A
valuable resource for all nurses, this current edition continues 10 focus on
the underlying concepts of the group process. Dr. t-'-.arram outlines the
scope of group work; discusses vanous theoretical frameworks; pinpoints
nursing's common objectives; and delineates special techniques, roles
and considerations. Students will beespeciallyintrigued with a helpful new
chapter on establishing, maintaining and terminating agroup. ByGwen D.
t-'-.arram, R.N., B.S., M.S., Ph.D. ] 978. 264 pp.. 1 iIIus. Price. 511.50.
New 3rd Edition. CRISIS INTERVENTION: Theory and
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comprehensive overview of the theory and principles of crisis intelV'ention
- from its historical developmentto present use. Tìmelynewdiscussions
examine rape, suicide and old age - and an outstanding new chapter
focuses on dealing with the chronic psychiatric patient on an out- patient,
crisis intelV'ention basis. By Donna C Aguilera, R.N.. Ph.D., F AA.N. and
Janice M. Messick. R.N., M.S., F.AAN. t-'-.arch, 1978. 206 pp.. ] 6 iIIus.
Price. 5 10.75.
New 2nd Edition. MENTAL HEALTH CONCEPTS IN
MEDICAL-SURGICAL NURSING:A Workbook. Thispracticalworkbook
shows how to apply both mental health concepts and the nursing process
in general patient populations. Logically organized sections examine
patients experiencing anxiety, body image alterations, and
psychophysiological dysfunction - each includes theoretical concepts,
clinical applications and review questions. A Student/instructor guide is
available. By Carol Ren Kneisl. R.N.. M.S. and Sue Ann Ames, R.N., M.S.
January, ] 979. 174 pp., 23 iIIus. Price. 51 0.25.
A New Book.
FUNDAMENTALS OF NURSING PRACTICE:
Concepts. Roles and Functions
Presents the concepts. processes and skills essential to all levels of
nursing with this dynamic text. The widely respected authors provide a
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many important roles of the nurse. Well-wntten and easy to understand,
this text:
. offers an overview of the nursing process, physical assessment
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comforter, healer, teacher. and rehabilitator;
. defines and analyzes each role in a separate chapter;
· summarizes nursing procedures in convenient, easy-to-read,
tabular form;
· concludes each chapter with a helpful vocabulary listand selected
study questions.
By Fay Louise Bower, R.N., B.S., M.S.N., D.N.Sc., F .AAN. and Em Olivia
Bevis, R.N.. B.S., M.A., F .AAN.; with 8 contñbutors. January, ] 979. 614
pp., 391 iIIus. Price. 516.75.
A New Book. COMMUNIlY HEALTH CARE AND THE NURSING
PROCESS. An eclectic overview of community health nursing, this
innovative text helps students become change agents in the system. The
author uses a holistic approach to human development, stressing three
basic concepts: the health-illness continuum; humankind as an open
system; and the effects of various situations, health problems and
stressors on the health and development of the individual, family and
community. By Margot Joan Fromer, B.S., M.A., M.Ed.; with 7
contñbutors. January, 1979. Approx. 480 pp., 110 iIIus. About 517.50.
For more Information on these and any other Mosby texts. or to have a
sales representative contact you. write: The C. V. Mosby Company. 86
North&ne Road. Toronto. Ontario. M4B 3E5. A90214
IVI OS BV
TIMES MIRRDR
THE C. V. MOSBY COMPANY, L TO
B6 NORTHLINE ROAO
TORONTO, ONTARIO
M4B 3E5
111 Februery 11171
The C8n-.lI.n NUrH
()P )'()
89 mB
Jennifer Craig and
GordonC. Page
.,
"
PALM
I
CUBIT
Shorter distances were measured by using the lengths of various part.
of the body.
While we were having coffee the other
day, Maria's account of her
altercation with Dr. Super Jock was
interrupted by a groan from Jane,
our inveterate newspaper reader.
"Guess what?" Jane interjected,
lowering the paper to stare at us with
the look of a conveyor of dire news.
"Canada will be completely metric by
1980."
"Gross'" Maria said. (She is a
mother). "Why do they want to do
that? We're OK as we are."
"It's because we're losing
between 1 00 and 200 million dollars a
year in trade, that's why," I replied,
believing myself to be the resident
expert. "All the countries in the
world, except the United States, are
using the metric system or are
converting to it, and Canada can't
afford not to. "
"I've had trouble enough getting
used to temperatures in centigrade
and distance in kilometers," groaned
Jane, "what else is in store for us?
Isn't it time someone warned us?"
"You're right," I said. "I'll
write an article for The Canadian
Nurse and explain how the metric
system will affect nursing."
"Well, for heaven's sake, don't
get too technical," Jane pleaded.
"I won't," I promised. "And, by
the way, the proper name for the
metric system is Le Système
International d'Unités, commonly
referred to as SI."
Th. Cen-.llen Nur..
Februery 11179 17
,\
\
/
I
,."... ......
,-
(
ONE
SAXON
YARD
'OJ I
..-.J
\
The Saxons,for their yard. took the QI'erage distance around the waist of their
kmgs.
History of Our Present Measurements
or
"Wh} We're In the Mess We're In"
Many years ago. lengthy distances were
measured in units oftime. An old
American Indian drawing of a canoe and
three suns represents ajourney lasting
three days. When we say ajourney
downtown is 20 minutes or a hike up a
mountain is eight hours, we are still using
units oftime to measure distance.
Shorter distances were measured by
using the lengths of various parts of the
body; for example. the digit and the foot.
The foot is still being used. of course, but
our twelve inch foot is longer than the
original Greek foot. A glance downward
as you walk around will enlighten you as
to the vagaries of the human foot. If you
were an ancient merchant and wished to
medsure a length of shoddy for a
customer. whose foot would you
choose? Why. the smallest (and cleanest)
available of course!
A set of standard units for
measuring length was developed by the
Romans but these units were lost with
the fall ofthe Roman Empire. By the
Middle Ages. almost every European
town and every different trade guild had
set its own standard units for
measurement. In England, the system
was chaotic. The Saxons, for example.
took the average distance around the
waist oftheir kings for their yard! In an
effort to reduce the chaos, successive
monarchs tried to set specific standards.
Henry I held out his ann and decreed
that the standard yard would be the
distance from the tip of his nose to the tip
Henry I held out his arm and decreed that the standard yard be the diHance from
the tip ofhis nose to the end of his thumb.
ONE YARD
HENRY I . }I
-.....
.
"'
11<' . \
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..
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...x....,. \
of his thumb. In the sixteenth century, an
inch was described as the length of three
round and dry grains of barley laid end to
end. Twelve ofthese inches became a
foot. Elizabeth I then decided that 5,280
feet was to be a mile. The Nuclear Age is
still using measurements based on the
whims of these medieval monarchs.
The history of units for measuring
weight and volume is equally fascinating.
