'6 --- . t 1 f --- . ." The Canadian Nurse . . G..l51.a ,} MISS JE STOCK 608-l11 wURJEMBu G OTTAriA 2 ONI "?o " .... t J ./ - \ \ \ WHITE SISTER The Timeless Look --- \1 \ WHITE SISTER I --- 8 -/ -- ---. J . .., A. Style No. 46463 Sizes 3-15 Royale Corded Tricot White, Pink . . . . . . . about $26.00 ( ) I I """ITE ....Ð SISTER CAREER APPAREL See our new line of Whites and Water Colours at fine stores across Cana< B. Style No. 46415 Sizes 3-15 Royale Corded Tricot White, Cantaloupe. . . . . about $28.00 C. Style No. 46850 Sizes 3-15 Royale Seersucker, 100% Woven Polyester White. Pink. . . . . . . . . . about $35.00 --.......... 76 The Canadian Nurse 4 6 13 48 Your next CNA convention 16 50 Frankly Speaking S. Stinson 17 Crying: A McGreevy, The Neglected Dimension J. Van Heuke/em 18 Cross-Canada Registration 22 Brushing Brigade H.K. Moggach 26 Blindness Can Be Prevented F. Doner 27 Nursing Via Satellite N. E. Henderson 31 Communicable Diseases and Immunization L Cranston 34 Input News Calendar Research Library Update The official journal of the Canadian Nurses' Association published monthly in French and English editions. Volume 72 Number 1 Cover Photo' Health and Welfare Canada Communications services in Canada s far north are presently undergoing expansion and revitalization as a result of technological progress. For nurses In the north, such as the one featured on this month's cover. these improvements mean better health care for their patients. Read Nursing via Satellite on page 31 . -- i< . ..... "' The views expressed in the articles are those of the authors and do not necessarily represent the policies of the Canadian Nurses Association. ISSN 0008-4581 Indexed in International Nursing Index, Cumulative Index to Nursing Literature. Abstracts of Hospital Management Studies. Hospital Literature Index. Hospital Abstracts. Index Medicus. The Canadian Nurse is available in microform from Xerox University Microfilms. Ann' Arbor, Michigan, 48106. J The Canadian Nurse welcomes suggestions for articles or unsolicited manuscripts. Authors may submit finished articles or a summary of the proposed content. Manuscripts should be typed double-space. Send original and carbon. All articles must be submitted for the exclusive use of The Canadian Nurse. A biographical statement and return address should accompany all manuscripts. . A Canadian Nurses Association. ':::( 50 The Driveway. Ottawa, Canada, K2P 1 E2. Subscription Rates: Canada: one year, $8.00; two years. $15.00. Foreign: one year, $9.00; two years, $17.00. Single copies: $1.00 each. Make cheques or money orders payable to the Canadian Nurses Association. Change of Address: Notice should be given in advance. Include previous address as well as new. along with registration number. in a provincial nurses association where applicable. Not responsible for journals lost In mall due to errors in address. Postage paid in cash at third class rate Montreal. P.Q. Permit No. 10,001. . Canadian Nurses Association 1976. 2 The Canadian Nurse January 1976 You're Beautiful So who says your shoes have to be ugly? " , \ \ \ \ ... " .\ .1 professional. you need shoes that art> comfilrtahlp and durahle. Bu t \ ou' re also a woman \\ ho cares ho\\ she look,'. So \ ou want shoes \ùth sh It'. too. \\'ell. \\e\e got just that shoe. BE\l'TY 0'\ Dl"T\. Professional shoes h\- Baht. Comfortahle, durahle and becau'se the\-",'e li'om Batao also \ en- stdish. ' E\-en hetter, BE\lTY 0:\ DlTTY shoes are priced to gi\ e \ ou tht' most for -our dollar. And nO\\. ou can sa\ e an e:\tra 82.00 with this coupon. '\0\\ (I/(It's a ht',mtilirl oner , , $16.99 '-------------------, I I i This Coupon is \\'Orth $2.00 I I hm ards the purchase of am J I BE\l'TY 0'\ Dl'TY white professional I I ,hoes, at ,UI\ Bata store. 1 I I oHer good ;mtil \Ia\ 1. 1976. <,' -, I I I L___________________ Ieet Thn e Beautjful Pmfe sj()nals Eaeh is distincti\l'h sh'led and features Baht's 3-wa comfilrt. S;,ft. 'qualit leather IIpper . Cushioned insoles \\ ith arch support. Fle\.ihle ,olt's. Set' the l'ntÌl'e ,election of Bata RE\l TY 0'\ Dl'TY ,hoe tolla\. at tIlt-' Bata ston' nearest \tHl. Then tr on .; pair. YOldl .1grl'l'. Thl' 'n" ht',wtilirl! $18.99 A world of comfort at your feet \t "(\ \\ )t(\': Efl iff. I ne Lanaalan Nurse .J8nu8ry 1'97ti What is there to say about a change in format as radical as the one which faces readers of The Canadian Nurse and L'infirmiere canadienne this month? Either you like it or you don't. Obviously, we hope very much that you do like it. We present it in good faith, relying on the combined expertise of a skilled young graphic artist, an innovative printer, and our own collective editorial opinions as to what you expect from your professional journal. Plans for the new format began almost a year ago. Development has proceeded slowly, allowing for lengthy consultations between the artist, the staff of both journals, the printer and other CNA staff members All of this planning will see its first concrete expression in this January, 1976 issue. At this stage, two weeks before press time, about all the editor can do is keep her fingers crossed and hope for the best. It is inevitable that there will be mistakes in this first trial run; I only hope they will not be big mistakes and that readers will remember how difficult the first few weeks under a new system can be. As for the technical details - those of you who have had some publishing experience will recognize the work that has gone Into the new format. Type faces and sizes are different throughout the book. Column sizes have changed: departments (news, lellers. etc.) now appear in new, narrower versions, lour columns to a page. Some of the names of these departme...ts have been updated to try to match the mood of the seventies. Most of all, there is a bold new design for the cover - one new look for both the English and French editions. This design will remain constant but the photos and color combinations will change with each issue. So much for the medium - what about the message? We have a new vehicle and, therefore, an obligation to make the contents live up to the format. One of the ways we will be trying to accomplish this is by accepting the constructive criticism offered by your provincial public relations officers. These representatives met recently with their national counterparts at CNA House to examine their respective roles as providers of information at national, infernational and provincial levels. Their comments will playa major role in editorial decisions over the coming months. Among other things, they said: tell us more about national health issues (not just nursing); give us more controversial articles: give us more clinical (how-to) articles; try to reflecf more closely the views of the average staff nurse; and let us know more about what our national association is doing for us. They also said: try to be less. impersonal: try for a less sCholarly, less pedantic approach: above all, look like you're having fun. Promises are easy to make and hard to keep. But those are suggestions we are going to try to live with, especially the last one. -M.A.H. Ilel-ei II Editor M. Anne Hanna Assistant Editors Liv-Ellen Lockeberg, Lynda S. Cranston Production Assistant Mary Lou Downes Circulation Manager Beryl Darling Advertising manager Georgina Clarke CNA Executive Director Helen K. Mussallem CNA Director of Information Service Michèle Kilburn J . f - ì. . .\.....:;,--=-... 1-' L.. l f-- ' 11-- - ------.. There IS something special about this January 1976 issue of The Canadian Nurse that doesn't immediately meet the eye. For the past ten years, address labels for both CNA journals have been produced by computer, using a service provided by IBM Ottawa Data Centre. This issue, however. comes to you via a new System 3 Model 8 computer that now resides at CNA House. Installation (pictured above) took place late last Fall and since then, circulation staff have been working overtime to get the system operating. The main advantage to you. the reader, will be faster and more efficient delivery of your journal. Our thanks to all t 20,000 of you for your co-operation and patience in this change. If a problem should arise witl your own subscription, or if you knoy of someone who hasn't received the copy, help us get things straight. ThE information we need: . CNA member - registration number: province In which you hold active practising/full membership: label from your lasf copy received. . Subscriber - present address; previous address and, most importam label from your last copy. Next month in The Canadian Nurse. three nurses who work In Canada s first multidisciplinary stroke uOlt at Sunnybrook Medical Centre in Toronto share their experiences Witt readers. Patricia Adolphus CatherinE Pallant and Linda Graham have eacl worked with stroke victims for sever years. In their three-part article next February. they describe the history 0 the unit, the physical layout, the nursing care involved. and the rehabilitation of stroke victims. 4 The Canadian Nurse January 1976 I 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. . VIEW WOUND SITE THROUGH ACCESS CAP, REMOVE CAP FOR EXAMINATION AND DRAIN TUBE ADJUSTMENT. 1111)111 ' OOPS, WE GOOFED... in the report on the last meeting of CNA Directors (The Canadian Nurse, December, 1975, page 33) the statement on predicted costs of the 1976 CNA convention should have read as follows: Since it is estimated that convention costs will increase by close to $15,000, registration fees will have to be increased to help cover expenses." \' , " .... '" -- Why Such a Long Wait? In the July 1975 issue of L'infirmière canadienne it was suggested that nurses considering going to work in a foreign country would be well-advised to secure authorization from that country before leaving Canada. I am writing to tell you of a similar experience right here in our own country. I wanted to leave Quebec to work in the province of Ontario. looking for new surroundings and new experiences. Of course, I intended to work in the field of nursing which is familiar to me. I had to wait eight months for the transfer of my license and I cannot tell you how many useless letters I received while I waited for the necessary papers. Travel can be enriching but if you have to make your decision a year ahead and delay your departure another eight months waiting for your license, the spontaneity of the whole project vanishes. Why such a long wait? Ii seems to me that a study of this situation would be in order. I urge those who have experienced similar hardships to send their comments. Perhaps your next trip will be smoother and more pleasant? -LP.r, N., Quebec. oU ,...\ \ --- \fO --- :..----- THE HOLLISTER DRAINING-WOUND MANAGEMENT SYSTEM KEEPS FLUIDS AWAY FRO"v1 PATIENT'S SKIN AND GUARDS AGAINST IRRITATION AND CONTAMINATION. Skin-conforming Karaya Blanket protects skin around wound site. It directs discharge into odor-barrier. translu- cent Drainage Collector which holds exudate for visual assessment and accurate measurement. There are no messy, wet dressings to handle or change . . no need for painful dressing removal. Supplied sterile. for application in O.R. or patients room. The better alternative to absorbent dressings, As you suggested, CNA's Information Service has conducted a study of problems related to the registration process in various provinces. We urge you to read the article entitled "Cross-Canada Registration" that appears in this issue of both The Canadian Nurse and L'infirm/ere canadienne. Write for more information .1 2 !e5 wIIiOWda,e. Ont M2J 1 P8 Nursing Positions Scarce? A copy of the following letter to the Ontario Minister of Health was sent by the author to the editor of The Canadian Nurse. It /s published here, with the permission of the author, as an indication of a situation which could have a direct or indirect bearing on the social and economic welfare of readers. If you have firsthand knowledge of similar situations, we would welcome your letters The Honorable Mr. F. Miller, Minister of Health, Parliament Buildings, Queen's Park, Toronto, Ontario. I am a recent graduate from George Brown College - Nursing Division, Nightingale Campus. In June of 1975 I was hired by the Doctors Hospital and the Toronto Western Hospital as a Graduate Nurse with registration pending. At this time I accepted the Doctors Hospital's offer of employment and consequently rejected Toronto Western Hospital's. In the first week of August. one month before I was to begin working, I was informed by Dr. V. Kirkpatrick, the Director of Nursing Services at the Doctors Hospital, that the job offer had been withdrawn due to budget difficulties. Since that time, although I have been actively searching for a job (nursing home at Christie and Bloor. Cancer Society, Red Cross. City of Toronto, Ministry of Community and Social Services, Manpower, YMCA, Mount Sinai, Hillcrest, Wellesley, Toronto General, Salvation Army- Grace. Toronto Western (again). Women.s College. Central, and Princess Margaret,) I have been unable to find a nursing position because all vacancies had been filled in May and June for Graduate NUrses. I feel that I was unjustly treated by the Doctors Hospital because they had confirmed my position, and then withdrew It when It was too late for me to find another job. I find myself now in great difficulty as a direct result of their unethical conduct. Having tried everything else I must now ask that the Doctors Hospital fulfill its obligations. I appeal for your help immediately. - Lvnda Hirtenfeld, Toront('. Ontario. "."U.'J 1:111'11 POSEY SAFETY VESTS The Posey Patient Restrainer is one of the many products which com- pose the complete Posey line. Since the introduction of the original Posey Safety Belt in 1937, the Posey Company has specialized in hospital and nursing products which provide maximum patient protection and ease of care. To in- sure the original quality product, always specify the Posey brand name when ordering. The Posey Patient Restrainer with shoulder loops and extra straps keeps the patient from falling out of bed and provides needed security. There are eight different safety vests in the complete Posey Line, #5163-3131 (with ties), The Posey Disposable limb Holder provides desired restraint at low cost, This is one of fifteen limb holders in the complete Posey line, #5163-2526 (wrist), ... , The Posey Keyloele Safety Belt is de- signed with a revolutionary new key- lock buckle which can be adjusted to an exact fit and snap locked in place, This belt is one of seventeen Posey safety belts designed for patient com- fort and security. #5163-1333 (with snap ends), . f , ;- .,.-,.,.,.. . 116 stt1 P ;ofr 8 III .,.- . -' . . i I 4, I"sofra-tulle I '" The bactericidal dressing C_poellion A hg"rwelg"r 'ano-parattJn gauze dressing Impregnated with 11iit Solramycln (hamycetln sulphate BP) Propøtle. The add.llon 01 the antlbtottc SotramYCln to the par atftn gauze ensures the preventIOn 01 erad,cabon 01 super1lclal bacterial infectIOn Irom wounds In a lew hours thereby reducing the need IOf systemiC antlblOhcs Sohamycln IS a bactencldal broad spectrum antlbfobc. etfec- bve agarnsl many organisms W"IC" "ave become reSistant to other antlblOhcs Including StaphylococcuS aureus Pseudomonas P)'ocyanea ESChetlChla colt Proteus spp So"amycln IS I'IIg"ly uble In wa.er mikes readily with eJlU- dales and IS not Inactivated by blOOd pus 01 serum AlthouØ1 It IS uncommon sensdllatlOn to Sotramvcln may occur and cross sensitization between Solramycrn and chemically related antlDotJcS eg Neomycin Kanamycin and Paromomy- cin IS common Cross reSIStance between Sotramycln and thIS gfOUp 01 antibIOtiCS IS not absolute Actw.nt.age. Rap.ð e,.adlcatlon 01 oacterla "om me wound EJlcellent gtlyslcal prOlectlOn lo'#lll InCidence 01 maceratIOn even after .tlree weeks In SI'U Non-adne,.enl can be- retnO\l'ed piiunlessly Saves dressing time Reduces wastage Eac" dressing IS parcl'lment-sheatnetl IOf no-touc" handling SenSdlzatlOn IS uncommon , \ The Posey Retractable Stretcher Belt can be adjusted to fit every stretcher. guerney or operating table. This is one of seventeen safety belts in the complete Posey Line. #5163-5605 (non-conductive), .nd)callon. TrllumaUc. LaceratIOns abrasions grazes (gravel ras") bites (aOlmél,'s and U"ISects) cu's puncture ounds crus" InJur.es surgICal wounds and InCISIOnS traumatic ulcers Ukerative: Vancose ulcers dlabellc ulcers bedsOfes tropICal ulc.ers Thermal. Burns scaldS Electhe: Skin grafts (dOnor and reCIpient sites, avulsion of t '1ger Or toenatls.cl,.cUmciSIOl1 MJlc.naneou.' Secondan1y Inlected Skin conditions - eg eczema. dermatitIS herpes zoster cOk>stomy acute pørony c"la. Incised abScesses (packing) 1I19rC*ttn9 toenails C_alndlcallona SensItizatIOn to lan ln or to Sotramycln '- Application II reQulI'ed the wound may hrst be cleaned A single I.yer of SOFRA-TULLE should be appl.ed directly to the wound and covered '#1111'" an appropriate dressing Suc" as gauze I.nen or crepe bandages In the case 01 leg ulcers It IS advisable to cut t"e dressing exactly to t"e sIZe olt"e ulcer In order to minimize .tle fisk of senSlllzatlOn and nol to overlap on the surrounding epidermis When the Inlectlve gtlase has cle.retOXlC1ty and Of nephrotoJl1Clty being produced s"ouk:] be remembered Packing 10 cm)( 10 cm (4' )( 4'.) cartons 01 10 and 50 stenle Single units 30 cm )( IOcm (12")( 4'"). cartons 01 10 sterile SII"Ig1e uI"II1S The Posey Footboard fits any stan- dard size hospital bed and is fully ad- justable to any comfortable angle, Helps prevent foot drop and foot ro- tation, Complete Posey Line includes twenty-three rehabilitation products. #S163-6420(footboard only), Send for the free new POSEY catafog - supersedes all previous editions. Please insist on Posey Quality - specify the Posey Brand name. ROUSSEL Send your order today! Enns and Gilmore 2276 Dixie Road Mississauga, Ontario, Canada L4Y 1Z5 (416) 274-257') Roussel (Canada) Ltd. 153 Graveline Montreal, Québec H4T 1 R4 6 The Can.di.n Nurse J.nu.ry 1976 Xe' s Bright Future Predicted for Nursing Research All "indicators" point towards a healthy future for research in Canada. This was Ihe conclusion reached by participants in the three-day 1975 National Conference on Nursing Research in Edmonton In November. "Development and use of indicators in research" was the conference theme. The 68 delegates heard three internationally known nurse researchers explore use of social. physical and psychologic indicators. Five major papers (each followed by crrtiques by two other expert researchers) and eight mini-papers on specific Canadian projects were also read. Presentations were chosen to illustrate use of indicators and explore the question:"Does nursing make a difference?" . - l Director of the 1975 National Conference on Nursing Research, Shirley Stinson, makes notes during an address by June C. Abbey, assistant professor and acting chairperson of the department of nursing in biological dysfunction. University of California. San Francisco. At right is Jack Hayward, principal nursing officer with the department of health and social security In London, England, and another keynote speaker What is an indicator? "Basically an indicator is a person or thing that points Oul - a pointer," keynote speaker, Lisbeth Hockey, explained during Ihe opening address. "In relation to nursing research, an indicator may be a pointer to a phenomenon relevant to nursing knowledge and nursing research that attempts to extend that knowledge .. Hockey, who is director of the nursing research unit in the department of nursing studies at the University of Edinburgh. Scotland. warned Canadian researchers of the need to be aware of overall social indicators since these have Important implications for their own studies. " Canadian studies Canadian presentations were chosen from a list of 47 projects currently underway or recently completed. The most complex was one being carried out under principal investigator Dr. Moyra Allen at McGill University. This project, now entering phase two of a five-year program. is concerned with development of instruments, questionnaires, audio-and videotape reviews and observations by expert nurse-judges and other health professionals to measure critical variables (or differences) in the expanded functions of nurses in three types of settings- a general hospital, a community health center, and a new type of special health and community resources center. Marian McGee, associate professor, faculty of nursing, University of Western Ontario, described a project in London, Ontario, to determine how well community nurses can assess a family's ability to make decisions. "Since... the family decision- making is the basis of all family functioning, then the extent to which family decisional skill is accurately assessed and subsequently modified IS ... 1 #I -.". \ "....- Some of the 68 delegates from seven provinces who attended the recent 1975 National Conference on Nursing one measure of effectiveness of Community Health Nursing," McGee said in her abstract. Her project is working on existing instruments and looking at ways these can be modified to be effective indicators. Another project is being carried out by Jeanette Funke assistant professor, school of nursing, University of Alberta. Its purpose is to test the reliability of current instruments (such as questionnaires and evaluation sheets) and possibly create new ones that will indicate how women adapt to pregnancy and to their newborn babes. Two completed studies Fabienne Fortin, doctoral candidate, University of Western Ontario. described a project recently completed at a large Montreal hospital. This study evaluated a structured preoperative patient education program and found that preop education by nurses does make a difference. Patients receiving the preop education program were less impaired by surgery when measured against a specific set of desired outcomes (such as ability to walk, go to the bathroom normally and so on) than patients in a control group who did not receive the program. The differences were most pronounced at two and ten days after the operation but considerable differences were still found 33 days postoperatively. Vivien Jenkinson, nursing systems analyst. Hospital for Sick Children, Toronlo, undertook to , .. - .. . - -- ;or '" ,.j '.... " , <. "- ... Research in Edmonton. The conference was the fourth to be held in Canada. develop a reliable measurement tool that could be used to quickly and effectively Judge the quality of nursing care of children. The final, single-page, evaluation sheet-called SAVE from the full title of Selected Attribute Variable Evaluation- contains 22 items and will allow head nurses, team leaders or other observers to assess the quality of nursing care given by anyone nurse to anyone child at any time. More than 1,000 evaluations have been completed since SAVE came into use at the hospital in March,1975. Planning future conferences The director of the 1975 conference was Shirley Stinson of The University of Alberta. Four university schools of nursing in the Prairie provinces were represented on the planning committee. Delegates agreed to ask the Canadian Nurses' Association for secretariat assistance in planning future conferences and CNA's special committee on nursing research for planning assistance. A limited edition of a full report on the conference and all its papers will be published in the spring. Copies will be available on loan through the CNA Library in the same way as proceedings of other nursing research conferences. Ine (;8n8048n Nur.. ..Janu8ry I fb CNA members are invited to submit resolutions for presentation at the Annual Meeting and Convention, June 1976. Resolutions must be signed by two CNA members and forwarded to the Resolutions Committee, CNA House by 12 February 1976. " -t\ 4 \ \ ... The Marjorie Hiscott Keyes medal was presented last October to Dean Armstrong of Vancouver by Eric Morris: national treasurer of the Canadian Mental Health Association (CMHA) The annual CMHA nursing award is in recognition of outstanding psychiatric services to the mentally il/. Armstrong IS head nurse on the psychiatric unit of Lions Gate Hospital in North Vancouver NUA Course Expands to Foreign Countries Canada s only national inservice educational program for nurses, the Extension Course in Nursing Unit Administration (NUA), now in its tenfh year of operation. has enrolled a total of 659 students for the 1975-1976 academic year. Almost three-quarters (72%) of these students are married: 43 are men: and the average age of the students IS 35 years. A total of 356 hospitals are represented in this year's program. Highlights of NUA activities were brought out at the most recent meeting of the Canadian Nurses' Association/Canadian Hospital Association Joint Committee that administers the program. The NUA program came into being as a result of a brief presented by a JOint Committee of the Canadian Nurses' Association and the Canadian Hospital Association to the W.K. Kellogg Foundation requesting financial support for a continuing educational program for head nurses. Requests from ministries of health outside Canada have resulted In implementation of the programs in Lebanon and the Republics of Zaire .;;'I and Haiti. These projects receive financial suppor1 from the Canadian International Development Association (non-governmental organizations). Violence in Lebanon, where the first overseas workshop was held, prevented completion of last year s session and has forced postponement of the 1975-76 classes. In Zaire, 15 students have been accepted this year. They attended an inilial session in Kinshasa In September. Five students have also been accepted for a similar program now getting underway in Haiti. The Extension course is an in service type of program planned to help nurses in supervisory positions improve their skills in the management of the nursing unit. It is directed towards those who are unable to attend a university school of nurSing. The program is conducted by combining home study and workshop methods. Information and application forms are available from Dorothy Nelson Director. Extension Course in Nursing Unit Administration, 25 Imperial Street. Toronto, M5P 1C1. Wanted: A Caring Heart and Warm Hands . Death is not the enemy - inhumanlly is. I want you to go back to your hospitals and seek out the enemy.-. Joy Ufema, internationally known for her work with dYing patients. was speaking to participants in a clinical day sponsored by the Royal Ottawa Hospital In Ottawa last November. "A caring heart and warm hands.' are the criteria for her job according to the Philadelphia-based registered nurse. Ufema explained that she did not promote anyone set approach for dealing with dying people but, in fact, stressed the individuality of the person and his right to die his own way. '" haven t had any experience in actually dying so - anything goes. ' she explained. She added that she frequently cries with the patient. and that she doesn.t offer any information the patient has not asked for. "I too must die," she said and "some days I don t want to do thaI." Another speaker, Joy Rodgers told the participants that "we are now married for a longer time. we invest a lot in one person. we no longer live as an extended family, and therefore. we put our emotional eggs in few baskets. The tradilions that once helped us cope have been stripped away. . Rodgers, a nurse consultant with the Clarke Institute of Psychiatry in Toronto, works with bereaved people. particularly widows. Problems of mental health. sleeping, and menstruation are just some of the risks of bereavement she said. Bereaved people, of which there are 470,000 annually in Canada can display anything from headaches and dizziness to increased alcohol consumption and suicide; these people need to believe that their feelings are normal and that you will accept them and listen, she explained. Rodgers stressed that feelings of anger and guilt cause the most difficulty and that these feelings need to be expressed verbally . Our program." Rodgers said, 'has found that other widows who have adjusted are the most helpful to the recently bereaved." We are hoping to offer our services to the community In the near future. she concluded. Dr. Ina Ajemian of the Royal Victoria Hospital in Montreal told participants how the' palliative unit" at that hospital came to be established. '-Patients who are termrnally ill are sent to this unit, and we help them maintain their dignity. listen to them. offer companionship and help them control their symptoms, she said She explained that visitors are welcome anytime and that even pets are allowed. Dr. Ajemian described the home care program and how It maintains the patients at home and decreases the amount of time needed in hospital. Assistant Editor The Canadian Nurse, a monthly journal published by the Canadian Nurses' A5sociation, needs an Assistant Editor. Requirements: R.N. and member of provincial nurses' association; bachelor's degree in nursing, journalism. general science. or arts, recent clinical experience; experience and/or interest in writing and editing; and willingness to tra ve/_ Location: Ottawa Qualified applicants are invited to send their complete resume to: The Editor. The Canadian Nurse, 50 The Driveway, Ottawa. K2P 1E2, Tough Luck! The New Brunswick Association of Registered Nurses was one of 85 Atlantic province organizations invited by the Prime Minister s Office to attend a special meetIng called to explain the Government s anti-inflation program. Glenna Rowsell, employment relations officer for the Provincial Collective Bargaining Councils. represented the association at the meeting held In Halifax November 14 In response to concern expressed by Rowsell regarding the effect of wage controls on New Brunswick nurses. the prime minister replied Ihat it was "tough luck' they were behind the rest of Canada in wages. Rowsell pointed out that Ihe concern was the relatively low salaries received by New Brunswick nurses compared to those in other Atlantic provinces. The Prime Minister s response angered many observers at the meeting, especially when he referred to N.B. nurses' wages as being historically behind Ontario and the rest of Canada. Mr. Trudeau later softened hIS stand and said that perhaps New Brunswick nurses could seek exemption from the 10 percent ceiling before the Government sAnti-Inflation Board. ø Xt>>\\-S The CanadIan NurBe January 1976 Cooperation Needed Between Mental Health Groups Volunteer, government and professional groups for care of the mentally ill have proliferated, but unless there is cooperation between them there is danger that care will be fragmented and incomplete, warns George Rohn, general director of Mental Health/Canada. The failure of the "piecemeal approach" was the reason for the Canadian Mental Health Association's three-year effort, Community Aclion for Troubled People, now in its second stage. "We have found that informal cooperative agreements do not work either," Mr. Rohn said at the association s annual meeting, Partnership ActIOn for Troubled People, in Vancouver 23-25 October. He pointed out that everyone gives lip service 10 the idea of cooperation, but no one seems concerned with how to make it work. "Now is the time to work out more formal agreements, perhaps contracts, certainly negotiated agreements,' the general director said In his opening comments. The three-day meeting was attended by 489 delegates from all parts of Canada. About 65-70 percent came from CMHA's 170 local branches across the country according to Lance Hale of Mental Health/Nova Scotia. The remainder were invited delegates from professional groups and government agencies. "Our aim is to discover. through the workshop groups, how to make partnerships happen and how to make them work, he said in an interview. Although most of the work was done in small workshop groups where ideas for implementation into community programs were hammered out, the delegates also assembled to hear panels of speakers provide overviews on the problems. Keynote speaker was Pat MacKay of Toronto, president of the Canadian Council on Children and Youth, who said lack 01 agreement on priorities was a major problem behind disagreements between groups supposedly working toward one goal. She said fragmentation occurs because some groups are concerned only with treatment and others only with prevention when both are vital. Huguette Labelle, principal nursing officer with the federal department of health and president of the Canadian Nurses' Association, was one of the speakers discussing ways to obtain needed community services. She stressed the Importance of looking for cures rather than treatment for obvious signs of trouble. "Is it really Ihe answer to add extra policemen in a small community when there is a sudden increase in juvenile delinquency?" she asked. Ms. Labelle stressed that the health professional is essential and must assume a greater role as "a community analyst, an organizer, an activator and a provider of service" Dr. Richard Foulkes, director of the BC government's health security programs, was the most critical of the speakers, saying, "If we talk only about organizing, reorganizing and reshuffling, we will be wasting our time. Change does not come from the top of an organization, which is dedicated to maintaining the status as it is. The creation of social change is at the bottom, at the neighborhood level," he said. Jean Lupien. new deputy minister of the federal department of health, said he is concerned that the federal government must take a greater leadership role. He promised more support for mental health programs. Nurse-Midwives in Health Care System Nurses Involved in obstetrical care, some of whom are midwives, met at Memorial University, St. Johns, Newfoundland last Fall to form the Atlantic Nurse-Midwives Association. They drew up a constitution and objectives of the Association. Their main objective will be to improve maternal and child care throughout the Atlantic provinces The Atlantic Association hopes that members 01 the Western Association will meet with them during the CNA Convention in Halifax In June. Further information can be obtained by writing to: Lynda MacDonald, Oalhousié University, School of Nursing, Halifax, N.S. A Canadian National Committee of Nurse-Midwives was organized in June, 1974, during the last CNA convention In Winnipeg. The group provides a communication link between regional associations of midwives and related health organizations. Canada was admitted to the International Congress of Midwives In July 1975 What is the midwife's role? An answer to this queston was published recently In the newsletter of the Alberta Association 01 Registered Nurses: The well-being of the mother and child is the goal of all members of the International Confederation of Midwives. According to Pat Hayes president of the Western Nurse Midwives' Association. the midwife s role differs from one country to another. being dep ndent on the socio-economic levels, the type of health care d<1livery system and the general and professional education system. In many countries nursing is not a reqUirement for midwifery practice and midwives are considered independent professionals. The length of their education equals or exceeds that of nursing. Although traditional midwives are stili employed in a few countries their education is constantly being improved. Countries such as Canada, the United States, New Zealand and Australia consider midwives to be highly specialized nurses. In effect the midwives' role is a development of the traditions of maternity care prevalent in each country. If the practice of midwifery rested solely on the process of delivering the baby it is doubtful whether midwives would be acceptable in Canada. But delivery is a small part of a spectrum of care which stretches from conception to the termination of the postpartum period. Midwives can be responsible for prenatal counselling, education, and continUity of care. Their expertise is of value in care of the mother in labor and in supervising the mother as she learns how to care for her new baby, as Canadian midwives are now dOing. Many perceive the midwives' role as part of the tradition of domiciliary practice. But in countries such as England Switzerland. New Zealand and Australia there is an Increasing trend towards hospital confinements and a system similar to that in Canada. A team approach is being advocated each professional bringing 10 the team unique skills and knowledge WhiCh, through a colleagual relationship. enables maternity care to be optimized. Canada s association with LC.M. will enable nurses in this country to learn from others and, also, to give information to others as well. Regional Trauma Centre Nurses will be members of a trauma resuscitation team established for the management of the critically ill at Sunnybrook Medical Centre. The trauma team notified in advance, will be prepared to treat the patient as soon as he arrives. Surgeons. anesthetists. and nurses will constitute the resuscitation team - just one part of the new regional trauma centre at Sunny brook. Dr. Robert McMurtry. director of Emergency Services, in a telephone interview, said that "all Emergency staff will be involved In educational programs. to update and refresh their knowledge on the management of trauma. Nursing will be involved In the decision-making process in the unit, and a nursing committee has been established. ." \ , I (/ J .. \ t , i \ I J t I / I I I , I) I A B A. S StyI. No. 467 / Izes 3-15 Royale Di White amond Tricot Knit Sugg. Retail $28.00 \.J'/ u 1 B. S S!y1e No. 46214 Izes 5-15 Royale Wick Polyester Te ' 100% Kni ured Warp White, Mint Sugg. Retail $30.00 C. S S!y1e No. 6256 Izes 8-16 Royale Wicke Polyester Te ' 100% Knit ured Warp White Sugg. Retail $25.00 IU X \\.S .ne Canachan Nurse January 1976 The 1975 index for The Canadian Nurse, vol. 71, is available on request. Write to The Canadian Nurse, 50 The Driveway. Ottawa, Ontario, K2P 1 E2. ONQ Publishes list of Nursing Procedures A nonrestrictive list of nursing procedures that nurses are allowed to perform without a medical order has been published as a result of the Order of Nurses' of Quebec's annual meeting last November. The document also indicates the slight difference that exists between an authorized medical act and a nursing procedure performed under a medical order. It does not, however, deal with the independent functions of the nurse. According to the ONQ, the decision to administer a nursing procedure is a medical act, but the performance itself pertains to nursing. Therefore, doctor's orders should not be required for these nursing procedures and authorization should be required only for the performance of certain procedures under particular circumstances. Negotiations between the Professional Corporation of Physicians and the ONQ have now terminated without agreement on the definition of acts or procedures to be authorized. According to the ONQ, doctors generally believe that nursing is an extension of medicine; therefore they are convinced that they must grant nurses the authorization to perform nursing procedures. "nursing procedures were medical acts, then doctors would have to assume the training and control of the persons who perform these procedures. Procedures such as catheterization are not medical acts, but rather nursing procedures performed under a medical order. Jeannine Tellier-Cormier, president of ONQ, points out that the rules adopted by the medical profession and released by the Quebec Professions Board in October do not take into consideration the nurse's position. AI Ihe annual general meeting of the ONQ in November, the general assembly recommended that: information about nursing as a career and an outline of educational requirements be made available to chapters, schools. and counselors; consideration be given to the possibility and praticality of requiring continuing education as a requirement for renewal of licensure; and CNA consider changing the name of the magazine L'infirmière canadienne to take into account the increasing number of male nurses within the profession. In addition to research projects concerned with the definition of nursing, the Order plans to intensify its information program on the role of the nurse for the general public. B. C. Nurses Seek Better Care For Elderly Expansion and improvement of British Columbia's facilities for the care of the elderly are being sought by the Registered Nurses Association of B.C. In a statement to the provincial government and all opposition parties, the association has urged an end to the present "poor utilization of beds and the inhumane way we shuffle people from one institution to another. " The Association calls for improved criteria for the admission of the elderly to longterm facilities; for the introduction of regional multi-disciplinary assessment teams to apply these critena; for the expansion of home-care services; for the redesignation of longterm care beds to prevent "gross people upheaval"; and for greater attempts to meet the personal care needs of the elderly. The statement also notes that: - present criteria make no allowances for psychosocial needs, age, prognosis, institutional limitations or the fact "that the commodity being assessed IS elderly human beings." - there are not enough institutional beds available in most areas. - home-care services are inadequate. The statement was developed by the Greater Victoria District of the RNABC and adopted by the provincial board of directors. \ , , , - I - - c.. --- ,., , Polyef.er Te . Jrej Warp Kr' \ Slyle 918-0 PantSul1 Pleated Trõm Polyester Ribbed Double Knit White - BI J - ICf! White Sizes 10-20 $24 00 Sizes 8-16 $38.00 Half Sizes 18" $25.00 \ \ o/tßG \ f o/tßG \ CAREER CLASSICS CAREER CLASSICS \ . It'- .. I "I,. .' - Style 822 PantS,,!1 POIYf"-ter Tf'" .. P White - B..Jt - f ,Ie Sizes 6-16 P,("-'sd Tr m I , 4 ' L_ .--vi \ " $35,00 \ v \ ll J \ ....... UNIFORMS REGISTERED Slyle 814 Panl Suil Polyester Text Jrf"1 Warp Kr1 White - B._e - ve ,JW - I .. 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All of the above is yours with the Tomac Hygienic Cleansing Cloth at a significant savings over your present jar system!! For free samples and additional information, mail us this coupon - .. ,------------------------------------------- I I FOR FREE SAMPLE AND ADDITIONAL INFORMATION I MAIL US THIS COUPON I -- rAl... TOM.4C .... HYGIENIC CLEANSING CLOTH .... , Name. Hospital Title. Address City. , .Prov. .. . ",'f u"",U,.t.þt.\Qt;.\ß1:\\ i6i .. .... tI"GILK'C. CU....s .6 C.Ult" -...- "t' \.. T..U:.."' _ - American Hospital Supply Division of McGaw Supply. 1076 lakeshore Rd. E., Mississauga, Ontario. l5E 386 ..-. "''fmt.'''c. ClU.M. tU.\ tl 1\\ . - 16 The Canadian Nurae January 1976 \70u I neXT COn\7enTIOn ò , CJ . ø . ' G qj o ò o Q . ç 77776 77766 77666 76666 "The quality of life," a concern of most contemporary North Americans, has been chosen as the theme of the 1976 Annual Meeting and Convention of the Canadian Nurses' Association, to be held at the Hotel Nova Scotian in Halifax, June 20-23. The Program Planning Committee has gone to great lengths to create a dynamic and innovative program that is in keeping with the needs of today's nurses. Although not all the names of speakers and participants had been finalized at press time, a general outline was available. During the opening ceremony on Sunday evening, June 20, WHEN YOU'RE IN OTTAWA BE SURE TO SEE ONE OF CANADA'S FINEST SELECTIONS OF WHITE AND COLORED UNI FORMS at e HOSfl.Y Wttifas (THE COMPLETE UNI FORM SHOP) WE ALSO CARRY: White Shoes Hosiery Nurses Caps Bras Slip Panties BELL MEWS PLAZA, BELLS CORNERS, ONTARIO Mrs. Catherine Buck, RoToR. (Mgr.) P.S. OH YES, WE. ARE OPEN EVENINGS international, national, provincial and local representatives will welcome delegates. The name of the guest speaker will be announced in The Canadian Nurse at a later date. A keynote speaker of international stature will lead off the professional program on Monday morning June 21. A discussIon period will follow. In the afternoon a debate is scheduled on the question: "Resolved that nurses have a responsibility to take action to preserve life in Ihe event of any decision by a patient, a family, or a professional to discontinue artificial life-maintaimng intervel}tion." Apolline Robichaud, director, Public Health Nursing, Department of Health, Fredericton, N.B. and past president of the NBARN from 1971-73. will chair the debate.. Following the debate, an interview dealing with the impact of the nursing profession on the quality of life will take place, Patrick Watson, well-known television personality. will interview Shirley Post. Post is presently conducting a study on the need for a Canadian Institute of Child Health. Tuesday, June 22, will be devoted to affairs of your national association: a schedule will be published at a later date. On Wednesday, June 23, delegates will focus on the quality of life in the work world of the nurse. This will take the form of two sessions: the , " -,... þ '"'--- \ '... it, -: r:;2.,. first, a panel composed of four participants who will present short papers on the following subjects: 1) the incompatibility between educational preparation and the practice setting: 2) uncertainty regarding the nurse's legal protection; 3) enforced proximity to stress In the client environment: 4) social and economic pressures in the work environment of the nurse. The second session entitled "You and the quality of life- action for today" will be presented as an audiovisual event intended to challenge nurses to try to improve the quality of their own lives and that of their clients, The final afternoon will be reserved for discussion of the report of the Resolutions Committee, the installation of officers and the president's reception. Interest session on research An interest session planned by CNA's Special Committee on Nursing Research will be held Thursday morning June 24, following the convention. This session, entitled "Old you ever wonder what would happen if ....?" will take the form of a roundtable discussion of research questions and answers. Beverlee Ann Cox, nursing consultant with the Department of Psychiatry and lecturer in the School of Nursing at the University of British Columbia, has accepted the chairmanship of the session. All interested members are welcome. Special interest groups interested in holding a meeting on the Thursday or Friday following the convention are invited to contact Hallie Sloan. nursing coordinator at CNA, as soon as possible. CNF annual meeting The annual meeting of the Canadian Nurses' Foundation will be held on Sunday June 20, from 14h to 17h, at the Hotel Nova Scotian. Next month: Social program and tourist attractions. ........................ This month's forum has been submitted by CNA member-at-Iarge for nursing education, Shirley M. Stinson, professor, School of Nursing, and Division of Health Services Administration, University of Alberta, Edmonton, Shirley M. Stinson In a current survey "The Teaching of Health SCiences in Canadian Universities," the authors, Bryans and Southall, raise the question. "Should there be national and/or regional centers for the preparation of health sciences teachers?" I would like you to consider this question from two perspectives: advantages and disadvantages to the health sciences in general and 10 nursing in particular. General Advantages: Potentially better utilization of "rare" faculty and complex A-V /library resources, plus the added advantage of developing in one or more centers a critical mass of related specialists; students could be exposed to a wide range of health science students and faculty; Interdisciplinary research projects could be a concommiltant development; economies of scale in the leaching of "core" content in such areas as curriculum development, health services research principles: centers might attract educational funds not otherwise available on a single institutional basis: centers could encourage large scale evaluative research of health sciences teacher preparation programs; further. if health sciences teachers were prepared together in an interdisciplinary setting, perhaps they would subsequenlly be capable of higher levels of interdisciplinary teaching in Iheir home instifulions. General Disadvantages: Even if many students are free to move to another city, to what extent is sheer proximity to programs a faclor in teacher fraining recruitment? Relocation would obviate "part-lime'. student provisions for other than residents in the areas in which the centers were located; to the extent that a substantial number of faculty in such centers would be drawn from those currenlly employed In various education and health sciences faculties across Canada. there could be a serious debilitating effect on the home universities: adequate clinical facilities for both teaching and research in a center of any consequence would likely be a problem in any location in Canada: there is the possibility of "lack of hybrid vigor" if teacher training in the health sciences gets too standardized, too Frankly Speaking about nursing education National and/or Regional Centers for Preparing Nursing Educators monolothic in its norms and policy control mechanisms; perhaps over time and through fairly large scale "bureaucratization" of teacher training, lack of responsiveness to new teachlng/learnrng needs could develop in large centers. There would also seem to be some advantages and disadvantages somewhat unique to nursing: Advantages for Nursing: It is possible that nursing might not be able to generate on its own the sociopolitical thrust necessary to get such centers in operation, and it could be an advantage to be able to "ride the wave" of such an innovation. In so doing, nursing could conceivably obtain a magnitude and quality of nursing teacher preparation beyond the scope of anyone school of nursing at this point in time. Further, the preparation of nursing educators could be carried out within an interdisciplinary health sciences context, a factor consistent with the learning and practice needs of today s nursing educators. The major disadvantages are few in number but important for their possible consequences; Disadvantages for Nursing: Approximately 60 percent of employed nurses in Canada are married. Many of these are logical candidates for teacher preparation. This constitutes perhaps the most crucial disadvantage of all, since the majority of these candidates have home commitments that would not permit them to relocate In other cities, even temporarily, in order to enrol in teacher preparation programs. A little less than half of university nursing faculty have masters' or higher degrees; and only 300 of the approximately 2,500 teachers in the total nursing teacher situation (i.e. university, hospital and college division programs), about 12 percent. are qualified beyond the baccalaureate level. In short, the number of faculty requiring graduate level preparation is so large that it can reasonably be argued that setting up a few centers would not effectively change this situation. On the other hand, it can be argued that, in contrast to other health disciplines, most nurses with even one year of university preparation, about 72 percent of the total. and 97 percent of university nursing faculty) do have some preparation in teaching-learning principles, and many nursing faculty have specific preparation in curriculum development. Indeed, it might well be argued that fhe need for centers which offer advanced substantive preparation in nursing practice and related biosocial sciences is as great if not greater than the need for teacher preparation centers. The crux is to have something valuable to teach. There is another factor to be considered. On the basis of well-established occupational sociological principles (not feminism!), it can reasonably be predicted that in multidisciplinary settings "lower status' professions tend to get shorter shrift than those of higher status. Since it took several decades for nursing to establish relative autonomy in determining its educational standards, nursing educators may be reluctant to participate in such a venture. Medical faculties, on the other hand, (which have historically dominated health sciences faculties) are unlikely to have the same reservations. Assuming that. In addition to educational specialists, a variefy of health sciences educators, including nursing educators, would be attracted to such centers, the effect of even one or two well-qualified nursing teachers and/or nursing deans leaving anyone university could be quite catastrophic, particularly for universities with graduate programs. This state of affairs in itself says much about the crisis in nursing teacher preparation in Canada today: we do not have enough teachers to prepare the teachers we need. Should there be national and/or regional centers for the preparation of nursing teachers? What do you think?.. 