The weight of a grain of wheat, referred
to as "grain" , became the unit of small
quantities. Specific numbers of grains
comprised a Troy and Avoirdupois
pound. Initially, shells. horns, gourds
and other naturally available items were
used to measure volume. Later, the
volume often pounds of pure water was
described as the Imperial gallon. For
convenience. quarter gallon amounts
were used and became known as quarts.
Wine merchants. however, used a
different measure. Queen Anne set
standards for their unit of volume
resulting in a second type of gallon - the
British wine gallon. The United States
adopted the wine gallon as the measure
of volume, while Canada, which
inherited its measurements from Britain.
uses the Imperial gallon. Any Canadian
cook who follows an American recipe
calling for one pint and who uses 20
ounces instead of 16 ounces will ponder
over a supersaturated flop de cuisine.
Special occupations such as
printing, diamond cutting and horse
racing developed their own measuring
units so that we inherited picas and
points. carats and furlongs. Such an
array of measurements. though quaint.
led to confusion and fraud. Something
had to be done!
,
The Metric System
or
"Vive Ie Metre'.
Although Stevin first proposed a decimal
system in 1585, accolades for the
founding of the metric system go to
Gabriel Mouton (1618-1694). His
principal unit of length, the milliare. was
defined as a specific portion (0.000 000
025 to be exact) of the arc or
circumference of the earth. This new unit
oflength was named the metre. From
this one measure. two further standard
units were derived. First the metre was
squared to produce a standard for
measuring area. Secondly, by
constructing a hollow cube with the
standard metre and filling it with water. a
standard for volume was obtained.
Unfortunately. the surveyors ofthe
earth's circumference erred - the metre
did not in fact represent the quoted
figure. Rather than reorganizing the
whole system, a platinum metre was
constructed to serve as a 'itandard for
length. The practice of using natural
origins for units of measurement was
finally overthrown.
I
I
I
1. Februery 11171
Th. Cen-.llan NUrH
The French Revolution upset the
progress ofthe metric system for awhile,
but 1840 saw the adoption ofthe decimal
metric system, or "SI", as the only
lawful system in France. The use of the
system gradually grew. Laboratories to
develop, house and monitor the
standards for the SI units were erected at
Sévrès, near Paris. These laboratories
eventually came under the control of the
Conférence Général des Poids et
Mesures, to which 40 countries,
including Canada, now send delegates.
As the SI system grew, the following
units were added to the metre and
kilogram. the originaJ units oflength and
mass: see Figure one.
These five units, the metre and the
kilogram, form the seven base units of
the InternationaJ System ofVnits or SI.
The International System of Units
or
"SImple When You Know How"
Table one summarizes the seven base
units of SI and gives the symbols for
each unit. In addition to these base units,
there are two supplementary units, the
radian and steradian. They have little
application in nursing and are shown
only for completeness. Aiew non-SI
units are of such practical importance
that they have been retained. These
include the litre, hour and minute.
Each base SI unit is specificall}
defined so that it is reproducible in any
adequately equipped laboratory. For
example, the metre is defined as the
length equal to 1.650,763.73 wavelengths
in vacuum of the orange-red line in the
spectrum of the Krypton-86 atom. I f this
definition overwhelms you, don't give
up. This is not a technical article and this
definition was given only as an
illustration of how the SI base units are
now defined. Those who wish to know
all the definitions of SI units may consult
one of the many books on the metric
system now seen in Canadian
bookstores.
The base SI units may be combined
according to physical laws to obtain
derived units to measure such things as
velocity, acceleration and pressure. For
example, the units of mass. length and
time combine to define the unit of
pressure which has been given the name
pascal. Other derived units are shown in
Table two.
The main advantage of a standard
system of units is simplicity. While
people in different countries or
professions use the same system of
numbers (i.e. the Arabic system), they
do not all use the same system of units.
This lack of unity often makes
interpretations difficult. Although the
names of the SI units will aJterdepending
on the language being used, there is
international agreement on a common set
of symbols.
.
. ,
, .
.
.
, .
. -=
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4 .
ONE
INCH
Elizabeth I decided that 5.280feet be a mile.
Figure one
Date Adopted Unit Name Unit of
1837 Second Time
1950 Ampere Electrical current
1954 Kelvin Temperature
Candela Luminou'i intensity
1971 Mole Amount of substance
The unit oflength, the milliare, was defined as a portion of the arc of the earth.
-'
STEVIN -1585
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MOUTON -1670
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The Cen-.llen NUrH
F_uary 11171 111
LENGTH AREA
VOLUME
metre sq.
metre
cubic metre
The metre was squared to produce a standard for measuring area and cubed to
produce a standardfor measuring volume.
Table one
The SI Base Units and Supplementary Units
Physical Quantity Name of SI Unit Symbol
Length Metre m
Mass Kilogram kg
Time Second s
Electrical current Ampere A
Temperature Kelvin K
Luminous intensity Candela cd
Amount of substance Mole mol
Plane angle Radian rad
Solid angle Steradian sr
The number can be raised to multiples often.
MULTIPLES
1000 met res
kilometre
J
10 metres
decametre
'l'\
---
1 metre
Another advantage of SI is that it is
a decimal system based on the number
ten. The number can be raised to
multiples of ten or reduced to
sub-multiples often. These multiples and
sub-multiples are indicated by a form of
shorthand. the prefix. SI prefixes and
their symbols are shown in Table three.
An example of their use is that instead of
saying 1.000 pascals or ten to the power
three pascals. we say kilopascals. The
rules governing the use of prefixes will
eventually have to be mastered.
When the SI system is introduced
into the health care system, two
measurements will be of particular
importance in nursing. These are the unit
of pressure. the pascal and the unit of
amount of substance, the mole.
The Pascal
or
"Watch Your Blood Pressure"!
At present. we have a confusing array of
units of pressure. Arterial blood pressure
is expressed in millimetres of mercury
and venous pressure in centimetres of
water. What could be more illogical? We
also describe pressure in terms offeet of
sea water. standard atmospheres.
pounds per square inch and inches of
water.
Pressure is defined as force per unit
area. In SI, one pascal is the pressure
exerted by one newton (the unit offorce)
acting on an area of one square metre.
Pressures will be expressed in multiples
or sub-multiples ofthe pascal. For
example, blood pressure, now measured
in millimetres of mercury will be
expressed in kilopascals. The "normal"
BP will be 16/11 kPa. The present
inflation pressure in centimetres of water
and oxygen pressure in pounds per
square inch wiJl become hectopascals of
inflation pressure and megapascals of
oxygen pressure.
You will be pleased to know that
equipment used to measure pressure will
essentially be the same. The gauges.
inscribed with different numbers and
units. will seem strange at first. but
putting up a wall suction and monitoring
a C. V. P. will remain the same familiar
tasks.
j
tolar Units
or
"Is This a Blood Chemistry Report?"
The introduction of the mole as unit of
amount of substance will be one of the
most important. yet most difficult
changes we will encounter. The mole is
not only a new unit but a new concept of
measurement.
The mole is defined as that amount
of substance which contains as many
identical elementary entities as there are
atoms in 12 grams ofcarbon-12, that is,
6.025 23 atoms. You may recall this
number, known as Avogadro's number,
20 F-".ry 11171
The Cen-.llen Nur..
.
from your high school chemistry days. A
mole of any substance contains 6.025 23
entities. Elementary entities may be
atoms. ions. electrons or any other
identical particles - even marbles.
6.02Y" identical marbles may be
described as one mole of marbles and
6.025 2 " identical grain
of sand may be
described as one mole of sand. You will
realize. therefore, that a mole of one
substance can weigh much more or less
than a mole of another substance. A
mole of marbles will weigh much more
than a mole of sand.
As the conversion to SI progresses.
clinical chemistry results will be reported
in molar units rather than mass units:
that is in millimoles per litre rather than
milligrams per hundred millilitres. When
comparing molar quantities we are
comparing numbers of entities.
Currently used units. such as milligrams.
tell us little about the actual quantity of
particles in a substance. Relationships to
other substances must be memorized.
Take cholesterol and urea. A mole of
cholesterol weighs 386 grams and a mole
of urea weighs 60 grams. Very different
weight!>, yet both contain the same
number of molecules i.e. 6.025!.1
molecules. Does it matter? Yes. because
medicine is usually concerned with the
concentration of substances in
physiological fiuids. The relation!>
between these 'iub'itances are more
obvious when measured on the basis of
their relative number. For example.
consider the following laboratory results:
Cholesterol Urea
S.1. llnit 12.16 m mol/I 6.46 m mol/l
Present 250 mg/IOO ml 73 mg/IOO ml
Unit
Looking at the results expressed in
mass units (milligrams per 100
millilitres>. you would think that there is
over three times a
much cholesterol as
urea. The molar units (millimoles per
litre) however. show that there are twice
as many active particles (molecules) of
urea as cholesterol.
Drug dO'iages expressed-Ïn moles
rather than weight became more logical.
At present. there is confusion when a
doctor orders 10 mg of morphine. Does
he want 10 mg of morphine sulphate,
which contain
only 8 mg morphine. or
10 mg of active morphine? Using Slone
mole of morphine, or morphine sulphate,
contains the same quantity of morphine.
Potency between harhiturates ordered
by mass do
es Cdn only be compared
after consultation with the memory or
the drug manual. Molar doses. however.
allow a direct comparison of potency
because we are dealing with the relative
number of molecules.
As Canada "goes metric", nurses
can expect to meet the SI units in their
1 metre
þ
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't
decimetre
1
1õõ metre
centimetre
1
1õõõ metre
millimetre
I
.
SUBMULTIPLES
Or reduced to sub-multiples often
T able two
Some Derived 51 Units
Physical Quantity Name of SI Unit Symbol Definition of SI Unit
Volume Cubic metre - m 3
Force Newton N kg m S-2 = Jm- I
Pressure Pascal Pa kg m-' S-2 = Nm- 2
Work Joule J kg m 2 S-2 = Nm
Power Watt W kg m 2 S-3 = Js- 1
Surface tension Pascal metre - Pa m = Nm-' = kgs- 2
Periodic frequency Hertz Hz S-1
Elementary entities mav be atoms. ions, electrons or anv other identical particles
- e\'en marbles.
even
marblese
l
:
\ . .
p.
. -
025 X 10 23 :i
J.w- m8rbl
-'"
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-
---
-
---
--
op'-
--
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Th. Can-.llen Nurae
F.....u.ry 1 '71 21
. . . or
grains of sand
"--....
6.025 10 23 1
grains
one
mole
"
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.'
6.025!' identical grains of sand may be described as one mole of sand
Table three
81 Prefixes
Fraction SI Prefix Symbol
10. 2 tera T
10 9 giga G
10 6 mega M
10 3 kilo k
102 hecto h
10 deca da
10- 1 deci d
10- 2 centl c
10- 3 milli m
10-<; micro p.
10- 9 nano n
1O-t! pico P
10-1
femto f
10- 18 atto a
A mole of cholesterol weighs 386 grams and a mole of urea weighs 60 grams. Very
different weights yet both contain the same number of molecules . .
1 mole UREA
1 mole
CHOLESTEROL
m
!t
. ..... . .
. . .........
'" .... ..... ..
... . . . . . ...... . .. . ,
... ...
..!Þ...... · ..... ;
....... 386 .....
..:.. .....
>. .. .....
'f!....... ........,
. ..........."
.. .......... .
........ .
... e r
..!àY
- different weights
-same number of molecules
practice. The major changes will be the
introduction of the pascal as the unit of
pressure and the mole as the unit of
amount of substance. The short history
of our customary units of measurements
should have convinced you ofthe need
to adopt a more logical system. Although
it is natural to feel initially clumsy in our
attempts to master the SI units. the effort
to do
o should be repaid by the
increased understanding of the
relationships between pressures. now
expressed in a variety of units, and
between the relative concentrations of
substances in physiological fluids.
Epilogue
When I showed a draft of this article to
Jane and Maria to find out what they
thought. Jane sighed. "I still don't like
the idea. It might seem logical to you, but
I'll never remember all that."
"At least the children are growing
up with it." said Maria. "but I"m too old
to grasp all those tens to the minus some
number prefixes."
Which only goes to show that no one
likes changes! But they are coming! 'iii
Bibliography
Black. Gerald J. Thinking metricfor
Canadians, Toronto. Doubleday, 1975.
Hill. D. W. The application ofSI units to
anaesthesia,B r.J.A naesth.
41:1053-1057, Dec. 1969.
Karnauchow, P.N. Experience with SI
units in biochemistry, by... and L
Suvanto. Canad.Med.Ass.J.
114:6:533-535. Mar.20, 1976.
Qulton. John L Systems of
measurement: their development and use
in medicine.Canad.Anaesth.Soc.J.
23:4:345-356, Jul. 1976.
Padmore. G .R. SI units in relation to
anaesthesia. A review of the present
position. by... andJ.F. Nunn.
Br.J.Anaesth. 46:236-243. Mar. 1974.
Jennifer Craig is a graduate of the
GeneralInfirmary at Leeds, Englandand
obtained her B.S.N. from the V nh'ersity
of British Columhia in /976. She is
currently a graduate student in the
Faculty of Education at the V nil'ersitv of
British Columbia.
Gordon Page, Ed.D. is the Director,
Division of Educational Support &
Del'elopment in the Health Sciences,
V.B.C.
Both authors were im'olred ill the
production of a slide-tape show
".r.,Jediametric s". The artist was Bruce
Stewart. Photographs of his originals are
included with this article and are used
with the permission of the Department of
Biomedical Communications. V.B.C.
Copies of the slide-tape show are
obtainable from this department.
22 Febru.ry 1171
The Cen.dl.n NUrH
'st
. .
criSIS
,
Theresa O'Neil
Three months have elapsed since the
pathology report came back
following the surgery I underwent to
excise a molefrom my right knee.
The verdict: malignant melanoma,
class Ill.