18 .. . . ... . . A . .... . . . . . . . . . . . The Canadian Nurse January 1976 rying . . . . I . . . . . . . . . . . . ... . , . . . . .... , . THE NEGLECTED DIMENSION . ... . . . . I . .. .. · ;1\ 0: :"t'. , I I . . I. t .". . Abigail McGreevy Judy Van Heukelem Crying is a phenomenon familiar to all of us. Although our degree of comfort in its presence varies greally, crying is a part of life. It is an essential participant in the delivery of the neonate, and a companion in the grieving process. Crying can also be a constructive way of releasing tension, The fact remains, that, for the majority of nurses, the crying patient represents a difficult problem. Most of us tend to avoid this situation or to stop the crying immediately at any cost. The crying syndrome Crying is a distinctly human activity that takes place in response to emotional stimuli. There are many somatic changes manifested during crying, some of which can be explained physiologically, and others whose explanations are rather unclear. The limbic system, which has an important role in the control of emotional behavior, probably also functions in the crYing mechanism. The autonomic nervous system, through the parasympathetic fibers, stimulates lacrimation and nasal secretion. This serves to protect the mucous membranes of the naso-pharynx. Respiratory changes, with extended expiration. are ultimately responsible for reddening of the face and eyes, edema, and eye closure. Crying in humans, other than infants, occurs under many circumstances. usually in response to unpleasant stimuli. Most writers agree, however, that the effects are beneficial. Generally, crying seems to be a safety valve, a mechanism for releasing built-up tension or excess energy, - perhaps an internal change taking an altitude of hostile aggression and dissipating its energy in a nondestructive manner. I Whether lacrimation or fluid secretion (the actual tears themselves) during crying is to prevent dehydration and subsequent damage to nasal mucous membranes 2 or a physiological local defence with healing, nourishing and soothing functions for the eye] is open to question. These are just two of the theories regarding the reason for the tears. II does appear that after crying, a feeling of relief and relaxation seems to be prominent. This is a consistent theme to most studies of the subject. A general result of weeping seems to be a feeling of relief, a calmer frame of mind and possibly a desire for rest and sleep. 4 Some studies even claim to have observed that many forms of illness show tendencies towards recovery after crying. s For these reasons, there may be occasions when we want to encourage it, both The authors attempt to delve into an unexplored dimension. . . crying, so that nurses as members of the "helping profession" can do more for people who need to cry than just "give them privacy." in our patients and ourselves. Unfortunately, therapeutic crying is not found on the curriculae of most nursing schools. We do not know how to encourage crying when it may be physically, emotionally or spiritually beneficial. The threshold for crying, or point at which emotions can be stacked no higher (the emotional straw that broke the camel's back, so to speak), varies not only from individual to individual, but from one level to another within each person, depending on circumstances, Sex, age, cultural background and experience with crying differentiate the threshold between individuals, Within individuals, the threshold Table one - Factors In threshold variance Between Individuals may be raised or lowered depending on suggestion (situation, environment, such as a sad book or movie); privacy, or lack of it; acceptability, both stated and implied to others present and as perceived of oneself; and energy level, or general health. The degree of activity of the mind also has an effect as absorpfron in an energy-consuming activity would either dissipate the emotion that was to have been cried away, or at least defer concentration on it while the mind was otherwise occupied. T able one provides some examples of how these factors have the effect of raising and lowering the threshold of crying. Raises threshold Lowers threshold Culture example - Indian culture expect stoical approach example - weeping expected in Italian culture Past history father poked fun of daughter's crying mother expressed emotions freely and cried at times in front of family Sex generally in males crying less acceptable crying equated often with dependence and more acceptable for females Age adolescents & adults expected to cry less easily Within an Individual children & perhaps aged are allowed to cry much more frequently R aises threshold tired Lowers threshold Energy available absorption in a task (energy being diverted) rested and in good nutritional state (able to control self) ill hungry Social situation being alone being in a social situation where Individual is "in charge" being with people individual isn't comfortable with being with people or person who accept individual Expectations of Others crying means loss of esteem permission implied or stated permission denied by statement or implication suggestion, as in seeing others cry 20 The Canadian Nurse January 1976 Relating to crying HELP WANTED: Professional nurses, comfortable enough with self to deal constructively with crying patient. Inquire within. Crying is only one of several ways the mind and body deal with frustration, and when these other conventional ways are not available to us or have been unsuccessful. crying can constructively relieve tension. There is an element of truth in the adage that "tears come when words can't." Perhaps if we tried to answer for ourselves four pertinent questions, the discovery of a crying patient would cease to be the troublesome dilemma most nurses consider it to be. These questions which might help put crYing In perspective, are: How do I react to my own crying? What effect does someone else's crying have on me? What are the specific needs that crying expresses? What constructive action can I take? . How do I react to my own crying? Many people are uncomfortable expressing their frustrated feelings through crying; it makes them feel guilty, weak, helpless, or silly. In nursing education, the idea that crying is silly and unproductive is often either stated or implied. Crying is considered "unprofessional." As a result, the nurse has even more trouble crying than most people because she feels her professional identity is at stake. Before she can be comfortable with a crying patient, the nurse has to learn to accept her own occasional need to cry as an acceptable response for dealing with feelings. · What effect does someone else's crying have on me? Crying by another person can hold many different meanings for each of us. Some of the more common feelings, meanings and resulting actions or reactions are outlined below in chart form. It is not assumed that this is exactly what happens. These are just some of the results that might be seen when a helping person comes into contact with a crying person. This list IS by no means exhaustive, but is designed to help you get in touch with your own feelings. Perhaps this would be a g od time to stop and consider what your own personal reaction is to crying. Use the accompanying table. Look into yourself and determine how crying makes you feel, what meaning it has for you and what your typical reactions to crying have been. When you have dealt with your own feelings, then you are ready to think of the patient as an individual and work with him. . What are the specIfic needs that crying expresses? If crying is an expression of our frustration at failure to meet some of our needs, then a nurse's understanding of these needs, both physical, spiritual or emotional, of what an individual's crying represents to him or her, is obviously vital to dealing construcfively with this person. The danger lies in assuming too quickly that we know why a patient is crying, or in projectmg our own feelings and needs onto the crying individual. It is well to remember that physical, spiritual or emotional distress can bring about a lowering of self-esteem, resulting in an inability to handle situations adequately. Physical needs Pain or physical distress is an obvious cause for crying, most often seen in our culture in children. Acute pain can lead to crying in adults as well, perhaps because it leads to loss of control. The woman who has an abcessed tooth, has lost the ability to chew and is aching from head to toe, may break down into tears. The young man with a debilifating case of hepatitis may weep silently into his pillow after a painful injection. Emotional needs Any number of emotional needs may be behind a person's crying. We feel. however, there is one which predominates - the need for self-esteem. The need for self-esteem might be compared to an opened umbrella and its spokes. The umbrella of self-esteem can only stay open when the spokes of emotional needs are fulfilled. Some of the needs that must be fulfilled in order tor the umbrella of self -esteem to expand include: physical comforts; personal warmth; acceptance; a "special" someone we care about and who returns our affection; understanding, both on our part and on the part of others towards us; the need to deal effectively with and to express angry or hostile feelings. Spiritual needs Spiritual needs, though probably the last to be recognized and identified, are likely to be expressed in crying. While emotional needs deal with horizontal relationships to self and others, spiritual needs are vertical and directed to a Supreme Being, and involve a person's relationship with his God Spiritual needs can be defined as "any factors necessary to establish and maintam a person's dynamic, personal relationship with God." . There is a basic need tor relationship and out of it to find forgiveness, love, hope. trust. and meaning and purpose in life. Because the individual's relationship to his God is a very personal one, and to many people the subject of religion is taboo, crying may be one of the few ways that a spiritual need can be exhibited. Man is a whole being, not just the sum of his parts. Spiritual needs are often expressed emotionally (feelings of fear, guilt. worthlessness) or physiologically (sighing, resllessness, crying). The loss of one's relationship to God. or a real or perceived lack in this area, can represent a deeply troubling experience and arouse much anxiety. Illness and threat of death have a way of raising questions regarding the ultimate meaning of life. For some, there can be an awareness. never before felt. of a need for "making things right" with God (establishing a relationship with God). For others who have been religious most of their lives, illness, crisis, or impending death can raise serious questions about the goodness of God, the meaning of suffering, life after death. They may perceive that something has happened to their previous relationship with God. Crying then can express an individual s struggle to deal with his view of God in relation to the present crisis. . What constructive action can I take? The first thing a nurse can do is fo watch for prodromal symptoms of crying, as indicated by: tighlly-drawn lips, averted eyes. rapid blinking, eyes filled with tears, an inability to talk, a quiver or "catch" in the VOIce, sniffling and reaching or looking for a tissue. On rare occasions crying should be discouraged, for example with an hysterical or overly-manipulative patient. Generally however, the best course is to encourage crying by lowering the patient s threshold through: suggestion ("You look like you need to cry"); verbal permission ("It's alrightto cry," or "Go ahead and let it all out. "); non-verbal permission, such as reaching out and touching the patient softly, using a warm tone of VOIce, presenting a relaxed and unrushed posture by appearing ready to stay and conveying the attitude that "the world has stopped and you have my undivided attention. " Privacy will in most cases also lower the threshold of crying, although this will vary " dt . ..- ê ";;\ :.. '-t&. . .. . . tt -. greatly with the person and the situation. Some patients may need absolute privacy, even from a nurse. If an individual can be moved quickly and smoothly from a crowded or public area to a pnvate one, when the situation warrants it, this needs to be done. Beware, however, of the person who says he wants to be alone, but who indicates non verbally that he or she needs to be with someone who understands. If the patient insists on privacy, yet you still feei he or she needs someone, go away for a short time but return. During Once crying has begun, it is important to continue a posture of warm acceptance and to stay quietly with the patient. This is not the time to initiate or encourage conversation. If a tissue can be provided, do so quielly and unobtrusively by tucking it into the palm of the patient's hand. If you need to get up or leave the room to obtain the tissue, forget it. Large muscle movements will break the mood and the crying threshold will soar. It might be a good idea to always carry a tissue In your pocket for such situations. After a patient has stopped crying, be available \0 listen if he or she should wish to talk. A general leading question might be asked ("'s there some way I can help?" or "Would you like to talk about it?"), or a reflective statement made (" Seems like a hard time for you."). Be careful however, not to demand an explanation; there are times when it is impossible to give a reason for tears. After a long or hard cry puffy eyes, a red face and headache are common. A cold damp cloth can be soothing and reduce swelling. A cup of coffee or tea is often appreciated and the caffeine may decrease the headache caused by dilated vessels. If the headache is severe and persisfs, it may be necessary to obtain an analgesic. If possible. provide the individual with privacy by pulhng curtains and discouraging visitors, Some patients may need to sleep. They may be tired from the emotional energy spent, while others, for the first time In a while, may be relaxed enough to rest. If the person has to see others, help him wash his face. and if a woman, apply cosmetics. Remember, it is important to help the patient maintain a level of self-esteem. Often the patient needs to know you have not been burdened by the crying. One way to reassure the individual is to thank him or her for sharing the tears with you. The next meeting after the crying episode may be strained: awkward feelings may exist. It is helpful for both the patient and the nurse to be aware of this; otherwise, either may experience rejection and take it personally. One of the biggest personal dilemmas a nurse may face is her need to cry along with the Individual. It can be assumed that this is acceptable and may be beneficial to both, as long as the nurse s needs do not exceed those of the patient and she maintains a degree of objectivity. Though it is nof necessary for the nurse to cry along with the patient, this demonstration of feeling can be a beautiful way to show caring. When a nurse has gained a new self-awareness concerning her own reactions to crYing, she is more apt to understand the needs being expressed by the crying person and consequently. intervene appropriately. Crying can then be a constructive experience for everyone concerned." Abbie McGreevy (R.N., St. Claire School of Nursing, New York. New York: B.S.N., St. Louis University, St. Louis, Missouri) is an assocIate instructor of psychiatric nursing at the Kaiser Foundation School of Nursing. Judy Van Heukelem (B.S., University of Colorado School of Nursing: M.S., UniversIty of California, San Francisco) is a former instructor at the Kaiser FoundatIon School of Nursing and, at present, IS on the staff of the Nurse's Christian FellowshIp. References 1. Greenacre, Phyllis. On the development and function of tears. Psychoanal. Stud. Child 20:210, 1965 4. Löfgren, L. Borje. On weeping. Int. J. Psychoanal. 47.377, 1966. 5. Foxe, Arthur N. The therapeutic effect of crying. Med Record 153:167, Mar. 5,1941. 2. Montagu, Ashley. Natural selection and the origin and evolution of weeping In man Science 30:1572, Dec. 4, 1959, 6. Beland, Irene L. Clinical nursing. Pathophysiological and psychosocial approaches, by. . . and Joyce Y. Passos 3ed New York, Macmillan, c1975. p.1088 3. Greenacre, op. Clt., p.214. Feelings Meanings Actions/Reactions A Helpless ' My hands are tied." Immediate or inappropnate referral "There s nothing I can do Walk, or run, away Inadequate "I wish I were God." Depression 'I'm incompetent " Freeze; do nothing Frustrated Change topic Ignore Overwhelmed Cruel "I could have prevented this." Minimize situation: "It must be something I did." "That wasn't bad, was if?" Mean "I touched a sore spot." "It really doesn't hurt that much " "1 made him cry." "This is almost over." Rotten "I'm no good. ' Reprimand: "I'm supposed to be relieving "You're too old for that .. pain, not causing it." Insensitive "There's no need to cry." Ignore Tease Belittle: "Big girls don't cry. "You don't know what pain really is." Manipulated ''I'm not in control." Frustrated Avoid 'She's just trying to get her Anger Give in own way." Depressed B . . Pity "I fee l sorry for you " Oversolicitous "You poor thing. ' Loss of profesSional objectiVIty "Ill do anythmg for you. False reassurance: "I want to help. "Everythrng will be all right.' . Hopeless 'There s no way out. ' Avoid 'This situation has to be Immobilized major or overwhelming Concerned "I care about you." listen Stay and help C [ Nol awa,. of Walk away any feelings Ignore Find more pressing needs A Focus: Self (My feelings about me) B Focus: Crying person (My feelings about other person) C Unfocused 22 · 0" · tf et \ eg\S The Canadian Nurae January 1976 Guidance counsellor:"So, you want to be a nurse?" Prospective student nurse: "Yes, I want to travel across the country (or around the world) while I earn a living. I want to see new places, to meet new friends, to support myself and see the world at the same time." The romantic myth of mobility has traditionally provided nursing with a special aura that attracts the foolloose and fancy free. None of us today is gullible enough to believe that all we need to do to obtain work as a registered nurse in another province is to answer an advertisement offering employment to RN's and then report to the institution's director of nursing. I/je know that employers require an applicant to be registered with that province's registering/licensing body. What we tend to be somewñat hazy about are the precise details about how to accomplish this transfer of registration from one authority to another. Who is eligible? How long does it take? Where do I start? What does it cost? II is to provide answers to some of these questions that this article is written. , IfJI ! /1 If IA'r ...... - , I , } · t '- ..----...... ...._ What is registration? Nursing registration is the process by which a graduate nurse has her name entered in the nurses' registry maintained by the professional nurses' association, college, or order in that province, and is authorized to practice as a Registered Nurse (RN). Licensure is the process by which a graduate nurse is given a permit to practice nursing by the provincial or territorial nursing authority; registration follows automatically. In Newfoundland, Prince Edward Island, Quebec and the Northwest Territories licensure/ registration is mandatory; that is, nurses must hold a provincial license and be registered as members of a provincial nursing organization in order to practice. In the other provinces, licensure does not exist and registration is not required by law. This means it is legally possible to work as a "graduate nurse," but job opportunities at that level are scarce and salaries are lower. Who is eligible? What are the requirements? The Canadian nurse who wishes to obtain employment as a "Registered Nurse" in a jurisdiction other than the one where she received her nursing education or where she is currenlly employed must register with the nursing authorities of the province where she intends to work (see table one). At first glance, one would expect the registration /Iicensure process to be fairly simple (which it can be) since we are dealing with provinces within the same country. But, since Canada is a federation of ten provinces, each responsible for its own education and health services, requirements and procedures for registration/ licensure vary slighlly from one province to another. Many nurses seem to think that success in writing CNA examinations automatically confers on them the right to register and work anywhere in Canada. This is not the case: applicants must also comply with various provincial requirements before they can obtain employment as an AN in a particular jurisdiction. Generally speaking. candidates for registration/ licensure must meet the following requirements: . show evidence of registration with the registering body of the province where they completed a recognized program in general nursing; . prove that they are currently registered or eligible for registration in that province or the province of last employment; . demonstrate fhatthey have successfully written the Canadian Nurses' Association Testing Service or National League for Nursing registration examinations in medical, surgical,obstetrical, pediatric and in some cases, psychiatric nursing (a pass mark of 325 or 350 is required); . show evidence of competency in the practice of nursing, usually through reference from previous employers. . demonstrate fluency in speaking and understanding the official language of the province. In Ontario, Quebec, and New Brunswick, either English or French are acceptable for registration but it is a definite advantage to speak the language of the majority in the institution or region. As of 1 July 1976, all applicants (Canadians or immigrants) for registration/licensure in Quebec will be required to have a working knowledge of French.Presently, this requirement applies only to non-Canadians. Candidates who do not comply with this requirement must take a course offered by the Government of Quebec and write a French language test within a year. During that year, they may be given a temporary permit to practice if they meet all the other requirements of the nursing legislation and have been assured employment in a specific center. This permit is not renewable except with the authorization of the Lieutenant-Governor-in-Council when it is in the public interest to do so. All of her Canadian provinces require a working knowledge of English. Non-Canadian candidates who have taken their nursing program in a language other than English can be required to pass the Test of English as a Foreign Language (known as the TOEFL test), with a score of 450 to 500. Candidates must make their own arrangements for this test by writing to: Test of English as a Foreign Language. P.O.B. 899, Princeton, New Jersey, 08540, U.S.A, In Alberta, New Brunswick. Quebec, Saskatchewan and Newfoundland nurses who have not practiced for more than five years (10 years in British Columbia) are asked to take a refresher or orientation course. In other jurisdictions, this requirement is dependent on individual assessment. Most registering bodies require that candidatl3s submit a birth certificate, marriage certificate (where applicable), reliable references, language test results, a description of the general nursing program completed. a transcript of student records, the results of the registration examinations, proof of current registration or eligibility for renewal of registration and registration number. Non-Canadians are sometimes asked for a copy of their secondary school diploma. All documents should be written or translated in the official language of the province where registration is sought. Registration procedure and possible delays The length of time required to obtain registration is almost impossible to determine in advance. The entire process may take from a few months to more than a year, depending on a wide range of factors. Steps vary from one province to the other, but usually include the following: The applicant writes the registering body expressing her intention to become registered or asking for information on registration in that province. At this point, a brief resume of her qualifications helps to speed up the process. She then receives an information packet and forms to be completed by the original registration body, by the director of the school of nursing where the nursing course was taken and perhaps by her previous employer. If the applicant's mother tongue is not the working language of the province, she usually receives information on the language test. Upon receipt of the required certificates and completed documents, plus the processing fee, the registration body takes note of the documents and sends for confidential references. Delay may occur here if the previous employer fails to respond. When these credentials have been assessed, the applicant is informed of fhe results Applicants who are required to take a language test, refresher courses, undergo medical assessments, obtain work experience or write examinations, will encounter a delay at this point. Other delays can occur if applicants. employers, directors of schools of nursing or previous registration body fail to send all the required documents. Often the transcripts are lacking some important information and much correspondence follows. In many instances, the application must be submitted to the committee on registration for consideration. In addition, the province to which the candidate is applying may have a large number of applications to process. When this occurs, a backlog forms which further delays results. Once the application for registration is complete, the applicant is advised, given a registration number and requested to pay the registration fee. A registration card will probably arrive a few weeks after the official notice has been given. If you follow these steps, and no special problems arise, your application should be processed smoothly in a relatively short space of time. Be prepared, however, to recognize possible sources of difficulty or delays in the process, handle a good deal of correspondence, and wait awhile before receiving a definite answer. How to seek employment It is the applicant's responsibility to seek out and find employment; therefore, it is desirable to have a job offer before moving to a province. Information on working conditions and job opportunities may be obtained from various hospitals; a lisf of these is usually sent by the registration body upon request to candidates who qualify for registration. If nOf, candidates are referred to reliable sources of information. 24 I .. Applicants are advised to delay their departure until they are assured of eligibility for registration. No employer can commit himself to hire someone as an RN unless he IS sure the person is eligible for registration. Candidates who have to go to a province to follow courses, write exams or take supervised training for a few months can sometimes obtain a temporary permit pending registration. Requests for temporary permits are assessed individually. How much will it cost? It is easy to forget that all this correspondence and duplication of documents, added to processing fees, registration fees, examination fees (where applicable), and living expenses pending registration can constitute a severe drain on your finances. Fees for processing an application vary at the present time from $5 to $15, and registration fees range from $6 to $100 depending on the particular nursing legislation and the structure of the professional body (see table one). The cost of registration examinations is approximately $15 for each of five papers. (These costs can be expected to rise). A national system of registration .... why not? If you are now wondering why there is no national system of registration, read on. The following sequence of events may throw some light on the question. National - as opposed to provincial - registration has been a concern since the turn of the century. Even before provincial statutes delegating authority for registration/ licensure were passed in each province, efforts were being made to permit Dominion registration for nurses. One of the earliest of these was a bill proposed by a Member of Parliament from Toronto He asked the Federal Government to I ne L8naOlan Nuree January l!f/þ If you are moving to Canada... Over and above requirements outlined for Canadian nurses, nurses who graduated outside Canada and who are registering here for the first time must also meet the following general requirements: (Note: each jurisdiction may also set individual reqUiremenls). a have completed a general nursing program in a country or state where there is written nursing legislation (candidates having only a specialized course such as midwifery are not eligible); a have received during that general program between 500 and 800 hours of theory and from four to eight weeks of clinical experience in medical, surgical, obstetrical, pediatric and sometimes psychiatric nursing: a be a Canadian citizen or landed immigrant or hold a working permit (the registering body cannot intercede with the federal Department of Immigration on the applicant's behalf); a have a working knowledge of French if applying in Quebec. Non-Canadian candidates for registration in British Columbia, Saskatchewan, Manitoba. Ontario. and New Brunswick will probably have to write the Canadian Nurses' Association Testing Service examinations unless they have written the National League for Nursing examinations in the USA. Candidates for authorize creation of an Association for Trained Nurses of the Dominion. Although the bill received approval by the House of Commons, it was rejected by the Senate. A similar bill, drafted in 1938 also failed to become law. In 1932, following publication of the first national survey of nursing education, delegates to the annual meeting of the Canadian Nurses' Association appointed a Committee on Dominion registration to formulate some plan whereby a more uniform standard of RN examination might be established throughout the Dominion. The 16-member committee included representatives of CNA and each province. They studied the question for six years and finally proposed creation of a Canadian College of Nurses or Canadian Council for Dominion Registration of Nurses to permit voluntary registration on a national basis. However, some provinces opposed the suggestion and CNA decided that the question should be reopened when greater unanimity of opinion warranted further study. In 1956, a CNA Task Committee on Special Aspects of Registration Requirements was formed with a mandate to study this question again. Instead of reciprocal registration, the Committee recommended that CNA concentrate on a national accreditation program and adopt a national system of licensing examinations. It also pleaded that provincial registration authorities demonstrate greater flexibility in the assessment and evaluation of nursing qualifications and suggested that the question of national registration be postponed again. Role of the CNATS It seems obvious that a national system of registration would offer immediate advantages ii1 terms of individual nurse mobility. The political structure of this country, however, makes this difficult, if not impossible, to achieve. Canada is a federation of ten provinces, each responsible for its own education and health services. The organization of the nursing profession reflects this structure. Each province has its own nursing legislation: provincial responsibility for registration, licensure, approval of schools of nursing, etc. are already established. Standards in these areas have been set to meet specific needs In each province. It is unrealistic to expect these to be identical across Canada. Nevertheless, a significant alternative has been achieved. In 1970, the CNA established a National Testing Service to prepare examinations for graduate nurses seeking registration. All provincial registering and licensing bodies are free to use this service for both graduate nurses and nursing assistants. To date, the French graduates of Quebec are the only ones not writing the CNA TS exams. This is because these exams were originally written in English and subsequently translated. French Exams will be finalized by 1978. Success in registration examinations is only one of the requirements to become a provincially registered nurse, but the use of the same registration examinations at least provides one nation-wide standard for admission to practice. ... Nicole Blais is with CNA Information Services, Ottawa. registration in Alberta. Quebec, Nova Scotia and Newfoundland may be asked to take courses, sit for exams or undertake a few months' probation, depending on their educational background and clinical experience.(The regulations of the Northwest Territories Association in this matter were not available at the time this article was produced, since it was recognized as a registering body only a few months ago. Applicants coming to Canada without completing these requirements may find jobs as graduate nurses (although these are scarce) or obtain a temporary permit. At the present time, registration examinations are written in January, June and August and it can take a few months before the results are announced. If you are moving ouf of Canada... Nurses wishing to obtain employment abroad should take advantage of the Nursing Abroad Program of the International Council of Nurses. For information, write to: Nursing Coordinator, Canadian Nurses' Association, 50 The Driveway. Ottawa. Ontario, K2P 1 E2 Participation In the Nursing Abroad Program is made possible through CNA's affiliation with ICN Table I Provincial Registering Bodies Registered Nurses' Association of British Columbia, 2130 West 12th Avenue, Vancouver, B.C. V6K 2N3. Alberta Association of Registered Nurses, 1 0256-112th Street, Edmonton, Alberta. T5K 1 M6 Saskatchewan Registered Nurses' Association, 2066 Retallack Street. Regina, Sask. S4T 2K2. Manitoba Association of Registered Nurses, 647 Broadway Avenue, Winnipeg, Manitoba, R3C OX2. College of Nurses of Ontario. 600 Eglinton Avenue East, Toronto, Ontario, M4P 1 P3. Order of Nurses of Quebec. 4200 Dorchester Blvd., Montreal. Quebec, H3Z 1 V4. New Brunswick Association of Registered Nurses. 231 Saunders Street, Fredericton. N.B_ E3B 1 N6. Registered Nurses Association of Nova Scotia, 6035 Coburg Road, Halifax, N.S., B3H IY3. Association of Registered Nurses of Newfoundland. 67 LeMarchant Road, SI. John's, Nfld. A 1 C 2G9. Association of Nurses of Prince Edward Island 76 Euston St., Charlottetowr. P.E.1. C 1 A 1 W2. Northwest Territories Registered Nurses' Associafion Box 2757, Yellowknife, N.W.T. At Last... y - a Canadian supplier fCN nurses needs No IftIn}IIiIg IIbout Castoms- Noduly to".,. \\IIHnFR\ ",wnc This fR II ..hite vin.1 POCKET S-\\ t'R for II Pf'DS. sci680rfli. etc. (,hNk bo... 00 toupou. STETHOSCOPES 'orRSF'i TE:THII"COPESin 5 colours. ExceptionalsOIIM Inmnnurion. adJ1'llable ligAlweigAI bina..ral.J; replacemenl part. avadabk in Canada. 11414 Salver. 11415 Gold. 11490 m.... 11492 G.-ee>o, 11494]>;M. 19,00 e.d.. lJU:hul.. iniliala e7lgrat, dfree_ Dr-\L HEAD STETHOSCOPE Amplifle.øJlfr.qKe1Irie._ &wle. a.ction liar .xlra larg. diapAragm. AdJ1'llable cArome bina..ral.J. #413_ 115.95 e.ch SPHYG}IO\lA.,"O\lETER R..gged and depe-ndable, wilA Aneroid ga..g. callbraled 10 J()(} m_ m \'.Icro 10000A- 1) Go c:;Q;\ have also been made in the incidence of ott-er communicable diseases - for example. whooping cough (pertussis). Most Canadians, a"d all health professionals, are aware of these trends. What they are inclined to forgE't, according to officials of the Epidemiology Bureau of Health and Welfare Canada, is fhat these gains could be wiped out by carelessness, hey warn that Canadians are becoming overly complacent about diseases that can now be prevented. As proof, they cite epidemics of diptheria that have occurred within the past three years in Newfoundland, Quebec, and British Columbia. Some immunization programs have been slow to gain acceptance among Canadians. We lag behind the United States, for example, in using vaccinations that prevent rubeola (red measles) and rubella (german measles). Although both of these diseases are now considered preventable, Health and Welfare Canada figures indicate that in the first ten months of 1975, a total of 12,000 cases of \ 1 \ 1 , . l I \ rubeola and 11,000 cases of rubella had occurred. Rubeola has a treatment to prevention ratio of 20:1, that is, we treat 20 cases for every. one that we prevent. Similarly, rubella has a treatment to prevention rafio of 10:1. Both rubella and rubeola have serious implications for the victim, his family. the community, and the health care system. One of these consequences is a measurable increase in public health care costs. 11 has been estimated. for example, that the 2,000 cases of congenital rubella syndrome that occurred in Canada in 1964-65 will cost taxpayers close to half a billion dollars over the next 20 years. More recently, the province of Nova Scotia reported 30 cases of rubella syndrome in one year - 1975. Officials estimate that this health care bill will be $6 million over the next decade. Two points seem clear: immunization programs can save both lives and money: they can also lead to the eradication of communicable diseases. The World Health Organization predicts thaf, within 12 months, smallpox will no longer be found on the face of the earth. Canada has not had.a case of variola major for the last 25 years, and because the risk of reaction is now greater than the risk of exposure. vaccinations for smallpox have not been recommended since 1971 for primary immunization. The nurse working in the hospital, in public health, and in doctors offices has a challenging opportunity to teach, interpret, encourage primary immunization of all children, stress the importance of schejuling the vaccinations, and emphasize the need for maintenance of reinforcing doses af'e. boosfers. Only thftjugh immuniza!iùn can we hope to have optir al control of communicable diseases. I -- - -- . , The Canadian Nurse January 1976 '1 ommunicable iseases .. incidence of communicable diseases imml lization 'r-- ItS t 1 rfl.1ò 001 W8r1 é'1Olt:>U cno iiqOOr1W .81qtn I I opl!fT1al control ÖftI& ,en tol!i 3B b J8YQO Øftt I .. ,f: 1'( incidence of communicable diseases complacency -- Classification of Immumty 1. Natural Immunity - species -race - individual 2. Acquired A GÌ ive - by attack of disease Natural , Pa sS ive - by placental transmission A GÌ ive - by vaccination Arti fi cial , Passive - by injection of antiserum (prophylactic and therapeutic) with: live organisms attenuated ones dead ones toxins toxoids toxin - antitoxin \ . chedule of Immunizations D diphtheria P pertussIs T tetanus P polio 0 diphtheria T tetanus P p Olio T P polio Tetanus toxoid given at 3 months, 4 months, 5 months and 6 months to 1 year of age given at 6 to 13 years of age every 5 years given at 14 years of age and over every 5 years if booster over one year (depends upon policy - could be from 6 months to 3 years) give for laceration, burn, puncture wound, dog bite, and cat scratch (Ietanus antitoxin given if no previous immunization) M M R red measles (rubeola) mumps (epidemic parotitis) german measles (rubella) given at 12 months of age in a single injection I I I I I I I i , tuberculin given at one year of age then once yearly r- L i Scarlet Fever Causetive Organism & Transmission I Organism Group A Hemolytic Streptococcus Transmission - by direct or intimate contact with patient or carrier [ , Incubation and Identification Incubation Period: 1-7 days (usually 2-4) Identification - Abruptly by fever (39.5 0 C) (normal within 5-6 days) - Vomiting, sore throat, headache, chills, malaise -12-48 hours post onset tYP.lcal rash: fine erythematous rash 10 dark & dusk}' then to desquamation appearing most often on neck, chest, in folds of axilla, elbows & groin, and on inner surfaces of the thighi - Skin is dry and scaly - Strawberry tongue to raw beef tongue - Tonsils enlarged & reddened - Lesions - not on face - forehead & cheeks are Nushed - area around mouth pale (circa moral pallor) - Types Mild Septic Toxic Diagnosis 1. Clinical manifestations 2. Throat culture 3. Serologic tests Treatment - Penicillin (Choice) Immunization None Nursing Management - Isolahon for 7 days (at home) - Push fluids Complications Early 1) Cervical Adenitis 2) Otitis Media 3) Sinusitis 4) Broncho- pneumonia - Erythromycin - Good skin care - Hot saline gargles - TPR-q4h - Bed rest - Lotions for skin Late 1) Rheumatic Fever 2) Acute Glomerulonephrit - Diet as toleraled (Pertussis) Whooping Cough Causative Organism & Transmission Organism Bordet - Gengou Bacillus (Bordetella Pertussis) -High mOrlality in infants (Iyr. -F}M-increasing mOrlality & morbidity rates , Transmission by direct contact, by droplet, with discharges from laryn- gealand bronchial mucous membranes of infected persons. . Incubation and Identification Irlcubation - usually within 10 days Identification Clinical Course 1) Catarrhal 2) Paroxysmal 3) Convalescent 1) Catarrhal: 1-2 weeks S & S of URI-Sneezing, lacrimation, cough, low grade fever - in second week cough more severe & hacky 2) Paroxysmal: 4-6 weeks cough - explosive bursts, characteristic "whoop" (cyanotic or red in face) mucous, anxious, - Vomiting may follow coughing, severity increases 1 sl or 2nd week - Remain at same level 1-3 weeks. 3) Convalescent - Cessation of vomiting & whoop - Fades 1-3 weeks Diagnosis 1) Naso- pharyngeal swab (auger suction) 2) Clinical manifes- tations Treatment Immunization Nursing Management 1 Interstitial pneumor None at birlh Perlussls immune globulin for pts c severe whooping cough ! Severity - One attack recommended -+ lasting for pts. immunity under 2 years. D.P.T.P. (6-8 weeks) Complications - Bed rest as long as fever - Ventilated room - Eliminate factors that tend to 3. Bronchopneumonia increase coughing - - Activity, excltemenl, dust, smoke, sudden changes in temperature - Pro r nutrition if 6. Asphyxia from vomiting _ Small frequent feedings severe paroxysms - 02 if cyanotic or dusky 7. Nutritional - Suctioning - done if disturbances necessary (too often aggravates choking spell) - Choking - turn upside down pat on back - remove mucus from mouth f kleenex. - Period of communicability 7 days after exposure to 3 weeks after onset of typical paroxysms (after 4th week organism seldom found) 2. Rectal prolapse 4. Atelectasis 5. Convulsions !1um p s (Epidemic Parotitis) ausative Incubation and Identification Organism & Transmission ..Jrgantsm Myxovirus Parotiditis 1 Filtrable virus Virus enters through nose & mouth Transmission - Direct contact or droplet infection - Mumps virus · has been C , ; t man I saliva, \ blood, urine & C.S.F. Incubation 16-18 days Identification - Salivary gland enlargement particularly parotid glands - Parotitis (Uni or Bilateral) - Orchitis (20-35% of males) - Fever, headache, anorexia, malaise/localized pain near ear aggravated by chewing - Enlarged gland-max. size 1-3 days - T! 1-6 days - Swelling! 6-10 days Diagnosis Treatment Immunization Nursing Management Complications - One attack - Isolation - home 1. Deafness 1. Serologic Symptomatic lifelong (9 days from onset 2. Neurologic tests & Suppor- immunity of swelling) (complement tive complications fixation) - Infants - Oral hygiene - facial born of neuritis mothers - Fluids Î-+ soft diet - myelitis 2. History who had -post of exposure mumps - Nothing strong infectious possess or acidic encephalitis passive immunity - Bed rest 3. Pericarditis 3 Clinical picture - Live 4. Arthritis attenuated vaccine 5. Hepatitis available Red Measles (Rubeola) Causative Organism & Transmission Organism Measles Virus Transmission - direct (droplet spread) contact with secretions of nose, throat and urine of infected persons 'I - indirect - less com- monly airborne ... Incubation & Identification Incubation 10-11 days Identification - Fever & malaise within 24 hours normal. - Coryza, conjunctivitis & cough reach peak c eruption on 4th day. - 2 days before rash - Koplik's spots on buccal mucous membranes opposite molars - By end of 2nd day - T! & Koplik s spots disappear - Rash a) Rarely exceeds 5-6 days (Erythematous Maculopapular) b) Eruption appears first at hairline involving forehead, area behind ear lobe; upper part of neck c) Then spreads downward to involve face, neck, upper extremities & trunk d) Lesions on face & neck - confluent lesions on legs - discrete e) Rash fades in order of appearance f) Rash is purple-red in color Diagnosis Treatment Supportive Immunization - One attack lasting immunity 1. Clinical manifesta- tions. 2. Serologic tests - Passive- pooled adult serum 3 Isolation of virus - Gamma globuhn causes modified symptoms - Measles vaccine: a) Live attenuated vaccine (97% effective) b) Inactive measles vaccine (75% effective) Babies have passive im- munity for approx. 6 months, if mother has had disease Nursing Management - Isolate at home till 7 days after appearance of rash - Liquid or soft diet - Cough syrups - for cough if necessary - Eyelids cleaned with warm H20 (Conjunctivitis) - Protect from bright light if photophobic - No longer contagious after 5th day of rash Complications 1. Otitis Media 2. Mastoiditis 3. Pneumonia 4. Cervical Adenitis 5. Acute Encephalitis : I German Measles (Rubella) I Causative Organism & Transmission Organism Rubella Virus TransmissIon - droplet or (jrect contact with patient - indirect with articles freshly soiled with discharges from nose & throat - airborne could occur - infants with congenital rubella syndrome excrete the virus Incubation and Identification Incubation 16-18 days Identification - In a child, rash is first sign - In adults & adolescents - 1-5 day period of low grade fever, headache, malaise, anorexia. mild conjunctivitis, coryza, sore throat & cough - Rash a) pinkish-red in color, first on face b) then spreads rapidly downward (more quickly than measles) c) by end of 1st day- whole body covered c macule papules, d) 2nd day begins to disappear from face e) lesions on trunk - coalesce to form blush while lesions on extremities remain discrete and do not coalesce f} by end of 3rd day - rash disappears Diagnosis 1. Clinical manifestations 2. Isolate virus 3. Serologic tests Treatment Symptomatic Immunization - One attack permanent immunity - Gamma globulin to modify clinical manifesta- tions -Live attenuated vaccine (90-95 0 0 effective) Nursing Management Complications - Bed rest 1. Arlhritis - No diet restrictions -Isolate (at home) till rash gone - ASA if increase in temperature 2. Encephalitis 3. If exposed during a) 1st Trimester of pregnancy - Congenital Anomalies b) - 2nd Trimester of pregnancy - Premature Birlh Chickenpox (Varicella) Causative Organism & Transmission Organism - Varicella- zoster Virus Transmission - direct con- tact, droplet or ..".borne sp' "'ad of secrE; .ons of respIr- atory tract of Infected persons - indirect through articles freshly soiled by discharges from vesicles and mucous membranes of infected persons Incubation & Identification Incubation 14-16 days Identification - abruptly with low grade fever, malaise, and rash Rash a) rapid evolution from macule through papule - vesicular - crusting (taking 6-8 hrs.) b) centripetel distri- bution of lesions which appear in crops c} presence of lesions in all stages in anyone anatomic area. d) eventual crusting of nearly all the lesions. - In typical cases of chickenpox, three successive crops of lesions appear over a three day period. - Lesions -+ crops which are T concentrated on trunk area ore profuse on upper arms and thighs Diagnosis 1) Clinical- manifestations 2} Isolation of virus 3} Serologic tests Treatment - Symptomatic - Calamine lotion Immunization - Gamma Globulin to modify disease to special high risk persons. e.g. t) children with blood dyscrasias 2) infants under 1 month of age - permanent immunity having had disease t Nursing Management - Isolation (home) - Transmission to others from approx. 1-5 days before onset of rash until all the vesicles have become dry. - ASA for fever - Cut fingernails so won't scratch lesions (scratching causes scarring) Complications 1 2nd bacterial infection (Strep or Staph) 2. Encephalitis 3. Varicella Pneumonia 4. Varicella Hepatitis l' Diphtheria Causative Incubation & Identification Diagnosis Organism & Transmission Incubation usually from 2-6 days 1. Signs Organism and diphtheria symp- bacillus toms. (Klebs- Identification: Loeffler - onset insidious with bacillus) fatigue, malaise, 2. Throat sore throat, fever and - bacillus causes acute nasal Transmission inflammation of pharynx cul- - by direct - secretion of toxin that tures. or indirect irritates the tissues --> contact fibrinous exudate that coagulates Into a - droplet tough, leathery, infection grayish-white - organisms "pseudomembrane" - not always present or typical II present in in color or consistency saliva and - this membrane could nasal occlude air passages discharges of - cervical adenitis occurs patients and - extensive swelling of carriers the neck (bull-neck form) is possible - membrane could form in larynx - respiratory embarassment II" ""'_.._u..n nu.-_ .,.nu_ry nua Treatment - antitoxin Immunization - D.P.T.P. Nursing Management - strict bed rest, flat, turn q4h - only essential nursing procedures to decrease exertion on the part of the patient - isolation - room well-ventilated with fresh air - pulse, respiration and BP checked during administration of antitoxin - epinephrine and hydrocortisone kept for emergency use - tracheotomy tray, oxygen & suctioning - Tq4h, P & R q1 h - saline mouthwash - warm throat irrigations - ice collar -1&0 - fluids p.o. or IV -DAT. - observe for respiratory difficulty Complications 1. Myocarditis 2. Paralysis of soft palate 3. Respiratory paralysis 4. Nephritis 5. Paralysis of ciliary muscles of eye, pharynx, larynx, or extremities S II * (V . I ) . provided for ma pax ana a information only 'I - toxoid to immunized contacts - newborns have passive immunity for 1 st year of life Diagnosis Causative Organism & Transmission Organism Poxvirus Variola Transmission - direct & indirect contact Incubation and Identification r, II I Incubation: 12 days 1. Clinical manifest- ations Identification: - 3-4 days prodromal period - Chills (children convulsions) - iT (above 40 0 C) - Backache - Headache - Vomiting 3rd or 4th day - ! T and eruptive stage begins - Lesions a) move through macular --> papular --> vesicular --> pustular --> crusting stage b) appear on mucous membranes 6. Serologic of mouth, throat and respira- tests tory Iract c) have a centrifugal distribu- tion, and lesions in anyone regional area are in same stage of development d) First appear on face and forearms and then spread to upper arms and trunk, particularly back and finally reaches lower extremities during pustular stage; i T and the constitu- tional symptoms return after 2 weeks - complete epithelial regeneration (some scar formation) 2. History 3. Acutely ill toxic person - Airborne I } I - Infected dry crusts - source of infection 5. Local eruption 4. Biphasic curve n - anti- biotics - Schick tesl for deter- mining presence or absence of significant antitoxin Treatment Immunization Nursing Management Complications - usually - active - Hospital - rigid 1. Impetigo started at immunity isolation beginning by - Feeding by gavage 2. Furuncles of pustular having stage disease - Eye care with 3. Cellulitis normal saline 4. Pneumonia - penicillin - active - Oral and nasal or immunity discharges burned 5. Septicemia tetracycline by vaccina- - Isolation - until 6. Osteomyelitis - supportive tion at scabs have disappeared therapy 12 months 7. Septic Arth- then - (Contact local health) ritis - parenteral every flds. 6 years 8 Laryngeal (not Edema - eyes done if cleaned eczema ë N/S present) I I I j,g 1'1 Ul , Uj!J,g o t01'llJ01'(- If you re planning to see Europe and spend some time in London, this advertisement is of special interest. . . '11111 , J I IJE IT)' / -;/ E . ,1 \./'/ ' WESHNO{ . t. . _ , \:; t- ?!! -;!;,,'--- D" .æl 1 J " 6 12æ5 5 {dCJ\; I 61 StJAMESfB RICHMON;; 61 .... PARt< W / (- 5 fB S1:HEUEII 2 MILES 61 61 $ 61 fB QUEEN MAR\I'3 CARSHAUON $ A Qualified nurse like you can now mix pleasure with work. Just a short way from the King's Road. Chelsea and the heart of trendy London. are some of the most famous hospitals in the city. And almost every one of them is looking for trained nurses for short term as well as longer appointments. You can choo e the branch of nursing that suits you best: you name it. we have it. We can offer accommodation and uniform. and of course. there's the salary to think about- a good-size cheque 10 help pay for your costly globetrotting. Get in touch with us before you leave, then we can send you all the information about us and Nursing in England. We're waiting LO hear from you Miss Joan Clague SRN, SCM Area Nursing Officer. Merton, Sulton & Wandsworth Area Health Authority, 14 Atkins Road. London SW12 DAD England. " "' HI)SI'IT L QUEEN MAR"S H,."halllp,n" s.. JOHN' , SI.GEORliE'S, SI. JAMES', SPRINGFIELD, I S'. HELlER. QUEE'" OIARY'S HOSP'T AL FOR CH 'LDREN. s.. EBBA'S, SUTTON IiENER AL) =--- "'" GOOD THINGS haQ ll en WHEN YOU HELP RED CROSS ......,;/ MRS. R. F. JOHNSON SUPERVISOR ..... , III CHARLENE HAYNES - l ; !.' \ .' 'OHN. L.P.N. -- , 51 ,---.- c...... fron popu r !la_pi' ..,... l't abo ., des- cnbod bolow, Fill out Clu,.n be.... SAVE WIth 2 IDENT. .. 1 IfIC, 11101'1 c...-n nt and . Ipare an co.. .. lass. . ALL METAL...S"-h, ","n_ IPI" 2..49 1 Pm 3.25 . orners Chome Pohst)ed, Satin. Of . 'leW Duot comb_n.." satin 2 Pms 3.99 2 Pms ..95 background with polished edJas fUII'Ie mel I mel . PLASTIC LAM'NATE...s"mmel, ( Pin US (Pin US . broader; engl'a'oo'@d thru surflce to ontrastlng core color. Beveled 2 Pins 1.95 2 Pins 2.90 border matches ttenng. (""" -I lu.,..ryme D METAL'RAMED ..C....'" 1 PIn 2..49 1 Pin 3.25 .. 1eslKn; snow wt1lte pblsttc wIth 2 Pins 3.99 2 Pins ..95 smooth. polished beve frame (urn.Nmel na_' MOLDED PLASTIC. Simple, smart. 1 Pin US 1 Pin US tcOtJCJmIU' C"IØ white badcj'round. 2 PIns 1.95 2 Pins 2.90 ;)mooth rounded corners and edaes. fUl'll@namel ly,.....alT'f' Free Initials and Sack with roor own Littmanri BRAND Nursescopef Famous Littmann. Nurses' Stethoscope. widely preferred tor high sensitivIty, dependability. smarter styling Welgtls only 2 OlS. 28" over. all. Fle.,ble Bray. antj-colJapse tubing. non :; = :g: e e: :e 'f : rl:t 1 c:r:i Goldtone. Silvertone. Blue. Green. Pink. YOUR INI1IAtS ENGRAVED FREE on c ..' piece lor IRdiwldual distinction and Identification. Also FREE SCOPE SACK includ.d. lrost.d v,nyl witb dust-proof closure. .New . MEDALLION" sty. ling also available. with tubing In colol'1 to matcn chest poece N.. 21&0 Nlnoscop./lnilla',/S.ck . . . 1695 N.. 2I&OlIllIb.... ..M.d./liIll...I)'I....11 95 on Duty Iree , ÞU BLOOD PRESSURE SET Outstandinl Reeves Aneroid SphYI. trom Japan - meets IU US. Gov. specs; :::t:3mm Iccuracy 1U8ranteed 10 years. 81ad.lchrome manometer ul. to 300mm. 'Jelcro. Irey cuff, antl-collapse ,- f l: = llì.sor :, es ttin : :'J; cision "ehtwelght f3 ozJ Nurus' Stethoscope in silver fimsh. With H " dil. non-ctlillinl dia- phr'llm. FREE Scope SocII Included No. 4t-loo Co.pl.t. B,P. S.t . . . 33.15 I/o. 101 s' rr IIly/ilJbll.d .... . . . 2US Duty Iree I .-:-:\ :ð MEOI-CARD SET Hindi." ref.r.nc. ever! 6 smoottl plastic cards (31,1" x S\2") f; se , W t r O e :u: "ftou 'rd life,s.. Temp. QC to of. Prescrip. Abbr., Urin- alysIs. Body Chem J Blood Ctlem. liver Tests. Bone MaIJow. Disease Incub. Periods. Adult WitS. etc. All In wtll'e vinYl leather_ No. 289 Card Set . . . 1.50 ... Initials IOld-stamped on back of holder I add 50, WRITE FOR COMPLETE REEVES CATALOG! TO: REEVES CO., Box 119-C, Attleboro, Mass. 02703 NAMEPINS: SlyleNo._DOnepon 02 same name METAL COLOR (169 and 100 only), DGoid DSilver METAL FINISH: U69 and 1(0), DPo'ished DS.tin DOuo'one LETTERING COLOR:DBlack OWhite ODk Blue 8ACKGROUNO:OWhite OBlack DGreen DBlue LETTERING 2nd line NURSESCOPE: o No. 2160 DNo.2160M Color_ B.P. SET: ON.. 41-100 Color _ ON.. lOB only MEDI-CARD SET: DNo. 289 I NITIALS as required \ Pi.... .dd 50r handlina/po.taao I enclose $ i on ord.n totallina under $5.00 No COD's or billing to individuals. Mass. reSIdents add 3% S. T. Send 10 . Street CII:' State .Zip __.. __ __, SATISFACT.ON GUARANTEED! Pi.... .lIow time for dellv.ry ..c ::: -ro 0Q) ccI 00Q) :;::;:;::;..c roro- .- - c U ._ oQ)en en.....E ro -<(0, en co Q) o ..... en Q.. ::;-c en zCoQ) Q)._ c c E m 'ë. ro Q) u.- .- - :J U "Cro CJ) ro - "C .- c wwo ro Ü ! I :ß <( ..ê E z_ 0 ]j üE .g .- ëii e (/) GJ - 0.>"-- o c: (/). I OOGJ:t= Qj:5 !3.E s:::. (/) 0,- 0 "2õ rn g-ë<ë >C: I -GJZ ern EGJEü a.'C (/) 0>>> a.C:Eêæ.2.2 rnrnrn_ a.o> (/) c: 0>!!1 GJ E c: Ooo:2GJC;::; '5 is..; '0 . GJEc:s:::.rnæ :ð e .9 ;, CD c -a.rnc:>.Q(/) '0 s:::. U'': 8 rn GJ ñ; = .c - "0. o æ "2 . 0 CDs:::. s:::.GJEU <( c: :ß t- E E.Ç; Z 0 g è '0 !!1 ü GJ GJ 0 rn-. D GJ c: '0 ëñ iñ GJ 0 -EO(/):ßGJ õl õ:ßêE o>!!? æ is.. ..ê Qj C:C:s:::.0> .-'0 -.;:: Q) c. L.O - rn GJEo,---OGJ GJGJ oGJ- E-C: -ë5>> _ !!1.Q c: (/) c: (/)(/)rnGJë'C<( c:::=s:::.GJ . GJ .Q -g = E c:-g -E'ij5u 2 e <( -OU:::: XD a.rnrn(/)GJrn ..... ".".v.all nVIDc; ".I1UD'Y 1 '1IIl The Canadian Nurses' Association believes that a national program for coordinating accreditation of educational programs in the health disciplines would be in the best interests of the public and the health professions. The Association therefore supports the establishment of a national committee/agency to coordinate the accreditation process being carried out within each health profession and to provide the necessary liaison among all of the professions, agencies and institutions involved. The Association considers it essential that the national body charged with this responsibility: I be broadly representative of the health professions, the government and the general public: II be given clear and specific terms of reference regarding the provision and evaluation of the service; and III be encouraged to act with all possible speed, Terminology The distinction between approval and accreditation has a direct bearing on attempts to evaluate health sciences education programs in Canada. It is imperative that all of the health sciences reach a consensus on the usage of these terms before proceeding with the development of accreditation programs. CNA stafements and papers on the subject are based on the following definitions: I Approval Approval means that a health education program has met the prescribed minimum standards set by the appropriate provincial body. Approval is compulsory and is based on minimum standards designated in Provincial acts or regulations authorized by these acts. These standards usually include preparation and size of faculty, the nature and content of curriculum, the quality and type of clinical practice areas and administrative practices and control. This process is deemed necessary for the good of the public or, as it is usually expressed, "to protect the public from incompetent practitioners." /I Accreditation Accreditation means evaluation and recognition of a program of education according to a national voluntary program. Nursing Education Programs I Approval The process of approval has gone on for more than 50 years in schools of nursing in all provinces. Only graduates of approved schools are eligible to write registration examinations, and only graduates of approved schools who meet all other requirements, are Iigible for provincial registration. /I Accreditation At present, there is no national voluntary accreditation program of schools of nursing in Canada. There is, however. a commitment on the part of CNA to pursue this program in collaboration with all appropriate organizations The principle of national voluntary accreditation was approved by the . Association in 1945 This commitment still exists today. ..c ::: ro Q) c I .Q "C -c . ro U en OQ) en en en..... <(:J -z en Q)c enO ..... :J- c Z .Q cEõ . 2 E "CroO ro-..... cWQ.. ro Ü CNA believes that nurses are responsible for maintaining and improving their own health. At the same time, it is the collective responsibility of members of the nursing profession to do all they can to maintain and improve the health of their clients. The practice of nursing carries with it an obligation to improve the level of well-being of each client by responding to the immediate needs of the sick and disabled, by preventing illness and by promoting health. CNA regards health as "a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity,-' the definition endorsed by the World Health Organization. Corollary Action I Nurses can help to reduce self-imposed and environmental health risks among the general populatIon through their example and actions. This implies the choice of a lifestyle which maximizes well-being: the evaluation of current patterns of living in the light of their potenfial risks to health; and, as far as possible, the avoidance of self-induced risks and disease. It also implies that education programs in nursing will integrate these concepts into their programs and that working conditions of nurses are consistent with the maintenance of health. II As practitioners in health promotion and disease prevention programs, nurses need to establish constructive partnerships with their clients as well as with other health and allied practitioners. In order to be effective, it is important that nurses know what community resources are available and what assistance their clients can obtain from other health and allied professions. This Association sees the need for more effective utilization of available nursing manpower to promote health among school children, industrial workers and the aged. III Health promotion is also an important aspect of caring for the sIck and disabled. During an illness, many patients are unusually receptive to suggestions for improving the level of their health. A nurse has more contact with the patient, his family and friends, over a longer period of time, than any other member of the health team. The ability to utilize this receptiveness and relationship is an important aspect of nursing practice. It is essential that nurses recognize the needs of the patient and his family and use these opportunities to assist them, both from the nurses' own resources and through referral to the appropriate agency. October 1975 PERFDRMANCE: af knawled'=le · · Rely on these new texts to help students perform with optimum results - optimum patient care A New Book! FUNDAMENTALS OF OPERATING ROOM NURSING Designed for students with no OR experience, this new text presents the principles and procedures of operating room nursing, Discussions cover basic information on preopera- tive hospitalization, intraoperative care, and post- anesthesia recovery; electrolytes; patient needs; terminolo- gy; and more. Explicit illustrations of accepted techniques and a unique photo-quiz highlight the text, By Shirley M. Brooks, R.N. May, 1975. 184 pages plus FM I-VIII, r x Hr, 207 illustrations, with photographs by author. Price, $7.30. - II u l- IP I- III I - II u I- 'D II E . 1 ,.. , a true test . New 3rd Edition! COMPREHENSIVE CARDIAC CARE For a completely current overview of coronary care, turn to this vastly expanded new 3rd edition. The text continues to stress prevention of cardiac arrhythmias and earlv rehabili- tation. Emphasizing fundamental principles, it thoroughly covers coronary artery disease and complications; physical examination; management of patients with pacemakers; and much more! By Kathleen G. Andreoli, R.N., B.S.N., M.S.N.; Virginia Hunn Fowkes, R.N., B.S.N.; Douglas P. Zipes, M.D.; and Andrew G. Wallace. M.D. September, 1975. 358 pages plus FM I-X. r x Hr. 959 illustrations. Price, $7,90. A New Book! NURSING MANAGEMENT OF RENAL PROBLEMS A clear presentation of the physiologic and psychologic bases for nursing intervention, this unique new text offers in-depth discussions on: normal and pathologic renal function; causes of renal disturbances; body responses; medical therapy; and nursing intervention. Methods and processes of renal restoration are carefully detailed, with special attention to dialysis and transplantation, By Dorothy J. Brundage, M.N. January, 1976,204 pages plus FM I-X, 6Y.z" x 9Y.z", 21 illustrations. Price. $6.85. New 2nd Edition! DECISION MAKING IN THE CORONARY CARE UNIT Revised and expanded, this new 2nd edition teaches students how to make decisions in the coronary care unit. Simulated crisis situations illustrate general principles and provide clinical experience in decision-making. Realistic cases offer adequate information to determine treatment goals, actions, and methods of evaluation. A new chapter discusses patient education. By William P. Hamilton, M.D. and Mary Ann Lavin, R.N., B.S.N., M.S.N. April, 1976, Approx. 184 pages, r x Hr, 126 illustrations. Price, $6.85. A New Book! PATIENT CARE STANDARDS This new text is the first to present patient care standards to help nurses plan, implement, and evaluate care, In concise outline form, it provides step-by-step guidelines for total patient care. More than 400 patient care standards cover medical-surgical, obstetric, and pediatric situations, in- cluding special operating room procedures. By Susan Martin Tucker, R.N., B.S.N., P.H.N.; Mary Anne Breeding, R.N., Mary M. Canobbio, R.N., B.S.IIj.; Gloria D. Jacquet, R.N.; Eleanor H. Paquette, R.N.; Marjorie E. Wells, R.N.; and Mary E. Willmann, R.N. September, 1975.420 pages plus FM I-XXII, r x Hr,71 illustrations. Price, $13,55. III - II 1! II rw L - . E II 11 C ::I .... New 9th Edition! SELF-TEACHING TESTS IN ARITHMETIC FOR NURSES This updated new edition continues to help students develop a strong background in basic applied arithmetic, in class or by independent study. After an introductory review of basic arithmetic, the text discusses weights and measures. The final section covers solutions and calculation of dosages for infants and children. By Ruth W. Jessee, R.N., Ed.D. and Ruth W. McHenry, R.N., M.A. February, 1975.216 pages plus FM I-XII. 7114" x 10112",15 illustrations. Price, $6.25. A New Book! CLINICAL IMPLICATIONS OF LABORATORY TESTS A concise guide to the clinical significance of laboratory tests, this valuable new text first discusses the routine laboratory screening panel. Unit II describes evaluative and diagnostic tests for specific entities. A table of potential variations of normal values compares specific entities found in the routine screening panel. By Sarko M. Tilkian, M.D. and Mary H. Conover, R.N., B.S.N.Ed.; with 1 contributor. October, 1975. 232 pages plus FM I-XVI, 6112" x 9W', 42 illustrations. Price, $7.90. New 9th Edition! INTRODUCTION TO PHYSIOLOGICAL AND PATHOLOGICAL CHEMISTRY This new edition clearly relates principles of chemical reactions to clinical medicine, covering concepts of physical and organic chemistry and the role of biochemistry in normal pathophysiology and disease states. Expanded and revised throughout, the text features a new section on thermodynamics, many new tables and new il1ustrations. By L. Earl Arnow, Ph. G., B.S., Ph.D., M.D., March 1976. 492 pages plus FM I-XXII, r x 10", 227 illustrations. Price $12.55. I ne \..8nSOlan Nurse ..anuary 197ti New 9th Edition! INTRODUCTION TO LABORATORY CHEMISTRY This popular laboratory manual presents experiments correlated with INTRODUCTION TO PHYSIOLOGICAL AND PATHOLOGICAL CHEMISTRY, 9th Edition. Exper- iments vary in complexity, but each uses only the simplest of equipment, Featuring three new experiments, the lab manual demonstrates that facts developed in the laboratory are basic to chemistry, biochemistry, and medicine. By L. Earle Arnow, Ph.G., B.S., Ph.D., M.B., M.D. March, 1976. 102 pages plus FM I-XVI, 5112" x 8112", 43 illustrations. Price, $4.45. New 12th Edition! ROE'S PRINCIPLES OF CHEMISTRY Clear and compact, this new 12th edition presents the fundamentals of inorganic and organic chemistry and biochemistry for student nurses. Relating principles to practice, this current revision includes updated material on molecular and anatomic structure; a new chapter on "The Physical States of Matter"; a new appendix on logarithms; new illustrations and tables. More emphasis is placed on biochemistry than in previous editions. By Alice Laughlin, B.S., M.S., Ed.D. March, 1976. Approx. 464 pages, 6:Y4" x 9:Y4", 122 illustrations. About $12.55. New 7th Edition! ROE'S LABORATORY GUIDE IN CHEMISTRY A favorite for many years, this laboratory guide is designed to accompany ROE'S PRINCIPLES OF CHEMISTRY, but can be used with any other text. This new 7th edition features a variety of experiments requiring only inexpen- sive apparatus. New additions include: a periodic table; greater variety of chemicals used; and new illustrations of the Florence flask and volumetric flask, By Alice Laughlin, B.S., M.S., Ed.D. March, 1976. Approx. 216 pages, 5112" x 8112", 47 illustrations, with 2 color plates. About $6.85. New 13th Edition! PHARMACOLOGY IN NURSING Now in a new 13th edition, this leading text outlines current concepts of pharmacology in relation to clinical patient care. Thoroughly revised and updated discussions cover mechanisms of drug action, indications, contraindications, toxicity, side effects, and safe therapeutic dosage range. Two new chapters examine "Antimicrobial agents" and "The effects of drugs on human sexuality, fetal develop- ment, and lactation," By Betty S. Bergersen, R.N., M.S., Ed.D.; and in consultation with Andres Goth, M.D. February, 1976. Approx. 732 pages, 8" x 10", 143 illustra- tions. About $14.20. New 2nd Edition! NURSING CARE OF THE PATIENT WITH BURNS This unique book serves as a concise yet detailed resource for bum care, from first aid treatment to prolonged care of bum patients. Updated and expanded to include a chapter on fluid therapy, this new 2nd edition places more emphasis on pathophysiology, causes and prevention. By Florence Greenhouse Jacoby, R.N. January, 1976. Approx. 176 pages, 6112" x 9:Y4", 15 illustrations including 2 color plates. About $7.30. e a .- iI I- M II .- e .- E -a II III III I II I- M .. II II :1 II II .- ) A New Book! THE NURSING PROCESS: A ScientIfic Approach to Nursing Care This compilation of theoretical concepts explores all four phases of nursing process and discusses tools used in their implementation. Each chapter includes an annotated bibliography. By Ann Marriner, R.N., Ph.D. June, 1975.242 pages plus FM I-XIV. 61,/2" )( 91,2", illustrated. Price, $7.10. " ., A New Book! NURSING SERVICE ADMINISTRATION: Managing the Enterprise This practical new text examines the fundamental structure of administration and provides a knowledgeable baseline to identify and deal with its strengths and weaknesses. By Helen M. Donovan, R.N.. M.A. October, 1975. 272 pages plus FM I-XII, 7" )( 10", illustrated. Price, $7.10. A New Book! THE PROBLEM-ORIENTED SYSTEM IN NURSING: A Workbook This first-of-its kind workbook presents the problem-oriented system as a theoretical and practical basis for comprehensive health care management. All stages of the process are explained. By Beth C. Vaughan-Wrobel, R.N., M.S. and Bet1y Henderson, R.N., M.N. February, 1976. Approx. 184 pages, 7'14")( 10'12", 19 illustrations. About $7.60. '. "", --. '- A New Book! MANAGEMENT FOR NURSES: A Multidisciplinary Approach Articles from a variety of sources supply basic concepts necessary for the development and improvement of management skills. Discussions examine structural, personnel, and economic factors. By Sandra Stone, M.S.: Marie Streng Berger, M.S.; Dorothy Elhart, M.S.: Sharon Cannell Firsich, M.S.: and Shelley Baney Jordan, M,N. December. 1975. 280 pages plus FM I-XII, 6 4" )( 9 4". 24 illustrations. Price, $8.65. A New Book! CHRONIC ILLNESS AND THE QUALITY OF LIFE Exploring the psychological and social problems faced by patients with chronic disease, this unique text shows how nurses can help patients and families adjust. Case studies dramatize the need for further understanding. By Anselm L. Strauss, Ph.D. June, 1975, 160 pages plus FM I-XIV, 6'}4" )( 9'}4", Price, $6.05. New 2nd Edition! TEACHING CHILDREN WITH DEVELOPMENTAL PROBLEMS: A Family Care Approach Directed toward the care of dÜ,abled children in infancy and preschool years, this new edition discusses: nursing responsibility, child development and handicapping conditions, family reactions, and more. By Kathryn E. Barnard, R.N., B.S.N., M.S.N., Ph.D. and Marcene L. Erickson, R.N., B.S.N., M.N. May, 1976. Approx. 184 pages, 6" )( 9". 16 illustrations. About $6.25. A New Book! HUMAN SEXUALITY IN HEALTH AND ILLNESS This useful new book prepares students to counsel patients on: sexual development; adaptation to events that threaten sexual integrity; and adjustment to diseases and disabilities that affect sexual function. By Nancy Fugate Woods, R.N., M.N. April, 1975.232 pages plus FM I-X, 6" )( 9",7 illustrations. Price, $7.30. II u e II .- u III " - II - I- a .- > II ... \ . \. J: II .a 46 III II .- L. II III III II > .- .... u II a. III L. II a. 11 c II II u .- .... u III L. a. i! II L. L. :I u New Volume I! CURRENT PRACTICE IN OBSTETRIC AND GYNECOLOGIC NURSING Students and practicing nurses can probe far-ranging issues in obstetric and gynecologic nursing with this new book. Useful, original articles offer information on the physical and psychological needs of parents during pregnancy and delivery; fe.tal and neonatal care in normal and abnormal births; gynecologic surgery; abortion; genetic counseling; and more. By Leota Kester McNall, R.N., M.S. and Janet Trask Galeener, R.N., M.S. February, 1976. Approx. 224 pages, 6 " x 9 ", 39 illustrations. Price: about $11.05 (clothbound); about $7.90 (paperback). New Volume I! CURRENT PERSPECTIVES IN PSYCHIATRIC NURSING: Issues and Trends Thought-provoking articles examine current trends, issues and disputed topics in psychiatric nursing, Topics include: clinical supervision; the nurse- physician relationship; conflicts between the nurse's roles as a human being and a professional; counseling the rape victim; behavior modification; social- psychological approaches to family mental health; and much more. By Carol Ren Kneisl, R.N., M.S, and Holly Skodol Wilson, R.N., Ph.D.; with 24 contributors. February, 1976. Approx. 256 pages, 6 " x 9W', 9 illustrations. Price: about $11.05 (clothbound!; about $7.90 (paperback). - ø IIIII::' "èlflaUIGIII"UI_ "'ClIIUClI, .8.... New Volume I! CURRENT PERSPECTIVES IN NURSING EDUCATION: The Changing Scene Here, nationally known educators explore the mul- tidimensional aspects of nursing education, from history to international perspectives. Timely articles discuss how to: ed ucate a sufficient number of nurses to meet growing needs while raising the level of education; provide opportunities for individuals with diverse backgrounds; and other current topics. Edited by Janet A. Williamson, Ph.D., R.N,; with 18 contributors. February, 1976. Approx. 208 pages, "x 9'Y4", 12 illustrations. Price: about $11.05 (clothbound); about $7.90 (paperback). New Volume I! CURRENT PRACTICE IN ONCOLOGIC NURSING Experts from 14 different cancer centers contribute original articles on early screening and detecting of cancer; therapy; maximizing the quality of life; and rehabilitation. The nursing process is emphasized throughout, including the nurse's role from detection clinic to terminal care in the home, Pertinent assessment guides precede appropriate chapters. Edited by Barbara Holz Peterson, R.N., M.S,N. and Carolyn Jo Kellogg, R.N., M.S.; with 26 contributors. February, 1976. Approx. 232 pages, 6'Y4" x 9'Y4", 2 illustrations. Price: about $11.05 (clothbound); about $7.90 (paperback). New Volume I! CURRENT PRACTICE IN PEDIATRIC NURSING These original articles present new attitudes toward the roles, theories and tools in pediatric nursing. Part I discusses infant day care, transcultural nursing, etc. Part II emphasizes family needs during fetal de- velopment and early childhood. Current concepts and methods of nursing care of children with special problems are presented in Part III. Edited by Patricia A. Brandt, R.N., M.S.; Peggy L. Chinn, R.N., Ph.D., and Mary Ellen Smith, R.N., M.S. February, 1976. Approx. 240 pages, 6'Y4" x " , 13 illustrations. Price: about $11.05 (clothbound); about $7.90 (paperback). IVIDSBV TIMES MIRROR THE C V MOSBY COMPANY. L TO 86 NORTHLINE ROAD TORONTO ONTARIO MilB 3E5 Nature gives it. Zincofax * keeps it that wa o )' Afcer every bach, every diaper change and in becween, soothing Zincofax proteCts baby's nature-smooth skin, ProteCts againsc chafing and diaper rash, against irritation and soap-and-water overdry. But Zincofax isn' t i ust for delicace baby skin, It. s for you and your entire family-co soothe, smooch and moisturize hands, legs and bodies all over. Whac's more, Zincofax is economical, even mOre important now wich a new baby at home. \, . ,\ -;. ",. , -'--. ..f - , '"' \ " , '" \ -\ - .. f . ZinèofaX' t - R BABY-S sIIJII _ a -: -- --" Zincofax 'a ,,'S SI0 important cooking instructi ons the author writes "about the beginning of this century, yogurt. . . WaJ, hailed as a valuable health-giving foe.d. Actually, it has no special virtues bE 'fond those of 2-percent milk or butte' milk." Many Canadian autt>'Jrs are praised for "their Canadian cO'ltent" and I praise Dr. Elizabeth C nant Robertson because this is a wei'.-written, refreshing book on a subject we all participate in three 0: more times daily - so, we are, you fiee, all experts in criticizing nutrition texts! Maternal and' Child Nursing, by Janice L. Goe rzen, and Peggy L. Chinn. 210 pages. St. Louis, Mosby, 197 ,. Reviewed by Margaret Armstrong, Teacher, Health Sciences [Jivision, Humber College, ^ orth Campus, Rexdale :Jntario. The int.;!r It of this book is to provide a concise a nd brief summary of maternal a'ld child nursing, useful to students a nd graduates of nursing. The I:: 0- Jk has 11 chapters and is present e' j in a question and answer format r >ertinent information about the farnlly, human sexuality, contre,r.eption, abortion, and adoption is inc'l,ded in the first two chapters. UsinlJ the heading, "Nursing and the Grow' ,h and Development of Indi'Ji duals," normal pregnancy and the r .are of the normal child through ad JI escence is presented. There are five chapters on high risk pregnancy all( J care of the child at risk through adolescence. Although the fie quencing of the chapters does not fr,lIow a traditional pattern, one can easily find the content by review of the t able of contents, or the excellent Index. In each chapter, questions or problems are presented in bold type followed by easy-to-understand, concise answers. The choice of the questions or problems appears 10 be those commonly encountered by a nurse and the answers, although brief, are accurate. Factual information as well as nursing action is included ar." an up-to-date list of references is available at the end of each chapter. Tables offer further detail in some content areas. This book should prove useful to the nursing student as an adjunct to her prescribed texts both In the learning of new content as well as in review. Nursing personnel in the clinical areas should find this book helpful for quick reference. Textbook of Anatomy and Physiology (9th edition) by Catherine P. Anthony, and Norma J. Kolthoff. 597 pages. Saint Louis, The C. V. Mosby Co. 1975. Reviewed by Marilyn Bowers, Humber College, Osler Campus, Weston, Ont. Textbook of Anatomy and Physiology, already familiar to many nurses, is an excellent book used in several diploma schools of nursing. The ninth edition is updated to comply with recent research and reorganized to give the contents better continuity. Reproduction is reorganized into three chapters: Cell Reproduction, Female Reproduction and Male Reproduction. The Nervous system is also presented in three chapters and a new chapter has been formed in Metabolism. Throughout the book, the tables and diagrams have been correlated more closely with the text. Appropriate additions, revisions and deletions have been effected. Revised subjects include: functions of the skel tal system, functions of the muscular system, functions of the liver, the physiology of the nerve synapse, mitosis, meiosis, and glycolysis. The metabolism of vitamins, minerals and water has been deleted, whereas biofeedback, the electrocardiograph, oogenesis, and spermatogenesis have been added. Stress is presented in two chapters, one discusses Hans Selye's concept of stress and the second, the current concepts. In any book which covers such a potentially large subject as human anatomy and physiology the authors face the decisions of what to include, omit, where to elaborate, and condense. In many sections the authors have found it necessary to condense and simplify complex concepts. For nurses who wish further understanding of these concepts supplementary readings have been listed for each chapter. The emphasis throughout the textbook is on physiology and function. Anatomy is covered adequately and the accompanying illustrations are excellent. Nurses may, at limes, reqUire further elaboration of some anatomical details. e.g. the spleen. For anatomy and physiology courses taught in current nursing diploma programs. this book provides a valuable resource 10 which the student may refer as she progresses The ninth edition of Textbook of Anatomy and Physiology updates information and the content has beer reorganized to give better continuity. This is an excellent textbook for nurses sludying anatomy and physiology. System of Nursing Practice, A Clinical Nursing Assessment Tool, by Eileen Becknell and Dorothy M. Smith. 176 pages. Philadelphia, FA Davis Company, 1975. Canadian Agent: Toronto, McGraw-Hili. Reviewed by Joan Royle, Assistant Professor, McMaster University School of Nursing, Hamilton, Ontario. The clinical nursing tool develope< by Dorothy M. Smith is a guide for collecting and organizing data to be used in planning, implementing, and evaluating nursing care. It provides fOI standardization of data collection am a means of applying the scientific method to the identification and solution of nursing problems. The system of nursing practice describec in this text is based on the nurse-patient relationship and the USI of the problem-solving process. In the first section of the book, thE authors discuss the purposes of the tool and provide background information on the problem-oriented system, as well as the theoretical concepts and skills necessary for the systematic collection of data. The second section is concerned with the process of clinical thinking used by the nurse to identify patients' nursing problems, develop a plan of care am evaluate the results of nursing care. The book is well-organized, writter in a straightforward style, providing simple step-by-step directions on hm to apply the problem-oriented systen IA i I) .e.l.eIJ l T 1)(1.1 t (t to nursing practice. The examples of each part of the process focus on clinical nursing situations making the context and its application more meaningful to nursing care. All nurses can benefit from this excellent text that gives meaning and direction to nursing care activities and insight into Ihe thinking processes involved with the identification and management of nursing problems. As the authors state, this book would be especially useful for students and practitioners of baccalaureate programs and would be a valuable reference for nurses in institutions uSing problem-orlented records. Death The Final Stage of Growth, by Elisabeth Kubler-Ross. 175 pages. Englewood Cliffs, N.J., Prentice-Hall, 1975. Reviewed by Marjorie W. Hayes, Project Administrator, Research Programs Directorate. Health and Welfare, Canada, Ottawa- Death is an integral part of our life whether we accepl it or not, and Kubler-Ross assists each reader to face this issue. The reader is constantly reminded of how society rejects death and its finality and how important it is for each person to face it and cope with it. The author selected a number of writings concerning Individual experiences of death and drew them together to tell a story of life. Through the experiences of others, as well as herself, we are exposed to the thoughts of death by different religions, creeds, myths, and mysteries. In philosophy, literature and art we are also shown that death inspires great work. Traditions playa vital role in the expression of grief and the acceptance of the loss. The greatness of this work is to remind each reader of his past in the dying process. Over and over again Kubler-Ross makes it clear that one's role must be ACTIVE in the dying and death process. The recognition of death is necessary for a whole and full life. The description of "Old Sarah" planning and predicting the day of her death is a moving and heartwarming instance. The entire community participated in the funeral arrangements and shared in her peaceful rest. Audrey Gordon's description of America "The death-denying society" is startling, but helpful in understanding the reason for denial and dishonest communication. Raymond Carey s description of the "Living until Death Program" shows the problems in instituting change by means of a program. This section is of special help to the nurse. The summary of the findings assists the nurse to face questions of great relevance in the care of patients and in helping her to face her own questions. I am convinced that eacfi nurse who reads this section attentively will be able to face the emotional adjustment of dying and death. Each will understand how to deal with her own feelings and senses. 'Death and Growth: Unlikely Partners' written by Kubler-Ross shares her personal experiences with death. She shares the desire to avoid death and how one can gain valuable growth in accepting it. She assists each reader in assessing his individual honesty concerning communications with the dying. This area ofthe book is especially useful 10 those 10 psychiatry or nursing who have experienced the dying patient or to those who have grieved a loved one. Thinking about one's own death is very traumatic, especially for those who have been shielded from this agony by society, family or self. This book will assist the searcher to experience the meaning of life in fInding the reality of death. Death is a problem in our society because we refrain from facing it. In reading this book each nurse will be challenged 10 deal with the problem and in the solution each will find a peace never before known .. Publications recently received in the Canadian Nurses Association Library are available on loan - with the exception of items marked R - to CNA members, schools of nursing, and other institutions. Items marked R include reference and archive matenal that does not go out on loan. Theses, also R, are on Reserve and go out on Interlibrary Loan only. Requests for loans, maximum 3 at a tIme , should be made on a standard Interlibrary Loan form or on the , Request Form for Accession List" printed in this issue. If you wish to purchase a book contact your local bookstore or the publisher. BOOKS AND DOCUMENTS 1. American Nurses Association. Clinical conference papers 1973. Kansas City, Mo., American Nurses Association, 1975. 195p. 2. Annas, George J. The rIghts of hospital patients. New York. Avon, c1975. 246p. 3. Association des Höpitaux du Canada. Annuaire de J'association. Toronto, 1975. 77p. R 4. Association des Universites et Collèges du Canada. Repertoire canadien des fondations et autres organismes subventionnaires. 3d. Redigé par Allan Arlett. Ottawa, c1973. 169p. R 5. Banister, Betty. Trapped: a polio victim's fight for life. Saskatoon, Western Producer, 1975. 102p. 6. Beadle, Muriel. A nice neat operation, and the hospital where It occurred. Garden City, N.Y.. Doubleday, 1975. 196p. 7. Besombes, Anne-Marie de. Les ;ouets de votre enfant. Paris, Centurion, c1975. 94p. 8. Boubée, Michel. Bilans analytlques et fonct;onnels en reeducation neuro/oglque: tome premier, tronc et membres inférieurs Paris, Masson. 1975. 110p. 9. Brisou, J. Mesures a prendre en vue d'assurer fa salubrite du littoral mediterraneen: aspects sanitaires de la pollution. Genève, Organisation Mondiale de la Santé, 1975. 96p. (Organisation Mondiale de fa Santé. Cahiers de santé publique, no. 62) 10. Bureau dïnformatique dans Ie domaine de la sanfé. L'ordinateur au service de la sante canadienne: catalogue et descriptions; vol. 2, no. 1, juin 1975. Ottawa, Bureau d informatique dans Ie domaine de la santé, 1975. 246p. R 11. Canadian Film Institute. A directory of films on the health sciences. Available from. . Researched and edited by Margaret Britt. Ottawa, 1975. 167p. 12. Canadian Hosp;tal Association. Office and association directory. Toronto, 1975. 77p. R 13. Cayeux. Sabine. Votre enfant va nattre. Paris, Centurion, c1975. 76p. 14. Conference on Redesigning Nursing Education tor Public Health, Washington, D.C., May 23-25, 1973. Redesigning nursing education (or public health' report of the conference, May 23-25, 1973. Bethesda, Md.. U.S. Division of Nursing. 1975. 137p. (U.S. DHEW pub. no. (HRA 75-75)) 15. Courtney, A.E. Investigation of use and reasons for use of non-prescription drugs. Report D: National purchase diary, by. . . et al. Toronto, C.H. and Z, 1974. 1v. (various pagings) 16. Dade, Marsha Ann. Modelmg and evaluation of the health care delivery system. Santa Monica, Calif., Rand, c1973. 89p. (Thesis (M.Sc.N) - California) 17. Dubuc, Françoise Tremblay. La perinatalité, planification famifle. grossesse, accouchement, aJlaitement. nouveau-ne. Montréal, Agence d Arc, 1975. 415p. 18. Francis E. Comps International Symposium on Sudden and Unexpected Deaths in Infancy. Toronto, May 15-17, 1974. Proceedings. Toronto, Canadian Foundation for the Study of Infant Deaths, c1974. 364p. 19. Franklin. Doris R. Selective and nonselective admissions criteria in Junior college nursing programs. New York, National League for Nursing. c1975. 68p. (League exchange no. 104) 20. Froissant. Anne. Ouand votre enfant apprend a lire. Paris, Centurion, c1975. 95p. 21. Garreta. Bernadette. Les petites maladIes de votre enfant. Pans. Centurion, c1975. 79p. 52 I.J I) '-11'-IJ l T 1)(111 t e The Canadian Nurse January 1976 22. Glénard. Pascale. Votre enfant commence a parler. Paris, Centurion, c1975.84p. 23. Godeluck, Armelle. Comment faire garder votre bebe. Paris, Centurion. c1975. 111 p. 24. Governmental response to drugs: fiscal and organizatIonal. Washington, Drug Abuse Council Inc., c1974. 48p 25. Handbook of neonatal respiratory care. Ed. by Thomas J. Williams. Riverside. Calif., Bourns, 1975? 131p 26. Hatem, Charles J. La transmission et la pathogenie de la tuberculose. Québec (ville), Société du Timbre de Noël de Québec, 1917, 69p. 27. Hayward, Jack. Information - a prescription against pain. London, Royal College of Nursing, c1975. 151p. (Study of nursing care project reports, series 2, no. 5) 28. L'infirmiére enseignante. Lyon, Amiec, 1975. 77p. (Etudes sur les soins & Ie service inflrmier cahier no. 1 ) 29. Hunt, Jennifer M. The teaching and practice of surgical dressmgs m three hospitals. London, Royal College of Nursing, c1974. 106p. (Study of nursing care project reports series 1, no. 6) 30. Ingalls, A. Joy. Maternal & child health nursing, by. . . et al. 3ed. St. Louis, Mosby, 1975. 689p. 31. Jones, Daniel C. Food for thought a descriptive study of the nutritional nursing care of unconscious patients in general hospitals. London, Royal College of Nursing, c1975. 185p. (Study of nursing care project reports, series 2, no. 4) 32. Kao, Frederick F. Respiratory research in the People's Republic of China. Bethesda, Md., National Institutes of Health, 1975. 141 p. (U.S. DHEW Publication no. (NIH) 75-770) 33. Leininger, Madeleine M. Bafflers and facilitators to quality health care. Philadelphia, Pa., DavIs, 1975. 125p. (Health care dimensions: Spring 1975) 34. National League for Nursing. DivIsion of Research. State-approved schools of nursing - LP.N.lL V.N.: meeting minimum requirements set by law and board rules in the various jurisdictions. New York, 1975. 126p. (NLN publication no. 19-1569) 35.-. Division of Community Planning. Quality assessment and patient care. Presentations at the 1974 forum for nursing science administration in the west. New York, National League for Nursing, 1975. 56p. (NLN publication no. 52-1572) 36. Ontano Hospital Association. The primary care nurse in the hospital emergency department. Joint brief to the government of Ontario from the. et al. Toronto, 1975. 1v. (various pagings) 37. Smith, Duncan N. A forgotten sector; the training of ancillary staff in hospitals. 1 ed. Oxford, Pergamon, 1969, 178p. 38. Southern Regional Education Board. Council on Collegiate Education for Nursing. Meeting, 23rd, Apr. 2-4, 1975. Atlanta. Ga Report of Regional planning for nursing project: Atlanta, Ga.; 1975. 115p. 39. The teaching of human sexuality in schools for health professionals. Edited by D.R. Mace, R.H.O. Bannerman and J Burton. Geneva, World Health Organization, 1974. 47p. (World Health Organization. Public Health papers, no. 57) 40. 370 demissions! Pourquoi elles ont démissionne de f'Hópital de Hull? Hull, Qué., Secrétariat d'action politique (CSN), 1975, 146p. 41. World Health Organization. Health education: a programme review; a report by the director-general to the fifty-third session of the executive board. Geneva, World Health Organization, 1974. 78p. (World Health Organization. Offset publication no. 7) 42.-. Expert Committee on Evalua- tion of Family Planning in Health Ser- vices, Geneva, Nov. 18-22, 1974. Evaluation of family planning in health services. Geneva, World Health Organization, 67p. (Technical report series no. 569) 43.-. Expert Committee on Smoking and its Effects on Health, Geneva, Dec. 9-14, 1974. Smoking and its effects on Health. Geneva, World Health Organization, 1975. 100p. (World Health Organization. Technical report series no. 568) 44. Zeidler, Eberhard H. Healing the hospital. McMaster Health Science Centre: its conception and evolution Toronto, Zeidler, c1974. 165p. PAMPHLETS 45. Agmg and organic brain syndrome. Don Mills, Ont., McNeil Laboratories, c1974. 23p. 46. American Nurses' Association. Human rights guidelines for nurses in clinical and other research Kansas City, 1975. 11 p. 47.-. Medical-surgical nursing practice standards. Kansas City, Mo.. 1974. pam. 48.-. Standards of cardiovascular nursing practice. Kansas City. Mo., 1975. 12p. 49.-. Standards of nursing practice: operating room. Kansas City, Mo., 1975. 12p. 50.-. Standards Qf orthopedic nursing practice. Kansas City, Mo., 1975. 12p. 51. Arden House Conference, Harriman, N.Y., Jan. 29-31.1975. Entry into professional practIce. Albany, New York State Nurses' Association, 1975. 39p. 52 BlaCk, Stella H. An investIgatIon of the approach to early detection of breast cancer. Vancouver, Regis- tered Nurses' Association of British Columbia. 1975. 12p. 53. Brooke, Eileen M. The current and future use of registers in health information systems. Geneva, World Health Organization, 1974. 43p. (World Health Organization. Offset publication no. 8) 54 Canadian consumer credit factbook. 4ed. Toronto, Canadian Consumer Loan Association, 1974. 84p. _ 55. Canadian Hepatic Foundation. Symposium on Viral Hepatitis, Toronto, 1971. Proceedings. Ottawa, Canadian Medical Association, 1972. p.417-528. 56. Chater, Shirley. Understanding research in nursing. Geneva, World Health Organization, 1975. 36p. (World Health Organization. Offset publication no. 14) 57. Harris, Eileen. Acupuncture. Bowling Green, Ohio, Bowling Green State University, 1974. 13p. (Bibliographic series, no. 36) 58. Harrower, Molly. Mental health and MS New York, National Multiple Sclerosis Society, c1953. 15p. 59. Hu, Teh-wei. An economic analysis of cooperative medical services in the People's Republic of China. Bethesda, Md., National Institutes of Health, 1975. 41 P (U.S DHEW Publication no. (NIH) 75-672 60. Hypertension, the silent kil/er. Bethesda, Md., National Institutes 0 Health 1975. 18p. (U.S. National Institutes of Health. Clinical Center. Nursing Clinical Conference no. 13) 61. International Council of Nurses. Constitution and regulations as amended 1975. Geneva, 1975. 26p 62. Jones, Arlene Draffin. L 'éducatior du malade et de la famil/e. Québec (ville), Société du Timbre de Noël dl Québec, 1917. 21p. 63. Love and life: fertility and conception preventron. Ottawa, Serena, c1975. 47p. 64. National League for Nursing. Committee on Perspectives. Perspectives for nursing. New York National League for Nursing, c1975 20p. (Pub. No.11-1580) 65. National League for Nursing. Dept. of Baccalaureate and Higher Degree Programs. Doctoral program. in nursing, 1975/76. New York, 1975 4p. R 66.-Faculty curriculum development. New York. c1974. 6 pts (NLN Pub. no. 15-1521,1530,1558 1522, 1574, 1576) Papers from "series of curriculum evaluation workshops", 1973. Contents ,PI. 1. The process of curriculum development. 67. Order of Nurses of Quebec. Decisions of the Bureau on draft project prepared by Professional Corporation of Physicians of Quebec Regulation concerning medical act which may be done by classes of persons other than physicians. Montreal, 1975. 29p. 68. Plummer, Elizabeth. The nurse and multIple sclerosis. New York, National Mutliple Sclerosis Society, 1968. 12p. (American journal of nurs ing, v. 68, no. 10, Oct. 1968) 69. Research in medical care. London, Medical Department, Britist Council, 1974. p. 195-290. (British medical bulletin, v. 30, no. 3, Sep. t974) 70. Réseau d'action et d'informatiol pour les femmes. Memoire sur Ie pro jet de loi, 50, Loi sur les droits e libertes de la personne. Québec (ville), 1975. 26p 71. Services PNP Memoire present au Ministre des affaires sociales. Montreal, Services PNP, 1975. 30p. New... ready to use... "bolus" prefilled syringe. Xylocaine100 mg (lidocaine hydrochloride injection, USP) For 'stat' I.V. treatment of life threatening arrhythmias. o Functions like a standard syringe. 'iì' o Calibrated and contains 5 ml Xylocaine-2%. o Package designed for safe and easy storage in critical care area o The only lidocaine preparation with specific labelling information concerning its use in the treatment of cardiac arrhythmias. \ , +J- <'. 0" . -v . "'0 o ? .; an original from A S T I A I Xylocaine!\' 100 mg (lidocaine hydrochloride inJection U S P) I"lDICATIO'lS-Xylocaine administered Intra- venouslv i) specitkallv indu:ated in the acute management of( I) ventricular arrhythmias occur- ring dunng cardiac manipulaÜon. such as (Bcd.ae .ur80ry; and(2) Jiro,threatenin8 arrhythmias. par- ticularly those which are ventricular inorigm. such as occur during acute mvocardial infarction. CONTRAI /)/CATlO'l/S-Xylocaine is conlra- indicated (I) In patients with a known history of hypersensitivity to local anesthctics of the amide type: and (2) in patients with Adams-Stokes syn- drome or with severe degrees of sinoatrial. atrio- ventricular or intraventricular block. WAR "lINGS-Constant monnonng with an elec- trocardiograph is essential In the proper adminis- (ration ofXylocaine intravenously Signs of exces- sive depression of cardiac conductlvltv, such as prolonsation or PR interval and QRS complex and the appearance or aggravation of arrhythmias, .hould be rollo"'ed by prompt cessation or the mtravenous mfuliilOn of this agent It is mandatorv to have emergenc'\' r suSC1tatl c equipment and dru 5 immediate)\, available to manage possible ad erse reactwns in ol ing the cardiovascular, respiratorv Or central nef\'OUS systems EVidence for proper u5a@.e m children IS limited. PRECAUTIONS Caunon should be employed in the repeated use of Xylocame In patients with severe liver or renal disease because accumulation may occur and may lead to toxic phenomena. since X}locaine is metabolized mainl" in the "vcr and excreted b) the kidney. The drug should also be used with caution in patients with hypovolemia and shock. and all form. of hean bJock (see CON- TRAINDICATIONS AND WARNINGS). In patients with sinus bradvcardla the admmis- (raUon orX"locaine intravenously for the elimina- lion of ventricular < - o:t t .... , - ---.. ' NOW ::t. . 30 . -- . ,. VOLUMESI .. THE new ENCYCLOPAEDIA BRITANNICA Now available at a Special Group Offer Discount For over 200 years Encyclopaedia Britannica has been recognized as the reference standard of the world, Now. . . the world's most authoritative and complete reference work has been redesigned and totally rewritten to bring a far more readable, usable, informative encyclopedia than ever before. You can choose either the Heirloom or Imperial binding and select your choice of valuable options - included at no extra cost. All this can be yours at a Special Group Discount - a price lower than that available to any individual. 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J Sunnybrook Stroke Team An Innovative Experience Pt. II Acute Nursing Care in the Stroke Unit Pt. III Aphasia Pt. IV Stroke Rehabilitation A Creative Process What Are the Bonds Between the Fetus and the Uterus? Reaching Tomorrow's Citizens Enjoy Halifax Volume 72, Number 2 13 14 P. Adolphus 16 C, Pallant L. Coderre 18 21 L Graham 22 V. Adamkiewcz L.E. Lockeberg D. Miller 26 29 34 I l& ') .. -I . ... 