What follows is an attempt to give
you some idea of what it's like to be
"on the other side of the fence" - a
family practice nurse one day, a
patient suffering from what could be
a life-threatening illness the next. It
is based on a diary I started at the
suggestion ofafriend, a staff doctor
who thought this might be. a way for
me to let off steam and relieve some
of the tension during the ordeal
ahead. My diary begins afew days
after I received the news of the
pathology report.
Some of my comments and
impressions are not flattering. I trust
that these remarks will not be
construed as being directed against
anyone hospital or against
individual staff members but will be
understood to focus on the health
care system in general. I believe
that, as health care professionals,
we have a tendency to get caught up
in our desire to keep the system
operating smoothly; when this
happens it is easy to forget about the
needs of the individual patient. I
hope that, as you read about my
experiences, you will see what I
mean.
,
"
\
'-
,
,
.
.
The Cenedlen Nu...
F....ry 1171 23
I finally found the courage to seek
medical advice about the mole on my
right knee following a holiday visit to the
South. The mole had been there for two
years but lately had shown signs of
changing in size and texture. I am not
sure now whether my reluctance to have
it looked at was caused more by fear of
the actual surgical procedure or by the
possibility of a positive pathology report
...1 think the latter.
A few days after the mole was
removed my suspicion was confirmed
with a positive report. I t is interesting
how one reacts in a crisis. The report
that I had been half expecting was now a
reality and yet I refused to believe it.
What a strange feeling: I felt numb all
over, like a zombie but my mind was
racing. "My God, I am going to die! I
will not let them take my leg - whenever
I go. it is going with me." And then the
denial. "I am not going to die. I'm too
healthy. " I remember the doctor who
had a mole like mine removed a couple of
years ago. He is doing fine. just like I
will. But. I also remember the young
seminarian who had one on his finger-
a young, healthy guy, dead two years
later. "Oh God, please don't let me die!"
Telling my family was difficult. The
two people I expected to be overcome by
the news were my husband and my
mother but, instead, they became my
strongest supporters. I did not realize
how much my husband meant to me until
I was faced with a life-threatening illness
or how much I needed him and
appreciated the fact that he was there.
The following morning I saw the
plastic surgeon who assured me that the
picture was not as black as I had thought
My chances of a complete recovery were
good. I was booked for a wide excision
and skin graft - something I did not
question. Just get it over with so I could
be a whole person again.
The weekend was long and full of
anxieties. The thought of spending the
next few weeks undergoing scans,
X-rays, blood work and surgery was
pretty frightening. This was one road I
had to walk alone. I seemed to swing
from high to low. I suddenly realized that
I had not shed a tear since receiving the
bad news. I was experiencing fear and
anxiety but I had to admit that I was also
enjoying the attention I was getting. That
sounds morbid, doesn't it? I began to
wonder why I was saving my money for
a future that might never happen: the
concern of providing for my senior years
was suddenly lifted from my shoulders,
rather a pleasant feeling.
I found the role change very
difficult. I became judgmental of all
health care workers: some were good,
others were not.
Before the liver scan, the doctor in
charge of nuclear medicine talked with
me. His first request: "Tell me what you
know about your problem." This seemed
to me to be a very sensible approach: a
doctor who makes sure that his patients
are knowledgeable must care about what
happens to them.
Liver scan negative. One more
check mark on the wall. While being
scanned, I listened to the staff talking
about their personal lives - parties, the
budget, vacations. etc. I wanted to
scream "Hey guys, get on with it-I've
got a malignant melanoma."
The next hurdle was the Gallium
scan. "Iff get negative on this, I am
home free ... I think!"
Then there was a misunderstanding:
I was booked for a lung scan instead of a
full Gallium scan. I refused to leave until
I got my full scan. Following the scan, I
was ushered into another doctor's office.
His message was clear: "Just because
the scan was negative does not mean that
things are all right: secondaries could
appear any time. " On a scale of one to
ten. he rated only one in my books. Was
I becoming over sensitive?
My family doctor gave me the same
message but with a lot of reassurance
and support. I appreciated his sensitivity
and honesty. One doctor appeared tuned
in to the technical procedure of the scan,
while the other was aware of his patient's
anxiety and need for reassurance.
Both scans and chest X-ray were
negative. Just the surgery to face.
A few days prior to my surgery, my
hus band and I were invited to a party.
Everyone at the gathering had heard of
my illness. They seemed disappointed
when I assured them that things were
looking very positive. Did I imagine this,
or is it a quirk of human nature to always
look for a little excitement to relieve the
monotony of everyday life? I don't
know.
In hospital
I entered hospital on a sunny and
unseasonably warm April day. The nurse
who admitted me took a detailed history
using questions recited from an
admission sheet. An hour later the whole
procedure was repeated by the resident
in plastic surgery.
The big day arrived and after
receiving Communion, I made my way to
the Chapel. How easy it is to pray. and
how near we feel to our Maker when the
chips are down. I hope I will have as
many prayers of thanksgiving when this
IS over.
The O.R. supervisor was very
supportive and stayed with me until I
was asleep. By mid-afternoon I was back
in my room with a painful knee and hip
(donor site). Now I began to find out
what "routine nursing care" is all about.
How different it is to be on the other side
ofthe fence. An hour after my return, my
"full fluids" supper tray arrived.
Although I protested vehemently, I was
urged to consume the contents of the
tray so that the [. V. could be
discontinued. The chicken soup did not
taste any better coming up than going
down. The I. V. was discontinued the
next day.
At 10.00 p.m. I had my Demerol and
my vital signs and dressings were
checked q4h for 48 hours but, somehow,
I found the human element missing.
Routine postoperative nursing care was
carried out with unfailing accuracy; but
good nursing care, where the needs of
the patient rather than the doctor are
met, seemed to be missing. Postop
patients are wakened and checked at
2.00 a.m. and again at 4.30 a.m. (6.00
a.m. is too late to get charts done and
report ready). It is unfortunate that the
comfort of the patient cannot be allowed
to interfere with hospital routine; 4.30
a.m. is an unreasonable hour to wake
postoperative or any patients, for that
24 Febru.ry 11171
The C.n.dlen Nur..
matter. starting their day with vital signs,
bed pans. medications. ice water. and
blazing lights.
I was reprimanded for changing my
mind about the need for pain medication
the first postoperative night: I did not let
it happen again.
Medical and nursing staff advised
me that it was important to keep the
donor site (left hip and buttock) dry to
prevent infection but they did not tell me
how thi" should be done. On the second
day. I was the one who suggested to the
nursing staff that a pillow at my back
would keep my weight off the donor site.
a simple nursing procedure thaI the} had
overlooked.
Today our profession is tuned to
producing a more sophisticated style of
nurse. We use Standard Care Plans and
Problem Oriented Records - both
important tools in implementing good
nursing care - but do we sometimes
neglect our patients because we are too
busy implementing these tools to find out
what their needs really are? I hope that
the nursing profession is on the right
track but I must admit that sometimes I
am concerned.