1_ . --- "The Ups and Downs of Communication" are the subject of this month's forum, Frankly Speaking (page 13). Author, Lorine Besel asks: "Are we makIng the best use of our time with our patients? What effect do variations in eye level have on communicatlonsT The photo illustration for this feature and the cover were provided by Health and Welfare Canada The views expressed in the articles are those of the authors and do not necessarily represent the policies of the Canadian Nurses' Association. ISSN 0008-4581 " Indexed in International Nursing Index, Cumulative Index to Nursing Literature, Abstracts of Hospital Management Studies, Hospital Literature Index, Hospital Abstracts, Index Medicus. The Canadian Nurse is available in microform from Xerox University Microfilms, Ann Arbor, Michigan, 48106. The Canadian Nurse welcomes suggestions for articles or unsolicited manuscripts. Authors may submit finished articles or a summary of the proposed conlent. Manuscripts should be typed double-space. Send original and carbon All articles must be submitted for the exclusive use of The Canadian Nurse. A biographical statement and return address should accompany all manuscripts. A Canadian Nurses' Association, 'bI" 50 The Driveway, Ottawa, Canada, K2P 1 E2. Subscription Rates: Canada: one year, $8.00; two years, $15.00. Foreign: one year, $9.00; two years, $17.00. Single copies: $1.00 each. Make cheques or money orders payable to the Canadian Nurses' Association. Change of Address: Notice should be given in advance. Include previous address as well as new, along with registration number, in a provincial nurses association where applicable. Not responsible for journals lost In mail due to errors in address. Postage paid in cash at third class rate Montreal, P.O. Permit No. 10,001. Canadian Nurses' Association 1976. 4 I)()'-SI)()(-. i .. The CanadIan Nurse February 1976 A couple of books people are talking about these day, with titles that go a long way towards explaining their contents, are: "When I Say No, I Feel Guilty" by Dr. Manuel J. Smith and "Don', Say Yes When You Want to Say No" by Jean Baer and Dr Herbert Fensterheim. The subject of these books - assertion therapy or assertiveness training - is a behavior concept that gives everyone something to think about. In essence. it says that each of us has the right to express his own needs, convictions and wants openly, in a direct and positive manner. The underlying Iheory, and one with a certain irresistible logic, is that, if we communicate our needs and beliefs clearly and convincingly, they are more likely to be understood and respected than if we camouflage them behind a subservient or diffident "don.t care" attitude. The aim is appropriate expression of these rights as we see them. It does not imply angry or overtly aggressive attitudes It does imply mutual respect and acceptance on the part of ourselves and our associates. Assertion therapy presents nursing with some interesling conundrums. Already, many individual nurses- whether or not they have undergone formal training or read the books, have changed their professional attitude in response to this concept. These nurses have stopped saying "yes" to unreasonable demands and are, sometimes to their own surprise. saying "no" or at least "why?" They are finding that the sell-confidence and self-respect they gain when they know their ideas and needs will be listened to, means that they can provide their patients with more appropnate care. For years, nurses have been caught between two absolute and often opposing lines of authority - administrative and medical. Psychologists point out that when a person is constantly made to feel subservient and subordinate, without being allowed to express annoyance or anger, that person otten vents his anger on unthreatening people in his immediate envirooment. It may not be appropriate to take out our frustration on a helpless palient but all of us have been tempted to do it. What happens. though, if the majority of the nursing profession accept the need to assert themselves and to participate openly In decision-making? What will be the new rules for the "doctor-nurse game" that has not only allowed but even encouraged nurses to manipulate and wheedle the medical profession into making the decisions nurses wanted? Will nurses be able to establish new lines of communication and patterns of interaction with the medical professioD and administrative hierarchy based on mutual respect and recognition of each others talents? It s worth thinking about, isn't it? - M.A.H. II.. .-.. i II Editor M. Anne Hanna Assistant Editor Liv-Ellen Lockeberg, Production Assistant Mary Lou Downes Circulation Manager Beryl Darling Advertising manager Georgina Clarke CNA Executive Director Helen K. Mussallem CNA Director of Information ServicE Michèle Kilburn ..,. " ..,....... i .;::...., p o by Gabor zllasl Next month The Canadian Nurse will feature a series of articles especially chosen to complement the work of nurses whose clients include mothers and their newborn offspring. Topics include a look at how drug use (prescription and non-prescription) affects lactation as well as a useful guide to helping new mothers establish a successful breast feeding routine. The Canadian Nurse has joine a small but growing number of Canadian publications that are computer typeset. (Optical characte recognition is the name printers use In theory. elimination of the possibiht of human error at a certain stage 0' production could result in error-free copy. Sometimes strange and unpredictable things happen howevE and this month s copy included several paragraphs that looked like this:' 0-- T1... _....__ VYc o ....__ %i 5_C o @#/{_ (%01%) V1JW#.!%T 1}%%oß_% Y....[- T1...i %ß{i %ß{ coß{i /1% ,__ ß_ % ß" % V1%0 ....Y ...UT .%) ....}T%1.%} ß1 {1'CJo t ß_% .. JT 1V ß_% 001001...%0%__ J}% 171>-- %%o}...ß/}Co__i It is reassuring to know that tho printing gremlins that used to give u "sherdlu" in the old days have survived the computer age and are alive and well and living in prinl shop across the country. b"legant New :*}OJt LOOK Jor pnng I ) J ' o \, A AT YOUR FAVOURITE STORE i designer's r choice A PROUD CANADIAN NAME IN THE FASHION INDUSTRY ,, I'III"III:; 1 I I I- '1 ! I A) Style No. 46570 Sizes 3-15 Pristine Royale White, Mint. Cantaloupe About 529.00 B) Style No. 46540 Sizes 5-15 Pristine Royale White About 525.00 C) Style No. 46585 Sizes 3-15 Pristine Royale White, Slue About 528 00 111]){lt Nursing in Quebec In Quebec Nursing Shortage Not Due to Immigration (October, 1975) I am quoted as saying:"The shortage is more acute In other countries than in Quebec. Canada will have to train more nurses." Actually, I said:"lf it was proven that we have not enough nurses to give the nursing care required by the population, Canada will have to train more nurses." In the paragraph regarding Bill 22, you said that the bill will apply to Canadian nurses from other provinces as of July 1 st, 1976. This is not correct. As of July 1st, 1976 the requirement of a working knowledge of the French language (Bill 22) will apply to all nurses from other countries, other provinces, or from Quebec. Also, you state that after the temporary permit has expired, nurses will not be allowed to practice in Quebec without a certificate. This is not clear. After the expiration of the one-year temporary permit, a nurse, to be recognized and qualified to practice in Quebec, must obtain a certificate attesting that she has a working knowledge of the French language. Gertrude Jacobs, N., B. N., Registrar. The Order of Nurses of Quebec. Sex Talk and Nursing One of your respondents (Letters, Sept. 1975) mentioned a program, Human Sexuality and Fertility, conducted by McMaster University in Hamilton as one with which she was familiar, and she encouraged the development of other similar courses. I want to inform your readers of another program that is currently in its second year of existence. Conducted by the Health Sciences, Continuing Education Division of Algonquin College, in Ottawa, the program is 360 hours in length extending on a part-time basis from September to April. It is multi-disciplined with all students holding a previous diploma or degree in nursing, social work, theology, education, counselling, and related areas. As human sexuality is a relatively new educational area I strongly feel that those of us involved in teaching it should be aware of what others are doing so that we can share and constantly improve our programs. If any of your readers wish further information about our program, I would be most pleased if they would contact me. My sincere thanks to The Canadian Nurse for publishing the original article "Sex Talk and Nursing." Hopefully, it will stimulate nursing educators to implement courses in sexuality in basic nursing programs. Lorraine Hill, R.N., Algonquin College, Continuing Education, Health Sciences, 2135 Knightbridge Rd., Ottawa, Ont. A description ofthis course offered by Algonquin Community College was also sent to the editor by Rosemary McDonald, B.S.N., Ottawa. Editor's Note: "Sex Talk and Nursing, .. (June 1975), the first forum written by CNA member-at-/arge, LOflne Besel, deserves critical acclaim for its long-term box office appeal. Responses to this column continue to reach both the author and editor. Although we appreciate your interest, the author is concerned about the possibility that other significant issues are being overlooked. She asks that you express your convictions througf' positive action rather than further correspondence on this subject. A Liberated Male I find it rather ironical that some of your authors, who profess to be feminists, commit a self-defeating error in their efforts to bring equity to women. I refer specifically tothe use of the gender"she" or "her" in making general statements about nurses. All nurses are not female. Believe it or not - there are male nurses in the world. Men need liberation too. We must be conscious of these subtle discriminatory addresses if women are to really gain social equality, instead of becoming female chauvinists. May I suggest to potential future authors the use of "the nurse" or he/she after the person in the article has been identified by their full name. Christopher Lemphers, R.N., Old Masset. B. C. A Pat on the Back The article Caring for the Untreated Infant ( December 1975) proposes an approach to a problem that many nurses have faced. The author comes to grips with the basic question of how a nurse is to care for an infant that others have decided is to die. This is a situation that faces nurses regularly and one for which nurses have been ill-prepared. Young students find this situation of "letting a baby die" basically opposed to their personal value system and what is taught them in nursing. Colleen McElroy has written the definitive paper on the subject. Her concern for life and her commitmenl to nursing as it should be practiced are impressive She should be awarded the gold star for excellence. Eileen Mountain, executive secretary, Canadian Association of University Schools of Nursing, and assistant to the secretary-treasurer, Canadian Nurses' Foundation. Nursing Heritage Preserved A year ago you published a letter in which I explained my concern that no archives in Canada was assembling a collection of material that would tell future generations the story of the nurse in the north. Since that time, I have worked toward the establishment of such a collection and feel that many of your readers would be interested to know of the work being done. In cooperation with the archives of the Glenbow-Alberta Institute, an eighl-part documentation has been established. It consists of: 1 )original writings (that is, letters or diaries) 2) written reminiscences; 3) copies of short published writings; 4) photographs; 5) documents and memorabilia; 6) taped interviews; 7) a bibliography of major published works; and 8) a cross-indexed file of resources. Readers who wish to contribute material to this collection should contact me. Items need not be permanently relinquished but will be photocopied and returned if the owner so requests. This fall I received a Canada Council grant to continue my work on the colleclion and expand the taped interview section. I am currently assembling names of nurses with northern or early frontier experieno who might be considered suitable interview subjects. I would urge any your readers who have had this type experience and would agree to an interview, to contact me as soon a possible. Joy Duncan, R.R 3. High River, Alberta, TOL 1 BO. Primary Care Practitioners We are a group of Nurse Practitioners working in primary car settings, who have formed an intere: group, with the intent of sharing an seeking solutions to common problems, and adopting unified terrr of reference. We are interested in hearing fro other similar groups across Canad1 regarding membership, function, ar the problems they have faced and solved since being in existence. Please contact Margaret Nixol c/o Klinic Inc., 567 Broadway, Winnipeg, Man. R3C OW4. - Margaret Nixon, Nurse Clinician, R.N., S.R.N. Comprehensive Care Model The article Nurses and the My of Full Employment (September 1975) has stirred my interest. It is , fact that the health care delivery structure is changing. As hospitals change, nurses must also change, and the central problem is whether nurses can change appropriately. I found it disappointing that Monaghc would suggest nurses use their background as a basis for movemel into administrative support service positions. Granted, we will need administrative support - but these people do not need to be nurses. Th shift from training in a hospital for é specific role within that organization t education in an institution of higher learning, has already suggested a broader role. The nurse of the futur must be a practitioner of the science c nursing, and be prepared to care fc people in whatever setting they are found. James D. Parsek, R.N., Instructor t Nursing, The University of Wisconsin /Milwaukee, Milwaukee, Wisconsin c '- SKI MILl' '" " ..... . I -- - RIFJf" .... ............ Nlazola CORN OIL 100 0 PURE HUILE DE MAíS "- r....... . 32 oz fI 909"" '''VGS .........-IT_-- , Best Foods Living up to our name. I . . . . I . An important study of a nutritious diet designed to reduce serum cholesterol. Not long ago, an encouraging study was re- ported from the University of Minnesota on a dietary program to reduce serum cholesterol. The diet tested was a palatable, well-balanced regimen that included skim milk, poultry, fewer eggs, fish, lean meats, and Mazola 100% pure corn oil. Results: Serum cholesterol levels were effec- tively reduced by an average of 17%. For a detailed report of this timely study, please write to Nutritional Information, Best Foods Division, The Canada Starch Company, P.O. Box 129, Station A, Montreal, Quebec H3C 1Cl. Mazola Corn Oil contains: 54% polyunsaturated fats and 14% saturated fats. O V 1""- c, O I ",,-" ø- "- 8 The Canadian Nurse February 1976 X""'.S --;:;;s- -- ,. - - .- - -.... _. --- ... ----- -... ..,-., - - - - - - - '... -.--- - - ::r. -- -- - ... - -- - iJ .1 . ., I ' IJ \\- r Blueprint Committee Studies Comprehensive Exam The dream of a comprehensive examination lor all Canadian registered nurses is a step closer to realization after two recent planning meetings in Ottawa. The "Blueprint Committee on Comprehensive Examinations.' set up by the CNA Testing Service, met at CNA House in November and January for a total of eight days to begin work on a bilingual blueprint for a Comprehensive Examination for R.N.s that should be ready for use by 1978. The blueprint is based on a conceptual model developed by the Ad Hoc Committee on Comprehensive Examinations and accepted in June 1975 by the CNA Committee on Testing Service. The new examination will emphasize a general, multidimensional approach to nursing, rather than using a variety of tests to measure knowledge of specific clinical areas. This change reflects the shift 10 more integrated nursing education programs across Canada, and will result in an examination more closely attuned to the' real" world of nursing. The Committee is composed of four French and lour English- StudiO Cnamplaln Marcil speaking members. Pictured above during the most recent meeting of the committee in January, are (left to right) front row: Denise Dionne. Montreal; Helen Evans, Willowdale, Ontario; Myrtle Kutschke (chairman) Sudbury, Ontario; Margaret McCrady, Winnipeg; back row: Claire Kermacks, Vancouver; Michelle Charlebois, Montreal; and Velma Wade, Moncton. Absent for the photo was Madeleine Corbeil of Montreal. Further information about the work of the Blueprint Committee and the development of the Comprehensive examination will appear in future issues. Manitoba labor Group A new independent labor organization called the Manitoba Organization of Nurses Associations (M.O.N.A.) has been established to replace the Provincial StaN Nurses' Council. Provincial bargaining units, now composed of 48 certified Nurses' Associations, are members. Nurses' elected to the Provincial StaN Nurses' Council last May will finish their terms as members of the Executive Council of M.O.NA The President of the new organization is Shirley Codd of Winnipeg and the vice-president is Kathleen Connors of Thompson. CNA Supports International Convention The Canadian Nurses' Association has replied to a questionnaire on conditions of work and life for nursing personnel, prepared by the International Labor Organization. Results of the survey will be discussed at the 61st session 01 the International Labor Conference in Geneva in June, 1976. Among suggestions proposed by CNA' - the International Labor Conference should adopt an international instrument on the situation 01 nursing personnel; - - this instrument should take the form of a convention, rather than a recommendation; - the instrument should apply to two levels of nursing personnel, the professional nurse and the auxiliary nurse, as described in the Report on the Joint Meeting on Conditions of Work and Life of Nursing Personnel sponsored by the International Labor Organization and World Health Organization. Adoption of a convention based on the ILO - WHO repor1 would involve both provincial and federal government in Canada' since both levels of authority have Jurisdiction over working conditions of nurses. CNA's response to the ILO questionnaire was prepared at the request of the International Council of Nurses by Glenna Rowsell (CNA member-at-Iarge for social and economic welfare) and Margaret Wheeler, associate secretary and consultant in labor relations, Order of Nurses of Quebec. It was ratified by CNA directors at the October 1975 meeting. An Addendum to the 1974 Edition of the Index of Canadian Nursing Studies is now available on request from the Canadian Nurses' Association. (Price $1.00) Both the 1975 addendum and the basic index were compiled by the CNA Library. The index update lists studies on which information was retrieved between July. 1974 and October, 1975. Copies of the basic index are still available at $5.00. RNAO/CNA launch Pilot Health Project From January 20 to March 20, 197 CNA , in collaboration with the Registered Nurses' Association of Ontario will implement a health promotion pilot project at Toronto General Hospital. The project is aimed at raising nurses awareness their own health standards and promoting changes in their lifestyle It will provide for the measurement the "health status" of individual nurses. using some of the tests demonstrated at the 1974 CNA convention In Winnipeg Once their present stale of health has been determined, nurses will be given assistance to establish fitness programs that suit their individual needs Provision will be made lor continued follow-up of their progres This project is intended for use in in-service educational programs. 4 .. :' ( t "-- r ., '" A report on the demonstration project will be made to the CNA Bo of Directors in February 1976. Directors will then consider extendi the program to other provincial nursing associations. The plan is being implemented meet a directive from CNA members at the Winnipeg meeting "BE IT RESOLVED THAT CNA explore ways and means of developing a plan of action to sensitize or raise the level of nurSE to lifestyles conducive to optimum health. The Canadian Nurse February 1976 9 New B.C. Minister Explores Dimensions of Health Care Brit;sh Cofumbia"s new health minister IS sure there IS an expanded role for nurses but not so sure how It can be developed. Six days after being named to the portfolio, Health Minister Robert Howard (Bob) McClelland, 42, admitted he is not 'too familiar-- with Ihe expanded role program. "I guess that s a subject for discussion with the doctors. 100. I think the nurses in our community can take a much greater role in delivering health care to people, yes. and I d like to see that happen..' Asked whether he sees this as a prerogative of Ihe medical profession, he replied: Well, I think that's why I'd have to talk to the doctors. I'm sure some of them think that it is. There must be areas where we can provide a cheaper form of care without endangering the patient. I feel that probably doctors don t know where to go on this one either." McClelland said he could not express an opinion about apprenticeship training of licensed practical nurses, as it is being urged by the Hospital Employees Union and opposed by the Registered Nurses' Association of B.C. He said he has no plans to interfere with present legislation covering professional licensing bodies, but may extend licensing to other groups. Acupuncturists were the only example given. Continuation of the public health nursing freeze, imposed by the former NDP government several months ago. depends on the extent of provincial financial problems, he said. "I don t like to see a freeze on essential services. I'm very surprised there hasn t been an uproar aboul it from the public health people. The freeze prohibits replacemen1 of public health nurses or hiring of additional staff. The former opposition health crillc said it was too early for him to say whether B.C will require a spending freeze similar to that imposed recently by the Ontario health ministry. Hospitals have been given financial restrictions "10 live within their budgets" which "may in effect cause a freeze,'. he said. But he added, "hospitals are nol doing this and there will be deficits." There is a $17 million overexpenditure in hospital programs for which funds are not available, he said, snd medical services costs are over by about 54? to $48 million but Ihese will be parUy covered by 530 million in the Medical Commission reserve funds. McClelland IS a former moving van driver. broadcaster and publisher, and has served on the board of the Langley, B.C. Memorial Hospital. He became interested in health care while serving on a committee eslablished some years ago by the former Narcotic Addiction Foundation in Vancouver. RNANS Holds Workshop On Caring For Aged "Old age is not a disease, it is something that comes to all of us," Frances Moss. Executive Secretary, RNANS, said in opening the association's recent workshop on new approaches to meeting the needs of the aged. "Old age can be a time of loneliness and depression, but it can also be a time of serenity and quiet joy The difference is sometimes the presence of a caring nurse, a nurse like those of you here today who have come here because you are touched by the theme of this workshop 'Someone Like You':" The workshop was open to R.N.'s and Adminislrators of Nursing Homes and Homes for the Aged. Nearly 70 people participated, the majority of them nurses from Homes for Special Care. Shirley Campbell, Director of Nursing at Ocean View Manor and Chairman of the new RNANS Special Committee on Needs of the Aged, was general chairman of the workshop. Anti-Smoking Group Appoints Executive Director The Canadian Council on Smoking and Health, a national anti-smoking lobby group with headquarters In Ottawa, has appointed Kurt Baumgartner as Executive Director. Baumgartner was head of health science program development and. later, coordinator of allied health programs at Algonquin College in Ottawa. The council IS composed of national voluntary health organizations which share an Interest in smoking and its hazards to health. Activities include examining legislative approaches intended to prevent smoking. publishing information on adllances in related research, raising funds for research projects and disseminating technical data on smoking and ils consequences. CNA is represented on the 1975-76 Board of Directors of the Council by Jane Henderson, Associate Executive Director of the national nurses' association. .. -... I -t '. Did you know? That nurses across Canada look to CNA for information on continUing education? In answer to these requests, CNA library staff maintains an up-to-date list of all short-term and non-degree courses available to graduate nurses across Canada. This list provides information on tille, duration. date, fee and location of the course as well as names of persons to contact for further information. It's available at no charge from the CNA library. Community Nursing Course Offered By Correspondence , The first correspondence course in nursing to be offered at a Canadian unaversity was developed in Saskatoon and is now under way. The course, a half-class in preventive health care, was prepared by the College of Nursing at the University of Saskatchewan and is available through the University's Department of Correspondence Courses. It will be followed by a full class at Intersession or Summer Session on community health nursing, during which the practical and clinical aspects of the nurse's ro1e will be emphasized. The package was developed for degree graduates in nursing whose undergraduate programs did not include a course dealing with preventive health care in a community setting. Professor A. E. Caplin, of the College of Nursing, points out that in recent years there has been a growing emphasis on communify nurSing through public health departments and private agencies such as the Victorian Order of Nurses. In the College's five-year degree program, phased out in 1971, community nursing was an optional subject and some of the students, as well as some from other universities, graduated without experience in this growing field. As a result, they are at a disadvantage if they wish to seek community nursing positions in health regions or elsewhere. The objective of the correspondence course is to help nurses understand their role in a changing health delivery system that is placing increasing emphasis on preventive health. Health requirements will be analyzed in terms of factors such as basic human needs. the environment and quality of life, disease and disaster. \ , , \ , \. , , \. r \. , \ , \ , . Q "- . HJ 333 3 Piece Suit Double Knit 100% Polyester Colours: Green, Blue, Pink, Yellow Sizes: 3-15 Suggested Retail $45.00 s: HJ 31 2 Piece Sl Plain Warp Kr 90% POlyest. 1 0% Nylc White on Sizes: 4-1 Suggested Reté $35.( ,/ ./ ø '-, . . ... . (f)) 1'- \ from .Ie latest \00 o White Cross , For additional information' HAMP TON MFG ( . . 1966) LTD. qt? q ilable at your favourite St ol"e J 15 F->ce Suit a Warp Knit Polyester JC Nylon t19 only z ): 3-15 Jel's ,J ... . .. '".. .. , \ , 'III ., rROCTER . C"'NBLE CAR.3ZZ The C8n8dlan NUlM February 1976 13 ........................ his month's forum has been submitted by CNA 1ember-at-/arge for nursing practice, Lorine Besel, )irector of Nursing, Royal Victoria Hospital, and 'ssistant Professor, School of Nursing, McGill ,/niversity, Montreal. Frankly Speaking about nursing practice The Ups and Downs of Communication I "='" I .- \7,. I , - Lorine Besel Try this experiment. Take a friend home to bed. Distortions in experimental results may occur if one )f you is male and the other female. There is experimental evidence that males tend to dominate conversations by the simple mechanism of using up the available speaking time. So, for the pilot project at least, let's stick. to inviting the same sex as yourself to your bedroom. Experimental Proced_ure 1 Keep readinq, This is serious, 2 Choose agenda betore adjourning to bedroom, a) Social Agenda. Two topics such as books: movies, concerts which both have experienced. b) Sickness Agenda. Two areas of poor health which are of concern to your friend e.g. headaches, constipation, sleeplessness, lost loves. whatever, 3 Have available a 3-minute timer and a recorder 4 Have available a chair - to be used only as instructed. 5 Friend is to lie down on bed covered by blanket (patient roJe). 6 Have chair available near the bed and close enough to sit if you wish to do so. Start timer and tape recorder at beginning of each sequence. 7 Discuss one Social Agenda item for 3 minutes while remaining standing beside the chair. Note reactions in self and friend, 8 Discuss one Sickness Agenda item for 3 minutes while remaining standing beside the chair. Note reactions in self and friend. 9 Discuss one Social Agenda item for 3 minutes while sitting down. Note reactions in self and friend. 10 Discuss one Sickness Agenda item for 3 minutes while sitting down Note reactions in self and friend. 11 Variations on the experiment can include; . wearing a uniform in one set of the Social and Illness Agendas, but not in the other. . reversal of roles . ... try the experiment in hospital with real patients and variations such as high or low beds, standing over sitting patient, or sitting beside sitting patient. Observations and Reactions to be Recorded Are there differences in the sense of comfort or discomfort experienced by each of you in relation to variations in eye level of communication between the sitting and standing positions? Does the length of time that each person speaks change as you sit or stand? Does the content of each person's speech change as you move from the sitting to standing positions? Does this vary equally with the Social and Illness topic, or do process and content vary more significantly with the topic than they do with the position in space of one of the parties? Does the standing person tend to ask questions of the person positioned at a "lower level" regardless of the agenda topic? The person in the "lower level" position has a smaller range of body movement (a communication mode) available to to him - how does this make him feel in relation to the standing person? Does the standing person feel more comfortable standing while on the Illness agenda than on the Social agenda? What of the urge to sit, or not sit, in that convenient chair? If you feel more comfortable sitting or standing. how does it affect the participation of both parties in the interaction? The questions to be considered are as endless as your own curiosity and concern about the nature of nurse-patient interaction, These days we are all concerned about truly "communicating" with patients. We sometimes have the mistaken notion that this is happening when we listen and they talk or when we talk and they listen. Here IS an unproven hypothesis and further unanswered questions; The person who stands above the other will assume dominance in amount and content of communication. Would we allow this dominance to the patient by sitting below his/her eye level? Would we gain more data this way? Would this affect our helping role favorably or unfavorably? Time is precious. Time studies have shown that patients experience a 3-minute "sitting" helper being there for longer than 3 minutes. and a 3-minute "standing" helper being there for less than the actual 3-minute period. We spend endless hours complaining that we do not have "time to spend talking to patients." 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" ..:. .. -,..:-.. . "...' ' .....'.....- :'.:-'. ',:.:::. .-.:. .' .::.::..,::.........::. .::::...:. . .. . " .'. .. ....,. ........ ..'........... . ':-:.... -..:. . '} "'il'-'- ... ..: .. . . .::......::'..:.::.:.:.; ...... . ....:... ...,....,:::-:....... t ...... :,.-:- :.. . .. ....:........................ '1 , . . .:.:'.::. .':.'. : .i . .' - il :' ' :' . .......::. ........:.:;:.: ... ..:..../.. .. .'. ...... ..... . '.'. '. . . .. -. . . -. . .. :. ..:../: ....::..:....::::..:.:. .:: :..-.::.. '.:-. ....? : ., Cerebrovascular accident is the third largest killer of I .... :. )//}.-:-: t:::. Canadians. On January 6.1975 Canada.s first ,. ':":'''::':::''':. .' .-- " :-:'. multidisciplinary stroke unit admitted its first patient. ,.;.... . ::\:."...:....""",-: . .': . . .:" '-"." . ....:.... The three authors present an overview of the unit and the l:ft1 :( :\/.:..:. '.> .;:.... .... . rehabilitation process of stroke patients. ... 16 The Canadian Nurse February 1976 Stroke SUNNYBROOK STROKE TEAM AN INNOVATIVE EXPERIENCE In the first year of operation 134 patients were admitted to the Stroke Unit. The following statistics were gathered: Total Number: Stroke 101 59 (66") 42 (75") 91 10 8.6 days Non-Stroke 33 Dia g nosis: Males (mean a g e) Females (mean a g e) Cerebral Infarction Other ( SAH, SOH, etc .) Ep ile p s y 14 O ther 21 2.6 days Average Duration of Stay: Only 8 deaths occurred during the year: 7 strokes; 1 diabetic coma. The "Report of the Joint Committee for Stroke Facilities" notes that, in general, 50 percent of stroke victims die within the first month. Further statistics, gathered on 39 stroke patients, follow: Total Number: Incidence of Arrh y thmia: Ty pe o f Arrhythmia: Patients with cardiac disease 30 13 7 '4 2 1 1 1 Patients without cardiac disease 9 2 2 Premature ventflcular beat atrial fibrillation Parox y smal atrial tach y cardia p remature atfla l b eat nodal rh y thm ideo ventricular rhythm " The range of ages was: for males 48-87 for females 49-82 There are many definitions of a "stroke" or CV A, but for the purpose of this article it is: a rupture or blockage of a blood vessel in the brain. depriving parts of the brain of blood supply, resulting in loss of consciousness, paralysis or other symptoms depending on the site and extent of brain damage. The main cause of CVAs is a hardening of the arteries to the brain which in turn is related to high blood pressure, diabetes, and other factors producing a progressive hardening of the arteries. In Canada, cerebrovascular accident is the third largest killer after heart disease and cancer, and is probably the most common cause of long-term disability. Stroke patients in most hospitals are cared for on medical wards and have often been regarded with despair and frustration. At Sunny brook Medical Centre, we have been treating stroke patients on the neurological ward. and to further improve on diagnosis, treatment, and rehabilitation of these patients, we have opened an acute stroke unit. The patients stay in the unit for 4-5 days and are then transferred to the neurological ward for the remaining time in hospital. We have established a team approach in treating these patients, combining the skills of neurologists cardiologists, neurosurgeons, neuropsychologists, physiatrists," nurses, physiotherapists, occupational therapists, speech therapists, and social workers. History of the Unit A few years ago, a man named Graham MacLachlin suffered a stroke. He was admitted to Sunnybrook Medical Centre where he made steady progress. Upon discharge, he was unable to assume his previous position in the business w.orld and, being a man with an active and inquisitive mind, he became interested in the cause and effect of strokes. To gain knowledge in this area, he spent many hours in medical libraries reading books related to strokes. MacLachlin initiated a stroke fund and within two years it amounted to more than $100,000. Once approval was obtained from the executive director and board of trustees, a stroke committee was formed. Many hours of discussion, planning and looking at equipment ensued. Final results were as follows: " Physician who specializes in rehabilitation medicine. Two four-bed wards were remodeled into five-bed intensive care uni1.(See figure 1) A central area was partitioned with glass provide a working area. i.e. central monitor. ødications, telephone, etc. (See figure 2). Panels were installed featuring: oxygen, Icuum. compressed air, time-lapse clock. nergency buzzer directly to "locating" for Irdiac arrests. emergency buzzer to the ain nurSing station, sphygmomanometer. ld control of overhead examining lights with timing device. Adjustable I.V. poles were mounted in e ceiling. A cardiac monitor was installed af each : dslde, capable of monitoring ECGs and BP I rnul1aneously. (One has an extra feature - omtormg intracranial pressure). The .cision was made to install cardiac monitors i ?cause of the close relationship between I .art disease and strokes: - if the heart is falling as pump, there is a lance that not enough blood will reach the ain. - a damaged heart is more likely to throw boli that could occlude an artery leading to e brain. if atherosclerosis (the mosf common cause coronar.y disease) is detected elsewhere in e body, then there exists a high possibility ,al it is also present in the arteries leading to Ie bram. By monitoring these patients, we hope to tablish a relationship between cardiac regularities and brain function., Since the .ening of the unit. we have observed cardiac egularities in 70 percent of stroke patients. Stretcher beds were chosen to facilitate lobility to and from X-ray for arteriograms, ain scans. EEGs. etc. An air conditioning unit was installed and 1 oil painting donated by the founder. Because of the size of the unit. it was not 'asible to staff it separately. Therefore. it is 1der the jurisdiction of the head nurse on the 18urology ward, and all staff nurses from the ard rotate through as they develop lowledge and expertise in caring for these atients. One of the main problems we faced was ow to prepare nurses for a unit with which no ne had any previous experience. We ecided to approach the problem by using lore aids to assist in our nursing care and þbse vations, and by realizing that the I I ,--- rne l::anaOlan Nursa February 197ti patients would be similar fo fhose we had been nursing on the neurological ward. Our preparatory program included: - a series of lectures and discussions regarding neurological conditions, including strokes, under the direction of our neuroscience nurse clinician, a neurologist and a neurosurgeon - a course in basic arrhythmias, the completion of which was a prerequisite to working in the unit - discussions with the staff regarding progress and whaf to expect once the unit was in operation - instruction in chest physiotherapy - an intensive orientation of staff as soon as the unit was ready - a demonstration of the use of the panels, monitors, and stretcher beds. Canada's first multidisciplinary stroke Unit admitted its first patient on January 6, 1975 (on nights) and all systems were go. As could be expected, there was a lot of discussion regarding the criteria for admitting patients to the unif, such as age limits, infarction only, hemorrhages only, efc. Criteria for admission to the unit: . First complete stroke . Stroke in evolution . Transient ischemic attacks The largest group of misdiagnosed admissions has been people in 1ne posllctal state of a seizure. Goals of the Unit: 1 To enhance the diagnosis. treatment. and rehabilitation of stroke pafients by: - providing a suitable environment with modern equipment to facilitate the intensive observation and care of these patients - providing nursing staff who have advanced preparation in intensive care nursing of neurological patients - providing a multidisciplinary team with special interest in cerebrovascular disease. 2 To undertake an ongoing evaluation of new diagnostic and treatment methods. 3 To establish a mOdel unit 10 increase the awareness of the factors involved in stroke management. 4 To evaluate the effectiveness of such a unit in the progress and ultimate recovery of the patient. --. ___ 2 , 17 In addition, we hope to create a climate of understanding, patience, and encouragement within which the patient is supported emotionally and motivated to function. We hope to help him and his family understand the problems related to his stroke and help them learn to cope. Medical Coverage Two neurologists take turns as director of the unit on a two-month rotation. One neurologist does all the protocols daily and one is responsible for the care of the patients. Once discharged from the unit to the ward, the patient is turned over to his appropriate doctor. Current situation At the present time, almosf exactly a year after the unit opened, sleep EEGs are being done on many pafients to identify the relationship between the disturbance shown and the part of the brain damaged. A pattern is emerging - patients who show normal sleep patterns on admission are likely to do well; those who do not show normal sleep patterns either die or will need chronic care. Also, - Classes in arrhythmias are being continued - Instruction in chest physiotherapy is being continued. - Multidisciplinary conferences take place three times per week with neurologists, nurses, neuropsychologists, physiotherapists. occupational therapists, and speech therapists. The patients are discussed and plans for their care are made. - A weekly conference is held with cardiologists, neurologists. and nurses to discuss the cardiac status of the patients. -:- All patients are referred to the neuropsychologist for testing of Intellectual impairment. - The standardization of the medical assessment of strokes is being developed. -- Cerebral blood flow studies using Xenon are being carried out. Patricia Adolphus (R.N.. Sherbrooke Hospital. Sherbrooke, Quebec: Certificate in Nursing Administration, University of Toronto) is the nursing administrator of special services at Sunnybrook Medical Centre, Toronto. II .\ , \ III .- a I 1 _J I ,. . " l: '-. ..../!t -; .. " i 18 The CanadIan Nurse February 1976 S'troke ACUTE NURSING CARE IN THE STROKE UNIT 5 1 . . --.- -"'- ..u.. . I . . ....RL ,...." .....&. iL. ................. ........:Jo ] Until recenlly "the altitudes of many health care professionals toward stroke patients have been those of despair, hopelessness, disinterest, and avoidance."1 At Sunnybrook we discourage these attitudes and promote an innovative multidisciplinary team approach to the care of stroke patients. As a member of this team, the nurse in the Stroke Unit provides an acutely ill person with consistent nursing care, preventive rehabilitative measures, and psychological support. She also plays an important role in the I research and education involving the unit. With comprehensive knowledge of strokes, their etiology, types, and effects, she is belter able, to understand the stroke patient and meet his I special needs. The effects of a stroke depend on the site and extent of brain damaQe. A stroke in the left hemisphere (see figure 3) results in impaired motor ability on the right side. Sensation and proprioception are decreased on the right and tactile discrimination IS poor. The left hemisphere is 88 percent dominant in the speech center for both left- and right-handed people; therefore, a left hemispheric stroke results in speech difficulties such as receptive or expressive aphasia or dysarthria, These patients may have difficulty with concepts and abstractions and may have a poor short-term memory. The patient could lose the ability to judge solutions to verbal problems and retain the ability to hear and follow visual commands, but to a lesser degree. The patient may have difficulty understanding the words he reads and be confused by a variety of stimuli. Those who suffer a left hemispheric stroke tend to be slow, methodical, and anxious. A stroke in the right hemisphere (see figure 4) results in impaired motor ability and sensation on the left side. The patient's balance may be poor and he may have perceptual difficulties, such as difficulty judging positions, distances, rate of movement, form, and the relation of his body or its parts to the objects around him. Impaired spatial learning or motor memory is possible and he may neglect his affected side, may have difficulty with right and left discrimination, or have poor tactile discrimination. Those who suffer a right hemispheric stroke tend to lack prudence, are easily distracted, have a poor memory, and are emotionally labile. A stroke in the brain stem basically results in cranial nerve abnormalities and the patient 3 f" HEMlSÞi-t \.-E'r-" - - t:: ../ -I 88 0 "Ó dominant tor speech . Motor control Impaired on rig :Ie ( . Unable'o solve verbal proble"..'" . Can hear and follow visual In NJ . Ottflculty wdl1 speech lant . Otfflculty with the (1. word . Bener al undefSlandlng than speakll"lg .... 'oatlon ) -1" '- \ )mplains of such things as vertigo, diplopia. impairment of vision, Admission procedure Most patients are admitted to the unit rectly from Emergency but some are referred other hospitals. The nurse completes an 1 jmiSSiOn note with the help of the family, cluding information about the patient's past ,Iedical history, allergies, medication, diet, /imination habits, hygenic preferences and ')Cial background. Witl"l this information the rse develops a care plan that is revised as e patient progresses. The family IS o!iented the Unit and ef1couraged to visit, one at a e, for short periods between 1100 and 00 hours. Neurological rounds are made ree times weekly and all members of the am are invited to participate. Everyone is IUS familiar with the patient's progress and sists the nurse in keeping her care plan , -to-date. Immediately upon admission to the troke Unit a head injury routine that includes n evaluation of the patient's level of onsciousness, pupillary reaction, motor ower, and vital signs is done by the nurse. ;ee figure 5) Patients admitted to the Stroke 'nit are on head injury routine every one or YO hours for the first twenty-four hours and len every four hours. The physical layout of le unit permits the patient s neurological tatus to be monitored and any change is T1mediately reponed. Even a slight alteration a patient's level of consciousness or pupil ize may be indicative of paîhology requiring 'rompt attention. As soon as the patient is admitted to the nit, cardiac monitoring is initiated and ontinues until discharge from the unit. ,Ion-stroke patients in the unit are monitored I s a control group for research purposes only. , Besides poviding research data, the iardiac monitor and the nurses' ability to Iscognize abnormalities have resulted in the l 'arl Y detection and prevention of cardiac rrhythmias. According to the docfors, seventy ,ercent of stroke patients studied have had ome form of cardiac disease or have ,isplayed arrhythmias. Twelve lead ECGs and ardiac enzymes e.g. LDH, SGOT and CPK ire obtained the first three days after a hatient's stroke to rule out myocardial hfarction. The cardiologist does rounds ,,'eekly with the neurologists to familiarize I 4 ;í HEMISPHc 00 ______ ---.... 0.,--/ / Not dominant , lor apHC:h . Domnanr 'or sparlal learnIng and molor memorIes . Mo1or contr Impaired on left Side . Lack dscrehon . Perceptual dfficunaes '-- ð .(\ ( >/ ) -Jl 1--. "-- .... _a, __" .. ......._ . çw,,,.,w .01 ... himself with the patients and their cardiac status. The nurse's role In research also involves the sleep EEGs The EEG runs continuously from 2300 --{)600 hours and it is the nurse's responsibility to begin, discontinue, and monitor the recording. These EEGs are studies of the sleep patterns of stroke patients. The doctors would like to discover whether or not the disturbed sleep patterns, of which there have been many, are environmental or pathological. A strong relationship appears between degrees of unconsciousness and the sleep pattern, and there may also be a relation between the site of pathology and the sleep pattern. The patient's fluid'balance is monitored by accurately recording intake and output on each shift. Intravenous solutions are administered to those patients whose oral intake is below 1500 ml per day_ If a patient is unable to drink due to motor impairment or unconsciousness, tube feedings are given. The feedings have one calorie per ml, and the patient is started on quarter strength and builds up to full strength feeding, Patients are given 200 - 400 ml five times a day depending on their needs. While administering a nasogastric feeding it is important to keep the patient's head elevated to prevent aspiration. The patient IS encouraged to take sips of fluid even with the tube In place so that it may be removed as soon as possible. Acute stroke patients need individual consideration with regard to bladder function. Our patients are not automatically catheterized and the need for ar. indwelling catheter is assessed by the nurse and the physician. A bladder IS often flaccid for the first 48 hours after a stroke and then becomes spastic. The return of tone in the bladder appears to coincide with the return of tone in the affected arm. Our rehabilitation consultant, believes that the best method for bladder training is intermittent catheterization (catheterized q4 hours to residual below 100 ml then q6 hours and then q8 hours). The second choice is a catheter clamping routine (clamp for 2 hours then off for 20 minutes, gradually increasing time). This retraining begins in the unit because an indwelling catheter increases spasticity and decreases the capacity of the bladder. Incontinence can be the result of mental rather than motor dysfunction and bladder tone must be preserved to spare the patient additional difficulties in rehabilitation. Preventive Nursing Care The nurses in the Stroke Unit realize the importance of preventive rehabilitation. We strive to avoid the effects of prolonged immobility such as pneumonia, contractures, and discomfort in the affected hmbs. We work to maintain skin integrity and to promote range of motion in the joints. Pneumonia is always a threat to the elderly and bedridden patient. We turn and position our patients at least every two hours so that both lungs expand as much as possible. The physiotherapist is active In the patient's care from the first day - clapping, vibrating, and suctioning congested chests. The nurses provide this therapy during the evening and night shifts and on the weekends when the therapist is not available. If the patient is able to cooperate, he is encouraged to deep breathe and cough five times in one hour. Sputum specimens are sent for culture, and sensitivity and antibiotic therapy is initiated if necessary. Maintaining skin integrity IS an important part of the nursing care of an acute stroke patient. Because many of these people are unable to turn themselves they risk decubitus ulcers. The patient is turned and positioned every two hours and pressure points are inspected and rubbed. When the patient is turned he is lifted and not pulled across the sheets. We attempt to keep pressure off all honey prominences, e.g. by elevating the heels with a small pillow. using Posey booties, and elbow pads. Turning sheets are also very helpful in preventing skin breakdown. An air mattress that changes pressure points is used for patients whose skin IS difficult to protect, Keeping the patient and the linen dry is essential to prevent skin breakdown. If the patient has developed a decubitus ulcer or is admitted with one, we have found that the following steps are effective in promoting healing - the patient is kept off the area, the ulcer is exposed to the air, and it is kept dry. The steps are easy and basic but surprisingly successful. The development of contractures or pain in the patient s affected limb can badly hamper his rehabilitation. While the patient is in bed he is placed in a variety of positions and the length 20 The Canadian Nurse February 1976 Stroke of time on the affected side is limited. Correct body alignment is maintained using devices such as pillows, footboards, and sandbags. When being turned the patient is lifted with firm support under the joints; subluxation or incomplete dislocation of the shoulder :ould result from pulling on a patient's arm to T10ve him. The patient is encouraged to assist n turning, but only to the extent of his ability. While positioned supine, the feet are placed against the footboard at right angles to fhe legs - this prevents footdrop. Knee flexion is avoided because "knee flexion contractures of more than twenty degrees leads to inability to learn to walk; transfer from bed to chair; or chair to toilet. "2 While the patient is supine we try to prevent a frozen or tight shoulder by supporting the patient's affected arm on a large pillow that is tucked well up in the axilla. When positioned on his side the patient's head and trunk are in alignment and the arm is . supporfed away from the body at shoulder level. elbow slightly flexed. with the hand in line with the forearm. To prevent dislocation, the affected hip is not allowed to drop forward and the leg is supported with pillows to prevent pressure. Because an armboard prevents early mobility of the arm, intravenous solutions are not infused into the affected arm. The care of the intravenous could also result in damaging manipulation of the limb. Passive range of movement is "the extent of movement within a given joint achieved by an outside force, without the assistance or resistance of the patient. "3 This is a vital therapeutic routine for it can prevent permanent or long-term disability. The physiotherapist visits the patients in the unit daily and the nurses incorporate range-of-motion exercises into the patient s daily care. Each movement is done slowly in smooth motions about five times, the patient is never pushed beyond his existing range of motion and force is never used. By watching the patient's facial expressions, the movements are kept pain-free. Our patients are encouraged and instructed to do some of their own exercises as soon as they are able. Even in an acute care unit many patients can become involved in their rehabilitation. One of the easiest exercises is shoulder flexion - the patient holds his affected arm, grasping it at the elbow and then lifts his arms to shoulder height and down again. repeating two or three times. Patients in the Stroke Unit are mobilized out of bed on the fourth day, if their neurological and cardiac status is stable. This early movement is helpful in preventing the effects of immobility and gives the patient a psychological lift The family of the patient is always pleasanlly surprised to hear that their relative has been up. They are encouraged to provide the patient with his own housecoat. slippers and toiletries. Having his own belongings often improves the patient s self-image and stimulates a healthy interest in his own appearance. Psychological Support The nurse in the Stroke Unit not only provides acute nursing care and preventive rehabilitative measures; she must also cope with the patient's psychological response to his stroke. A previously active person who is suddenly paralyzed and unable to speak, reacts with fear. anger, depression, frustration and emotional lability. The nurse realizes that the patient is afraid he will be incapacitated for the rest of his life and will never be able to return home. She assists per patient to work through his feelings of depression and frustration. She is aware that improvement will be inconsistent and never chastises the patient for being unable to perform. By stressing the day-to-day improvement she encourag s the pallent to take one step at a time. She does not allow him to attempt too much, understanding that as the patient becomes fatigued he is less capable and more easily discouraged. She reassures her patient that these feelings are normal and helps him to redirect this energy toward rehabilitation. If the patient is emotionally labile the nurse explains to him that she understands he cannot always control his feelings. It is also her responsibility to help the family understand and cope with their relative's emotional response. It is not uncommon for a patient to cry at the sight of his family but this certainly does not always indicate unhappiness. As a result of the stroke. the patient's body image may be disturbed. He may perceive himself differently because of visual disturbances, or his appearance may be distorted as the result of a facial droop or flaccid limb. The nurse endeavors to improve the patient's feelings about himself by maintaining his individuality, e.g. a female appreciates the application of cosmetics, a male enjoys a daily shave and most patients feel more hke themselves in their own sleepwear. The individual is always addressed by his proper name and is not given a nickname. The nurse must be empathetic but not sympathetic. She must encourage and reinforce any improvement, stressing the I positive and accepting the negative. She musl' understand what each patient's disability means to him and to his future. Most important the nurse must come to terms with her own feelings about stroke. Catherine Pal/ant (R.N., Ottawa Civic Hospital, Ottawa) is a staff nurse on the neurology floor at Sunnybrook Medical Centre. Toronto. The Canadian Nurse February 1976 21 APHASIA A NURSE'S GUIDE TO COMMUNICATING WITH APHASICS .. 1. Help the aphasic maintain a desire for communication by encouragmg all his attempts at communication. .. 2. Jf the aphasic makes errors in his speech, it might be good to correct him. But If you are not familiar with his own means of facilitation, then say the word or the sentence he wants to express and encourage him to try a second time. .. 3. Avoid raising the intensity of your voice when speaking to an aphasic. .. 4. Give instructions clearly but naturally. Use simple sentences and if necessary put emphasis on the most important words. Remember that the aphasic s comprehension of language is better If you speak about an event, an object or a person present in the situation. .. 5. If you cannot understand what the patient is trying to say and If he nevertheless persists unsuccessfully in his attempts, then it is better to change the subject of the conversation and tell the patient: "We will leave it at that tor the moment and come back to it later on. " .. 6. If the patient is totally unable to express himself, then formulate your questions so as to have "yes" and "no" answers. But you have to know your patient very well to be sure that the signs he uses really refer to "yes" and "no", .. 7. While performing your clinical activities, you can contnbute to the language stimulation by verbalizing what you are doing. But avoid unnecessary verbiage with the aphasic: you must insist that he keep silent while you are conducting your treatment .. B. Encourage the patient to use social expressions like "hello" "how are you," "J'm fine." "how's the weather," etc. .. 9 If the patient is severely dysarthric or apraxic without a concomittant aphasia, you can encourage him to wTlte what he wants to say. If he has a paralysis that prevents him from writing, have him point to letters of the alphabet. .. 10. Do not be surprised if the patient swears when he is unable to utter a word. Give him, if possible, the word he is looking for. .. 11. Give the aphasic all the time he ne ds to express himself Do not interrupt him by offering him all kinds of words or sentences that can only contribute to increasing his confusion. If his attempts are unsuccessful, give him the missing word or the begmmng of the word so that he can finish it by himself. .. 12. Do not hesitate to make Jokes with the aphasic. He can sometimes enJoy them as well as any other person. .. 13. Avoid carrying on a conversation in the midst of background noise Turn off the television set and ask the others present not to interfere. .. 14. If you have aphasics regularly in your department, a scrap book with illustrations of dally activities in a hospital is recommended By pointing to them, the aphasic will be able to make his needs known. .. 15. Avoid changing the routme activities without preparing the patient. For example, if the patient has to change rooms. prepare him in advance and give him explanations. .. 16. Ask the family to bring photographs of the aphasic's children and his favorite magazines_ Have information about his work, his habits. and his hobbies to start a conversation on a familiar subject. They can also be used to understand what the aphasic is trying to communicate. This guide was prepared by Louise Coderre speech pathologIst The Rehabilitation Institute Montreal Quebec_ 22 The Canadian Nurse February 1976 Stroke STROKE REHABiliTATION A CREATIVE PROCE$ 9 -..... " \f f;J , - - - - GJ 00 00 . Velcro is a Registered Trademark of Velcro Corp. . Dulcolax is a Registered Trademark of Boehringer Ingelheim 6 7 .#If #-. ..." " >\ l' : . ,. i _.. '-; . 1 ,--...,\\;ø j:' \ ttLt - .\ \... . What do Robert Louis Stevenson, G. Frederick Handel, and Louis Pasteur have ir common? They all suffered strokes! More I important, they all recovered sufficiently to continue their life's work. Handel wrote the Messiah and Louis Pasteur accomplished 90 percent of his research after having a stroke The lives of these men offer unquestionable evidence that a cerebrovascular accident need not result in total disability. Rehabilitation is a creative process that begins with immediate preventive care in the first stage of an accident or illness. It is continued through the restorative phase of care and involves adaption of the whole being to a new life. 4 Rehabilitation is also a teaching-learning process in which the patient is actively involved. At Sunnybrook, because the patien is cared for by a multidisciplinary team, his rehabilitation is not only physical. but also mental, social, economic, and vocational. The team members use the same fundamental approach for each patient and therefore are able to supplement and complement each other. The major portion of rehabilitation is carried out on the neurological ward and the central focus of the stroke team is the patient. The team must care for not merely a body with impaired functions, but rather a human being whose disability is an integral part of his total person. As part of the team, the nurse must be capable of exercising initiative and judgment In making nursing diagnoses, in planning and implementing thE patient"s care, and in evaluating and modifying the plan of care as the needs of the patient change. The three basic alms of the team, and particularly of the nursing members, are: prevention of further impairment - maintenance of existing abilities - restoration of as much function as possible. Prevention of Further Impairment To prevent further impairment, a nurse musl be future-minded. "Far too many patients have a prolonged or postponed rehabilitatior program because of the need to correct or minimize a problem that should never have been allowed to occur. "5 Correct positioning is a basic nursing measure and important 8 """ , 1t' / I .. . , "'" Î111... . 'Ìo. I The CanadIan Nurse February 1976 23 'Vhether the patient is sitting in a wheelchair or tanding. While sitting. the patient must keep 11S body aligned. This is difficult for most ;troke pafients due to the hemiplegia and ,isual disturbances. Subluxation or partial 1islocation of the shoulder and edema of the 1and could occur because of the hemiplegia. :>ome of the preventive aids thaf we use at :>unnybrook are: a trough with Velcro' straps for the arm of he wheelchair to keep the patient s affected 3rm in a comfortable position (See figure 6) t a pillow across his knees to support the bHected arm occasionally. a sling. (See figure 7) portable full-length mirror allows the patient o see how he is sitting and thIs helps him to T1aintalO a total body image. A patient. Jositioned comfortably in the wheelchair. leeds to shift his weight every few minutes to .Jrevent skin breakdown. and the patient and taff should check frequently for any signs of 'riction, cuts or bumps resulting from transfers o the wheelchair. or the use of the Nheelchalr. A patient s rehabilitation progresses more safely when the nurse and the patient ollow these few precautions. For patients who are able to walk. correct I posture is less tiring than incorrect. When a cane is required, it is held in the unaffected '"land (See figure 8). If the paralyzed arm is laccid. the patient wears a sling to prevent he arm from getting in the way, being injured f sensation is diminished, and dragging the ;;houlder down. If a sling is worn, it must be laken off perrodically and the arm exerCIsed Proper body positioning is an important part of the patient s rehabilitation program. Bladder retraining is important because I,ncontinence IS unacceptable in our society. Regardless of the bladder program ollowed, adequate fluid intake is a must. and Ifrequently the patient is unable to see the Iglass of juice in fronl of him. reach and grasp .t easily, or ask for something he likes to drink. As a result. he easily becomes dehydrated which creates several problems. e.g.. dry skin. burning on urination. The most obvious way to check his Intake IS by output. If he IS I voiding small amounts of concentrated or foul-smelling urine. his fluid Intake IS !ncreased Fruit juices, water and soups are I encouraged. More than a couple of glasses of milk a day are discouraged as the calcium may create further kidney and bladder difficulties in the inactive patIent. Most stroke patients try to drink 3.000 ml of fluid spread throughout a 24-hour day. A daily bowel program is extremely important for stroke patients as they tend to become constipated easily. The patient s routine prior to the stroke is followed as closely as possible and the nurse encourages fluids and roughage in the diet. His bowel movements are charted daily and if he is used to having a daily bowel movement and doesn t. he receives a laxative. The use of a commode is helpful since it is a more comfortable and natural position and allows more privacy If a patient is confused and the date of the last bowel movement is not known. a rectal examination is done. With most patients. a Dulcolax' suppository works more effectively and less fraumatically than an enema The prevention of further impairment requires a total team approach. The nurse uses many of her basic nursing measures to meet the individual patient s needs. The nursing care plan Indicates these needs and allows for modification after evaluation. Maintenance of Existing Abilities Maintaining the patient s existing abilities is accomplished by getllng hIm out of bed and encouraging activity. Every day of immobility requires three days of activity 10 regain the strength and endurance lost. 6 Restorative Phase Restoring function is a goal most patients and all team members eagerly pursue. A couple of the basic rules are: . assist the patient when necessary. but do nol "do.' for him . progress slowly, gradually Increasing the patient s abililies and tolerance The main aspects of the restorative phase are speech, activIties of daily hVlng. and the family I Speech It is during the restorative phase of rehabilitation that the patient must become actively involved in the teaching-learning process. For the patient to effectively learn, the teaching process must be adapted to meet the needs of each particular person. For the patient who has suffered a stroke in Ihe left hemisphere, the fotlowing guidelines apply: - don't overestimate the patient s ability to comprehend speech; use simple word commands use simple demonstrations - break any task into small steps - give frequent encouragement For the patient with a right hemispheric stroke: - use verbal cues. few visual distractions and slow movement around the patient - keep the room well-lighted - break a new learning task into small segments that the patient completes one step at a time. - watch to see that the task is safely completed because the patient frequently overestimates his abilities. The speech of a patient who has had a stroke can be affected in several ways. The main difficulty is aphasia, which means that the patient has a disturbance in understanding others and in expressing himself. AphasIa is classified very generally as receptive. expressive and global. Receptive aphasia is the inability 10 comprehend spoken and/or written symbols. Expressive aphasia is the inability to express ideas In speech and/ or writing. Global aphasia is a combination of a complete receptive and expressive deficit This deficit means that not only is a pallent s speech affected, but also his understanding of speech, reading. writing. and arithmetic. A patient can seldom be classified as having expressive or receptive aphasia; more often than not, a mixture of the two problems appears, although one deficif may be greater than the other. Some key findings from recent Interviews with post-stroke patients 7 regarding their aphasia, follow: . The capacity to understand returned very shortly after the stroke and it consistently increased long before the patient was able to respond 10 what he heard. . Staff need to speak more slowly and 10 present one question at a time. . People need to be aware of their subtle signs of impatience while waiting for the patient to speak. e.g. audible sighs and eye movements. This behavior affects the patient s morale. motivation. and progress adversely. r 12 \ J " , '- il f ,.. \ . "- '" I J · A.. . ' , \ . ." <-- . . .., --_. . II ' 't ,t(" '. " \ "r -- .... - "-- t 1. - .. - \. f \ . '" < 1 \ 24 The Canadian Nurse February 1976 Stroke The aphasic patient usually has complicated problems to solve. He is evaluated by the speech pathologist who works with him on an individual basis; during the rest of the day, team members follow through with a similar approach. (see box) The speech board (See figure 9) is a device used to assist the patient. He points to the item desired, the nurse names the article and the patient repeats it. The patient can also be asked to describe the article or point to a specific item. If a patient is having trouble finding a word, it is not supplied for him immediately. However, if he has attempted the word a couple of times and is unsuccessful, the word is spoken - he is then able to repeat it. The patient's speech tends to be inconsistenl from day to day. The ability to say a word or a phrase one day does not mean that he can do it the following day; comments like, "but you said it yesterday" only increase the patient's frustration. His speech is usually best early In the day, before he becomes physically tired and emotionally frustrated. The patient's family needs a lot of support and explanation. Some examples of problems we have encountered are: . Following his stroke, a patient spoke his native language of Finnish rather than his second language of English. The family were told that bilingual patients usually find it easier to use their native language rather than the acquired language. . A deaf and mute woman had to relearn her hand signs. . A patient, who had seldom sworn before his stroke, was using strong profanity frequenlly following his stroke. The family and staff had to learn to accept this language without comment or displeasure as the patient was using automatic speech and was unable to stop the responses. The key things to remember are that aphasia affects each person differenlly, and that it can involve a disturbance in understanding others as well as expressing oneself. II Activities of Daily Living Activities of daily Iiving,ADL. include the patient s ability to transfer to the wheelchair and toilet seat, bathe, dress, and feed himself With ADL, the physiotherapist, the occupational therapist, and the nurse work 14 "'-,... closely together in order to coordinate and reinforce each other's teaching. Most stroke patients use a wheelchair until they learn how to walk again. A one-wheel-drive wheelchair is available for the patient, but is not necessary since most hemiplegic patients can propel and steer a regular wheelchair with one foot and hand. However. an extension of the brake handle on the paralyzed side may be necessary. To facilitate transferring, the wheelchair is always placed on the patient s unaffected side. This allows the patient to see the wheelchair and lead with the stronger side; thus he has less chance of "tripping" over the weaker leg, and can protect the affected side. (See figures 10 - 13) A knee lock is used on the stronger leg in order to prevent the knee from buckling or the foot from slipping during the transfer. The patient gradually progresses from being assisted by two people to eventually being unassisted. When transferring, he is encouraged to place most of his weight on his stronger leg, to stand tall, and to look where he is going. Once in the wheelchair, the patient is taught how to position himself correclly. Bathing and dressing with only one arm can be extremely difficult andfrustrating.There are regular bathtubs available with safety !Jars for those patients who are able to use them. However, many of the patients wash themselves at the bathroom sink. With practice, most of the patients are able to brush their own teeth and dentures. The female patient s hair is usually curled by the staff, although there is a hairdresser located within the hospital. An electric shaver is available for the male patient's use. Frequenlly, a patient may neglect to shave one side of his face and a genlle reminder is necessary. To feed himself, a stroke patient may need to use a few aids to replace the functions of his paralyzed arm. A rocker knife (See figure 14) with a serrated edge allows the patient to rock the knife back and forth to cut his food and the prongs on the end of the knife can be used as a fork. A plate guard (See figure 15) prevents the food from being pushed off the plate and a non-slip mat can be placed under the plate to hold it firmly. A bread-buttering board (See figure 16\ 15, with suction cups holds a piece of bread steady while the patient butters and cuts it Each patient is assessed by the occupational therapist and the necessary devices are provided for assisting in the patient's activities of daily living. If the patient is able to function independenlly, his self-esteem is greally improved. Relearning how 10 dress and undress himself is always a struggle for the patient However, once he has mastered even a small I part of dressing himself, he begins to regain his dignity and self-respect. As soon as the patient leaves the Stroke Unit, he begins to learn how to dress independenlly. The nurse and occupational therapist work together, reinforcing each other s teaching. The stroke patient finds it easiest to get dressed in the wheelchair since he is sitting upright. To put on a shirt, blouse or sweater, the patient is taught to begin by pulling his weaker arm through the sleeve with his stronger arm. He pulls the shirt as far up his arm as possible, brings the other sleeve around behind him and puts his stronger arm through the correct sleeve. He then pulls the shirt down and does up the buttons, beginning at the top of the shirt. If the buttons are too small, he may need to use a button hook. (See figure 17) replace them with larger ones, or use Velcro tape. It is important to remember that the patient does not have the use of one arm, and therefore loses the ability to stabilize whatever he is doing. As a result, any device that is used must have a stabilizing effect. Underwear and pants are also easier to put on while silting in the wheelchair. The affected leg is put in the pant leg first and then the unaffected leg, The pants are pulled up the legs as far as possible and then the patient can either stand and pull the pants all the way up or continue to sit and, with a side to side mollon, pull the pants up a litlle at a time. Once he has his shirt and pants on, the patient checks that his shirt front and pants are straight, that his shirt collar is arranged properly, and that he is not silting on any wrinkles. The patient may need to use a sock-aid to pull on his socks. Elastic shoelaces are available that remain tied and allow the patient to put his shoes on like a loafer. He may need to use a long-handled shoehorn if he has difficulty with his balance when leaning H ". - .'" . .... , , .) . ..r."..'! . .., ,. . , .' t 1 _ :r.. lJíl.::( II.: ..J ", J )Ver. Zippered shoe laces (See figure 18) can be tied into the shoe, allowing the patient to emove his shoes by pullinq the zipper down. A few essential "extras" are necessary o help the patient feel like a human being. 130me patients have difficulty judging the Jassage of time, so they need to wear their ,Natches. Obviously, the desired effect is lost if he nurse merely puts the watch on the Jatient's wrist without winding and setting it. erfume, cosmetics, and jewellery for the .vomen, and aftershave for the men, are Ilmportant if they were used before the stroke. Slasses, properly positioned and cleaned, are a must. The vision of many of the patients is already blurred, so why increase this difficulty with sticky, smeared glasses? Throughout their lives, all patients have established routines for their activities of daily living. Following a stroke. these elderly people must relearn or change their ways In order to adapt to a new lifestyle. Most of them can learn to cope effectively. How untrue the clicM - "older people are set in their ways!" As stated earlier. rehabilitation is also vocational and economic Vocational assessments are done by the occupational therapist on most patients. A kitchen assessment is done with all housewives and suggestions are made to help the patient work out any problems she may be having. III The Family Stroke patients are in need of personal support, especially during later stages of recovery: it is at this time that they are most often Ignored. There are several ways to offer support to the patient. When referring to the patient"s body. the stronger and weaker sides are mentioned rather than the 'good"' and "bad" sides. For the patient who already has a one-sided neglect, referring to that side of his body as "bad '. only increases his negative body image. Once a week, Sunnybrook provides a therapy group for stroke patients led by the occupationallherapist and the author (a nurse). This IS a five-week rotating program starting with a film illustrating how people I cope with various disabilities. A member of the Toronto Stroke Recovery Association' visits and discussions follow on various aids that are available. the effects of the patient"s disability on his lifestyle, and the various coping mechanisms others are using. 17 "IV"'......IIoII'.,I...""..... I Ç"UI-'F lOll" The family members are counselled throughout the patient's hospitalization on the best ways of supporting the patient, and they receive a booklet describing the rehabilitation of the stroke patient. Most patients go home with the occupational therapist for an afternoon. This time IS used to assess the home for the patient's return and to offer suggestions for improvements. The patient then goes home for the weekend. This vis if allows the patient and his family to practice what they have learned in the hospital. The home visit is followed by a family conference with the team, where problems, encountered in the home are discussed. The patient and his family need factual information as well as practical solutions to the problems that they are having. Gradually, the family learns about the various deficits the patient may have besides the obvious ones of hemiplegia and aphasia. The patient may have problems judging the passage of time and the family should make use of clocks, radio, and television to assist him. He may have difficulty judging distances, e.g. from the table to the chair; and the use of verbal directions, keeping the furniture to a minimum, and not moving it unless necessary will be helpful. The patient may have unilateral neglect of his affected side and may need to be reminded to watch his positioning. He could have homonymous hemianopsia and thus be unaware of any objects or activities past the midline toward the affected side. If fhe patient is emotionally labile and begins crying for no apparent reason in the middle of a sentence, the family needs to know that he has no control over these outbursts, and that it is better to ignore them and keep on talking. Drawing attention to the outburst only prolongs it unnecessarily. Most patients continue to receive occupational therapy or physical therapy either in their home or at a rehabilitation center as an outpatient. The patient and his family are also taught the warning signs of a stroke 8 , including: - sudden, temporary weakness or numbness of the face, arm or leg - temporary difficulty or loss of speech, or trouble understanding speech - sudden, temporary dimness or loss of vision, particularly in one eye an episode of double vision - unexplained headaches, or a change in 18 I '" '" '" . . c::=.- ,"" - - - .' " ...-J . - the pattern of headaches - temporary dizziness or unsteadiness - recent change in personality or in total ability. Summary At Sunny brook, the creative process of rehabilitation is carried on throughout the patient's hospitalization. The patient and his family have been through a teaching-learning process involving all the members of the multidisciplinary stroke team. Because a stroke affects each person in a unique way, the stroke team has also learned from the patient- we have acquired more knowledge about a stroke, and have found more alternatives tor solving problems. When the patient is discharged from hospital, he takes with him the beginning ability to adapt to his disability... Linda Graham (B.Sc.N., University of Toronto; MS., Ohio State University, Columbus, Ohio) is clinical nurse specialist In rehabilitation at Sunnybrook MedIcal Centre, Toronto. References: 1 Report of the Joint Committee for Stroke Facilities. IV. Guidelines for the nursing care of stroke patients, by Nursing SII.., y Group. Stroke 3:5:637, Sep.lOct 1972. 2 Bonner. Charles M. Medical care and rehabilitation of the aged and chronically ill, by...and Freddy Homburger, 3ed. Boston, Little, Brown and Co., 1974. p.43. 3 Ibid.. p.40. 4 Stryker, Ruth Perin. Rehabilitative aspects of acute and chronic nursing care. Toronto, Saunders, 1972. p.13. 5 Ibid., p.36. 6 Kottke, F.J. The effects of hmltation of activity upon the human body. JAMA 196:826, Jun. 6, 1966. 7 Skelly, Madge. Aphasic patients talk back. Amer. J. Nurs. 75:7:1140-1142, Jul. 1975. 8 American Heart Association. Body language. New York, N.Y., n.d. Pamphlet. , The T.S.R.A. is composed of stroke victims and professionals who provide recreation, socialization, support and dissemination of information to other stroke victims and families Viewpoint '" . \ \ \ ' " .. (j{(f What are the bonds . QPJ) between the fetus and the uterus? ..... - - . --- ,. þ .... :1 '- '- ..., , . , . '-. .... II J f '" fl' __;a \I i , . 1 ....... m, _ 4t,mr __ ' oJ . '- - . -- , ... ? ( . toe lLoilnilQliln nurs., reurUllry ':ilIa ecause of her role as a provider of health care, the lUrse's involvement in the debate on abortion may be reater than she thinks. mcent W. Adamkiewicz .. n order to discuss the biological aspects of . bortion it is well, first. to distinguish between i bortion and the various methods of birth 'ontrol. as follows: ; Birth control methods p'revent, by natural -r artificial means, the union of the male sperm lith the female ovum at a time when the loman is not pregnant and whe there is no etus. Abortion on the other hand, is an xtirpation or removal of an existing fetus from a woman who is pregnant precisely as a result f the union between a sperm and ovum. Far rom preventing conception, an abortion annot take place without conception. It appears therefore, to be rather beside the point to argue in favor of abortion by appealing to arguments and reasons which are really concerned with birth control, family planning or the spacing of children. Woman's right over her own body "A woman's right over her own body" could be called upon in support of abortion in those cases where pregnancy resulted from parthenogenesis. This is a biological phenomenon in which the ovum develops into a fetus without an intervention of male sperm. Because of the genetic laws that govern the inheritance of sex, a woman's parthenogenetic babies would all be girls. Parthenogenesis is relatively easy to show. for example in rabbits But in spite of the affirmations of some specialists, parthenogenesis among women is probably as rare as the Immaculate Conception. In any case, the two historical examples of human birth without male intervention, first cited apparently in Buddhism and later in Christianity, could not have been parthenogenetic because they produced boys. Nevertheless. Buddha's sex is uncertain, I since this personality is variously depided as male, female or neuter. Normal pregnancies occur as a result of fertilization of the mother's ovum by the father's sperm. Consequently, the fetus is as much the "father's body" as the mother's. Therefore. the saying:"a woman has a right over her own body" loses much of its meaning when applied to the fetus and used as an argument in favor of abortion. The least a pregnant woman could do before ridding herself of the fetus is first to find out the father s wishes in the matter if at all possible. The genetic message The main discussion on abortion, however, concerns an entirely different question: "Is the fetus a human being?" Because if the fetus is not a human being, its extirpation by means of an abortion merely becomes one more simple surgical operation. On the other hand, if the fetus IS a human being, the act of terminating a human life by extirpation falls under the provisions of the Criminal Code. Let us examine this question in reverse, beginning with the end, which is birth, and ending with the beginning of the pregnancy, which is the fertilization of the ovum by the sperm. A newborn child, that is a fetus delivered after a full term or even prematurely, is a human being in all respects. Who would dare to consciously deprive it of life? Our conviction in this matter rests mainly on its anatomical resemblance to other human beings. If physiological resemblance is a criterion, we find, for example, that a two-month-old fetus already has a brain which emits brain waves (E.E.G.), and that a 20-day-old fetus has a heart which beats (E.C.G.) as in other human beings. Indeed, it is quite possible to study the nine months of fetal life by means of the various disciplines of biology, from the most macroscopic (anatomy) to the most microscopic (molecular biology), and show that, at each instant. the human fetus displays innumerable human characteristics: physical, chemical and biological. Indeed, the difficulty a biologisf encounters when retracing in reverse the life of the fetus is not in finding out that each instant it is a human being. Rather, the difficulty lies in establishing, at the very beginning of its existence, the fraction of the second, the electrifying moment, when the new individual is not yet! The male sperm and the female ovum carry within their nuclei a complete message containing all the information required to create a new human being. This genetic message is recorded on ribbons (chromosomes) by means of a special substance (nucleic acid) and in the form of various chemical molecules. Nevertheless, neither the sperm nor the ovum yet constitute new human individuals They are still part of the father and of the mother, and carry their genetic messages. Is it during fertilization, when the message in the sperm combines with the one contained in the ovum, that a new human being is born? Is birth a rearrangement of what already exists to produce something which did not exist a while ago? This newly conceived being is undoubtedly like its mother, since it carries all her message. It is also like its father, because it also carries his message. At the same time it is very different from both parents because ItS own message is a combination of the other two. This is the great paradox of which life is made: how to be different while at the same time remaining identical. The combined genetic message regulates the development of the human being during all the various stages of its life: fetal, infancy, adulthood and old age. It governs inexorably the form it will take, its bodily functions and its behavior. Gregor Mendel demonstrated by experimenting with peas how the genetic message regulates the form of living things. In the century since, many others have demonstrated the universal importance of the genetic message on the functions of all Jiving beings, ranging from viruses to man. In 1973, the Nobel Prize was awarded to Lorenz, Tinberger and Frisch for their demonstration of genetic controls over the behavior of vertebrate animals. Nevertheless. genetic control itself cannot escape the biological "difference-identity paradox." This is because, while transmitting the inexorable identity from one generation to the next, the genetic message continues to to be 'flexible". Indeed. each biological birth is necessarily and always accompanied by variations in the inherited resemblances (genetic variation). (Thus, "although the eyes of all women are beautiful. how much more so are the eyes of my beloved"). The triad: form, function and behavior, is not. however. enough to describe a human being. This is because, unlike other living things, man thinks. He has the ability to conceptualize, Of all the various human attributes, should the ability to conceptualize or think alone lie outside the control of the genetic message? Reason makes this difficult to accept. The founder of analytical psychology and psychiatry, Carl Jung, postulated the existence in man of archetypes, conceptual models which we need not learn because we recognize them automatically. Jung never explained the origin of archetypes, in spite of IJeing undoubtedly aware of the work on 28 The Canadian Nurse February 1976 Wllë! ë!r r-,e bonCl5___ heredity of animal behavior done by his contemporaries. Would not the existence of a material link between the genetic message (heredity) and the archetypal conceptualization constitute a molecular basis for man's conscience and, who knows, perhaps even for his idea of a Supreme Being? Should indeed such a link exist , it will undoubtedly be demonstrated sooner or later. We can only hope at present that the fetuses which have inherited the appropriate combination of genetic messages and have undergone the genetic variations necessary to elucidate this relationship will not have been aborted in the meantime. How to reconcile the rights of three separate beings? The mother's uterus is a special reproductive organ within which the fetus develops. What is not known generally is that the uterus also protects the fetus against possible harm from its mother, since the fetus, which is partly the father's body, constitutes a foreign tissue for the mother. Were it not for the uterine protective barrier, the mother would experience an allergic reaction against the fetus. Her body would destroy and reject it, as it destroys and rejects any implanted foreign tissue, be it a piece of skin or a heart.- In fact, some of the so-calted spontaneous abortions are caused precisely by such an allergic mechanism. Similarly, the mother's body constitutes a foreign tissue for the fetus. Were it not for the uterine protective barrier, the fetus would experience an allergic reaction against the mother. It would attempt to destroy and reject her, as it destroys and rejects any foreign tissue after it is born. This capacity of the fetus to experience an allergic reaction against its mother may be the most striking example of its biological individuality. Thus, the pregnant uterus is a very special organ. It belongs to the mother, of course, but it also contains another individual, the fetus. Moreover, this other individual is composed, in part, of the father's body and of his genetic message. Consequenlly, it belongs as much to him as it does to the mother. Three individuals therefore, seem to have claims on the pregm:mt uterus: the mother, the fetus, and the father. Why then, under the circumstances, should only one of them make the awesome decision regarding the life and death of the new individual? Would it not rather seem more appropriate to protect the pregnant uterus from such arbitrary decisions by granting it a certain extraterritorial status with respect to its mother's body and by surrounding it with the protection of the community? .. Vincent W. Adamkiewicz, professor of immunophysirnogy, Depanmentof Microbiology and Immunology. Faculty of Medicine, University of Montreal. This article also appears in the February, 1976, issue of L'infirmiere canadienne. Health Education . In Copenhagen For: Students in Health, Education, Community Nursing, Teaching, Social Work, Day Care and allied fields Dates: August 5 - 27, 1976 Cost: $999.00 includes air travel, room and board, tuition Credit: Can be taken for credit (6 credits) or non-credit For further Information contact: Gladys Lennox Director of Health Education 7270 Sherbrooke St. W. Montreal, Ouebec H4B 1R6 Tel: 482-0320 Local 427 Official Notice Canadian Nurses' Association 1976 Annual Meeting and Convention 20-23 June 1976, Halifax, Nova Scotia The 1976 Annual Meeting and Convention of the Canadian Nurses' Association will be held 20-23 June 1976 in the Commonwealth Room of the Hotel Nova Scotian, Hollis Street, Halifax, Nova Scotia. The opening ceremony will be held on Sunday evening, 20 June 1976 at 19:30, followed by a reception for members, students and guests registered for the meeting. Business and interest sessions will commence at 08:30, Monday 21 June 1976, continuing daily and concluding Wednesday, 23 June 1976 at 19:30 with the President's reception. Students enrolled in schools of nursing in Canada may register to observe the proceedings of the Annual Meeting and participate in interest sessions and social events. \",e t> ' , 'W . -.".. . . \' . ....................... Ik. .,' '#f!t' 'I. -:.,.; \ ,, : ,) ì j", '\ "\ . o S . ' C\ o1r\-L e {'L t ((\' ò. \'tJ O i,...., . C ", c. . \. \\\ Qt 09 . , C\lt\IC, Ò V- 0'1" J >/II' \\eø' ((\((\ùt\\., e òòe .r<\O'Cí lt\9 SC\\OO lt\eSO\ O \B ((\ : t. þ-s a. \. 0 ). 0.\' e1.\Bt\ð \,ot\ò \\\e 'l'iot\{lt\9 ,, \\ eò\l 'iOt\ te v, . 9'0 8 ' ùtSeS, 0\ \\e Q t\et ' '11. 0 LaC,.b erg te C\\lt\ \_,^ seò t\ " 0 \\\e to\e , "O\\\et g e ",,-0 \te Q ' 'V . 01' ' 0' Q" O(\ Of{\e(\S\ tYt.O(\S ò I'e'l'i \ e \\ea.\ \\ \tO òet\e . te Sù \\' S\'ð-(\\\'ð- 'Oe\(\g SU , ... \\ Þ 30 The CanadIan Nurse February 1976 Reaching Tomorrow's Citizens :} . : ... ,.- .. t , , , r , "" t' ' ..... t -,4t - 'Z; . . \ "'-'" .- .- .t' , !!!!!. IJII! ,.,' !!!"-''!! . ... . I >> . . .....\ , j. . At press time, continued funding from federal sources was in question. Two nurses from the Head and Hands Clinic in Montreal are teaching health "where iI's at" to the young people In their community - at the local high schools and community colleges (CEGEPs). They are the second team of Head and Hands health educators to carry this type of program into the schools of Notre Dame de Grace (NDG) In west-end Montreal. The Clinic that serves as their home base was established four years ago 10 meet the needs of the youth community in this area of the city. Since then, the orientation of the clinic has changed from a drop-in center for crisis intervention and drug counseling to a comprehensive health center for all ages. Head and Hands operates on funds provided by the federal government through the Non-Medical Use of Drugs Directorate.' Lawyers, dentists. doctors and other professional volunteers donate their services to Head and Hands without charge, although doctors do benefit if patients subscribe to Medicare. Paid personnel include the administrator. medical coordinator. counselors, health educators, nurses and office staff. Clients are asked to pay a nominal fee for tests and some services, if they can. An apartment over a shop next to pocket-sized Echo Park on Montreal"s Sherbrooke Street West houses Head and Hands. Furniture and equipment are donated, as are many of the medical supplies. Muc'h of the literature on the waiting room-s information shelf is obtained free from government agencies, associalions, food producers, and insurance companies_ Succinctly-worded posters on the walls are made by the staff. A notice board has been posted for the convenience of clients. In four years of operation, the clinic has come to serve more and more the general health needs of the young, and not so young, of NDG. The young come for counseling on drug and alcohol abuse. and family planning, for pregnancy tests, legal counsel, dental advice, and nutrition tips. The older segment of the population look to the clinic for the last three services. Hands reaching out As most of those using the clinic are under 20, it follows that many attend school. Thus, when the school nurse at nearby Dawson College asked the clinic to present a program on birth control to her students some time ago, the invitation was welcomed as an opportunity to extend the climc's services. Then, in October, 1973, the health educators. (at that time Elizabeth Best and Jane Turner ), set up their flrSI health display of pamphlets, samples of contraceptives, and a model of female reproductive organs. They decided to place their display tables just outside the cafeteria of the Selby Campus of Dawson College, where they hoped students would drop by on their way to and from lunch to look, ask questions, and ask for advice. The response was so encouraging that now, two years later, the health workers of Head and Hands spend most of their working day among the students at five CEGEPs and several hIgh schools in NDG. They are, however, still on the Head and Hands clinic staff. The first year of entry on the school scene was devoted mainly to developing a worthwhile program to dovetail with the efforts of nurses in the CEGEPs; preparing brochures, displays. and posters: obtaining educational materials and samples from producers; and coordinating suggestions from interested students. High schoots In the beginning" it was difficult to reach high school students. The two nurse-organizers wrote letters, and telephoned school principals and administrators of NDG only to receive no response, or the negative ones of "no time or "not feasible.-- Nevertheless, they continued to prepare IIleir battery of materials. It took a party to make everyone realize the clinic wasnt just for drug users and to generate active interest! In September, 1974, Head and Hands decided to hold a wine and cheese party. Formallnvitallons to high school teachers, nurses and counselors, and the school board of NDG brought nearly 60 visitors to the clinic tQ view the display of health teaching materials. tour the premises, and ask questions. Then, in 1974-75, several high schools asked Head and Hands for supplementary health education. Certain class times were turned over to Bess alJd Jane to allow them to teach human awareness, family planmng and preventive health in the two senior grades. When nutrition was the subject of discussion, students were encouraged to evaluate their own diets. Calorie counters. herbs to freshen the mouth, and nutritIous snacks were handed out to add interest and generate dialogue. In classes on family_planmng, Bess found working as a team with Jane to be especially helpful: dividing the responsibility for teaching and answering questions gave the sessions an air of informality and everyone gained confidence. Posters were used as a basis for reviewing the anatomy and physiology of human reproductive organs before going on to role playing. Bess or a student would play the role of a young girl and Jane that of the counselor. The dialogue that followed would cover wha a birth control pill can and cannot do, how a doctor examines a patient, the questions he asks, and a demonstration of bi rth control devices. Once, when demonslrating contraceptives, Bess inadvertently sprayed foam over the students in the front row! Laughter shattered any barriers that might have existed. Students are concerned about birth control methods, their side effects. and failure rates. Because they want to avoid peer reaction they usually save their questions until after the class. Several have asked: "My girl friend and I use this method. How effective is it ?" Not one hundred percenl, evidently, for pregnancies do occur among t'1e students and they usually follow a pattern, according to The CanadIan Nurse February 1976 31 Bess. Girls notice missed menstrual periods in September and October, after summer holidays or in February after the Christmas vacation. This has prompted scheduling of birth control displays to just before the summer vacation and the Christmas break. The displays are simple and practical. Some of the titles are: "This is what happens in the doctor"s office," "Questions the doctor will ask you," "This is a speculum." Bess and Jane are no longer with Head and Hands, buf their successors, Marg Hill and Marlene Fremming, are continuing to carry out the work they started and have built on the programs already established. Because of uncertainty about continued funding, they are also concerned about the future of their work in the community they are beginning to know. One addition to the original program is a session on smoking and health that was introduced at the request of one of the area high schools. It is now offered to 21 first year classes in two high schools. The students do breathing exercises as they learn the facts about smoking. A smoking machine is used to demonstrate the effect of smoking on the lungs. Marg and Marlene play down the danger of cancer, which means little to these 13-year-olds, but do emphasize the need for them to ignore peer pressure. Nutrition, dental care, and smoking are the main topics covered in this grade: family planning and venereal diseases are presented only to the more senior high school classes. "One school wanted us to include a lower grade in our birth control and VD programs," said Marg, "but we are not ready for that yet. We would have to do a lot of research to adequately reach these 11- and 12-year-olds and at the same time to feel comfortable in our own roles." CEGEP program In the CEGEPs, with up to 3,500 students, the bi-weekly health teaching program has to be informal. The original decision to present it at the busiest spot in the school, near the cafeteria, has proved sound. During lunch break, students cannot miss seeing Marg and Marlene at Head and Hands "Healthy Rider" booth at Selby Campus or at their pamphlet-laden tabie at other schools. Judging from the responses on evaluation Questionnaires, students like this casual approach and benefit from the educational materials and informal discussion of their problems. Each two-hour,noonday session is devoted to one subject, which may be drugs, heart disease, nutrition (including vegetarianism and snacking), dental care, or family planning. Other topics being prepared are stress, exercise, and ecology (pesticides and the environment), The CEGEP health nurses work closely with Marg and Marlene when planning programs by holding workshops and securing speakers and films to enlarge on the subjects dealt with at the displays An example of cooperative effort is the Fitness Fair jJresented in the cafeteria area twice a year. The fair on heart disease, for example, involves the dietetic and athletic departments of the school as well as Marg and Marlene. Dietitians are at their display table and are available for individual guidance on weight reduction and low cholesterol diets; the physical education instructors conduct tests for fitness on students riding stationary bicycles: and the health educators and school nurse take blood pressures and test vital capacity of the lungs. The multidisciplinary program helps to get across the idea that an individual's state of health is the result of many interrelated factors over which he has some control. Experience has shown that the fitness of CEGEP students generally is not up to the level expected of this age group. For instance, in the bicycle test, where students pedal a stationary bicycle at 60 strokes per minute, there are few who reach the 80% mark (upper 20% of population are considered fit) and too many who fall below the 40% level of fitness. Blood pressure is usually normal among the students, but when the systolic pressure reaches 130-140, they go to the dietitian's booth to be weighed and to discuss nutrition. They are referred to a physician for a more thorough checkup; many end up at the Head and Hands clinic for that. One student beamed with pride at having lost 15 pounds and hoped that his blood pressure would be down too. It was, but not enough to allow him to abandon his prescribed diet and exercise regimen. With encouragment and reinforcement from the nurses, he will probably eventually reach normal limits and regain a feeling of well-being, Conclusion The objectives that emerged during the first year of the program's operation are still applicable to the current, expanded program: . to help increase young people's awareness of health care, especially ifs preventive aspects . to encourage the young to adopt healthful lifestyles . to motivate young people to assume a more active role in their own continuing health education . to make health education an. enjoyable, relaxed nursing experience. Most important. informal liaison with school health personnel and flexibility allow the program to meet the changing needs of the young population served. In the future, it is hoped to increase the effectiveness of the program even further. by involving students in planning their own care program through a health council. .. Elizabeth Best (R.N., Montreal General Hospital school of nursing; B.A., Concordia University, Montreal) is now studying full time toward a B.Sc.N. Jane Turner (R. N., Montreal General Hospital school of nursing: B.A., Concordia University, Montreal) is with the federal government's medical services in Bntish Columbia. Marlene Fremming (R.N. Montreal General Hospital school of nursing) and Margaret Hall (R.N., Montreal General Hospital school of nursing; B.N., McGill University, Montreal), are the present health educators at the Head and Hands Clinic, The author is an assistant editor with The Canadian Nurse. -' ...... , ... \ -4 I '\ .. .. . ' - .. -- * --- - - .I,. -- .., :: r t \. -0' -;. " " ....i f . ..... t \, \ ... > \L ,.