When I was a patient it wa" difficult
for me to discard my role as a nurse. I
was experiencing intense physical and
emotional trauma: my knee had been
mutilated during the course of treatment
for a life-threatening disease.
Nevertheless. the only problem the
student nurses' clinical supervisor chose
to deal with was constipation. That nurse
and her students missed an invaluable
nursing education experience.
My next hurdle was the pathology
report following surgery. Again, the
report was negative. Everyone was
oveljoyed but instead of uttering a
prayer of thanksgiving. my initial
reaction was "My knee wa
mutilated
for nothing." I could not help wondering
if the surgery had really been nece
sary.
Should I hdve gambled and lived with the
initial mole removal? What would my
chances of
urvival have been? Who
decides how radical an excision to make.
and why? What percentage of reports
come back positive following surgery?
How are these positive reports brolo..en
down into classes (1.2,3.4.5)?The
questions I should have asked
preoperatively were suddenly now going
through my mind. Had the operation
really been neces
ary? Was I being
ungrateful? I had so many questions and
yet I found it difficult to voice them
because I did not want to hurt the people
who had been kind to me.
A nurse clinician brought me back to
reality. She made me realize that I was
looking at things from a selfish point of
view. I have a husband. four lovely
children. and a mother who would not
want me to gamble with my life. I o\\ed it
to them as well as myself to take no
chances on allowing the malignancy to
spread.
Going home
On the tenth day. I was discharged from
hospital, complete with leg splint and
crutches. A week later I was aI/owed a
tub bath - a treat that proved to he a
very humbling experience. Standing
naked in front of my husband with m}
imperfect body, waiting for him to help
me in and out of the bath. I realized how
completely dependent I had become.
This dependency has drawn us closer
together and now we feel that we have
both experienced real emotional growth
over the past three months.
Over the next month I gradually
shed my splint, the dressing, the tensor
bandage and elastic stoclo..ing. A new me
emerged. At first the graft was rather
tight. making climbing stairs difficult and
painful for me. but through perseverence
and determination I have mastered that
obstacle. Small car
are still a problem
but that too is being overcome. Dre"s
styles are longer now so dressing is no
problem. I have been wearing slack"
rather than shorts and I have bought a
new bathing suit that I plan to wear on
vacation. I have accepted my body the
way it is. If people are "hocked at the
sight of my knee, I realize that the
problem is theirs and not mine.
On thinking it o\er
The past three months have given me a
whole new perspective on life. I have
become more aWdre of my own
mortality, of the significance of each
day. of the love offamily and friends. I
discovered too that a temporary role
reversal can be a positive experience.
enabling us as health profes"ionals to
understand the fears. frustrations and
anxieties of our patients and their
families during a crisis situation. I have
come to realize, also, that a crisis like
this can lead to emotional growth and
can strengthen the bonds among family
members.
As nurses. we must put the needs of
our patients at the top of our list of
priorities. We must make sure that. in
our zeal to develop and implement
educational tools and to keep the system
running smoothly. we do not lose sight of
the patient. ..,
Author Theresa O'
eil recei,'ed her R.l\'.
from St. Mar...'s Hospital, Montreal and
a B.Sc.N.from St. Thomas UnÌl'er.rity.
N.B. She jpent the first fell' years
fol/oll'ing graduation in Oh.rtetrical
Nurs;,,!!.
After raising afwnily, she became
illterested in Family Practice Nursing
llnd has spent the last ten years a,r Head
Nurse in St. JÇJ,reph's Hospital Family
Medical Centre, London, Ontario.
Theresa is a clinical lecturer with
the Department of Family Medicine,
U ni"ersit\. of Western Ontario and has
spent part of her time coordinating an
In,ren-ice Education Programme for
Family Practice Nurses wor!..ing within
tlU' Department ofF amil\' Medicine.
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Th. C....-.lI.... NUrH
Februery 11171 25
41 nurse practition
r
in a community college setting
The Health Clinic at Mohawk College of Applied Arts and Technology in Hamilton, Ontario is many
things to many people. For some, it is a first aid station for injuries, accidents and burns; for others, it
functions as a community health center with a part-time physician; and for still others, it provides a
listening ear and a place to seek advice and information on health-related matters. AU in all, it is a
great place for a nurse practitioner to work.
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Diana Nelles
. . We hm'e a man 111 the boo!.. store in
diabetic comu. we thin!.. - please come
down. "
"C ome quickl\'. a student is hm'ing a
com'ulsion and I think he dislocated his
shoulder when he fell. ..
"C un I come in for the morning-after
pill?"
These are just a few of the situations I
encounter in the course of my work as a
nurse practitioner in a community
college health clinic. As you can
imagine. the health clinic, serving a
population of 5.000 students and staff is a
busy, active place. Not only does it serve
as a primary first aid station in cases of
injuries and accidents, but also functions
as a community health center with a
part-time phy!.ician on staff.
Because of the variety of services I
am called upon to provide. I have an
excellent opportunity to use my skills as
a nurse practitioner to their fullest
potential. At time!. this includes the role
of first aid attendant, occupational health
nurse. health counselor, classroom
teacher and drug information giver. I am
able to dispense drugs. prescribe
treatment and perhaps. most important
of all. to teach health education at a
primary level. Health teaching,
preventive medicine, health counseling
and drug information are a very
important part of my role.
...
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The NP-Physician Team
At our clinic, the family physician is
present three mornings a week.
Generally, I do the initial assessment of
all patients who come to the clinic unless
an appointment has been arranged
previously to see the doctor. This is a
good opportunity for me to explain my
role to clients and to emphasize that it is
not always necessary for them to see a
physician for minor complaints.
In this kind of arrangement. the
nurse practitioner and the physician
must work as a team in order to give the
best care possible to the patient. Because
the nurse is functioning in an expanded
role, the physician mu!.t trust the nurse's
judgment and the nurse must know her
own limitations and when to seek advice.
2e February 1171
The Cen.dlen NUrH
The nurse must be confident that the
decision she makes in assessing a patient
is the right one. Open, honest
communication between nurse and
physician ensures good patient care and
minimizes legal problems that might
develop.
The following examples show the
nurse practitioner-physician team in
action.
. A number of young female students
come to the clinic to have a well-female
examination. I initiate and complete a
history including social and family
history, past illnesses and allergies.
Blood pressure, weight and urinalysis
are followed by a pelvic exam, pap smear
and vaginal culture. A demonstration of
a breast examination and a discussion on
birth control is also included. Ifthe
. For the protection of both the
patient and the nurse, the doctor must be
present for allergy injections. Even
though the nurse gives the serum, the
physician must be in the vicinity. In the
past, we have experienced two serious
reactions, and medical treatment was
immediately available.
. The treatment of first degree bums,
removal of sutures, syringing of cerumen
from ears (after examination by the
doctor) and treatment of abrasions and
lacerations are all taken care of by the
nurse, the physician being notified in
case of infection or abnormalities.