- II ,-:d I; 1 V _I -'I :.. .. ,.. .... . I . ". . . r." , J . . 1 .r Ø,..J - . I ...... . '- --,,-- --, " p " . , ' .. . ..' "" '" ... .. \. ... ..... shops and boutiques is wide. There s L Entrepot - contemporary designs in everything from chairs to cutlery: The Pewter House, handcrafted designs from the Maritimes. The Doll House, a delight to children, rich uncles and loving grandmothers; and Nova Pine where you II find reproductions and heritage crafts. quilts etc.. of Nova Scotia. The Duke of Granville, a 19th century restaurant, IS here too, as well as the studios of the Nova Scotia College of Art and Design. Closer to the waterfront is Privateers Warehouse, the long, low, rough-cut gray stone building that forms the core of the waterfront resforation. It dates from the profitable privateering activifies of Nova Scotians during the Napoleonic Wars and now houses a pub and two seafood resfaurants. Browse through A Pær of Trmdles in the Old Red Store, a book shop specializing In Canadiana and books on Nova Scotia, The Merchant Adventurers. featurrng the work of Nova Scotia artisans. The Sea Chest On the Wharf, The Wooden Store and Sail/oft. Then. stop for a giant ice cream cone or a hearty sandwich at Scoops in The Carpenter Shop and eat it out on the wharf while you watch the swaYing masts of the Bluenose, last of the "tall schooners, the harbor traffic and ironwork tracery of the two harbor bridges There are four ways to see Halifax: . By car: Competent gUides can be obtained through the Halifax Visitors and Convention Bureau. Follow the Kingfisher Route signs throughout the city, or use your Metro Guide This has an excellent description of historical and interesting sights. '3 ...- ... --'E ... -.",,- i- -S;4 - - '" - -- - -... - --- . - - . 4 ...... ...".,.,. ::---........ .. - .' .. - - .... .. . - - ..r- ._- ..:& .. :;y -" :-.; c- <:" '.- ,.. -.....---.. '-.:... . By bus: Both the Halifax Transit Corporation and Gray Line have sIghtseeing tours. Passengers are picked up at Holiday Inn. Citadel Inn. Chateau Halifax. Lord Nelson and Hotel Nova Scotian. . By water: Halifax Water Tours provides a complete tour of the harbor and the Northwest Arm. Or. see Halifax from the water on the Dartmouth Ferry. . By toot: If you like walking, the 45-minute tour of old Halifax is for you. Take your Metro Guide or the Walking Tour Guide provided by the ViSitors Bureau and start off from the Citadel. You II enJOY the sense of history all around you, catch the views of what has been called the finest natural' harbor in the world, and perhaps stop at The Five Fishermen, located in the oldest school building in Halifax and famous not-only for ItS food but also for its stained glass decor. The bUilding dates from 1818 and was at one time an art school under the direction Anna Leonowens, famed governess of the King of Slam. Halifax can also be a relaxing city with plenty of places to sit on a park bench and dream. Almost in the middle of the city is the Public Gardens. 17 acres of "green survival. ' including botanical gardens, ducks and swans, and wild birds nesting around a large pond. The Band Stand, where free band concerts are given on summer Sunday evenings, was erected In 1887 to honor Queef! Victoria-s Golden Jubilee. Point Pleasant at the extreme south end of the city features 186 acres of woodland, a free supervised swimming beach, a nature trail, footpaths. picnic tables, and places to build's fire for a barbecue, within sight of the sea. " ,1!k "\. '- I 'J ... c ::1 -J2i --- - I '*...; l1;li. ... ' ,.. . , ... , ...... ...... . .:;. r Art gallenes and museums, an abundance of them, are also yours to enjoy in Halifax. The three universities in the city. Dalhousie. Saint Mary's, and Mount Saint Vincent all have art galleries with active exhibition programs. These are supplemented by the new Gallery of the Nova Scotia Museum of Fine Arts (soon to become the Art Gallery of Nova Scotia), the Centennial Gallery at the Citadel, and three commercial galleries, including Zwicker s, founded in 1886. The Nova Scotia Museum on Summer Street near the Commons, IS very much a part of the city's and the provinces cultural. scientific and historical life. This museum also has a History Branch on Citadel Hill. 'nterested in trains? The Scotian Railroad Museum is the depot for railroad enthusiasts. You'" find it on Mumford Road near the CNR main line. 36 The Canadian Nurse February 1976 ...... .. ...... ............................................................................. Halifax has many good eating places. Post-Convention Tours "One of the ten best in Canada" says the RNANS Tentative Social Program Toronto Star of Fat Frank's Proof of the for CNA Convention 1976 Pudding restaurant on Spring Garden Road . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . It is superlative food, superlatively cooked by Sunday Night - June 20 Fat Frank himself. Another "dinner only" spot is the Night Watch at the Chateau Halifax. Here you will find a beautiful view, excellent food, and lovely music for dancing. The Henry House and The Little Stone Jug are two equally good restaurants, just three minutes walk from the Hotel Nova Scotian, in the old stone house of the Hon. William A. Henry, a Father of Confederation, at 1222 Barrington Street. There's Chez Jean on South Park Street and L'Hermitage, and The French Casino. on Gottingen for really fine French cuisine, The Heidelburg for hearty German fare, Mario's and The Gondolier for pasta at its best, The Maharaja for curries, Zapata's for Greek and Mexican specialities, and many well-recommended Chinese restaurants, including China Town, which is right on the water at Bedford Basin. "Down east hospitality" is waiting for you. Come to the Convention in Halifax - fall in love with all Nova Scotia-stay for three days and you II become a member of the "Order of . AUernatlve menu available Good Cheer," with a certificate to prove your membership in this oldest social club in the New World. But we hope you"!1 stay much longer - and we know you'll have the time of your life. If you'd like more information or have questions, write the Nova Scotia Department of Tourism, Travel Services, Box 130, Halifax, Nova Scotia. The following publications are also available for the asking _ 5 Accommodations and Campgrounds - Highway Maps - Events Calendar - Nova Scotia Holiday - Fish Nova Scotia's Saltwaters - Fish Nova Scotia's Freshwaters - Hunt Nova Scotia - Golf Nova Scolla - Dive Nova Scotia - Tour Nova Scotia. ............. .................... An Invitation To Student Nurses The Student Nurses' Association of Nova Scotia joins with the Nova Scotia members of the Canadian University Nursing Students Association in extending a warm welcome to nursing students from across Canada. You are invited to participate in the activities planned especially for students during the Canadian Nurses' Association Convention. There will be an informal social evening on June 20th at St. Mary's University where accommodation at reasonable rates will be available for students. On the evening of the 22nd of June there will be a supper and a "Barn Dance". We look forward to welcoming student nurses with "down east hospitality." For information: Sister Sharon Young, President S.N.A.N.S. Halifax Infirmary, Halifax, N. S. - John Dow, National Chairman, C.U.N,S.A., 6829 Vaughn Avenue, Halifax, N. S. Welcome to Nova Scotia Punch Party - with musical entertainment to be held immediately after opening ceremonies, at the Hotel Nova Scotian. Rum punch and plain fruit punch with cold hors d' oeuvres will be served. ................................. Monday and Tuesday Nights - June 21 and 22 - choice of: Lobster with Laughter - Lobster dinner and Ceilidh - pronounced Kalley - a Ceilidh is a gaelic word meaning a get-together with music, singing, dancing and lots of laughter. Tour to Peggy's Cove ending at the Shore Club in Hubbards, by the sea, for a lobster dinner'and musical entertainment. Water Tour of Halifax Harbor ending at the Clipper Cay Restaurant on Privateers Wharf for a Shore Dinner. Dorothy Miller is the Public Relations Officer tor the Registered Nurses' Association of Nova Scotia. \ .. 1 .\ j .. ... .1, " ;I I 1 " I .' ,IJ fl.. ';;"'J r: - ....., .. '1"r -- ß \ \ 1\1 ....r< ..._ \ . Jf--- . -_.....- . , I . , ,, ,, . ' . t ( , i" ...."": , 1 ...;,)- .. ' , ;; -.;. \ 1 /1 I ...: 1.lt . \>. J. f;P:. -w. .. . .2 -L- ,,;. -. . .- -* ,. i ... --:.,. r ::' ..... ..... . .. \ - ..... .. . .;. ;r 4-day tour of mainland Nova Scotia including Cape Breton where you will see the fortress of Louisbourg and the Alexander Graham Bell Museum at Baddeck. Cross romantic Cape Smokey to Cape Breton Highland National Park on the Cabot Trail and visit the Miners' Museum. Enjoy the spectacular scenery. 6-day tour of Nova Scotia, Cape Breton and Prince Edward Island, visiting Oak Island, Lunenburg, Habitation at Port Royal, Grand Pré. Taking the ferry from Cape T ormentine to Prince Edward Island, visit Summerside, Charlottetown, Anne of Green Gables Museum, Cavendish Beach and then see Cape Breton, the Cabot Trail, Louisbourg and Baddeck. Air-conditioned motor coaches are used for the tours and a qualified tour director will accompany each one. For further information write: Nova Tours Limited, P.o. Box 1555, Halifax, N. S Tel.- 902-429-3702 Toronto General Hospital graduates are invited to gel in touch with Mrs. J. F. Rafuse, 22 Piers Avenue, Halifax, to indicate their attendance at the CNA Convention in Halifax. The graduate nurses from this hospital who live in Nova Scotia will be arranging a special get-together. ............................. E- "'" ..;... .. .- r 'I JL.. --., - roo. ', ' '- Photos courtesy Nova Scotia Communication and Information Centre. 1 Princess Louise Fusiliers, Halifax Citadel. 2 Aerial view Halifax Waterfront. 3 Privateers' Wharf (restoration project) Halifax. 4 Handicraft boutique, Halifax. 5 Church at Grand Pré commemorating Acadian expulsion. 6 Surf near Peggy's Cove. ./ k'" "'c., -g- i J;J -,' í, ' I \ \ \ -1\ 'I I /1 " l' I ,, .... '- Style 138 Polyester/Nylon Corded Jersey Knit White-Blue-Pink-Ice Mint Sizes 4-16 .$28.00 , H \ ,, 4 ,YI' \, f I Style 131 PantSuit Polyester 'Ny' n I"r-rded Jersey Knit-White L . Trim White-Blue P Yellow Sizes 3- $30.00 the M/\GI(: /),.(:iICN sleeve We are proud to introduce another major advance in our endless search for new and improved techni- ques in the construction of our uniforms that will add to the comfort and convenience of the wearer. You will love the MAGIC- ACTION Sleeve. Be sure to ask for it. 'Patent pending No. 873659 The Career PantSuits shown here all feature The Magic-Action Sleeve. UNIFORMS REGISTERED 718 KING ST. WEST, TORONTO, ONTARIO M5V 1 N6 AT BETTER STORES THROUGHT CANADA . ,'-- .. j J" I : I :;./ .:. ijjíII \: : :: "I ,. f: i " :Ii ;ß' :f: (:15 -; ;: ,,':.f ,..,.... f 4 Style 180 PantSuit Polyester/Nylon Corded Jersey Knit-Swiss Embroidery Trim White- Blue-Mi nt-Peach Sizes 8-20.. . . .$30.00 Style 130 PantSuit Polyester/Nylon Corded Jersey Knit White-Blue-Pink-Mint Sizes 6-18 $26.00 38 The Canadian Nurse February 1976 X.llll(>>S ill)(1 Fil(-eS Gladys Sharpe, a former president of the Canadian Nurses' Association and of Ihe Registered Nurses' Association of Ontario, died in hospital November 18. 1975 after a lengthy illness. After a 42-year career that spanned active nursing, teaching, administration, and military wartime service. Sharpe retired in 1968 as senior nursing consultant on operating standards with the Ontano Hospital Services Commission to work with kindergarten children. Among her career assignments have been those of director of nursing, Toronto Western Hospital; World War II, matron of the RCAMC Hospital at Camp Borden and liaison oHicer for the Canadian, British, and South African army medical services: and director of the school of nursing at McMaster University in Hamilloh. .... , . --, - \ Vivian MacDougall (R.N., Sacred Heart Hospital school of nursing, Havre, Mont.: Dipl. Teaching and Supervision, U. of British Columbia) has been appointed nurSing coordinator for the New Brunswick Association of Registered Nurses. She has held general staH and head nurse positions in Saskatchewan, Washington, California, and with the Royal Canadian Navy. She worked as a clinical instructor in Ontario before moving to New Brunswick. where she held similar positions at the Saint John General Hospital School of Nursing and Victoria Public Hospital School of Nursing in Fredericton. MacDougall coordinated NBARN'S recent reorientation course for inactive nurses conducted at Victoria Public Hospital. Senior nursing department appointments at the Lions Gate Hospital, North Vancouver, B.C. were announced a few months ago: Joyce M, Campbell IS nursing director. A graduate in nursing from the Vancouver General Hospital school of nursing, she has diplomas in teaching and supervision. public health, and business administration from the University of British Columbia. She has held various nursing and teaching positions at the Vancouver General Hospital and, in 1967, joined the staH of the Lions Gate Hospital, where she has been supervisor," various departments, and nursing coordinator/director of nursing administration, Jocelyn Howden (R.N., Vancouver General Hospital school of nursing: B.S.N., University of British Columbia) is assistant nursing director, responsible to the nursing director for the supervision of clinical functions of the nursing department. Her nursing career has brought her to Australia and Ontario. Since 1961 she has been on staff at the Lions Gate Hospital, as head nurse, supervisor, and nurse coordinator/director of clinical nursing. Helen Graham is assistant nursing director, responsible to the nursing director for the supervision of staH allocation and coordination with clinical requirements of the nursing department. She earned her nursing diploma at the Victoria Infirmary, in Glasgow. Scotland, and has studied nursing unit administration at the University of British Columbia, Vancouver. Before joining the nursing staff of the lions Gate Hospital in 1966, she was on staff at the Toronto Western Hospital and the Victoria Hospilal, London, Ontario. The Alumnae Association of the Montreal General Hospital school of nursing has awarded 7 bursaries for post-basIc education in nursing to its members for the year 1975-1976. Recipients are: Susan Collins. Ellen Hennessey, Karen Finestone, Anne Mutz, Susan Burrows, Heather Ayerst Tyler and Susan Lindsay. All are in the Bachelor of Nursing program at McGill University school of nursing, Montreal. Alma Leclerc (R.N., St. Paul's Hospital school of nursing, Saskatoon) has been appointed program director of The New Brunswick Tuberculosis and Respiratory Disease Association. Her nursing experience includes general staff and head nurse positions at the Saskatchewan Sanatorium, with the Saskatoon Anti-Tuberculosis League, the Central Tuberculosis Clinic in Winnipeg, and the Royal Ottawa Sanatorium. She also worked for the Ontario Ministry of Health in Ottawa where she was a clinic nurse dealing with TB Drevention. and the Sudburv and Distnct Health Unit. with emphasis on community work. Leclerc sees her new role as mainly educational, involving professionals and the public One of her top priorities is to establish a nurses' section of the Association, as part of the educational program for professionals or Judith M, Skelton (B.Sc.N., McMaster University, Hamilton; M.Sc.N., University of British Columbia) has been appointed coordinator of nursing education at Okanagan College, Kelowna, B.C. She has taught at St. Michael's School of Nursing, Toronto, The Vancouver General Hospital School of Nursing and the University of British Columbia. Most recently, she was employed as a public health nurse with the Central Okanagan Health UOIt, Kelowna. Okanagan College anticipates admitting its first class of RN students in September 1976. An LPN program is already established there. \. ,.- Constance Swinton (R.N.. Royal Alexandra Hospital school of nursing Edmonton B.N., McGill University, Montreal: M.P.H., University of Michigan, Ann Arbor) has been appointed consul1ant with CARE/ MEDICO in Solo, Indonesia. She is on loån for one year from the Canadian International Development Agency, which she joined a year ago. Her major function will be to work with CARE's country director and local authorities to plan and evaluate rural public health programs with a view to expanding and improving them, Swinton has been director of education and projects at the national office of the Victorian Order of Nurses: public heal1h consul1ant with child and adult health services, Health and Welfare Canada: and an assistant professor In the population unit School of Hygiene, University of Toronto. Mary Dohey (R.N.. St. John's Genera Hospital, St. John's, Nfld.) has been awarded the Cross of Valor, Canada's highest decoration for bravery. On November 11 ,1971, as an Air Canada flight hostess she averted a major tragedy by spending eight hours pacifying a man. armed with a shotgun and dynamite, who had hi-jacked a DC-8 plane flying out of Calgary. He forced the crew to land the plane at Great Falls, Montana, where he obtained a ransom of $50,000. Dohey then persuaded him to let the plane land again at Great Falls to allow the 118 passengers and some ot the crew to leave the plane. Dohey has been a part-time nurse at St. Joseph s Hospital in Toronto and recently was awarded her 10-year nursing pin. The CanadIan Nurse February 1976 39 p . FIRM À N E a true test of knowledge I I Rely on these new texts to help students perform with optimum results-optimum patient care \ .,jr - ...... I- - edicall surgical New 6th Edition! MEDICAL-SURGICAL NURSING The first text to effectively combine medical and surgical nursing, the new 6th edition of this popular book con- tinues to lead the field. With increased emphasis on physiology, nursing assessment, and pathophysiology, this edition provides thorough and current information on fundamentals while adding new material, Additions in- clude: new chapters on ecology and health; expanded in- formation on cardiac disease; new guidelines for family planning counseling, with explanations of physiology of reproduction and contraception; and new chapters on neurologic disease, musculoskeletal disorders, and in- juries; and more! By Kathleen Newton Shafer, R.N., M.A.; Janet R. Sawyer, R.N. Ph.D., Audrey M. McCluskey, R.N., M.A., SC.M. Hyg., Edna Lifgren Beck, R.N., M.A., and Wilma J. Phipps, R.N., A.M.; with 28 contributors. April, 1975. 1,032 pages plus FM I-XVI, 8'/2" x 11 " , 608 illustrations. Price, $17.35. A New Book! PAIN: Clinical and Experimental Perspectives For the first time, a single volume presents the insights and knowledge of foremost researchers in pain. This fasci- nating selection of readings provides both general and detailed views of pain from the perspectives of various ex- perimental and clinical disciplines. Among the intriguing topics explored are: sex differences in pain tolerance and perception; pain reactivity and family size; conttol of pain motivation by cognitive dissonance; surgical treatment of pain; pain and cancer; pain in psychiatric patients; etc. Edited by Matisyohu Weisenberg, Ph. D. July, 1975 386 pages plus FM I-XII, 7" x 10 V. ", 86 ,IIustrations. Price, $10 00. New 2nd Edition! ESSENTIALS OF COMMUNICABLE DISEASE For a concise presentation of communicable diseases and appropriate nursing care, offer your students this exten- sively revised new edition. Including up-to-date informa- tion and new statistics, the text examines each specific disease, its etiology and stages, clinical manifestations, diagnosis, treatment, prevention, and control. New material covers: jet borne communicable diseases, rashes, common cold, congenital rubella, venereal disease and the changing role of the nurse in caring for patients with V.D, By Mary Elizabeth Mcinnes, R.N., B.Sc.N., M.Sc.(Ed.) July, 1975. 402 pages plus FM I-X. 6'/2" x 9'12", 34 illustrations. Price. $10.45. 40 II The Canadian Nurse February 1976 , undamentals/basic science , New 11 th Edition! MICROBIOLOGY AND PATHOLOGY Thoroughly updated, this popular text offers the conte?1- pOtary essentials of microbiology a?d patholog . Pa t I 10- cludes: basic concepts of microbIOlogy; classification of microorganisms; microbe anions on living cells of the human body, and the effects; and ptevention and control of disease. In Part II, pathology is explored in the tradi- tional two-pan manner. Review questions accompany each chapter. By Alice Lorraine Smith, A.Boo M.D., F.C.A.P., F.A.C.P. April, 1976. Approx 720 pages, 8" x 10", 563 illustrations, 2 full page color plates. About $15.70. New 13th Edition! PHARMACOLOGY IN NURSING Now available in a new updated edition, this classic text presents current concepts of pharmacology in relation to clinical patient care. Complete discussions cover basic mechanisms of drug anion; contraindications for drug therapy; toxicity and side effects; safe therapeutic dosage range, ete. Expanded information is provided on drug in- tetactions, pharmacologic effects, nursing care, and more. By Betty S. Bergersen, R.N.. M.S., Ed.D., in consultation with Andres Goth, M.D. February, 1976. Approx. 732 pages, 8" x 10", 143 illustrations. About $14.20. New 9th Edition! TEXTBOOK OF ANATOMY AND PHYSIOLOGY The most widely adopted anatomy and physiology text- book is now available in an updated new 9th edition. This edition featutes three new chapters on the nervous sYStem; 26 new and modified illustrations; new information on brain waves, altered states of consciousness, and the" emo- tional brain"; biofeedback training; expanded discus- sions of liver functions, reproduction, physiology of cir- culation; and more! By Catherine Parker Anthony, R.N., B.A., M.S., wilh the col- laboration of Norma Jane KOlthoff, R_N., B.S., Ph.D. April, 1975_ 598 pages plus FM I-X, 8" x 10", 336 figures (145 in color), in- cluding 239 by Ernest W. Beck, and an insert on human anatomy with 15 full-page plates, with 6 in transparent Trans-Vision by Ernest W. Beck. Pnce, $13.90. New 10th Edition! WORKBOOK OF SOLUTIONS AND DOSAGE OF DRUGS: Including Arithmetic A concise workbook, this new edition relates basic mathematics to common solutions and dosages, and pro- vides information essential to proper calculation, prepara- tion, and administration of drugs, Updated throughout, material places more emphasis on the metric. system and includes many new problems. The totally rewntten appen- dix contains drug standards and legal regulations; metric doses and apothecary equivalents; and more. By Ellen M. Anderson, R.N., B.S., M.A. and Thora M. Vervoren, R.Ph., B.S. January, 1976. 168 pages plus FM I-VIII, 7'A" x 10'/2", 26 illustrations. Price. $6.55. A New Book! CLINICAL LABORATORY TESTS: A Manual for Nurses Designed for quick reference, this valuable new manu.al will help students transcribe physicians' orders, explam tests to patients, collen laboratory specimens, and under- stand written laboratory reports. Basic concepts of physiology and medical-surgical nursing are includ d where relevant. Laboratory procedures appear 10 alphabetical sequence; and abbreviations and symbols are explained, By Marcella M. Strand, B.S.N., R.N. and Lucille A. Elmer, B.S. in M. T., M.T.(A.S.C.P.). April, 1976. Approx. 104 pages, 5'12" x 8'/2", About $5.75. New 3rd Edition! THE FOUNDATIONS OF NURSING: As Conceived, Learned, and Practiced in Professional Nursing This timely text provides students with reliable informa- tion on responsibilities, opportunities, and changes in professional nursing. This new 3rd edition discusses p e- sent day nursing roles in relation to such televant topiCS as: abortion;- euthanasia; changes in nurse practice acts; transitional problems from student to practicing nurse; in- stitutional licensure vs. individual licensure; death and dying; ete. By Lillian DeYoung, R.N., B.S.N.E., M.S., Ph.D.; with 3 con- tributors. April, 1976. Approx. 336 pages, 7" x 10",14 photos, 29 illustrations. About $10.00. The CanadIan Nurse February 1976 41 r J amily . I nurSing '.11 t, " " '. New 2nd Edition! FAMILY NURSING: A Study Guide Updated discussions and new case studies help students ex- plore clinical application of family nursing techniques, In- dividual sections examine problems of beginning families, families with school age children, "middle years" and ag- ing families. By Evelyn G Sobol, R N., A.M. and Paulette RobisChon, R.N., Ph.D. June, 1975. 182 pages plus FM I-XVI. 7" x 10". Price. $7.90. ehavioral science A New Book! BEHAVIOR AND HEALTH CARE: A Humanistic Helping Process This clinically-oriented text helps students understand the social-emotional helping process in health care delivery, The authors present an advocacy model for humanistic helping that provides a framework for evaluation of care. By Jane E. Chapman, R.N.. Ph.D. and Harry H. Chapman, Ph.D. October. 1975. 194 pages plus FM I-XII. 7" x 10". Price, $7.90. i , - ,1 A New Book! BEHAVIORAL METHODS FOR CHRONIC PAIN AND ILLNESS The first book (0 discuss pain from a behavioral perspec- tive, this new text provides: a conceptual background of pain; detailed evaluation and clinical treatmem pro- cedures; and imponam guidelines for support nurses can give to patiems' families. By Wilbert E. Fordyce, Ph.D. February, 1976 Approx 256 pages, 7" x 10", 25 illustrations About $10.00. ssues, education, administration [, New 6th Edition! RIGHT AND REASON: Ethics in Theory and Practice In this new edition, thought-provoking material examines contemporary ideas on women's roles; education; en- vironmemal responsibilities; death; and trade. By Austin Fagothey, S.J. April, 1976. Approx. 488 pages, 7" x 10", 1 illustration About $13. 15. New 3rd Edition! CREATIVE TEACHING IN CLINICAL NURSING This new edition explores the role of creativity in clinical teaching. It includes teaching approaches, technology, and educational communication media By Jean E. Schweer, R N., B.S., M.S. and Kristine M. Gebbie, R N., M.N. February, 1976. 216 pages plus FM I-VIII" 7" x 10", 3 illustrations. Price, $8.35. A New Book! MANAGEMENT FOR NURSES: A Multidisciplinary Approach This excellem new (ext presents readings from various disciplines (business, behavioral sciences, ete.) - all designed to acquaim studems with leadership/manage- ment concepts, By Sandra Stone. M.S.; Marie Streng Berger, M.S., Dorothy Elhart, M S., Sharon Cannell Firsich, M.S.; and Shelley Baney Jordan, M.N. December, 1975. 280 pages plus FM I-XII, 6 3 A" x 9 3 /.".24 illustrations. Price, $8.65 1.,.. ritical care New 2nd Edition! DECISION MAKING IN THE CORONARY CARE UNIT Here, simulated crisis situations provide students with clinical experience in making decisions in the CCU, Each case includes an EKG tracing and adequate information to determine treatment goals, actions, and evaluation. A new chapter on patient education is included. By William P. Hamilton, M.D. and Mary Ann Lavin, R.N., B.S.N., M.S.N. April, 1976. Approx. 184 pages. 7" x 10", 126 illustra- tions About $6.85. k \ A New Book! SPATIAL ANALYSIS OF THE ELECTROCARDIOGRAM: A Program This new programmed text develops a method for spatial analysis of any electrocardiogram. Using a question-and- answer format, the book covers: orientation of frontal plane leads; mean frontal QRS vector; and mean horizon- tal QRS vector, By Irwin Hoffman, M.D.; Julien H. Isaacs, M.D.; James V. Dooley, M.D., Phil R. Manning, M.D.; and Donald A Dennis, Ph.D. May, 1975. 150 pages plus FM I-X, 7" x 10",199 illustra- tions Price, $7.65. New 2nd Edition! A COMMONSENSE APPROACH TO CORONARY CARE: A Program Students can learn all the major problems associated with acute myocardial infarction with this programmed book. This new 2nd edition includes new information on drug therapy of shock and heart failure; hemodynamic moni- toring; and more, Background material is included. By Marielle Ortiz Vinsant, R.N., B.S.; Martha I. Spence, R.N., 8.S., M.N., and Dianne Chapell Hagen, R.N.. B. S. October, 1975.228 pages plus FM I-XVI, 7" x 10" 439 illustrations. Price, $7.65. ractical nursing New 6th Edition! SIMPLIFIED DRUGS AND SOLUTIONS FOR NURSES, INCLUDING ARITHMETIC Updated throughout, this text helps students acquire the practical understanding needed to solve problems of dosage, solution, and interpretation of drug orders, In three sections, the book reviews basic arithmetic, systems of weights and measures, and dosages and solutions, By Norma Dison, R.N., B.A., M.A. March, 1976. Approx. 120 pages, 5V2" x 8'/2",18 illustrations. About $5.00. New 3rd Edition! BASIC MATERNITY NURSING This family-centered approach to obstetrical nursing emphasizes principles of care and nursing roles for all situations. Topics cover: reproductive anatomy and physi- ology; embryonic development of the child; complica- tions; effects of pregnancy on both parents; and more, By Persis Mary Hamilton, R.N., P.H.N., B.S., M.S. May, 1975. 248 pages plus FM I-X, 7" x 10", 159 illustrations. Price, $7.30. New 2nd Edition! CARE OF PATIENTS WITH EMOTIONAL PROBLEMS: A Textbook for Practical Nurses Designed to help nursing students identify and meet the emotional needs of patients, this new 2nd edition provides essential background information on personality develop- ment, dynamics of behavior, and manifestations of anxie- ty and defense mechanisms. By Dolores F. Saxton, R.N.. B.S., M.A., Ed.D. and Phyllis W. Har- ing, R.N., B.S., M.S., M.Ed. May, 1975. 110 pages plus FM I-VIII, 6" x 9".8 illustrations. Price. $5.00. IVIDSBV TIMES MIRROR THE C V MOS8Y COMPANY L TO 86 NORTHLINE ROAD TORONTO ONTARIO M48 3E5 The CanadIan Nurse February 1976 43 X tlll(tH tll(1 F I(.(>>H Recent appointments to the faculty of he University of Alberta school of ursing include: Joan Affleck (R.N.. Royal Alexandra Hospital school of nursing, Edmonton: B.Sc.N.. University of Alberta) lecturer, who was formerly with the Victorian Order of Nurses in Peterborough, Ontario; Rene Day (R.N., B.Sc.N.. University of Alberta school of nursing: M.S., University of Hawaii) assistant professor, who has been a public health nurse with the City of Calgary health department and a lecturer at the U. of Alberta school of nursing, Edmonton; Sylvia King-Farlow B.Sc.N., University of Alberta; M.Ed.. University of Ottawa) lecturer, who has had extensive nurSing, supervisory, and teaching experience in hospitals in Edmonton, Los Angeles, Culver City, and Guelph: Jane Ligowski (B.Sc.N., I University of Toronto school of I nursing), visiting lecturer. who has been a public health nurse in Midland, Ontario and staff nurse at the University of Alberta Hospital. Edmonton: and Reita Markovich R. N.. Victoria Hospital, school 01 nursing, London: B.Sc.N. University of Alberta) clinical supervisor, who has been engaged in general duty and public health nursing in London, Peace River, Port Alberni, Calgary, and Edmonton. Claire Kane (R.N.. St. Martha s school of nursing, Antigonish: B.Sc.N.. University of Ottawa) has been appOinted executive director of Planned Parenthood Ottawa, succeeding Mary Mills who has become executive director of the Planned Parenthood Federation of Canada in Toronto. þ Marjorie Hewitt (R.N., Vancouver General Hospital school of nursing: BASe., University of British Columbia) has been appOinted nursing consultant with the Saskatchewan Registered Nurses Association. Formerly assistant director of the Regina Grey Nuns (Pasqua) Hospital school of nursing she has also had extensive clinical and teaching experience with the Royal Inland Hospital in Kamloops, B.C., and the Regina General Hospital. Nurses appointed during 1975 to the faculty of nursing at Dalhousie university. Halifax, include: Shirley Halliday (R.N., Victoria Genera' Hospital school of nursing, Halifax, B.N.. Dalhousie University), lecturer. She was formerly instructor and curriculum coordinator at the Victoria General Hospital school of nursing, Halifax. Judy Harwood (R.N.. Toronto General Hospital school of nursing: Dip!. Public Health and Outpost Nursing, Dalhousie University), lecturer In outpost nursing. She has worked in the emergency department. Toronto General Hospital. and with the medical services branch of Health and Welfare Canada at Aklavik, N.W.T. Ruth C. MacKay (BA, McMaster University, Hamilton: M.N.. MA, Emory University. Atlanta, Ga.: Ph.D. University of Kentucky, Lexinglon, Ky.), associate professor. Since returning to Canada In 1969, Dr. MacKay has been associate professor a1 Queen s University, Kingston, and at McMaster University, Hamilton, Ontario. She has had articles published in several professional journals Hattie Lee Shea (R N., Dallas Methodist Hospital school of nurSing: B.S N.Ed.. M.S.N., University of Texas, Austin), associate professor. Her previous appointment was that of assistant professor, University of Western Onlario, London and, prior to coming to Canada In 1970, she worked In various centers in Texas. Marilyn Walper (B Sc.N.. University of Saskatchewan, Saskatoon), lecturer. During her nursing career as staff nurse and instructor she has worked In Saskatoon and Moose Jaw Saskatchewan; Barne, Ontario; Portage-La-Prairie, Manitoba; and Dartmouth. N.S Leslie White (R.N., Montreal General Hospital school of nursing: B.N., University of New Brunswick, Fredericton: M.Sc.N., University of Western Ontario, London), lecturer. She has been on the nursing staff of the Sensenbrenner Hospital, Kapuskaslng, Ontario; Montreal General Hospital, Montreal: Hotel Dieu Hospital. Perth. New Brunswick: a"d Victoria Hospital, London, Ontario. Ardythe Wildsmith (R.N.. Nightingale SChool of Nursing, Toronto; B.N.. Dipl. Public Health, Dalhousie University), lecturer. She was formerly an Instructor at the Victoria General Hospital school of nursing, Halifax. ( 11(t11(1 11. February 28 - 29, 1976 Post-Anesthetic Recovery - A Conference for Nurses, to be held at University of British Columbia, Vancouver, B.C. Formformation write: Continuing Education in Health Sciences, Woodward Instructional Resources Centre, University of British Columbia, Vancouver. B.C. V6T 1 W5. April 2 - 4,1976 Biennial meeting of the Northwest Territories Registered Nurses Association to be held in Yellowknife, NW.T. March 24. May 12, 1976 Course: 'Recent Advances In the Nursing Care of Ihe High Risk Pregnancy Patient and the Newborn Infant," Wednesday evenings at the McLennan PhysIcs Building, University of Toronto. For information contact: Dorothy Brooks, Continuing Education, Faculty of Nursing, University of Toronto, 50 Sf. George St., Toronto, Ont., M5S lAl. April 5-9, 1976 Rehabilitation nursing workshop to be held in Edmonton. For Information, write: Nursing Education Coordinator Glenrose Hospital, 10230-111 Avenue, Edmonton,Alta. April 29 - May 1, 1976 Annual Meeting of the Registered Nurses Association of Ontano to be held at the Royal York Hotel, Toronto, Ontario. April 23 - 24, 1976 Interdisaplinary Respiratory Disease Workshop sponsored by the New Brunswick Tuberculosis and Respiratory Disease Assoaation will be held at the University of New Brunswick in Fredericton, N.B. For further information write: Alma T. Leclerc, Program Director, New Brunswick TB and A.D. AssocIation, 123 York Street, Fredericton. N.B. E3B 5E3. April 19 - 23, 1976 Advanced refresher course for obstetrical nurses to be held at the School of Nursing, University of Alberta, Edmonton. For informatIon, wflte: Continumg Education for Nurses, 12-103 Clinical Sciences Building, University of Alberta. Edmonton, Albena T6G 2G3. May 17 - 19, 1976 General Foods National Nutrition Seminar at the Toronto Hyatt Regency Hotel, a multi-disciplinary approach to nutrition For information, contact: Una Abrahamson, Co-ordinator, Genera) Foods Nutrition Service, Suite 400, 4th floor. 2 Bloor Street West. Toronto, Ont.. M4W 3K1. 44 The CanadIan Nurse February 1976 I \\11 at s Ne\y · 4 .: 4 . . ----- ". .... J '\ --- -'- II. J . "" : .-= 1'J ..... J IV Feeding Pump The IV AC 600 IV Pump infuses IV fluids and drugs precisely and dependably in cc's per hour, using its own sterile disposable infusion set. Its infusion rates are from I to 999 cc's per hour. The prescribed infusion rate In cc's per hour is obtained by setting a dial. Weighing less than 9 Ibs., the Model 600 has selfcontained battery Power for portability, or operates on standard line voltage. Forinformation, contact: IVAC Corporation, 11353 Sorrento Valley Road, San Diego, California 92121, U.S.A. New Disposable X-Ray Cassette Cover A heavy-duty plastic x-ray Cassette Cover has been added to the Convertors line of disposable operating room safeguards. The cover is economical because no laundering, restenlization, folding or packaging is required. Made of heavy lint-free clear plastic, the cassette cover is impervious to blood and fluids. After the laminated package and sterile wrap are opened, the scrub nurse inserts her hands into the deep cuff where indicated. The circulating nurse then drops the x-ray cassette into the cover and th fold-over cuff Isolates contamination. One size fits all cassettes. For further information, write: Convertors Division of American Hospital Supply Corp., 1633 Central St., Evanston, III. 60201, U.S.A. Service Tray Vollrath s new tray is available in Mint Green or Gold. Made of strong polystyrene, and tear-drop-shaped, it holds a carafe and tumbler. The tray has feet to prevent it from sticking to bedside stand or table. It measures 8 7 / 8 " X 5 5 / 8 ", and is available in bulk, or as part of Vollrath's customized kit program for individual use. For information, write: The Vollrath Company, 1236 North 18th Street, Sheboygan, Wisconsin 53081. ...... --'L . . . - . _. . La Belle Pia-Malic Controller The Pla-Matic Controller introduced by La Belle Industries facilitates presentation of visual programs using existing remote-controlled slide or film-strip projectors. The Controller commands the projector to advance the visual presentation so that It is synchronized with the taped audio. It is useful when presenting audio/visual programs for in-plant or office training, on-the-road selling, or dissemination of important knowledge. The Controller can synchronize the audio with other switch-operated devices, such as animated displays or programmed lighting effects. The Controller weighs nine pounds and measures 9" x 6" x 6". A handle is furnished for easy carrying. Programs can be 18 or 36 minutes long. Slides or filmstrip frames can be rapidly changed for animated motion effects. For information write: LaBelle Industries, Box 128, Oconomowoc, WI 53066. C.R. Shoe Covers Shield disposable shoe covers from Convertors are designed to cover the shoe completely. They come in 3 styles, all of strong and lightweight nonwoven fabrics that create impermeable fluid barriers and prevent excessive heat build-up. The covers are durable, nonskid and noise-free. The "Perfect Fit" style (illustrated here) fits all sizes, Elastic instep insures snug, comfortable fit. Available with or without conductive strip, they are supplied in space-saving dispenser cartons. The elastic top shoe cover has a comfortable elastic closure and is color-coded for easy inventory by size. Available in 4 sizes, conductive only. "' tilt At ",I ) -- ) . -' 4f' j ... " " The Rubber Band Closure style, especially designed for men's and women's high-top shoes. assures a comfortable fit without binding at the ankle. Available in 3 sizes, conductive only. For information write: Convertors Division of American Hospital Supply Corp., 1633 Central Street, Evanston, IL 60201. PROTECT SKIN "- from contact with Irntatmg exudate with a Karaya Blankel around the wound site - ç- INSPECT WOUND through transparent Access Cap without trauma of dres-mg removal to treat wound or advance dram tube remove Just the Cap -COLLECT EXUDATE m a Dramage Collector that keeps flUid away from wound and odor away from patient Hollisters uu I sheds new light on draining wounds If only someone made a dressing you could see through. A dressing that lets you see hemorrhaging or other un- welcome conditions developing at the wound site A dressing that keeps dram age away from the wound and protects the skin A dressing that lets you easily assess and measure exudate Now someone makes such a dressrng The HOllister. Dralnmg-Wound Management System makes it easy for you to see what s happening at the wound site. No more guesswork. no more need for traumatic time-consuming and costly dressing changes Everything IS supplied sterile for quick application in the a.R. recovery. I.C.U. or patient's room. No messy wet dressmgs to handle or change so post-operative care will be simpler. . and generally less expenSive. If you want to see what s going on at the wound site. you' II want to see the. transparent dressing ,. Write for complete information. Hollisler Dr.ining-WOUn I;; G >JOLLISTER LlMITEO 332 CONSUMERS ROAO WILLOWOALE ONTARIO M2J IPS COPYRIG.....T 1975 HOlUSTEFt INCORPORATED ALL RIGHTS RESERVED 46 11()oJtS The Canadian Nurse February 1976 Nursing the Dying Patient by Charlotte Epstein. 210 pages. Virginia, Reston Publishing Co.. 1975. Reviewed by Betty Johnson, Lecturer in Nursing, The University of British Columbia, Vancouver. B.C. I I I II In the past ten years, the literature concerning the care of the dying patient has gone from next-to-nothing to remarkable in quantity (and, usually, in quality). The hard work and compassionate attitude of Elisabeth Kübler-Ross is an outstanding example of bringing to our awareness the personal needs we all have in facing death - our own and our patients'. Western society has encouraged us to deny death. In order to avoid running from our dying patients we have to face our fears about death. The literature GrIes out against abandoning the patient, but we are still left with the task of how to actually get ourselves into the real situation with our patients and their families. Charlotte Epstein's book Nursing the Dying Patient tries to help student and teacher (and in the author's approach these roles are always interchangeable) bridge the gap between theory and practice. Her objectives are to have us learn to face our own dying and learn to interact with dying people. The strength of the book rests in the way Epstein has provided the reader with a rich variety of exercises, role-play situations, practice interactions, and thought-provoking questions. This book is not to browse through. rather it is a book to be worked through in a small and supportive group. It contains a gold mine of activities outlined in specific detail and with a firm theoretical base. A group working with this book will get in touch with the myriad of emotions encountered when facing death and will also have the practice needed to confidently enter nurturing relationships with dying patients. Clinical Nursing 3ed., by Irene Beland and Joyce Y. Passos. 1120 pages. New York, Macmillan, 1975. Reviewed by Basu Majumdar, Assistant Professor, School of Nursing, McMaster University, Hamilton, Ont. This book is an improvement over the first and second editions. The authors have used patient-centered and problem-solving approaches. The book deals with the basic sciences necessary to understand "pathology." Most of the 19 chapters are comprehensive and include anatomy, physiology, biochemistry and family oriented patient care including the acute, chronic, and rehabilitative stages. The "psychosocial Impact of illness on a patient" and the spiritual needs of a patient are emphasized by the authors. In the preface. the authors explained that they have reorganized and updated the cc.ltent of the book. They have attempted to demonstrate the importance of nursing intervention in the clinical setting and also the importance of applying basic science principles to a variety of nursing situations. Focus is placed on the promotion of health, Ihe prevention of disease, the medical treatment and nursing care of people with illness, and the differences between health and illness. The case studies are very helpful and they provide opportunities to discuss and understand the dynamics of various biopsychopathologies. The book is organized and begins with physiology, injurious agents, and responses of the body to injury. The major focus is then given to specific problems in clinical settings. The illustrations and diagrams are helpful and the reference materials that are included at the end of each chapter are current . and comprehensive. Most of the common and current clinical conditions are treated by the authors. The discussion on 'Pain' is given in detail and the Important points are highlighted. The chapter "Summary of Some Responses to Injury" is well explained and organized "Nursing the Patient Having a Problem with Some Aspect of Transporting Material To and From Cells" IS an excellent and comprehensive chapter. Anatomy; physiology; assessment of the patient with different conditions, e.g., anemia, venous and arterial problems during therapy; diagnostic tests: surgery: and nursing interventions are included. Illustrations on page 672, are very helpful in understanding fluid retention in congestive heart failure. "Nursing the Patient in Shock," another excellent chapter, includes the effects of shock on each body syste,ll and the responses by the systems. Causes Qf shock and "how may the degree of cardiovascular responses be determined" are explained well. This reviewer believes that the book could not be used as a quick reference. The printing in this book is still distracting and the method of marking important points could be improved. However, it is a comprehensive text for the graduate nurse and an excellent basic text for baccalaureate nursing students. Designing Hospital Training Programs by Reba D. Grubb and Carolyn J. Mueller. 199 pages. Springfield, III., Charles C. Thomas, 1975. Reviewed by Sharon Richardson, Nursing Instructor, Selkirk Community College, Castlegar, B.C. Essentially a handbook on "how to"; Designing Hospital Training Programs IS rooted in the philosophy that a hospital-wide educational service is preferable to multiple, Independently organized. and administered inservice programs offered by separate departments within the institution. The rationale presented by the authors states that "hospital-wide programs should be designed to improve patient care, thereby, reaching the individuals involved, regardless of the department in which they work." Guidelines for evolving a hospital-wide educational program, including a basic overview of learning theory, are presented in the first half of the book. Included, are suggestions for the use of instructional material, a description of selected teaching methods and teaching aids. A diScussion of the formal organizational component required by a hospital-wide educational program, is Introduced in the first chapter. However, this aspect is not developed. The second half of the book is devoted to sample program outlines, or "modules." These modules are presented In some depth since "the authors hope that they may act as a guide to establishing and expanding training programs on a hospital-wide basis." At intervals throughout the first half of the book, the authors indicate that they perceive the role of a hospital education program as being considerably broader in scope than simply to serve hospital needs. For example, mention is made, on pp. 15 - 16, of hospital sponsored classes that "eliminate basic educational deficiencies and lead to a high school diploma." In light of existing educational resources for upgrading, e.g.. high school, adult learner classes, and college preparatory programs, duplication of services by the hospital seems unjustified. Essentially, the authors appear to have achieved their stated goal of presenting in a single volume the synthesized elements of a hospital-wide educational program. Unless one is employed as an educational coordinator in an institution that uses this approach to inservice, the most informative aspects of the book would probably be chapters 2-4. The steps that are involved in planning and implementing a particular in service program are discussed here. This book cannol take the place of existing texts that deal with theories of learning or methods of instruction. However, it could serve as an adjunct In the development of specific, instructional programs. Nursing coordinators, in particular, might find it a useful guide to supplement other standard texts and articles. .. b N tCUU;) N YV btCUUt" UI;)\,UUN I;) on all Items shown. for eroup purchases. 8I'aduatlon t . favors, etc. 6,11 Same Items, Deduct 10%; 12-24 Same Items, Deduct 15% 25 or More Same Items, Deduct 20% E , Me , /1M 'If Choose style you want. shown rlpt Pnnt ßlme (and 2nd line If desired) on dotted lines below. Chtd other Into In bol" on chart, tllJI I!uI S<>cqround with polished edl" 0 Siltln awry 0 \'Itule 0 $ IwrN n..nel . PlASTIC LAMI AT[___sb'"'me'. . r; enj: thru $urface to -OI"Itrastlnø C01Of. Beveled border matches Ine.. II METAL FRAME.D _.ClasslC .. desl,": snow-wt\lte plastiC with smooth. polished be 1ed fr;t.me MOLDE.D PLASTIC . _ Simple, smart. economical Will Metler dlSColor_ Smooth rounded comen. and edges. Does Does o Black 0 1 P,n 1.25 o 1 Pin 1.85 no! not o Green 011 Blue 'POIy .'POIy o Blue Mllte 0 Z P'fOS 1.95 D2P.ns290 o Cocoa Lene only 'te 11,1_1 15oM1'Ier rne lo Pohshed Wh," o Black L)J.Pn 2..49 o J. Pin 3.25 050...' f me only 0011 Blue 0 ZPlns 3.99 D2Plns.95 only f5.MneNt"'W .......""'" Does Does Whl1e o Black o 1 Pon 1.25 o 1 Pin 1.85 not not only DOlo B'", 02P,..195 o 2 Pins 2.90 'POIY apply INIM ' Isarnef\Ml'll!} ENAMELED PINS Beaut,lully sculptu,ed stalus insiRni.J. 2-color keyed, hard fired enamel on gold Þeove; odd ''''.. 10 Drder No 2l60!l1XI coupon. FREE INITIALS AND SACK! Your intials engraved FREE on chest piece; lend individual distinction and help prevent loss. fREE SCOÆ SACK neatly carries and protects Nurse- scope. Heavy frosted .inyl, with dust.proof press.type closure LITTMANN COMBINATION STETHOSCOPE Maxllnum s.ensltlVlty from thiS fine prolesslonal IOslrument Con- vement 2Z ft overall length, welgf1s only 3\2 oz. Chrome b'rYUrals fixed .t conect angle Internal spnng. stilnless chest piece, 1 \í" diaphr3Jl1l. I 'Á" bell_ Removable non-chlll sleeve Gra)' vinyl tubing. Two initials .ogr. on chest piece. rREE SCOPE SACK INCLUDW No, 2100 Combo Sleth . ..29,95 ea. Duty Free CLAYTON DUAL STETHOSCOPE Llgh.....p' du.1 scope Importele ..1 JUSt ript lor every nurse l No. 41,100 B.P. Set... Duty Free 33.95..tcomplele SphYIL. only No. 108 .26.95 w.th cas. CAP ACCESSORIES " CA P TOTE keeps your cops cr.." ODd cleon. flexible c'eM plastic. white tnm. zipper, c..'rying strIP, .....g loop. Stores ftal Also 10' WIglets, curle.., eIt 8 . d.., 6" h.p No. 333 TOle. . . 2.95 ea. . WHITE CAP CLIPS Holds caps fi:l di n::: d : find .te PI , .. e..,mol on nc !prong sleel s..en 2" and lour . ",. . 3" cbps mcJuded in plastiC snap box_ , No. 529 Clips 85. per box (min_ 3 bOles) . MOLDED CAP TACS ---= Reøtace tip band instilntly Tin)' plastic taco daml I ""'" caduceus. Choose Black. Blue. White or Crystal wnll it ! Gold Caduceul. The nuter wa) 10 fasten bands r;:;':r.1\ No. 200 - S.t 016 Tacs -::; - W iðí . ...1.25 per..t I METAL CAP TACS '"' 01 dllnty (illJJ) le..elry-qu.1l1y Toes wilh griPpe". holds up bands securelr. Sculptured metal. iO finish, Jpprol " w,de Choose RN, lPII, LVN, RN C1"m Co1duccus 0' Pia.. Caduceus. G.II boled No. CT-l (Sp.Clfy Init.!. .... No. CT-3 (RN C.d.). . No. CT-2 (PI.,n C.d.). , , 2.95 p<. - ------- TO: REEVES CO" Box 719- C, Attleboro, Mass. 02703 OROER NO. ITEM COLOR QUANT. PRICE I I . \ Ple..e add 50<< handlinll/Postagt I I enclose $ I on orders totallinl under $5.00 No COD's or bill.ng to indi.,duals. Mass resldenls add 3% S. 1 I Send to . . I . I I I . Streel I City I... Use extra sheet lor addit.onal items or orders INITIALS as desired: _ _ _ TO ORDER NAME PINS, fill oul all information in box, lop left, clip ou1 and attach 10 this coupon State ..-.. '1 I .Zlp. .. .._1 48 The CanadIan Nurse February 1976 ... \11(1 i.Þ,-iHlllll \ ) - \ - \ \\' - """' -.) . First Aid Help Is,.. A 15-minute demonstration of first aid at the roadside-what to do in the critical minutes before police and ambulance arrive. A comprehensive treatment that includes not only on-the-spot assistance but also the individual responsibility of every motorist in today's traffic picture. Produced in co-operation with federal and provincial medical and traffic authorities. Commissioned to Chetwynd Films Limited for Health and Welfare Canada and available from any of the regional offices of National Film Board. . Sex Education VD - Fact Or Fantasy This is a 15-mlnute, color videotape describing what VD is, what symptoms to watch for and how to get treatment. Produced by the Division of Instructional Media Services, University of Toronto, this videotape can be purchased from: Media-Science, 728 Bay Street, Toronto, Ontario, M5G IN5. Purposes of Family Planning This is a 18 min. color film of the positive purposes of family planning- health, emotional stability, a child s need for individual love and attention - presented simply for all ages and income levels. To request this film contact the Canadian Film Institute, 303 Richmond Rd.. Ottawa, Ontario 4\00 About Conception and Contraception This is a 12 min. color film illustrating reproductive physiology, sexual intercourse, conception, and methods of contraception. To request this film contact the Canadian Film Institute, 303 Richmond, Rd., Ottawa, Ontario. . Obstetrics Becoming In Super 8mm, 30 min. long, this describes the Lamaze method of natural childbirth. It deals with the physical and psychological factors of nonmedicated birth, and stresses the roles played by physician, nurse, and husband in creating and sustaining confidence within the family. The film is designed for nursing education and inservice training, childbirth educational classes, and classes dealing with family dynamics and human relationships. It may be purchased from: Hospital Audio Visual Education, 606 Halstead Ave., Mamoroneck. N.Y., 19543, U.S.A. Hello World This is a 35-minute, 16mm film designed to answer the questions that prospective mothers and fathers have about the birth of their child. The film was made by the Ottawa-Carleton Regional Health Unit in cooperation with the University of Ottawa and the Ottawa General Hospital's Obstetrics and Gynecology Department. The film is available from the Ottawa-Carleton Regional Health Unit, 1827 Woodward Drive, Ottawa, Ontario, K2C OR5. . Pamphtets Easy Eating with Canada's Food Guide This is a nutrition publication containing suggestions on what to eat for weight control, convenience, snacks, and how to cut food costs. The pamphlet is available in quantity from: Communications Branch, Ontario Ministry of Health, Hepburn Block, Toronto, Ontario. M7A 1S2. . Catalogues Films on the Health Sciences is a recent catalogue of films researched and edited by Margaret Britt. Included in the catalogue are films in the following areas: addictions, adolescent development, adoption, anatomy, child care and development, dental health, diseases, first aid and safety, hospitals, marriage and family life, mental health, nursing and patient care, and mental illness. For your copy of the Films on the Health Sciences Catalogue, write to the Information Officer. Canadian Film Institute, 303 Richmond Road, Ottawa. .. IJlu-u.-U ['ltdUh- Publications recently received in the Canadian Nurses' Association Library are available on loan - with the exception of items marked R - to CNA members, schools of nursing. and other institutions Items marked R include reference and archive material that does not go out on loan. Theses, also R. are on Reserve and go out on Interlibrary Loan only. Requests for loans, maximum 3 at a time, should be made on a standard Interlibrary Loan form or on the "Request Form for Accession List" printed in this issue. If you wish to purchase a book, contact your local bookstore or the publisher. BOOKS AND DOCUMENTS 1. Allied health material, a list to support an ongoing display sponsored by the Medical and Health Sciences Division, Canadian Book Publishers Council. Don Mills, Ont.. College Bibliocentre, 1974. 98p. (Its Current awareness lists) R 2. American Hospital Association. Career goals of hospital school of nursing seniors: report of a survey. Chicago, c1975. 67p. 3. Bailey, June J. Decision making in nursing: tools for change, by . . . and Karen E. Claus. St. Louis, Mosby, c1975. 167p. 4. Bonnemaison, M. Pediatne, par et C. Joly. 3ed. Paris, MalOlne, 1975. 411 p. (Diplôme d'état d'infirmiere) 5. Brooks, Shirley M. 1939- Fundamentals of operating room nursing St Louis, Mosby. c1975. 184p. 6. BUisseret Irene de. Deux Langues, six idiomes. Manuel pratique de traduction de /'anglais au français. Ottawa, Carlton-Green Pub., 1975. 480p. 7. C.M.A. Conference on Negotiations and Physician Remuneration. Ottawa, Oct. 17 and 18, 1974. Proceedings. Ottawa, Canadian Medical Association, 1974. tv. (various pagings) 8. Canadian National Conference for World Population Year, Ottawa. May 10-11,1974. Report. Ottawa, Canadian Council for International Cooperation. 1974. 68p. 9. Canadian Public Health Association. Annual meeting, 18-21 June 1974, Sf. John's, Nfld. Patterns of health delivery rural and urban. Proceedmgs. Edited by Andrew Sherrington and Lowell W. Gerson Ottawa, Canadian Public Health Association, 1975 407p 10. Canadian Red Cross Society. The healthy elderly 1ed Toronto, c1974 69p. 11. -. Healthy living. 1 ed. Toronto c1974 64p. 12. Caribbean Nurses Organization. Biennial Conference, Ninth. Curaçao, July 27 - Aug. 2, 1974 Report. Kingston, 1975. 100p. 13 Cintract. Maurice. Enseignement de techniques manuelles et electrotherapie en rècuperation fonctionnelle' T.MR. Paris, Maloine. 1975. 157p. 14. Curtin, Leah. The mask of euthanasIa. Cincinnati. Nurses Concerned for Life Inc., c1975 53p. 15 Elliot, James R. Living m hospital: the social needs of people in long-term care. London, King Edward's Hospital Fund, 1975. 84p. 16 Evans Richard Isadore, t922- Carl Rogers: the man and his ideas. New York, Dutton, c1975. 195p. (His dialogues with notable contributions to personality theory; v.8) 17. Feller, Irving. 1925- Nursing the burned patient. by. . and Claudella Archambeaull Jones. Ann Arbor, Institute for Burn Medicine c 1973. 407p. The CanadIan Nurse February 1976 49 I.lst I.IP- · atE t , . CURRENT DRUG HANDßOOK .,.,.. >' ..<<" Whatever your question on drugs in nursing care, you'll find the most recent clinical information in Current Drug Handbook 1976- 1978 . . . and you'll find it quickly, too. Over 1,500 drugs are included in this softcover reference- grouped by usage and fully indexed by both proprietary and generic names. The tabular format lets you grasp pertinent facts at a glance: . name, source, synonyms and preparations (including the Canadian name if it is different than that used in the U.S.A.); . dosage and administration; . uses. both primary and secondary; . action and fate; . side effects and contraindications; . pertinent remarks. The drugs are grouped under 16 categories, such as Antiseptics and Disinfectants, Anti-infectives, Biologicals, Antihistimines, etc. This latest Handbook has added a separate category for Chemotherapy of Neoplastic Diseases. There's also vital new data on potentially fatal hyper- sensitivity reactions to penicillin therapy. All listings in the book have been checked and carefully up-dated to reflect today's most accurate phar- macologic information. By Mary W. Falconer, RN, MA. formerly Instructor of Pharmacology, O'Connor Hospital School of Nursing, San Jose; H. Robert Patterson. PharmD, Prof. of Bacteriology and Biology, San Jose State Univ.; and Edward A. Gustafson. PharmD, Pharmacist, Valley Medical Center. About 275 pp. Soft cover. About $6.90. Ready March 1976, Order #3567-9. BrinQs YOU thE latEst uSEful data on morE than 1,500 druQs in common USE. Among the drugs added to the 1976-1978 volume, you'll find: Poloxamer -iodine (Prepodyne) used as an antiseptic. Miconazole nitrate (Monistat) in the treatment of can- d i d iasis. Silver sulfadiazine (Silvadene) for prevention and treatment of wound sepsis in patients with second and third degree bums. AmoxiciUin (Amoxil) in the treatment of susceptible strains of gram - H. influen- me, E. coli, P. mirabi/is, N. gonon'hoeae. gram + Strep- tococci (including S. faecalis). D. pneumoniae. nonpenicillinase-producing staphylococci. Cefazolin sodium (Ancef, Kefzol) for treatment of respiratory. genitouri nary, skin, soft tissue, bone and blood infec- tions - Cephapirin sodium (CefadyI) for the same uses as Cefazolin sodium . Cephradin (Velosef) for treat- ment of respiratory, urinary, skin and soft tissue infec- tions. and many other new agents. :tï' .o r s o t NY CANADA LTD. Pncessubiecttochange_ r--------------------p,;;e ,;_---------------c 761 I I I 0 Yes, send me a copy of Falconer et al.: Current I I Drug Handbook 1976-1978 (3567-9) just as FULL NAME I I soon as it is published. About $6.90, Examination I I on 30-dayapproval. POSITION a AFFILIATION (IF APPLICABLE) I I HOME ADDRESS I I I L [ check enclosed-Seunders pays postage [send C.O.D. . btll me CITY PROVINCE ZONE ----------------------------------------- 50 The Canadian N ur5e February 1976 IJh.ou.oU 1 I.duh. I 18. Goerzen, Janice L 1943- Review of maternal and child nursing, by. . and Peggy L Chinn. St. LOUIS, Mosby, CI975.210p. 19. Grant, John Charles Boileau. Grant's Method of anatomy; by regIOns, descnptlVe and deductive. ged. Edited by John V. Basmajian. Baltimore, Williams & Wilkins, 1975 654p. 20. Harmon, Vera M. Nursing care of the skin: a developmental approach. by . . . and Shirley M. Steele. New York, Appleton-Century-Crofts. c1975. 133p. 21. Jakobi, William. The cardiovascular system as it relates to heart pacing' a learning and reference guide for Medtronic employees and others concerned with pacemakers. Minneapolis, Minn., Medtronlc, c1975. 482p. 22. Kientz, Albert. Pour analyser les media: ranalyse de contenu. 2ed. Paris, Mame, c1 971. 175p. (Collection Médium) 23. Leininger, Madeleine M. Health care Issues, 1974. Philadelphia, Pa., Davis, 1974. 163p. (Health care dimensions. Fall 1974) 24. Levine, Harry D. Factors affecting staffing levels and patterns of nursing personnel, by. and P. Joseph Phillip. Bethesda, Md.. U.S. Division of Nursing, 1975. 110p. (U.S. DHEW Publication no. (HRA) 75-76) 25. Messel, Meer Abramovich. Urban emergency medical service of the city of Leningrad. Bethesda, Md., National Institutes of Health, 1975. 287p. (U.S. DHEW Publication no. (NIH) 75-671) 26. Mousseau-Gershman, Yolande. Manuel de travaux pratiques en sante communautaire; perspective internationale. Montréal. Les Editions HRW, c1975. 155p. 27. National League for Nursing. Division of Research. State-approved schools of nursing - R.N.; meeting minimum requirements set by law and board rules in the various jurisdictions 1975. New York, 1975. 137p. 28. Nurse ' by Giles. London, Beaverbrook Newspapers, c1975. 1v. 29. PaedIatrics and the environment. Scientific proceedings of the 2nd unigate Paediatric Workshop held at . . . London, June 1974. Edited by Donald Barltrop. London, Fellowship of Postgraduate Medicine, c1975. 106p. 30. ProfessIonal nurse gUIde, 1975. Richmond, Va., Health Publications, Inc , c1975. 64p. 31. Reilly, Dorothy E. Behavioral objectives in nursing: evaluation of learner attainment. New York, Appleton-Century-Crofts, c1975. 178p. 32. Richard, Robert N. Venereal diseases and their avoidance. New York, HolI, Rinehart and Winston, c1974 187p. 33. Robert, Paul. Le petit Robert 2. Dictionnaire universel des noms propres. Paris, S.E.P.R.E T., 1974. 1992p. 34. Robertson, Elizabeth Chant. The nght combination: a guide to food and nutntion. Toronto, Gage Educational Pub. 1974, c1975. 32p. 35. St. Mary's Hospital Medical Center, Madison, Wis. Clinical laboratory manual. St. Louis, Catholic Hospital Association, c1975. 474p. 36. Secourisme. 3ed. canadienne. Ottawa, L ambulance St-Jean. c1 974. 264p. 37. Shannon, Gary W. Health care delivery: spatial perspectives, by . and G.E. Alan Dever. New York, McGraw-Hili, c1974. 141p. (McGraw-Hili problem series in geography) 38. Sparrow, Christopher J. An annotated bibliography of Canadian air pollution literature, compiled by . . . and Leslie T. Foster. Ottawa, Environmental Protection Service, EnVIronment Canada, 1975. 270p. 39. Stevens, Barbara J. The nurse as executive. Wakefield, Mass., Contemporary Publishing, c1975. 260p. 40. Tichy, Monique K. Health care teams an annotated biblIography. New York, Praeger, c1974. 177p. (Praeger special studies in U.S. economic, social, and political issues.) 41. Villet. Barbara. Head nurse New York, Doubleday, 1975. 201p. 42. Wandell, Mabel A. 1917- Quality patient care scale, by . . . and Joel W. Ager. New York, Appleton-Century-Crofts, c1974. 82p. 43. -. The Slater nursing competencies rating scale, by , . . and Doris Slater Stewart. New York, Appleton-Century-Crofts, c1975. 101 P 44. World Health Organization. Fifth report on the World Health situation 1969-1972 Geneva, 1975. 322p. PAMPHLETS 45. Aaron, Dorothy. About face; towards a positive image of women in advertising. Toronto, Ontario Status of Women Council, 1975. 30p. 46. Association of Registered Nurses of Newfoundland. Personnel Service. Rational for the service. St. John's, Feb 1975. 4p. 47. Brown, Muriel. The joint social information unit. An interorganizational approach to the provision of information for the health and social servicés. London, King s Fund College, 1974. 16p. (King's Fund Project paper, no. 6) 48. Bush, William L The directory of audio-visual aids for hospital safety programs, by . . . and Ronald J. Cogan. Diamond Bar, Calif., Quest, 1974. 15p. 49. C.C.H Canadian Limited. Your Canada pension plan 1975. Don Mills Ont., c1975. 38p. 50. Canadian Conference on the World Food CrisIs. Ottawa, Oct. 8, 1974. Report. Ottawa, Canadian Council for International Cooperation, 1975. 30p. 51. Canadian Red Cross Society. Alberta - N.WI. Division. Family Health Department. Operation alert; security guide for senior citizens. Calgary, Alberta, 197? 28p. 52. Canadian Tuberculosis and Respiratory Disease Association. Report 1974-75. Ottawa, 1975. 11p. 53. Consultation on wider issues in nursing education, Birmingham, 4-6 Jan. 1974. Some of the papers given. London, Institute of Religion and Medicine, 1974. 28p. 54. Dutra de Oliveira, J.V. Food and nutrition. Toronto, General Foods, n.d. 18p. 55. Gardner, Robin. Nursing diagnosis. Toronto, 1972. 28p. 56. Hollingsworth, Dorothy. NutritIOnal problems in an affluent socIety. Toronto, General Foods, n.d. 12p. (General Foods Ltd. Distinguished international lectures on nutrition) 57. Irwin, Theodore. Male "menopause" crisis in the middle years. New York, Public Affairs Committee, c1975. 28p. (public Affairs pamphlet no. 526) 58. Katzell, Mildred E. Productivity, the measure and the myth. New York Amacon, c1975. 38p. (AMA survey report) 59. Levenson. Goldie. Type, length, and cost of care for home health patients. A report of the discharge summary feasibility study. New York National League for Nursing, CounCI of Home Health Agencies and Community Health Services, c1975 15p. (NLN Pub. no. 21-1589) 60. Montag, Mildred L Where is nursing going? The Ruth V. Mathene) Memorial lecture presented at the 1975 N.LN. convention, New Orleans, Louisiana. New York. National League for Nursing, Department of Associate Degree Programs. 1975. 9p. 61. National Conference on Employel Physical Fitness, Ottawa, Dec. 2, 3, and 4, 1974. RecommendatIons Ottawa, Health and Welfare Canada 1975. 7p. 62. National League for Nursing. Statement of purpose. . . approved by the Board of Directors,. . May, 1975. New York, 1975. 1p. 63. -. Council of Diploma Programs Characteristics of diploma education In nursing. New York, 1975. 5p (NLN Pub. no. 16-1588) 64. -. Dept. of Diploma Programs. Criteria for the evaluation of diploma programs in nursing. 4ed. New 'York c1969, 1975. 19p. 65. -. Division of CommuOily Planning. Outdate update continuing education. who, what where, when, how. Papers presentee at the Conference of the Northeast Regional Assembly of Constituent Leagues, New York. 1975. 37p. 66. New Brunswick Association of Registered Nurses. Folio of reports, June 10-12, 1975. Fredericton, 1975 14p. 67. Newcombe, H.B. A method of monitonng nationally for possIble delayed effects of various occupational environments. Ottawa. National Research Council of Canada 1974. 42p. 68. Ontario Hospital Association. Guidelines for emergency departments. Toronto, Ontario Hospital Association, 1975. 16p. The Canadian Nurse February 1976 51 69. Ozimek, Dorothy. The future of nursing education. New York, Nallonal League for Nursing, Dept. of Baccalaureate and Higher Degree Programs, c1975. 20p. (NlN Pub. no 15-1581) 70 Registered Nurses' Association of British Columbia Basic nursing education programs m British ColumbIa. Vancouver, Registered Nurses' Association of British Columbia, 1975. 27p. 71. -. Studying' a learnmg package to assist candidates who are preparing to write registration exammations. Vancouver, 1975. 11p. 72. Royal College of Nursing of United Kingdom Report 1974-75. London. 1975 16p. (RCN Nurs Standard no. 46, supplement, Sep.lOct. 1975) 73. Rozovsky, Lorne Elkin The hospital's responsibility for quality of care under English common law Presented on Se;>. 24. 1975 at The National Conference on Health and the Law. Ottawa, 1975. 11p. 74 Séminaire national sur Ie thème nutntlon: controverses et prlontes. Ottawa, 7 mal. 1975. Programme Ottawa, Conseil des Sciences du Canada, 1975. 19p. 75. Stein, Morris I. The physiognomIc cue test: a measure of a cognitive control principle. Manual for PCT. New York, Behavioral Publications. c1975. 30p. 76. Spector, Audrey F Regional planning for nursing education in the South, 1972-1975: a study in transition. Atlanta, Ga., Southern Regional Education Board. 1975. 42p 77. Symposium on Primary Care to the Elderly Patients, Sept. 10. 1974 Ottawa Proceedings. Ottawa. Council on Medical Services, 1974 Iv (various paglngs) (Council on Medical Services. Minutes of meeting, Sept. 9-10. 1974, appendix 1) 78. Victorian Order of Nurses of Canada. Report 1974. Statistical supplement. Ottawa, 1974. 44p. 79. Wandelt. Mabel A 1917- Definitions of words germane to evaluatIOn of health care. New York, National League for Nursing. Council 01 Baccalaureate and Higher Degree Programs, 1975. 4p 80. Wini.::k, Myron. Nutrition and mental development. Toronto, General Foods. n.d. 8p. 81 Yale University. School 01 Nursing. StudIes in nursing. Abstracts of reports submItted m partial fulfillment of the requirements for the degree of Master of Science m Nursmg. Sertes XVII. 1975. New Haven, Conn.. 1975. n.p. GOVERNMENT DOCUMENTS Canada 82. Advisory Council on the Status of Women. Report 1974/75 Ottawa, 1975 n.p. 83. Blbllothèque national du Canada. Format de communication du MARC canadien; monographies 2éd. Ottawa Bureau MARC canadien, Direction de la recherche et de la planification. 1974. 92p. 84. -. Inventa"e des publications en serie dans les domaines de I'educatlon et de la soclologle disponibles dans les bibliotheques canadiennes. Ottawa, 1975. 221 p. Are International Horizons for You? They can be yours when you read the International Nursing Review The InternatIonal Nursmg RevIew, official journal of the International Council of Nurses. is one of the nursing profession s most prestigious publications, read regularly by nurses In more than 100 countries around the world. Through its extensive coverage of nurSing affairs worldwide readers of the InternatIOnal Nursing RevIew can .. follow international trends In nursing .. follow activities of their colleagues in othe' countries .. keep up to date on international meetings and seminars e Increase then professional awareness outside their own country. SIX Information-packed issues per year will be yours when you fill out the coupon below and mail Don't miss the highhghls of the commg year in International nursing. Send your order now - and send a gift subscription to a friend at the same time. tnternational Council of Nurses P.O. Box 42 CH - 1211 Geneva 20 Switzerland Please enter my subscription to the InternatIonal Nursing RevIew I enclose SWISS francs 34.00 (or US$12.00 or Enghsh E4.50) for one year (Please bill me for) Please print Name Street City Province Position Institution Country Signature Please enter a subscription to the International Nursing Review as a g,ft trom me for the person named below: 1 enclose Swiss francs 3400 (or US$12 00 or English E4.50) for one year (Please bill me for) Name Position Street City Province Institution Country S2 The Canadian Nurse February 1976 l..i In-i"-!) ['I)(ht ft>> 85. Commission royale d'enquête sur la situation de la femme au Canada. Rapport. Ottawa, Information Canada, 1970. 540p. 86. Conseil national de recherches du Canada. Comité associé sur les critères scientifiques concernant I'ètat de I'environnement. Rapport d'activité, fevrier 1975. Ottawa, 19 7 5. 63p. 87. Dept. of Fif'lance The tax treatment of charities. Ottawa, 1975. 14p. (Discussion paper) 88. Dept. of Labour. Legislation Branch. Human rights in Canada 1975. Ottawa. Information Canada. 1974.70p. 89. Health and Welfare Canada. Canada's mental health, v.23, no. 5, supplemenl1975. Ottawa, 1975. 20p. Tropical and Parasitic Diseases 90. -. Fitness and Amateur Sport Branch. Revised Terms and conditions for contributions. Ottawa, Health and Welfare Canada, 1975. 10p. 91. -. Non-medical Use of Drugs and Directorate. Research on drug abuse 1973. Ottawa, Health and Welfare Canada, 1973. 1 portfolio. 92. Information Canada. Photos Canada v. 1-5. Ottawa, Information Canada, c1964-1974. 4v. 93. Labour Canada. Legislation Research Branch. Labour standards in Canada, 1964-1974. Ottawa, Information Canada, 1975. 11 v. 94. Law Reform Commission. Study papers prepared for the Administrative Law Project. Ottawa, 1974. 1v. Seneca College is offering short courses at the post- diploma level in Tropical and Parasitic Diseases. Courses start in February and September: International Health Course-One Semester Preparation to function intelligently in an environment where such diseases pose a health problem. International Health-Short Course 40 hours Incorporated in Ihe one semester course. Emphasis on: Incidence of tropical and parasitic disease in Canada, detection and referral, prevention and control. For further information, contact the Admissions office at the address ÍJelow, or telephone (416) 494.8900. j "W SENECA COLLEGE OF APPLIED ARTS AND TECHNOLOGY "'" 11>> SHEPPARD AVENUE EASI WllIOWDALE ONTARIO Mlk IEl 95. -. Section de la formation et du perfectionnement du personnel. Comment préparer un organigramme: un manuel d'enseignement séquentlel. Rédigé par Louise Newton. Ottawa, Information Canada, 1975. 1 v. (various pagings) 96. Manpower and Immigration. Canadian glossary of training terms. Ottawa, Information Canada, c1975. 30p. 97. Medical Research Council. Grants and awards guide 1975. Ottawa, Information Canada, 1975. 76p. 98. National Library of Canada. Research collectloRs m Canadian Libraries, /I Special studies, 2 Federal government libraries. Ottawa, 1974. 231p. Ontario 99. Council of Health. Health information and statistics. Toronto, 1975. 61p. 100. -. The nurse practitioner in primary care. Toronto, 1975. 41 p. 101. Laws, statutes, etc. The environmental protection act, 1971. Statutes of Ontario, 1971, chapter 86. Toronto, Queen's Printer and Publisher, 1971. 36p. 102. Ministry of Health. Report, reaction, response; the health care system in Ontario. A review of the reaction to the Report of the Health Planning Task Force and a summary of common ground on which health care strategy can be advanced. Toronto, 197? 16p. 103. Ministry of Labour. Research Branch. Major medical, prescription drug and dental plans in Ontario collective agreements. Toronto, 1975. 18p. 104. -. Selected cost-of-living provisions in Ontario collective agreements. Toronto, 1975. 13p. (Bargaining information series, no. 7) 105. -. Sick leave plans and weekly sickness and accident indemnity insurance plans in Ontario collective agreements. Toronto,. 1975. 18p. (Bargaining information series, no. 5) Quebec 106. Ministère des affalres soclales. Enquête alimentaire en milieu scola ire au Quebec (niveau secondaire) Québec, Mimstère des affaires sociales, 1972. 67p. STUDIES DEPOSITED IN CNA REPOSITORY COLLECTION 107. Anderson, Joan Madge. The concerns and coping behaviours of the single mother with a child aged SIX months to eight years. Montreal, 1973. 130p. Thesis (M.Sc. (Appl.))-McGill. R 108. Bajnok, Irmajean. A comparison of the quality of care provided by registered nurses working the twelve-hour shift and those working the eight-hour shift in a large general hospital. London, 1975. 251 p. (Thesis (M.Sc.N.) - Western Ontario. R 109. Desjean, Georgette. The problem of leadership in French Canadian nursing. Detroit, Mich.. 1975. 308p. Thesis Wayne State. R 110. Gousse, Claude. Les préoccupations des infirmiéres. Rapport final. Etude préparé pour I'AIIPQ par. . . en collaborations avec André Gagnon de Cadres Professionnels Inc. Montréal, C.R. OPP. Inc., 1970. 1v. R 111. Ingenito, Françoise. Memoire sur la penurie d'infirmiéres présenté par. . . et Suzanne Rollin-Lepage et patronné par I'Université du Québec, direction des études Universitaires dans I'Ouest québecois. Hull, P.Q., Conseil de la Santé et des Services sociaux de I'Outaouais, 1975. 150p. R 112. Kotaska, Janelyn Gail. The effect of guidance on learning in independent study. Vancouver, 1973. 87p. (Thesis (M.Sc.N.) - U.B.C.) R 113. McEwan, Ada E. Report of World Health Organization study tour of Sweden, Denmark, the Netherlands and Great Britain. Ottawa, Victorian Order of Nurses for Canada, 1975. 25p. R 114. Paquette, Claire. Personal history of persons complaining of back pam: a psychosocial approach. Seattle, 1972. 163p. (Thesis (M.A.)- Washington) R 115. Pope, Alice Marion. Canadian Health Services used by Korean immigrants and their perceptIOns of the helpfulness of those services. Toronto, c1975. 132p. (Thesis (M.Sc.N.) - Toronto) R 116. Service de dépistage des problèmes auditifs pour les comtés de Prescott et Russell, Ontario. Project décibel. Rapport final. Hawkesbury, Ontario, 1975. 21p. R The CanadIan Nurse February 1976 S3 "The more you want from nursing, the more reason you should be Medox:' Virginia Flintoft, R.N., Staff Supervisor \ "" ,'! ..... " Do y ou want to: . increase the variety of your work and gain experience to help you specialize? Work in a hospital, a nursing home or a doctor's office. Enjoy as- signments in a private residence, hotel or summer camp. Perhaps you want specialized experience in CC.. IC or another field. Medox can give you more variety. . work for a company that takes special care of its nurses in every way, including pay? Medox employs the best people at the best rates of pay in the temporary nursing field. You owe it to yourself to contact Medox. . free yourself from too many mandatory shifts and shift rotation? Medox nurses get the best of both worlds: the assignments they want and the shift work they prefer, Because there are more as- signments available. . to take advantage of free-lance nursing without the paperwork? When you work with Medox, we look after all paperwork. We pay you weekly and make normal deductions. Medox is your employer: the times, shifts and assignments are yours to choose. trade the rigid schedules of full-time nurs- . ing for the flexibility of temporary or part- time work? . choose to work only one or two days a week? As a Medox nurse, you can ease off the strict schedules of full-time nursing. Cut down to a few shifts or split shifts a week: the choice is yours. As a Medox nurse, you can pick the days you want to work; you're automatically on call forthe time you want. Medox nurses have more time to themselves, they can arrange as many "free" days as they want. . work shifts that tie in wIth your husband's work schedule? Wouldn't it be nice to work the same shifts as your husband: both home together and both earning good incomes? If his shifts change, Medox will arrange to change yours too. . retire from nursing, but not completely? If the idea of retirement appeals to you, yet not the thought of forced inactively, becomes a Medox nurse, Be retired on the days you want. .. As a registered nurse with more years experi- ence behind me than I care to think about, I know how important il is to keep growing in your job-to avoid that awful feeling of being stuck in the same rut. Certainly what you're doing is tremendously worth-while, and heaven knows there is a desparate shortage of nurses, But your job must be worthwhile to you, or else youïl eventually want to drop out". "That's why Medox has so much to offer a nurse today". "You see, at Medox. we supply quality nurs- ing staff on a temporary assignment basis to hospitals, clinics, doctors' offices, nursing homes and private residences. We're a part of the world-wide Drake International group of companies and we operate in major cities across Canada. the U.S. U.K. and Australia" "As far as you're concerned. however, the key phrase is "Tem- porary Assignments". Because, as you can see by the chart above, you can choose just about any working condition, or shift, or professional discipline you want". "It come down to this: if you want more from nursing than you're getting now, talk to Medox". "Write to me, Virginia Flintoft, R.N" Staff Supervisor, Medox, 55 Bloor St. W., Toronto, Ontario, or call the local Medox office". lM:EDoXJ a DRAKE INTERNATIONAL comp.nt' If you care for people, you're Medox. 54 Advertising rates For All Classified Advertising $15.00 for 6 lines or less $2.50 for each additional line Rates for display advertisements on request Closing date for copy and cancellation is 6 weeks prior to 1 st day of publication month. The Canadian Nurses Association does not review the personnel policies of the hospitals and agencies advertising in the Journal. For authentic information, prospective applicants should apply to the Registered Nurses' Association of the Province in which they are interested in working. Address correspondence to: The Canadian Nurse 50 The Driveway Ottawa, Ontario K2P 1 E2 , -"" H4'" OFF '4CE I 1 I , m\ H.\PPY! I h,.d ugl ,upertluou, hair. . W." unloved _ di'>C,'uraged. Iried man\ Ih1llg . . e\en ra"o; . "Jolhing \\oa', 'ali faclOr . J hen I dnd"ped a 'illl- pie. painle". ine....pl.'n,i\e. nondeclric Illelhod_ II ha, helped Iholl,.lIld, \\0 in beaUI}. Ime, h.tppine',. \J I'RFF boo". 'Whal I Did Ah"UI SlIpcr- fllll'u hllr" e....plain' melh"d. I\Jailed in plain elnel,'pe. AI", Iri.11 Olfer. \VI ill.' \Jme Annellc 1.IIlLelle. P.O. 80\ 610. Depl. C-flJ2. Adelaide SI. P.O.. Toronlo 210. Onl. LOVE IIUIIsf.' I The Canadian Nurse ('Ialssi 11(>>(1 .6. \(I (>>I.' is(>>III(>>II'H Alberta Reglst red Nurses required for lO-bed accredlled aC1lve treatment Hospital Full lime and summer relIef All AARN personnel polloes. Apply In writing to the Director of Nursing, Drumheller General Hospi- tal Drumhe1ler. Alberta British Columbia Expenenced General Du1y Nurses required for small hospital North Vancouver Island area Salary and personnel policies as per RNABC contrad Residence accommodatIOn $30.00 pel monlh Transporta lion paid from Vancouver Applylo Director of NurSing. Sf. George S Hosprtal. Box 223 Alert Bav. BnllSh ColumbIa VON lAG Experienced Nurses (eligible for B C reglstrahon, required 10..... 409-bed acute care. teach,ng hospl1al localed In Fraser Valley 20 minutes by freeway from Vancouver. and wllhln easy aCceSS of vaned recreahonal facllttles Excellent Onenlallon and ContinUing Educallon programmes. Salary S 1 049 00 to S 1.239.00. Clinical areaS Include: Medicine, General and Specialized Surgery Obstelncs PedlalncS. Coronary Care. HemodialysIs Rehabilitation. Operallng Room. Inlen- slve Care. Emergency Practical Nurses (eligible for B C license) also reqUired Apply 10 AdmIOlstratlve Asslstan1. Nursing Personnel. Royal Columbian Hospllal. New Westminster. Bntlsh Columbia. V3L 3W7 General Duly Nurses lor modern 41.bed hosprtal localed ón Ihe Alaska H'ghway Salary and personnel pohcles In accordance wl1h RNABC Accommodallon available In residence Apply Director of Nursing. Fori Nelson General Hospl1al. FOr1 Nelson. British C umbla General Duly Nurses lor modern 35-bed hosprtallocated In south- : B f{o e n w c: t , re nB i Nurse s home. Apply Director 01 NurSIng, Boundary Hospital Grand Forks British Coiumbla. VOH IHO. Nova Scotia F8culty Positions - Posl1lons available for all cllnlcar nurSing areas In an Integrated four-year baccalaureate program offered In coopera- tion with DalhOusie Umverslly School of Nursing Master S degree In clinical speciality areas. and/or cUrriculum development. educahon required. POSlhons Inv ve responsibility for theory and cllmcal teach- Ing In local hosprtals Candidates should be avaIlable July 1, 1976 Appllcahons. wl1h curricula vllae. should be directed 10 Dr Waher Shelton. AcedemlC Dean Mount Saint Vincent UniverSity Halifax. Nova Scolla B3M 2J6 Caneda Ontario Registered Nurses lor 34.bed Genera' Hospllal Salary $945 00 to $1 14500 per monlh. pluS expenence allowance Excellent personnel pol'cles Apply 10 Director of Nursing Englehart & Dlstnct Hospital Inc.. Englehart. Onlano. POJ IHO Registered Nurses and Registered Nursing AssIstants tor 45-beo Hospl1al Salary ranges ,nclude generous expenence allowances R N s salary $1 045 10 $1 245 and R N A s salary $735. to $810 Nurses residence - pnvate rooms with bath $60. per monlh Apply to The Dlreclor of Nursing Geraldton Dlslnct Hospital Gerald10n Onlano, POT 1 MO Registered Nurses required for our uhramodern accredlled 79-beo General HospItal In bilingual community of NOr1hern Ontano. French language an assel but nol compulsory Salary is $1 115 to$I,315. monthly with allowance for pasl expenence and 4 weeks vacation aher 1 year Hosprtal pays 100 0 001 0 H I.P , Llle Insurance (10.0001 Salary Insurance (75 0 .0 of wages to the age 0165 wilh U tC carveout). a 35c drug plan and a dental care plan. Master rotation In effect Furnished bachelor apartments available nearby and reserved through the Personnel Department Excellent personnel poliCies. Apply 10 Personnel Dtrector Noire-Dame Hospllal. POBox 8000. Hearst. Ontaflo. POL 1 NO Quebec Nurses for Chlldren's Summer Camps in Quebec. Our member camps are located In the laurentlan Mountains and Eastern Town- ships within 100 mile racbus of Montreal. All camps are accredited members of the Quebec Camping Assooatlon Apply to Quebec CampIng Association. 2233 Belgrave Avenue Montreal. Quebec. H4A 2L9. or phone 489 1541 February 1976 Quebec Registered Nurses and Nurses Aides wanled for summer camps end of June toendof August MUS1 be qualified to wortlln Quebec. Will consider one month Or two month baSIS. Apply JewlSt'l Community CampS, 5151 Cote Sle. Catherine Road Montreal Quebec H3W IM6 Telephone (514) 735.3669 One RegIstered Nurse lor ChIldren s Co-Ed Camp End 01 June to August 201h. Prefer season $700 plus Iravel laurenftan Region. Doctor on staff. excellent facilities Wn1e. Joseph A Ffledman. Dlrec- lor YM-YWHA & NHS ot Monlreal 5500 Weslbury Avenue Montreal H3W 2W8 Quebec Saskatchewan Director of Nursing required for acllve rural hospItal In Southern Saskatchewan Duties 10 commence Immediately Salary according 10 schedule and expeltence Fm furthØf Informalion please conlad Clifford Day. Chairman. or G.P Williamson. Secretary-Treasurer. Kincaid Union Hospllal. Kincaid Saskalchewan Director 01 Nursing: Immediate applicattons are Inv..ed for the POSI- hon of Director of NurSing In the 43-bed Wadena Umon Hospl1a1. Fnnge beneflls Inelude Registered PenSIOn Plan. Group life Insur- ance and Income Replacemenl Plan ThiS IS a seven year old wen- eqUipped hOspl1alln a town of 1500 populahon serving a large rural population Wadena IS centrally toealed 130 miles from each of two major Saskalchewan centres SupervIsory experience IS eSsenllal Nursing Admlnislratlon COurse desirable Attradlve salary scale : AJ I ;t ;;'sgp rlj loB =nc; xW : to S : : SOA 4JO Registered Nurses are required immedl tely for the 43-bed Wadena Union Hospital This IS a modern, altraChve acute care hospital situated in the lown of Wadena. Saskatchewan. a friendly parkland community wdh a population of 1500 At1raChve salary and fTinge benefits are provided under the Saskatchewan Umon of Nurses ag- reemenl In effect Please direct applications to Admlnls1rator. Wadena Union Hospital. POBox 10. Wadena. Saskatchewan United States Landed Immigrant Nurses - If you are looking for an exciting change then contact uS We are offenng SRNs the opportunity to work In the USA for SIX months or longer Choice locations available. We w.1I pay your fare and arrange accommodations for you Free Health Insurance and Visa Sponsorship Write Fllst Gill International. 333 North MlchlQan Avenue Chicago. illinOIs. 60601 R.N.'s -Iowa Methodist Medical Center invites you to explore nurs- Ing opporlumlreS In orthOpediCs. rehablhlallon ICU and CCU. medIcal-surgical and pedlatncs 700-bed general teaching hospl1al wllh expansion plan Well organized and directed nursing program :: b :c.l r : t 1:1 : r:rÝ % cimE I :1 Will asslsl wl1h vISa for Immigration tf Inleresled In further details please contact Personnel Director. Iowa Melhochsl Medtcal Center. 1200 Pleasant Streel Des Mornes. Iowa, 50308 or phone (5151 283-6313 1exas wants you! If you are an RN. expenenced or a recent graduale. come to Corpus Christ, Sparkling City by the Sea a city bUilding for a beller fulure. where your opportumhes lor recreation and slucbes are limitless MemOrial Medical Center 500-bed. general. teaching hospital encourages career ad\fancement and provides In- servIce orientation Salary from $78520 to $1 052 13 per month commensurate wtlh educahon and expenence Dlfferen1'al for Ø\fen- 'ng shifts available. Benefits Include holidays. sick leave. vacations. pad hOspitalization heallh life Insurance. pension program Become a vllal pert 01 a modern. up-Io-dale hospital wnte or call John W Gover Jr. Director of Personnel. Memonal Medical Cenler. P.O. Box 5280. CorpuS Chnsli' Texas 78405 R .N_'s needed Immediately for a 31-bed acute care hospital Rotahng shifts. We will assist In making arrangements to come to beautiful WYOming Call CoIlecI: Director 01 Nurses. Cheryl Karlnged use of antibiotics may resuh In the overgrOw1h of nonsuscept1t>'e orgamsms. IOCludlng fungi App "" , ' :", -;.;; ... . ,.... / I , : \ ..... "'. - . "(:í; \ Yi; 1,'1 , / " / -< 7%: J'N ' 1 \ 4í I + Health Sanlé et and Welfare B'en-ëtre socIal \ \ Canada Canada I. . ,-------------"""-. I Medical Services Branch I I Department of National Health and Welfare I I Ottawa, Ontario K 1 A OK9 I I I I Please send me more information on career I I opportunities in Indian Health Services. I I Name: I I Address: I City: Prov: _ _______________J The CanadIan Nurse February 1976 Index to Advertisers February 1976 The Canada Starch Company Limited 7 The Clinic Shoemakers 2 f'\esigner's Choice 5 Encyclopaedia Britannica Publications Limited 1 Hampton Manufacturing (1966) Limited 10, 11 Health Care Services Upjohn Limited 55 Hollister Limited 45 International Council of Nurses 51 Lanzette Laboratories 54 J.B. Lippincott Company of Canada Limited 32,33 MedoX 53 The C.V. Mosby Company Limited 39,40,41,42 Procter & Gamble 12 Reeves Company 47 Roussel (Canada) Limited 55, Cover 4 W.B, Saunders Company Canada Limited 49 Seneca College of Applied Arts and Technology 52 Uniforms Registered 37 Uniform Specialty Cover 3 White Sister Uniform Inc. Cover 2 Advertising Manager Georgina Clarke The Canadian Nurse 50 The Dnvewa Ottawa K2P 1 E2 (Ontario) Advertising Representatives Richard P. Wilson 219 East Lancaster Avenue Ardmore. Penna. 19003 Telephone: (215) 649-1497 Gordon Tiffin 2 Tremont Crescent Don Mills, O. ,tario Telephone; (416) 444-4731 Member of Canadian Circulations Audit Board Inc. mn:J 76 The Canadian Nurse F0003'57 Ù P I s-s J:: -STcrr 60B-ilL KTc 8U G CTTAhA 2 CNT ... --- ' /' A t ,II , I A) Style No. 6482 Sizes 8-16 Royale Corded Tricot White, Cantaloupe About $29.00 \ B & C) Style No. 46548 Sizes 3-15 Pristine Royale, 100% Polyester Textured Warp Knit White, Cantaloupe About $35.00 \) !J;)B J C See our new line of Whites and!J..r Colours at fine stores across Canada I I ""HITE Hè) SISTER CAREER APPAREL For a clearer perspective on nursing care... Gillies & Alyn: PATIENT ASSESSMENT AND MANAGEMENT BY THE NURSE PRACTITIONER The brand new text by these respected nursing authors is ideal for developing your skills in interviewing and physical examination. It focuses on interviewing techniques. physical examination proce- dures, laboratory test interpretation, and protocol in the manage- ment of patients with chronic illnesses such as hypertension, diabetes, osteoarthritis. arteriosclerotic heart disease, obesity. alcoholism, and chronic obstructive lung disease. By Dee Ann Gillies. RN. EdD, Asst. Director of the Dept of Education, Health and Hospitals Governing Commission of Cook County, Dlinois; and Irene B. Alyn. RN, PhD. Assoc. Prof. of Medical Surgical Nursing, Univ. of III. College of Nursing. About 320 pp. II\ustd. About $11.30. Ready April 1976. Order #4133-4, Falconer. Patterson & Gustafson: CURRENT DRUG HANDBOOK 1976-78 Whatever your question on drugs in nursing care. you'll find the most recent clinical information on about 1.500 drugs in common use in the Current Drug Handbook. Its tabular format lets you grasp pertinent facts at a glance. and iI's fully indexed by both proprietary and generic names The drugs are grouped under 16 categories, such as Antiseptics and Disinfectives, Antihistimines, and-new to the 1976-78 handbook-Chemotherapy of Neo- plastic Diseases. By Mary W, Falconer. RN, MA, formerly of the O'Connor Hospital School of Nursing; H, Robert Patterson. PharmD. Prof. of Bacteriology and Biology, San Jose State Univ.: and Edward A. Gustafson. PharmD. Pharmacist, Valley Medical Center. About 275 pp. Soft cover. About $6.70. Ready March 1976. Order #3567-9. Howe: BASIC NUTRITION IN HEALTH AND DISEASE. New 6th Edition From explanation of how food is chemically converted mto human tissue-to the modern principles involved in diet planning. pur- chasing and storage-this text covers all the material necessary for a better understanding of basic nutrition. There's plenty of infor- mation on diet therapy, common misconceptions about food, and weight control; and the appendix includes an alphabetical listing of modified diets. By Phyllis S. Howe. RD. BS. ME, Nutritional Insl7uctor. Contra Costa and Diablo Valley Community Colleges. California. About 465 pp. /lJustd. Soft cover. About $7.75. Ready April 1976. Order #4788-X. Mayes: NURSE'S AIDE STUDY MANUAl. New 3rd Edition Designed to equip the student aide with a working knowledge of good patient care, this book teaches principles that are applicable in any hospital or nursing home situation. It covers: basic nursing arts procedures, her ethical and legal responsibilities and limita- tions, what to do in emergencies, and basic anatomy and physiol- ogy. (An InstTuctor's Guide is available.) By Mary E. Mayes. RN. formerly Supervisor. Emergency Room. Ventura General Hospital. California. About 285 pp.. 130 ill Soft cover. About $6.20. Ready April 1976 Order #6191-2. Kron: THE MANAGEMENT OF PATIENT CARE: Putting Leadership Skills to Work, New 4th Edition Here's a modern look at the challenges of nursing leadership in the rapidly changing health care field. It examines the responsibilities of the professional nurse. the legal aspects of practice. ways to improve communication and understanding. the administTative and managerial responsibilities of nurses. methods of work im- provement. and leadership skills. Particular attention is paid to defining the role of each member of the nursing team, their interac- tion with other hospital personnel, and the use of the problem- oriented record system. By Thora Kron. RN. BS About 290 pp. Jl]ustd Soft cover. About $5.15 Ready April 1976. Order #5528-9. Simmons: THE NURSE-PATIENT RELATIONSHIP IN PSYCHIATRIC NURSING: Workbook Guides to Understanding and Management, New 2nd Edition This practical workbook shows you how to establish a therapeutic relationship with the mentally ill patient Each of 19 guides presents a specific aspect of the process-from orientation and communica- tion to final evaluation. This revised edition includes new guides on observation of anxiety. assessing the milieu, theoretical approach. crisis intervention. descriptive data, assessment of the client's learn- ing, and assessing of the nurse's learning. By Janet A. Simmons. RN, MS, School of Nursing, Univ. of Mas- sachusetts. About 240 pp. Soft cover About $7.00. Ready April 1976. Order #8286-3. Anderson: CLINICAL ANATOMY AND PHYSIOLOGY FOR ALLIED HEALTH SCIENCES Ideal for community college nursing curricula or for para-medical courses. this eloquent. beautifully illustrated book effectively in- tegrates clinical considerations with the study of basic anatomy and physiology. By Paul D, Anderson. MS, Assoc. Prof. of Anatomy and Physiology, Massachusetts Bay Community College. About 480 pp.. 315 ill. About $10.25. Just Ready. Order #1234-2, Anderson: lABORATORY MANUAL AND STUDY GUIDE FOR CLINICAL ANATOMY AND PHYSIOLOGY FOR ALLIED HEALTH SCIENCES This valuable manual is designed to be used with the author's textbook. It gives your students detailed laboratory directions. useful background information about the tissues examined. and challenging questions that lead thern to a broader understanding of the material. By Paul D. Anderson. MS About 225 pp.. 140 ill. Soft cover About $6.70. Ready April 1976. Order #1236-9, W. B. SAUNDERS COMPANY CANADA L YD. '---'_ 833 Oxford Street, Toronto, Ontario M8Z ST9 PncessublecttoChange ,- T-;;'-;;; title s-;;' 3D-day appr o-;;'. ' ber ana author: - - - - ---;' e Pri ;;; - - - - - - - - - - - - - - - ;;;;;-I I I I I I I I I I AU: AU: AU: I FULL NAME I I I POSITION & AFFILIATION (IF APPLICABLE) I I HOME ADDRESS I I I L heck Io..d- n .la _ ndC . O.D ._ -"'II m _ ITY __ _ _ _ _ _ _ _PROVINCE =- _ _ _ ZON ':.......--=-_I . """'" \ C L IN/( I . - o I --\. " o at shoe do most n es prefer? THE LINIC TRADl.IMIUIta NO. \J.&. PAT CWP I CAHAØA. .. U.I-A SHOE p.k Wkai,@ For a complimentery pair 01 white shoeleces, folder showing all the amert Clinic styles, and list 01 stores selUng them, write: THE CLINIC SHOEMAKERS · Dept. CN-3 7912 Bonhomme Ave. . St. Louis, Mo. 63105 3 76 The Canadian Nurse March 1976 3 Input News Calendar Names and Faces What's New Books Audiovisual LIbrary Update The Canadian Nurse The official journal of the CanadIan Nurses' Association published monthly in French and English editions. 