. As a team, we have also given
lectures to classes in the college on
subjects such as birth control.
communicable diseases in children and
"recognizing the sick child".
.
\
Although some clients may have had
ba<;ic sex education in school. many of
them have a poor knowledge ofthe
reproductive system and birth control.
Some clients have never had the
opportunity to discuss this topic with a
medical person . Young women, in
particular, often reluctant to visit their
family doctor because he is a "friend of
the family". seem more at ease
discussing birth control in the accepting
atmosphere of the clinic. Maria, a
22-year-old student, is a good example.
She was waiting at the health clinic one
morning when it first opened and was
obviously distraught and very agitated.
After I brought her into the office and
she calmed down, we talked about what
was troubling her. She was convinced
that she had become pregnant the
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patient wants some form of
contraceptive, this is discussed, as well
as any problems or concerns the patient
may have in this regard. This kind of
assessment and teaching forms a large
part of the nurse practitioner's role. If
the patient wishes to take the birth
control pill, she is seen by the physician.
The patient can drop in any time later to
discuss any problems regarding the birth
control method she has chosen.
. Pre-employment physicals and
immigration physicals are done by the
nurse practitioner. This frees the
doctor's time for more serious medical
problems. However, if! suspect an
abnormality or if! am concerned about
any aspect of the examination, the
physician is notified.
The Clients
Because the clinic is conveniently
located on campus, it is well utilized b}
staff and students alike. On the average,
40-50 patients a day come to the clinic
with the physician seeing about .-:!O
patients each morning she is in. The
majority ofvisih are made by students
who range in age from 17-25 years. Many
of them do not make appointments, but
drop in to discuss particular problems
they are having.
Students in this age group often
have concerns about:
. birth control
. urethritis
. venereal disease
. obesity
. acne
. sexual problems.
previous night. However, as we
discussed the situation, she reported that
she did not have intercourse with
penetration and there was no ejaculation.
Maria came from a strict I talian family
and had been very protected. I reassured
her about her concerns but she refused to
believe that she wasn't pregnant.
I saw Maria in the clinic every
morning for two weeks after this incident
and discovered how uninformed she was
about all areas of sexuality and her own
anatomy. During that year, health
teaching and counseling gave Maria a
more healthy and realistic attitude
towards her own sexuality and gave her
enough confidence to break through
some of the restrictive bonds at home.
The Cen-.llan Nurae
Februery 1171 71
Often. younger girls seek guidance
in a group. rather than act alone - a
great chance for health teaching "en
masse" . Students from out oftown use
the clinic as their "family doctor" and
often come to the health center for minor
ailments. But those with chronic illness.
such as hypertension. epilepsy and renal
disease also drop in to talk over the
problems they may be having with
medication and their side effects. If these
patients have their own family doctor. I
always refer them back to their physician
for follow up.
Foreign students are another group
who are often anxious about their health
and who may be homesick. In many
instances. they have no knowledge ofthe
resources available to them. As a nurse.
,
I I
Because the clinic is so convenient.
staff members who might not otherwise
find the time to go to their family doctor.
drop in to the clinic. A good example of
this is Miss D., a 42-year-old faculty
member who visited the clinic because
she had detected a lump in her breast.
She had seldom visited a doctor since
she had always been in excellent health
and she was reluctant to do so even now.
When I examined her. I could feel a hard
mass approximately 3 cm in diameter
under her left breast. We talked over the
implications of this finding and she
agreed to go to a surgeon. Subsequently.
she had a left mastectomy. That was
eight years ago. Today, she is
functioning well, is still teaching and
continues to come to the clinic for
.. J
Conclusion
Case studies like these show that a nurse
practitioner in a community college
health service can provide primary
health care to a large student and staff
population. In a collegial relationship
with a physician, the nurse can use her
skills and judgment to assess patient
problems and to initiate treatment in the
shortest time possible. Health care costs
are reduced, and good preventive and
follow-up care in the form of counseling
and teaching is stressed."
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I am able to provide them with some
support and guidance in many aspects of
day to day living. The Ontario Health
Insurance Plan covers all visits to the
doctor in the clinic and students without
OHIP are treated free of charge. There is
no charge for visits to the nurse.
Of course. staff also utilize the
services of the health clinic. For
example. in the role of an occupational
health nurse. I am responsible for
attending to employees who sustain
injuries on the job. for maintaining
accurate health records and initiating
workman compensation claims.
Employees with drug and alcohol
problems and/or those whose
absenteeism has become a problem, are
interviewed and counseled with
subsequent programs initiated.
periodic checkups.
The convenience of the clinic for
clients was evident on another occasion.
Two days before Christmas. two female
employees, aged 22 and 24. came to the
clinic and expressed concern that a
co-worker had German measles. Both
women had missed a period and
suspected that they were pregnant. They
were unable to contact their doctor and
the college physician was also away. I
completed pregnancy tests on both
women, and both were positive. The
patients were sent to the lab for a rubella
titre and fortunately had levels higher
than I :8. The tests were completed along
with results in less than a day. and a
worried Christmas was avoided. Eight
months later, they delivered normal.
healthy babies.
Diana :\Telles (R.N., Hamilton General
Hospital; Diploma in Primary Care
Nursing, McMaster Vnil'ersitvj is the
Supervisor of Health Services at the
Fennel/Campus, Mohawk College of
AppliedArts and Technology. Diana has
worked at the College for the past ten
years and prior to this time worked in an
emergency department and in a
physician's office.
2e February 111711
The Cen-.llan Nur..
Understanding the physiology of
Anne H edlin
Dr. J. Dostrovs/"y
Wherever you work, you
encounter patients with pain.
These patients expect you, as a
nurse, to relieve their pain.
Knowing about the physiological
and. emotional components
involved can give you a better
understanding of patients'
reactions to pain and how you can
help.
Virtually everyone has experienced pain
of varying intensity and duration but no
one has yet been able to provide an
explanation for the phenomenon of the
pain sensation. Many puzzling questions
can be raised about the mechanisms
involved in the experience of pain. For
instance. why is it that a severely injured
person does not necessarily experience
pain? How is it possible for Indian fakirs
to walk on red hot coals or lie on a bed of
nails without evidence of discomfort?
Why is the needle prick of an injection
absolutely dreaded by some but accepted
calmly by others? How can there be pain
when no evidence of physical injury can
be located? Why does the leg-amputee
complain of pain in the amputated limb?
The failure to discover satisfactory
answers to these and other questions is
not because of a lack of interest. Not
only is "pain" the subject of intensive,
world-wide research, but medical and
nursing personnel devote much time and
effort to alleviating pain resulting from
disease, accidents and surgery. Although
answers cannot be provided for all
questions about pain. certain facts are
recognized.
Pain stimuli
In order to experience a sensation-
whether it be visual, auditory, heat, cold
or pain - impulses must be generated by
a specific stimulus and then transmitted
along a specific pathway to a particular
area of the central nervous system. For
example, impulses that cause a painful
sensation arise from stimuli which have
the potential to produce tissue damage.
([he exception to this rule is found in
some abnormaJ or pathologicaJ states in
which pain can result without evidence
of noxious or tissue damaging stimuli).
These painful stimuli activate specialized
nerve endings which respond only or
primarily to these stimuli. Other nerve
terminals found in the same tissues are
activated by non-painful stimuli such as
hair movement, vibration or cold.
The nerve fibers that transmit the
pain signals to the brain are of small
diameter and have conduction rates of
about 0.5 to about 30 metre/second.
They can be divided into two groups, the
A b fiber group and the C fiber group.
The A B group, composed of nerve fibers
.Myelin - the fatlike substance forming a
sheath around certain nerve fibers.
which are myelinated.. conduct
impulses more rapidly than do those of
the unmyelinated (' fiber group. This fact
may contribute to a dual pain sensation
in many instances. i.e. an initiaJ sharp,
pricking. well-localized sensation
followed by a more prolonged.
well-localized, burning type of pain. The
latter. which is generally more
unpleasant, is mediated by the C fibers.
Transmission of pain impulses
Pain fibers travel together with other
sensory fibers in the peripheral nerves
such as the sciatic nerve and enter the
spinal cord via the dorsaJ roots (or the
trigeminal nerve for pain impulses from
the face). As illustrated in figure one,
these fibers terminate in the superficial
dorsal (posterior) region of the spinal
cord. Here, they excite neurons whose
axons cross to the opposite side of the
spinal cord and travel up to the thalamus
by way of the anterolatera.l regions of the
spinal cord in the spinothalamic tract.
Pain impulses go primarily to the
midline region of the thalamus.
However. it is not known whether pain is
perceived by activation of specific
thalamic pain neurons or whether it is
relayed to the sensory cortex where all
other senses are perceived. Some fibers
originating in the spinal cord enter a
dense network of interconnected nerve
fibers in the brain stem, caJled the
reticular formation. It is believed that
this region also plays an important role in
The Cen-.llen NUrH
F-..ery 11171 21
MIDBRAIN
Nucleus ot Tnge,mna. Spln.1 Tract
MEDULLA
Reticular Fonn.'tOn
Figure one
Pathways for impulses from peripheral sel1sory neurons and the trigeminal nerve (V
cranial nerve). Synapses occur in the substantia gelatinosa of
he spinal cord and in the
thalamus. Collaterals connect these ascending neurons with the midbrain reticular
formation.
the sensation of pain.
But pain is not simply a sensation, it
is an unpleasant sensation. This fact
imparts a distinctly different quality to
pain and distinguishes it from other
sensations such as hearing. touch and
smell. As indicated by Melzack in The
Puzzle of Pain. it "motivates or drives
the organism into activity aimed at
stopping the pain as quickly as possible.
To consider only the sensory features of
pain and ignore its motivational-affective
propenies, is to look at only part of the
problem" . I
The thalamus and cortex are the
main structures involved in pain and
other sensations. Other brain regions are
also involved, in what can be classified
as the motivationaJ-affective dimension
Figure two
Olfactory Bulb
A diagram including the limbic system and related structures which make an important
contribution to the motivational-affective dimension of pain. A-amygdala.
M-mammilIary body, S-septum, TN-thalamic nucleus.
-
of pain and are believed to include both
the brain stem reticular formation and
the limbic system. Exactly how pain
influences these regions is not clear. The
reticular formation, which receives input
from ascending pain pathways, has
connections to most brain regions
including the structures ofthe limbic
system (figure two).
The limbic structures, together with
the hypothalamus. are believed to
mediate emotional behavior. Evidence of
this has been demonstrated by frontal
lobotomy. Severing the connections of
these structures with the frontal cortex
can produce relieffrom pain but at the
expense of profound changes in
emotional behavior characterized by a
marked reduction of emotional
responsiveness. Experimental
stimulation of amygdala. hippocampus
and hypothalamus. has been shown to
induce behavior which is otherwise
associated with painful stimuli. Thus.
behavior in response to or in anticipation
of noxious stimuli is believed to be
mediated by the limbic system and such
structures as the hypothalamus,
thalamus and midbrain reticular
formation.
The type and extent of cerebra!
cortex involvement in the experience of
pain is unknown. Certainly impulses do
reach the cerebral cortex but no specific
area of cortex can be identified as a
"pain center". Perhaps the cortical
contribution is one of cognitive activity.
Factors such as the influence of an
individual's cultural background.
attitude to unpleasant experiences.
emotional stamina, tendency to be
influenced by suggestions etc. could be
fed back from the cortical regions to the
thalamus, limbic system or brain stem
and could modify the experience. This
could account for much of the individual
variation in response. On the other hand,
the cortex may be involved in
localization of pain rather than in
mediating the motivational-affective
dimension of pain. Each area of sensory
cortex receives impulses from a specific
cutaneous region and therefore the origin
of the impulse can be identified.
In addition to the modulation..
which may occur in the brain, it is known
that pain transmission to the brain can be
influenced in the spinal cord. The
gate-control theory proposed by
Melzack and Wall (\965) suggests that
the dorsal horn cells act like a gate which
can regulate the transmission of impulses
to higher centers in the central nervous
system. Whether the gate is open to
alIow pain impulses through or closed to
inhibit impulse transmission depends on
(a) the relative amounts of input from the
uModulation - alteration of response.
30 F.bruary 1171
The C.n-.ll.... Nurae
large non-pain transmitting fibers (e.g.
touch) and the small pain fibers and (b)
on inhibitory impulses descending from
the higher centers. Higher centers which
may be involved include the midbrain
reticular formation and the cortex,
especially the frontal cortex. Through
memories of painful experiences,
emotions and preoccupation with other
activities, these centers may exert
considerable control over the central
transmission cells of the spinal cord. A
modification of Melzack and Wall's
schematic diagram of the gate-control
mechanisms is presented in figure three.
Opiate receptors
For many years treatment of pain has
relied heavily on analgesic preparations,
the most effective agents being morphine
and morphine derivatives. In the past
few years, there has been great
excitement in the field of pain research
following the discovery that the brain
possesses specific receptors for
morphine and moreover that the brain
produces its own morphine-like
compound. The receptors. known d"
opiate receptors, exist in high
concentrations in certain regions of the
brain and spinal cord in a distribution
that suggests a close relationship with
Morphine-like compounds called
enkephalins have been isolated from
brain tissue. Relatively high levels of
these substances are found in the frontal
cerebral cortex, medial thalamus,
hypothalamus, amygdala and
periaqueductal grey matter. In addition
to the enkephalins. other endogenous
morphine-like compounds, endorphins,
have been isolated from the pituitary
gland. The endorphins are fragments of
the pituitary hormone, B-lipotropin.
Both enkephalins and endorphins exert
an analgesic effect. It is proposed that
they act as neurotransmitters (chemical
substances which mediate impulse
transmission at synapses) in pathways
concerned with pain modulation. This
inhibition may be effected through
binding to opiate receptors.
Electrical Stimulation
Recent experiments have shown that
electrical stimulation of the
periaqueductal grey matter can produce
analgesia. This technique is now being
used in a number of hospitals around the
world to treat severe chronic pain. which
cannot be treated by conventional
methods. Stimulation of the brain stem
activates some of the pathways that
Descending Inhibitory Pathways
To Thalamus
---< excitatory synapse
-of Inhibitory synapse
...... inhibitory mterneuron
Hgure three
A modification of Melzack and Wall's schematic diagram ofthe gate control mechanism.
Stimulation of touch fibers and impulses from higher centers can inhibit central
transmission cells and therefore prevent (close the gate to) central conduction of
impulses by pain fibers.
the pain pathways. In the brain. the areas
of high concentration are: the amygdala,
thalamus and hypothalamus (structures
concerned with the
motivational-affective dimension of pain)
and the periaqueductal grey matter of the
brain stem. In the spinal cord and
trigeminal nucleus. the area of high
concentration is the substantia
gelatinosa. It is believed that morphine
produces analgesia by acting on the
opiate receptors found in these areas.
morphine activates. The brain stem
neurons, which have axons extending
down to the spinal cord dorsal horn can
intercept and block the transmission of
pain impulses from spinal cord to the
thalamus. Further investigation of the
anatomy and physiology of these
endogenous pain inhibitory pathways
could lead to the identification of better
methods of activating the body's own
analgesics and thus could provide more
efficient treatment of pain.
Nursing implications
A wareness of the fact that there are
several dimensions to pain is especially
important for nurses. The absence of a
physical basis for pain does not eliminate
the possibility of an experience of pain;
motivational-affective dimension
through emotions, e.g. anxiety and fear,
can aggravate and enhance the painful
experience. Psychological needs of the
individual such as a need for attention
can also contribute to the presence of
pain. Attitudes toward pain vary greatly
and may be influenced by ethnic
background. Some believe that
complaining of pain is an admission of
weakness while others do not hesitate to
display their suffering. Maximum use
should be made of the inhibitory
influence of higher centers. For example,
procedures which can divert the
patient's attention from the painful
stimulus such as back rubs, conversation
etc. can be used as a supplement to pain
relieving measures.
The scope ofapplication of the
growing knowledge of pain is enormous
and. for nurses. an area that they cannot
afford to ignore."
Anne M. Redlin (8.S c.N., University of
Saskatchewan; M.Sc., Uni
'ersity of
SasJ...atchewan; Ph.D., Physiology,
University of Toronto) is a research
associate in the department of
physiology and a lecturer in the faculty
of nursing at University ofT oronto. She
has had experience in general duty
nursing, public health nursing and
nursing education. A nne has published
numerous articles, on blood coagulation
and bloodfibrinolysis, her main area of
research.
Dr. J. Dostrovsky(M.Sc., University
College, London, England; Ph.D.,
V niversity ofT oronto) is an assistant
professor in the physiology department
at the U nh'ersity ofT oronto. His main
area of research is the .
neurophysiological basis of pain.
References
I Melzack. Ronald. The puzzle of
pain: re
'olution in theory and treatment.
New York, Basic, 1973, p.93.
Bibliography
Fields, H. L. Brainstem control of spinal
pain-transmission neurons. by... and
A.I. Basbaum.lnAnnual review of
physiology. Vol. 40. Edited by Ernest
Knobil et al. Palo Alto. Ca, Annual
Review. 1978. p.217-248.
Melzack, Ronald. Pain mechanisms: a
new theory, by... and P.O. Wall.
Science 150:971-979, 1965.
Snyder, Soloman H. Opiate receptors
and internal opiates. Sci.Amer.
236:3:44-56. Mar. 1977.
.,
The patient in pain:
handling the
guilt feelings
Gillian Doherty
Nursing a person suffering
chronic or prolonged pain is a
draining experience often
associated with feelings of guilt.
Learning how to handle these
guilt feelings in a way which is
not harmful to the patient or to
herself is one of the hardest tasks
a nurse has to face.
A nurse's training emphasizes her duty
to relieve suffering. Therefore it is not
'\urprising that few situations cause a
nurse to feel more of a failure than caring
for a per,>on whose pain she cannot
alleviate. Being unable to relieve pain is
frustrating and, as psychological
research has demonstrated, frustration
often turns to anger at the object or
person perceived as responsible, The
anger reaction towards the individual
whose pain will not go away usuall}
causes the nurse to feel guilty. I f the
failure-fru'itration-anger-guilt sequence
is repeated several times in connection
with one particular patient. then the
nurse begins to associate that individual
with unpleasant feelings.
In order to not have to face the
di5comfort that this patient evokes in her
the nurse may begin to avoid him. This
avoidance often originates
subconsciously as an attempt to screen
out unpleasant reality. in this case failure
to alleviate pain and the associated guilt
feelings. As long as the nurse does not
see the patient she can believe he is no
longer suffering. However avoidance
rna} not be successful and may actually
increase the nurse's feeling of guilt when
she realizes what she is doing.
How can the nurse constructively
handle the feelings that are aroused in
her when she cares for an individual
whose pain she cannot alleviate? The
first requirement is that she face the fact
that in some cases it is not possible to
totally relieve suffering. Therefore the
patient's continuing pain does not
automatically mean that the nurse has
failed. Prolonged pain does, however,
signal a need for the nurse to accept
responsibility for assisting the person to
cope with it and this requires some
understanding of pain's psychological
effect.
Ho\\< people react to pain
For the victim, prolonged pain is a
demoralizing experience which thrusts
the individual into the role of dependent
- a person who cannot take care of his
own needs. When this happens the
patient's frustration with the situation
may show itself as anger directed
towards the nurse. Prolonged pain is abo
a frightening experience. As the pain
continues it wears the person down until
he begins to feel that he is in the power of
an alien force which he cannot control. If
others avoid him in his pain he feels
betrayed and abandoned to his fate.
Unfortunately the behavior of an
individual in pain tends to encourage
people to avoid him. Characteristically,
as pain continues. the person becomes
increasingly preoccupied with his
suffering and less responsive to others. It
is important to remember that the
individual in this situation still needs the
comfort of having people spend time
with him even though he probably does
ot indicate that this is the case.
Spending time with a patient does
not mean that the nurse has to attempt to
engage him in light chatter. To do so
when he is in pain is to act a5 if he i5
merely out of sorts and suggests lack of
sensitivity to the individual's experience.
This kind of behavior may even be
interpreted by the patient as denial of his
pain; to deny a person's perception of
the reality he is experiencing is to rob
him of his self-respect.
If the nurse wants to assist the
patient to retain his dignity in the face of
pain, she must verbally acknowledge the
existence of the pain and the patient's
right to feel frustrated"and angry that his
suffering cannot be alleviated. In this
way, the nurse indicates respect for and
empathy with the individual. but this is
not sufficient if the nurse then rushes
away. Non-verbal communication is also
essential to convey real understanding.
This can take the form of turning the
person's pillow or some other physi 