6 8 16 44 46 48 46 54 Frankly Speaking Physical Assessment of the Newborn A Practical Guide to Successful Breast-feeding Freezing Breast Milk at Home The Treatment of Mastitis in Nursing Mothers Babies At Risk? Matthew My Son Shaping a New Future Plenty of Room for You and Your Family Volume 72 Number 3 F. Harrison 19 V. Marcil 20 M.E. Taggart 25 D. Théberge-Rousselet 31 D. Théberge-Rousselet 32 D. Théberge-Rousselet 34 B MacLellan 36 B. Ratsoy 40 D. Miller 42 L--. - New approaches to childbirth and the care of the newborn give nurses the opportunity to take an active role in promoting a healthy mother and child. That's why the focus, this month, IS on that very important character, the neonate. The photo of the one on the cover was provided by Information Canada, Ottawa. The views expressed in the articles are those of the authors and do not necessarily represent the policies of the Canadian Nurses' Association. ISSN 0008-4581 Indexed in International Nursing Index, Cumulative Index to Nursing Literature, Abstracts of Hospital Management Studies, Hospital Literature Index, Hospital Abstracts, Index Medicus. The Canadian Nurse is available in microform from Xerox University Microfilms, Ann Arbor, Michigan, 48106. The Canadian Nurse welcomes suggestions for articles or unsolicited manuscripts. Authors may submit finished articles or a summary of the proposed content. Manuscripts should be typed double-space. Send original and carbon. All articles must be submitted for the exclusive use of The Canadian Nurse. A biographical statement and return address should accompany all manuscripts. A Canadian Nurses' Association, ':::( 50 The Driveway, Ottawa, Canada, K2P 1 E2. Subscription Rates: Canada: one year, $8.00; two years, $15.00. Foreign: one year, $9.00: two years, $17.00. Single copies: $1.00 each. Make cheques or money orders payable to the Canadian Nurses' Association. Change of Address: Notice should be given in advance. Include previous address as well as new, along with registration number, in a provincial nurses' association where applicable. Not responsible for journals lost in mail due to errors in address. Postage paid in cash at third class rate Montreal, P.Q. Permit No. 10.001. CCanadian Nurses Association 1976. 4 The Canadian Nurse March 1976 Save 20 0 00n all Professional Shoes .Bøtø CßEAUTY' ON'ÐUrY NORTH z;:smA Reg. $18.99 $15.19 --':>(-t i,-e 'What's the use of a new invention," someone is supposed to have asked Benjamin Franklin. To which he replied:"What's the use of a newborn child 1" Well, useful or not, the neonate is an important, often noisy, part of the responsibilities assumed by many nurses. His well-being, and that of his mother dunng those first few, crucial, postpartum days, depends, in large measure, on the level of nursing care they both receive. To a great extent, too, it is the nurse who determines the quality of the relationship that mother is going to have with her new offspring when she returns home. If, during her stay in hospital, she has grown familiar with the pattern of her baby.s needs and desires and has learned how to cope with them, she is less likely to look on those early weeks and months of co-existence as a frightening period of never ending new responsibilities that she can't possibly handle. One of the ways a nurse can help get this relationship off to a good start, is by helping the mother to establish a successful breast-feeding routine -if that is the ambition of the mother. That's why, this month we offer three articles dealing with this topic. Fashions come and go and right now, breast-feeding seems to be enjoYing a resurgence of popularity. Our prime minister's wife has set an example for other young mothers by nursing all three of her children. She refuses to let official duties stand in the way of this responsibility and, as a result, the three youngest Trudeau s are alreaay' experienced world travelers. Not every mother IS going to choose to breast-feed her baby, but most mothers are concerned about a more natural approach to the entire process of gestation, childbirth and child care. That's why the story by Montreal artist and writer, Beverly MacLellan, is included in this issue. Somehow, the support and encouragement that she needed to back up her preparation and training in childbirth and infant care were not available when she needed them most. 'Putting it all together," in the case room, the nursery and obstetrics ward, so that the neonate gets off to a good start and his mother remembers the event of his birth and her stay in hospital as an enriching experience, takes real skill and teamwork. And that's what nursing is all about. isn't it? "What's the use of a newborn child? To raise the dead heart - To set wild the fettered hope." (Witter Bryner) Editor M. Anne Hanna Assistant Editor Liv-Ellen Lockeberg. Production Assistant Mary Lou Downes Circulation Manager Beryl Darling Advertising manager Georgina Clarke CNA Executive Director Helen K. Mussallem CNA Director of InformatIon ServIces _ MAH. Michèle Kilburn lit.>> I-t.>> ill - '... --A' L " , \ -- yo , - ....: ----- - - .... -;....- " Bernadel Ratsoy was the driving force behind the setting up, in 1971, of a new postpartum program at St. Paul's Hospital In Vancouver. The program, aimed at encouraging parents to make decisions and adopt a positive, independent role in the care of their newborn babies, is described in The Canadian Nurse, April 1974. In this month s issue, she relates her experience at St. Paul's to the broader field of health care planning and outlines a strategy that any nurse can use to launch her own ideas. The article is based on a paper prepared for the 63rd anniversary meeting of the RNABC when members examined the potential role of the nurse in health care planning Next month, Barbara Geyer a nurse at the Charles Camsell Hospital in Edmonton, describes the nursing care involved in the replantation of a severed limb in a young patient. Two-year old Theresa was brought 10 the hospital with her left arm completely severed. Today, she has close to normal function in that limb. 6 The Canadian Nurse March 1976 Ill))11t Nightingale debunked As a student of Florence Nightingale for 25 years, I wish to take exception to the image projected by Simpson and Green in the December issue of The Canadian Nurse. Florence Nightingale is what is wrong with the nursing profession. She most certainly had organizing ability but did not personally assemble a staff in less than a week. She spent most of the time in her rooms in Pall Mall while four friends interviewed the applicants who were few in number. It would have been impossible for anyone to impose order in Scutari, even Florence Nightingale. Efficient it never became! Florence Nightingale warm and sympathetic? Never! She was a cold fish, her personal relationships were unsatisfactory and she remained emotionally immature throughout her life. She spent less than three of her 90 years practising nursing and never set foot in a hospital, except as a visitor, after 1856. Founded a school of nursing reluctantly and visited it for the first lime, 22 years later. Opposed the registration of nurses and the enfranchisement of women. Despised women. Liked men. Was a martyr, fanatic, mystic and hypochondriac. Her influence has done more harm to the nursing profession than any other single factor. Florence Nightingale was not the founder of nursing, but because her "clout" was greater than anyone else's. her attitudes prevailed, giving rise to the apprentice system and a militaristic structure with a chain of command, hierarchical form and unquestioning obedience. She has descended through the last 120 years as a myth. Sweet, gentle, perfect, noble, self-sacrificing lady. Florence Nightingale is the epitome of the perfect nurse. Ergo, every nurse must be sweet, gentle, perfect, noble, self-sacrificing and a lady. The nursing profession has been led by pale imitations of the myth of Florence Nightingale since 1885 or thereabouts, ladies every one of them. "Ladies"nursing did not need, but tough, assertive women. Because of the legend of Florence Nightingale, there is no room in the nursing profession for the iconoclast, the intellectual, the rebel or the maverick. Every nurse has to fit the mold, drab, dull, conditioned and brainwashed. Yet, in every field of human activity, progress and innovation has been brought about by individuals or groups who have been rebels, iconoclasts, intellectuals or mavericks. Name five statesmen whose names are in the public domain. Name five wnters. Name five politicians known throughout the English speaking world. Name five nurses. Well, there is Florence Night- ingale. And Florence Nightingale. And Florence Nightingale. And Florence Nightingale. Maybe, Edith Cavell because she got shot. Who else? - Pat Barr, Carstairs, A1ta. Heart of the matter I am writing to comment on what has to be the best article ever published in The Canadian Nurse - Colleen McElroy's "Caring for the Untreated Infant" (December 1975). The author sees clearly through the maze of confusion that is the downfall of so many of us - rigid, blanket policies, legal red tape, satisfaction of curiosity (as opposed to legitimate research) - to the heart of the matter, this one patient's welfare and best interests. A humanist philosophy is the only one that has any place in the care of the untreatable patient: with it, one can always be sure of doing the right thing. That will mean to treat one patient, not treat another, or change approaches with a third, without hesitation. We have generally applied "rules" of care for the living, with intensity of application measured appropriately to each situation. Why are we so afraid to develop appropriate care for the dying? Appropriate care would mean the positive promoting of comfort measures, as actively as is necessary for the patient's comfort, rather than just negatively withholding life support. Care of the dying (or untreatable) still means caring, and as such resolves concern over questions of feeding such a patient, or providing stress-relieving oxygen therapy, thereby "prolonging his suffering." McElroy touches a crucial point when she mentions these patients have no awareness of time: rather the problem is one of our projecting our own feelings and fears onto them. This is definitely an area that cries out for further discussion and debate. Any institution that cares for the ill would do well to organize a workshop or study session to face the question. - Lucille Pakalnis, R.N., Sudbury, Ontario. Cutting corners Being a graduate of the 2-year program and having worked three years in a hospital setting, I have a poor regard for this course. At the present time in Ontario, especially since budget cuts have reduced the staff drastically, new graduates are placed alone on wards on afternoons and nights and are often in charge. They are usually young (18 and 19) and many of them have little practical experience. I feel this is placing extreme pressure on young grads and also placing the life of the patient in jeopardy. Recently I have come across young grads who 1) gave 1,000 ml of IV with pitocln in it in a very short time and didn't know of the dangers of this,2) one new grad who catheterized a postpartum patient for 1100 ml straight and had no concept of the fact this procedure could set a patient into shock as the bladder collapses, 3) another grad was to give a preop enema. The ward was very busy and she had never performed this procedure. No one was available to assist her. I realize these are only three instances of poorly prepared grads but I must state the patients in the care of these girls were clearly not in the safest hands. Another very serious problem is the system of admissions to community colleges. The quality of applicants is not well assessed and often colleges are more concerned with filling their enrolment quotas than pruning the group and having those suited to nursing placed in the program. It seems to me we have lowered our standards now that hospitals are no longer competing for the best students. - Margaret, Davidson, Chatham, Ontario. Psychiatric Journals As the national nursing library we try to achieve complete runs of Canadian nursing journals. At the moment we are trying to find back issues of the Canadian Journal of Psychiatric Nursing to complete our holdings, and to fill an outside request. The issues we seek are volumes 1 to 7, number 7 inclusive, that is from 1960 to August 1966. If any readers can assist us, we shall be most grateful. - M. Parkin, Librarian. CNA House, 50 The Driveway, Ottawa. Pension Benefits Amended The December 1975 issue of The Canadian Nurse contained an article "Is There Sex Discrimination in Health Care?", which stated that Ontario Community Colleges discriminate against female employees for pension purposes. This is not the case, and has not been so since November 1974. In that amendment, the word "Spouse" was submitted to include either the widow or the widower of an employee. There is no longer any need for a widower s previous dependence on a female employee to entitle him to the pension death benefit. I trust that this will clear up any misunderstanding of our pension plan that you may have reæived. As you know, all colleges are under the same plan. - E Karen Sendall, Employment and Benefits Officer, Conestoga College of Applied Arts and Technology, Kitchener, Ontario. The editor replies: Thank you for pointing out this inadvertent error on our part. The example of perceived discrimination you refer to was cited by a teacher in a community college. It was incorporated in the article in good faith since it was impossible to verify all of the comments contained in the many questIonnaires returned by readers. Perhaps thIs error on our part will serve some purpose if it alerts other faculty members to the amendment you refer to. The Canadian Nurse apologizes for any Inconvenience you may have suffered. \' " '" - \ \ -.... ............... -r--...... . ì . (\ f '- 1 / '"' . I " ./ , '-- ..-/ The 'Littmann' Series Portfolio of Ä. Y. Jackson drawings Free with your order Reproduction of A. y. Jackson drawings by special permission of the McMichael collection. Littmann STETHOSCOPES . . . tru Iy the fi nest stethoscope a nurse can own The Medallion Combination Stethoscope The highest quality bell and diaphragm chest piece, the stethoscope for nurses who practice in critical care areas. Choice of five tubing colours - goldtone, silver tone, blue, green and pink. The Medallion Nursescope Colour co-ordinated in five jewel like colours. This stethoscope was especially designed for the nurse. Weighs only 2 oz. and fits neatly into uniform pocket. Group Purchase Package Your local selected surgical supply dealer handles the complete line of'Littmann' stethoscopes and will offer discounts on group purchases of five or more. Write us today! for complete details on: D The 'Littmann' stethoscope line D The Group Purchase Package D The 'Littmann' Series portfolio D A list of selected 'Littmann' dealers MEDICAL PRODUCTS m 3m CANADA LImITED .,.I. POST OFFICE BOX 5757 LONOON ONT'ARIO N6A 4T1 6 The Canadian Nurse March 1976 Ne".s t (.w ) "'" ...\ , / "" \' ). NBARN members Arlyn McGee (far left) and Evelyn Matthieu (center) meet Dr. William Forster, N. B. Director of Mental Health Services during a 1 I New Brunswick nurses with a special interest in providing more effective care and better understanding of the suicidal patient received some expert assistance recently at a two-day workshop on "Suicide and Self-destructive Behavior." Dorothy Burwell, associate professor, faculty of nursing, University of Toronto, and Patricia Delbridge, founder and former executive director of the Ottawa Distress Centre, a telephone service for crisis intervention, were resource persons for the two-day meeting. "After the initial response to the suicidal act, it is important that a total care package be devised for each patient," Delbridge told her audienæ. "By total care I don't mean round-the-clock company and custody, but a care package that recognizes that in 60 percent of attempts, we are dealing with an at-risk period that may be for the duration of the crisis but may also return at each crisis or indeed become a way of life." The speaker, who is presently director of Help the Aged, a British " \...7 - . " f:.:.-. i . -' .-r "'- , . ...:. , I recent workshop on crisis intervention. Resource persons were Patricia Delbridge (far right) and Dorothy Burwell. agency now extending its operations to Canada, stressed the importance of "Caring." "About the only thing experts agree on," she said, "is that when a nurse, counselor or friend thinks someone is suicidal, the best thing he or she can do is listen and sympathize." Burwell, who was formerly director of nursing education at the Clarke Institute of Psychiatry in Toronto, reminded her audience that "modern science has uncovered only the tip of the iceberg when it comes to communication between humans." She described Crisis Centre volunteers as more advanced than the professions at breaking down barriers between people. Panel participants included Ryllys Cutler, associate professor, faculty of nursing, and Kenneth Fuller, director of counseling services, UNB. The workshop was sponsored by The New Brunswick Association of Registered Nurses and the N.B. Department of Health, in cooperation with the UNB Department of Extension Serviæs. .. MARN members Support PCWM Brief on rape The Board of Directors of the Manitoba Association of Registered Nurses has given its support to a Brief on Rape prepared by the Provincial Council of Women of Manitoba. The Brief, which was unanimously approved by the Manitoba Council 01 Women,has been submitted to the National Council of Women and is being considered for inclusion in its annual presentation to the Canadian government in November. MARN representatives have requested Directors of the Canadian Nurses' Association to consider endorsing the Brief at their meeting in February. In the Briel, the PCWM emphasizes the need to recognize rape as a "crime of violence" rather than simply a sexual offence. "The Criminal Code presently attaches significantly greater importance to the sexual act than to other aspects of the attack," the Brief points out. "Women who are raped are indeed assaulted, although the law does not emphasize this aspect." The PCWM recommends legislative amendments to recognize rape as sexual assault under the general heading of assault, with specifications of various forms and degrees of assault. Making the length of sentence correspond to the degree of assault, would help to place the offence of rape in its proper perspective according to the Council. The Brief contains a summary of the Council's reaction to recent proposals by the federal Minister of Justice to amend the Criminal Code respecting rape, as well as related recommendations. The 10 recommendations include one suggesting changes in courtroom procedure "to spare the rape victim as much embarassment and indignity as possible, for example in the display of intimate apparel and questioning as to previous behavior." The Council stresses the need for liaison between the medical, legal and police professions and recommends expansion and strengthening of counseling services, review of methods of interrogation, and medical procedure. The Council also notes the need to "prepare girls to be less submissive so as to begin to eliminate their vulnerability to attack." "The school physical education curriculum should provide female students with courses in basic self-defense skills at an appropriate time in their development. Self-defense may n.ot be sufficient to repel an attack, but il would make girls/women more familiar with situations they should avoid; it would also teach girls/women how to think their way out of a difficult situation, be a physical conditioner, and a form of self-discipline. Recent studies indicate that the difference between the physical potential of women and that of men could be greatly lessened by early physical training for girls on a basis comparable to that received by boys. This would encourage girls to reach their full physical potential." National survey studies Community nurses If you are one of the roughly 14,000 registered nurses working in community-based settings in Canada, chances are that you will soon be called upon 10 help describe this aspect of nursing practice. The Canadian Nurses' Association is presently conducting a national postal survey of nurses to determine the responSibilities, practice setting, education, remuneration and legal protection/status of nurses working in the various public health agencies, occupational health agencies, visiting care agencies, community health centers, physicians' offices, private and commercial nursing agencies, and treatment centers across Canada A random sample 01 8,000 of the estimated 14,000 nurses working in these settings will soon be receiving questionnaires from CNA. Names of the recipients were chosen by computer on a random basis and anonymity is assured by the principal Investigator. CNA requests the cooperation and assistance of all nurses who receive questionnaires. - l!t I I -_.:. I ' '- , f . \ '\.1 \' \' / / ( lr'! iIi/) I \, J. J -\ ) C' ..\ \', \ I .. -- ì\ ,;"-\V6 '- ': ' nothmg happened. , . NOT SURPRISING. . ..' t1 RETELAST is so comfortable and g ives . , '".-jJt such fast relief. Moreover, RETELAST . . costs up to 40% less than any other 1 i ' dressing or traditional bandage. ' I . .\, -.. @ @) 0 @ PHARMACEUTIQUES LTEE PHARMACEUTICALS LTD Laval, Que. Canada DEMONSTRA TION AND FOLDERS UPON REQUEST 14 The Canadian Nurse March 1976 XP\'-S Good health The yoga way Recipe for health: Start with exercise, a few simple postures to stretch the muscles and keep the body in tune. Add lots of fresh air, sports, a dash of country living. Eat healthy food. Calm yourself. Breathe deeply. Reach inside yourself for inner happiness. Sound promising? This was the message of Suzanne Piuze, a yoga teacher from Montreal, who has done much to adapt these classical teachings to the North American way of life. While in Ottawa recently to promote her method of teaching yoga, she visited CNA house to talk to journal staff about yoga and its relationship to the medical profession. "T 0 me, yoga IS an art of better living, and also a school of happiness. It's a way to find peace of mind, to control your body as well as your mind, instead of being a slave all your life to your environment, to your work, to sadness, to whatever comes from the outside. Yoga helps you to get inside, deep inside and find happiness where it really is:' she said. To help people find their way, she teaches a combination of the many forms of yoga, including Hatha Yoga (yoga of postures) and Raja Yoga (yoga of the mind) at her studio in Montreal and a live-in Yoga Centre In the Laurentian Mountains. I' 1 . .. \1 "- -'" ! '.':I! : t ' "uQo --"").- "You have to start with your body, but at the same time something happens while you are so aware of your muscles, of your health, of movement, you also control your mind because you have to think only of what you are doing." The exercises themselves, she says, are only one .ft 4 t, . If I(AU 11 iiA '.....I.,niJ . I: -:( I I .11 .... I I , 5r: :1:1 . 2 . It- J. j t - ,\ co.o..JfO" :IIOo,Oc:P- Oo,,,,...!!! J , A - -4 " '- ó _. .." .. " Two CNA journal staff members, Viviane Marcil (assistant editor, L'infirmiére canadienne) and Carol way to cleanse the mind. She also teaches transcendental meditation. a technique to calm the mind and stop the inner "movie camera" from producing its constant flow of images To facilitate this type of relaxation students repeat a mantra, usually a Sanskrit word, over and over as they follow their breath. Because the word has no meaning for them, it doesn't bring to mind any particular thoughts or worries, but does help to push out other thoughts that seem to control the mind. Nutrition is also an important part of her teachings. She does not smoke, nor drink coffee and avoids eating sweet foods like cakes and pies. She does drink tea, however, and serves her students at the Yoga Centre a variety of herbal teas, specially mixed to take advantage of their medicinal effects. Far from regarding it as quackery, Piuze says that more and more doctors are recognizing the beneficial effects of yoga, particularly for psychosomatic diseases and cases where relaxation is important, e.g. heart conditions. and many are sending pallents 10 her. She stresses that yoga is basically preventive and should complement medical advice rather than being used as a substitute for it. To this end she has studied anatomy, physiology and acupuncture, and is committed to a personalized form of yoga where postures are adapted for the individual and his physical capabilities. She also adapts the postures for other groups, including expectant mothers who can take advantage of her prenatal yoga classes to learn to breathe properly and relax. In fact, she says, many of the breathing exercises taught in Thiessen, right, (The Canadian Nurse) interview Canadian yoga expert, Suzanne Piuze. community prenatal Iasses have their origin in yoga. Among her clientele are many nurses who come for personal reasons and "sometimes because they want to get away from pills, just the sight of them." Asked how nurses can apply wnat they learn to their jobs, she replied: "The best way to teach is by example. Instead of telling someone to do this or that, if you apply it to yourself, it reflects. Also, if they are more aware of their patients, if they are 100 percent with them, it helps too. With yoga, when you are present, you are really present." She also suggested that nurses can encourage good health "by telling patients that when they get out of the hospital they should go near the sun as much as they can and eat better. They should walk, they should practice sports, they should drink lots of water between meals, they should go to the country as much as possible, they should not drink too much coffee." In her own way, SuzannePiuzeis trying to spread the message of "yoga for health." She has published three books, La Santé par Ie Yoga, Hatha Yoga, and Yoga Sex; she teaches yoga in a studio in Montreal; she gives one half hour a week of yoga on community television; and she teaches adolescent girls in jail one night a week. In addition she publishes brochures encouraging those who are interested to come to her Yoga Centre in Eastman for intensive weeks or weekends of yoga, seminars on physiology, stress, etc., fresh air, sports and healthy surroundings. AARN celebrates Diamond jubilee The Alberta Association has announced that the theme of its Diamond Jubilee Celebrations will be "Co-ordination of Health Care Services." In the 60 years since it was established, the AARN has grown from the initial nucleus of 12 members to a total of more than 35.000 registered nurses at the beginning of 1976_ Looking back on the history of the association's preliminary steps towards organization, a spokesman for the AARN, recalls: In 1909, the embryonic Canadian Nurses' Association set out to encourage nurses to organize at the provincial level. Before this, nurses in the various provinces were not organized as a provincial body but as alumnae within the provinces. In Alberta, prior to 1916. local nurses' groups existed in four major Cities. Local registries of qualified nurses for private duty nursing were also kept. The main reason behind the development of provincial Graduate Nurse Associations was that trained nurses found themselves competing for status and wages with 'nurses' who had little or no training. No legal controls to curb this situation existed. Trained nurses in each province therefore united to lobby for ProvinCial Registration Acts that would establish uniform standards for preparation and graduation and give qualified nurses legal status. When the Alberta (Act) developed bytheAARN, was passed in 1916, the province became the third in Canada to enact nursing legislation. Nova Scotia (1910) and Manitoba (1913) had passed acts incorporating registration procedures shortly before this time. The AARN 1976 annual convention takes place May 11-14 in Edmonton. Think piece - A full 90 percent of the wort< done In this country is done by people who don't feel weli...People who write the most interesting and effective letters never answer letters... they answer people ....And, when you come to the end of a perfect day... check back carefully. I trav I - I - II f\l\&Lo\U ARIFJf seru h Recentl M" m c olesterol y, a dieta ry mnesot I' was re ted progra fish, lean a t Included s ':; "from the IT to reduce Result: seru: ' and Mawla "li:' poultry, :e,:ity of average of 17% holesterol level % pure com oil eggs, . F . s were reduced . 1m or a an I .portant stud complete r nformation B y, please wr. t eport on th. Star h C ,est Food "' e to Nt"" 's Stat" ompany P 0 s DIvision Th u 2tlOnai H3C o l n C A , Mont;eaÎ Q . Box 129,' e anada 1 ' uebec Mazol C ' 54% a lorn Oil cont . 14 po yunsaturated ms: l! saturated fats. lats and ct \. . B st Foods Llving up t o our name. '\ ttazol S CORN O.a.. OO% plJtt" '...... 1J f5 ....... ..._.,_ " ........ -- 16 The Canadian Nurse March 1976 Ca:tlendal- March 23 - May 11, 1976 Course: "Conserving and Promoting Health for the Mentally Retarded," Tuesday evenings at the McLennan Physics Building, Umversity of Toronto. For information contact: Dorothy Brooks, Continuing Education, Faculty of Nursing, University of Toronto, 50 St. George St., Toronto, Ont.. M5S IAI. March 31 - April 1, 1976 National Nephrology Forum: A Conceptual Approach to Patient Care at Hyatt on Union Square, San Francisco, CA For information write to: American Association of Nephrology Nurses and Technicians, Two Talcott Road, Suite 8, Park Ridge, Illinois 60068. March 30 - April 1, 1976 21st annual convention of the American College of Nurse-Midwives to be held at Stouffer's Riverfront Towers, St. Louis, Missouri. On March 29, a workshop on Adolescent Health Care; April 2 workshop on Attitude Reassessment for the Sexual Counselor. For information, write: American College of Nurse- Midwives, 1000 Vermont Avenue, N. W.. Washington, D. C. 20005. March 24-27, 1976 Association for the Care of Children in Hospitals conference to be held in Denver, Colorado. For pre-registration information, write: Lynn Moulthrop, ACCH Colorado Affiliate, P.O. Box 613, Aurora, Colorado 80010. 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 Please complete appropriate category Postal Code/Zip o I hold active membership in provincial nurses' assoc. reg. nO./Pl?rm. cert./lic, no. o I am a personal subscriber Mail to: The Canadian Nurse, 50 The Dnveway, Ot1awa K2P 1 E2 April 1 - 3, 1976 Workshop: Current Concepts In the Care of the Diabetic to be held at Jasper Park Lodge, Jasper Alberta. Information from: Continuing Nursing Education Division of Continuing Medical Education, Clinical SCiences Bldg., University of Alberta, Edmonton, Alia. TOO 2G3. April 2 - 4,1976 Biennial meeting of the Northwest Territories Registered Nurses Association to be held in Yellowknife, N.WT. April 3 - 4, 1976 "Nursing Today in Émergency Care" to be held in Vancouver. Apply to: Continuing Education in the Health Sciences. P.A Woodward Instructional Resources Centre, University of British Columbia, Vancouver, B.C. V6T 1W5. April 9 - 10, 1976 "Practical Application of Psychosomatic Obstetrics and Gynecologic Concepts to Patient Care" - conference to be held in Chicago, sponsored by the Canadian and U.S. sections of the International Society of Psychosomatic Obstetrics and Gynecology. For information, wf/le: Toby Hofslund, 1307 East 60th Street, Chicago, Ill. 60637, U.S.A April 21 - 24, 1976 Symposium on fetal monitoring to be held at Chateau Frontenac, Quebec City. In English and French, with simultaneous translation, information from: Dr. Adrien Bastide, Hôpltal Saint-François d'Assise, 10 de I'Espinay, Quebec, Quebec, G 1 L 2H 1 . (Tel: 418-688-8710) April 23 - 24, 1976 Interdisciplinary Respiratory Disease Conference sponsored by the New Brunswick Tuberculosis and Respiratory Disease Association will be held at the University of New Brunswick in Fredericton, N.B. For further information write: Alma T. Leclerc, Program Director, New Brunswick TB and A.D. Association, 123 York Street, Fredericton, N.B. E3B 5E3. April 26 - 30, 1976 National conference of Operating Room Nurses and Biennial Institute of the British Columbia Operating Room Nurses Group to be held at the Vancouver Hotel. Information from: Ellen Schodt, Chairman, Registration Committee BCORNG, 103-930 Glenacres Drive, Richmond, B.C. April 29 - 30, 1976 Session: Current Nursing Methods and Resources in Coronary Care to be held at School of Nursing, University of Alberta. Information from: Continuing Nursing Education Division of Continuing Medical Education, Clinical Sciences Bldg., University of Alberta, Edmonton, Alta. T6G 2G3. April 29 - May 1, 1976 Annual Meeting of the Registered Nurses' Association of Ontario to ba held at the Royal York Hotel, Toronto, May 11 - 14,1976 Alberta Association of Registered Nurses convention to be held at the Edmonton Plaza Hotel. Theme: Coordination of Health Care Services May 12 - 14, 1976 Annual meeting of the Registered Nurses' Association of British Columbia to be held at the Vancouver Hotel, Vancouver. May 16 - 18, 1976 Manitoba Association of Registered Nurses annual meeting to be held at the North Star Inn, Winmpeg. May 17 - 19, 1976 Cardiology 76: third annual conference on cardiac care for doctors and nurses, to be held at Humber College, Toronto. Information from: Conferences and Seminars Office, Humber College, P.O. Box 1900, Rexdale, Ontario. May 28, 1976 Annual meeting of the Registered Nurses' Association of Nova Scotia IS to be held at the Hotel Nova Scotian, Halifax, Nova Scotia. June 8 - 10, 1976 Annual meeting of the New Brunswick Association of Registered Nurses to be held at the Playhouse, Fredericton. The Canadian Nur.. March 1976 17 en you are CONVENIENT STERILE . INEXPENSIVE OB DISPOSABLE PRODUCTS FROM HOLLISTER Nothing to get ready, nothing to clean up when you're through. With every Hollister disposable you use. you are ridding yourself of the cross-con- tamination hazards of reusable instruments, What's more, our disposables don't crimp your budget. It's possible to perform amniotomy, clamp the baby's umbilical cord, footprint him and circumcise him for as little as 93 . FOR AMNIOTOMV FOR CIRCUMCISION the Double-Grip' UmbIlical Cord-Clamp maintains a constant pressure on the cord until it dries. 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She is Health ServIces dministrator - Nursing, Alberta Hospital ,)er.vices Commission =ernande Harrison The folklore of Central America offers a hought-provoking anecdote describing the Jehavior of a monkey and a fish caughf in a food. The monkey was able to climb into a learby tree, and from this secure perch, he ! atChed the fish struggle against the turbulent aters. Finally he grew impatient with the truggles of the poor fish and called down, 'You should be as clever as I am, and come up lere." But the fish did not reply and continued I liS fight with the waters. Finally the monkey ::ould stand it no longer. He reached down and labruptly pulled the fish from the water. The ish, of course, did not respond well and lay here gasping with what little breath he had. Observing that the fish really appeared about 10 die, the monkey threw it back into the water and forever after proclaimed to anyone who Iwould listen that there was no use trying to do anything for fish, because they did not show þroper gratitude when they were helped. This anecdote can be applied in a very linteresting manner to the current situation of ,most hospital nursing administrators. Like the fish, they are caught in a "flood" of budgetary ,controls and the pressure of increasing patient service needs. The monkey and his actions are represented by those who demand immediate solutions to these very complex problems. Nurses at various levels of responsibility have been exposed to strict economy measures. Budgetary control in coming months could easily dishearten the most conscientious nursing service directors. Yet, while the federal and provincial economic measures constrain the operation of nursing service departments, demands for health care services are rising steadily. This presents a genuine dilemma for nursing administrators: realistic solutions to the problem are not easy to visualize, In the original anecdote, the fish turned a "deaf ear" to the monkey's suggestion to climb up into the tree. Even though the fish's decision was wise, the monkey was frustrated by his seeming stupidity. It appeared obvious to the monkey that the fish didn't know what he was doing. Frankly Speaking about nursing administration A Contemporary Dilemma in Nursing Administration Nursing Administration High administrative nursing directors often turn the same "deaf ear" to suggestions from nursing staff. Their reasons may be valid but often they are hot obvious to others. The suggestion may not be useful to the administrator, for several reasons, even though to the nursing staff it seems perfectly logical and straightforward. Staff members quickly become frustrated with the apparent inability of administration to cope effectively with the situation and this leads \0 anger and bad feelings. Similar misunderstandings may occur when administrators must make severe budget cuts to particular departments. Supervisors of such areas may feel personally insulted by the reductions and interpret them as an insult to their personal competence and the significance of their department. Just as the monkey challenged the decision of the fish, the nursing staff question not only the fairness, but the wisdom, of administrative decisions and actions. The intensity of these feelings and the way in which they are expressed largely determines how constructive or detrimental such criticisms can be. Administrators who are skillful in dealing with their staff could use this energy and drive to work out a better solution to many problems. Focusing for a moment on the fish, one wonders if administrators cannot learn from his adaptive behavior. Even though he took a rather dogged approach to his problem, nevertheless, he survived. Survival in terms of maintaining the quality of patient care under tight budgetary control will be a great challenge for administration in the months and years ahead. The Challenge While individual approaches will necessarily vary to reflect local circumstances, many nursing administrators will have to rethink the philosophy and objectives governing their department. Some will go further. Policies, procedures and ritualistic practices influencing individual care plans of patients and underlying staffing patterns will be carefully reviewed. Some leaders may approach the dilemma from the pOint of view of resource allocation. Given that fair decisions can only be made on the basis of up-to-date and reliable data, activities will be geared to upgrade the information base upon which staff are allocated around the clock and throughout the week. Peaks and valleys in the weekly work load will be identified and positive steps taken to even out sporadic demands for nursing hours. A system of patient classification according to needs might be instituted. The relationships between nursing and other groups in terms of their complementary roles, more appropriate use of personnel, and economy, might also be seriously considered. A critical review of "what is" and inquiries into "what could be" are logical steps in the solution of any problem. Just as the fish had to swim because it was the most natural thing for him to do, so the nursing administrator must take the most basic steps to solve her problems. The most familiar steps would obviously be an appraisal of current practices and alternative approaches, with the aim of maintaining quality services within the present budgetary constraints. The introduction of improved information systems to achieve superior managerial decisions might be termed by "outsiders' a very simplistic and elementary approach to the "flood" of budget cuts and the heavy demand for patient service. But is it really, if it means survival? If there is anything to be learned from the fish and his actions, it is Ihat survival depends upon just this type of natural action.... 20 / '- 'r , II I '" " I '" c: '" u I .. I ãi 3: T) " OJ I Õ LC Q. The Canadian Nurse March 1976 ........ '. , The CanadIan Nurse March 1976 21 PHYSICAL AS)ESSMENT OF IF-iE NEWBORN . If( ... r . . :. .. , ..ç ;. . . ft{; ' - .. . ... Bibliography 1 Clausen, Joy Pnnceton. Maternity nursing today, by... et al. Toronto, McGraw-Hili 1973. p. 638-700. 2 Ingalls, A. Joy. Maternal and child health nursing, by...and M. Constance Salerno. Saint Louis, Mosby, 1975. p. 186-250 3 Keay, A.J. Craig's care of the newly born infant, by...and D.M. Morgan. 5th ed. Edinburgh, Churchill Livingstone, 1974. p. 89-297. 4 Lerch, Constance. Maternity nursing. 2nd ed. Saint Louis, Mosby, 1974. p. 279-343. 5 Moore, MaryLou. The newborn and the nurse. Toronto, Saunders, 1972. p. 87-182. -........- i Viviane Marcil Birth is a most traumatic experience and negotiating successfully from intrauterine to extrauterine life is a major challenge to the neonate. In fact, statistics reveal that the largest percenta'ge of infant deaths occur during the first 24 hours after birth and the great majority of these occur in the first hour of life. In the light of this, the nurse has the important function of assuming responsibility for immediate, careful, and constant observation of the newbom; she is the one most likely to detect the first clue that all is not well with the infant. Not only must she be thoroughly familiar with the physical mechanisms of the neonate in order to provide optimum supportive care in the stabilization of respiration and temperature, but she must also have broad and specific knowledge of the range of usual physical and behavioral findings of the normal infant in order to recognize those that indicate pathology and require immediate medical attention. One of the best means of detecting any abnormality is to proceed with careful. thorough, and systematic physical examination of the newborn. Before the nurse proceeds with the actual examination of the infant, she should review the antenatal history (health of the mother during pregnancy, Rh typing, complications of pregnancy, and drugs taken) and the birth history (kind and duration of labor, type of delivery, sedation or anesthesIa, resuscitation required, Apgar score, birth weight and length, and gestational age) as they may reveal pertinent information as to where abnormality Or pathology may exist. The infant's body temperature. respiratory rate, pulse rate, cry and color are also evaluated. Careful observation of the state of consciousness and general activity also provide valuable general impressions that can be confirmed or modified later. Although the sequence of the examination should normally be standardized, the nurse may adapt the system of examination to the particular infant and situation For example, it may be best to examine the chest and abdomen first if the baby is sleeping or to examine the mouth, palate, gums and facial contractions if the newborn is crying. Whatever the approach, the nurse should make sure that no part of the examination has been missed. Afterwards, a detailed recording of the examination IS made in order to provide valuable base-line data for the physician who will later examine the child himself, and for other nursery staff who will subsequently be responsible for the care of the infant. A standardized system of recording makes it easier for others to identify specific information more efficiently. 22 The Canadian Nurse March 1976 Normal variations Abnormalities Usual findings Head Face Eyes Ears Size Shape Symmetry 35 2.5 cm circumference Molded, if vaginal delivery, round If cesarian section Palpable anterior and posterior fontanels and sutures Anterior fontanel flush with neighbor- Ing parts (can be expected to be slightly depressed when child is in sitting position) Sutures are normally felt as ridges immediately after birth or as depressions within a day Symmetry between left and right side of face Symmetrical contractions of face when infant cries or grimaces Color Red <33 cm - microcephaly (eg. anencephaly) >38 cm - macrocephaly (eg. hydrocephalus) Asymmetry due to molding, hematomas or edema (eg. caput succedaneum, cephalhematoma) Posterior fontanel may be closed Tension of the anterior fontanel (to be determined when child is in sitting position) depressed (eg. dehydration) bulging (eg. intracranial pressure) Notify physician immediately There may be overriding of the sutures Hemorrhage (intracranial) Observe and notify physician Depressed skull fracture Notify physician immedIately Asymmetry between left and right side of face (eg. congenital malformation, hemiplegia) Movement of only one side of face when infant cries (eg. facial nerve palsy) Pallor, gray color Persistant cyanosis (eg. congenital cardiac malformations) Centered or deviated to right or left Marked edema or inflammation Discharge Moderate discharge from irritation by silver nitrate Drooping Setting-sun sign Purulent Cornea PupilS Iris Correct placement on face in relation 10 each other Edema due to instillation of silver nitrate Blink reflex present None Bright and shiny Round shape Equal and reacting to light Dark or slate blue Reaction to light discernible Hazy or dull Oval or irregular shape Constricted (eg. cerebral paralysis) Fixed and dilated Symmetry Eyelids Hemorrhage Jaundice Sclera Bluish-white Retina Coordination Shape Hearing Nystagmus usually present when Occasional uncoordinated child rotated laterally. Does not persist movements when replaced in crib Well-formed Red reflex Cartilage present Upper part of ear should be on same plane as angle of eye Blinking of the eyes, momentary cessation of activity or startling indicate positive reaction to sound Moro reflex Opacity of lens Persistent uncoordinated movements Malformations (eg. branchial clefts) Preauncular papillomas may be present Amount of cartilage varies (lessened amount is usually a sign of prematurity) May be folded or creased Malformations (eg. low placement) No response to sound Nose No response to Moro reflex (eg. intracranial hemorrhage Symmetry Shape Patency In midline of face Appears flattened Infant should breathe easily through nose when mouth closed Some mucus present in nares may Interfere with free breathing Deviated to right or left Malformation Unusual flattening Flaring of nares (eg. obstructed airway, atelectasIs) Check for other signs of respiratory distress The CanadIan Nurse March 1976 23 Usual findings Normal variations Abnormalities Mouth Lips Malformation (eg. cleft lip) Tongue Palata Gums Pink Rooting reflex Pink Inside mouth Normal volume Pink and well-formed Pink May have transient circumoral cyanosis Short frenulum linguae (insignificant) Epstein's pearlS Inclusion cysts Rear gums may be whitish May appear quite jagged Teeth may be present Inclusion cysts Thrush ProtruSion Frenulum linguae extending to tip of tongue (may interfere with sucking) Large and thick (eg. Down's syndrom e) Malformation (eg. cleft palate or unusually high) Salivation Reflexes Neck Appearance Motion Scant Sucking reflex initiated when lips touched Extrusion reflex Gag reflex initiated by tongue blade Short. straight Head moves freely from side to side and from flexion to extension Excessive and frothy (eg. tracheo- esophageal fistula) Loss of sucking reflex (eg. physiologic jaundice) Masses Distended veins or edema Webbing Restriction of motion Congenital torticollis Opisthotonus Chest Size Averages 30 to 37.5 cm <30 cm - prematunty Shape Expansion Respirations Breath sounds Almost circular Symmetry of movement with respirations Rate - 40/m;n. Vesicular May range from 30 to 60/min. Gross abnormalities Bulging Depressed sternum Asymmetrical movements (eg. diaphragmatic hernia) Labored breathing Grunting on expiration Retractions with respirations Rales Rhonchi Wheezes Breast Tissue Nipples Present in both sexes Symmetrical placement of nipples Excessive amount of breast tissue Milky secretion may be evident Asymmetrical placement of nipples (eg. fracture of clavìcle) Signs of infection Presence of supernumerary nipples below nipple line or In axillary region Heart sounds Abdomen Shape Rate ' 120 to 150/ min. Rhythm-irrpgular following physical or emotional stimulus Quality - first sound (closure of mitral valve and Iricuspide valve) and second sound (closure of aortic and pulmonary valve should be sharp and clear Contour cylindrical and relatively prominent Sounds of poor quality Extra sounds Heard on right side (sign of dextrocardia) Murmurs accompanying heartbeats Asymmetry DIstensIon Localized bulging (eg. hernia) Scaphoid abdomen (eg. diaphragmatic hernia) Check for other signs of respiratory distress Femoral pulses Present Umbilical stump Bluish-white Umbilical hernia may be present and Dry within several hours after birth is usually insignificant Abnormal redness, bleeding or infection Odor 24 The Canadian Nurse March 1976 Usual findings Normal variations Abnormalities Genitalia Size In both sexes, tend to appear Edema present in breech large in relation to rest of body delivery Size of penis and scrotum varies widely Color Red May have increased pigmentation in dark-skinned races Appearance Female: labia minora are quite Smegma prominent and prof rude over labia majora Vaginal discharge - mucoid or Excessive vaginal bleeding Male: prepuce usually adherent blood-tinged Malformations (eg. epispadias, to the glans hYpOspadias, phimosis) Testicles usually in scrotum Cryptorchidism Scrotum small and firm or fairly Hydrocele loose, relaxed and pendulous Meatal opening should appear as a slit Meatal o p enin g appears round Extremities Generally flexed but can be put in May retain in utero position when Limitation of movement in any Appearance full range of motion passively sleeping joint (eg. fractures, paralysis) Alignment of parts and presence of Absence or defects of parts or all all limbs and extremities of extremities Color Cyanosis may last for several hours Difference of color or temperature after birth between the extremities Hands Fists clenched Malformations (eg. webbing or Flexion of hand at wrist is approximately presence of extra digits, clubbing 1100; extension is 80 0 of fingers, unusual shortness Grasp reflex or curvature of little finger, simian crease on palm of hand) Arms Shoulders abduct from trunk Limitation of motion (eg. fracture, about 120 0 paralysis) Range of motion at the elbow Feet Plantar fat makes feet appear flat Malformations (eg. club feet. Grasp reflex absence of toes, abnormal Babinski reflex spacing between first and Usually held in varus or valgus May turn in but can be passively second toe) attitude but can be straightened turned out without forceful manual stretching Flexion and extension of ankle about 130 0 Legs Mild degree of bowing or medial Extra folds or asymmetry rotation (eg. hip dislocation) Symmetry of medial skin folds on anterior and posterior thigh Hip Range of motion should be about Limited abduction of one or both 160' to 170 0 in flexion and extension hips (eg. dysplasia, hip dislocation) ThlQhs flexed at hip should abduct to an angle of 160 0 between thighs Skin General Red in color Pallor; jaundice in first Appearance Varies with race and ethnic origin 24 hours of life Cyanosis of lips, fingernails, toenails, Harlequin Sign Generalized cyanosis (eg. hands and feet Erythema toxicum neonatorum cardiac, neurologic or respiratory Capillary hemangiomas malformations) Lanugo Vernix caseosa Tinted vernix caseosa \ Tendency to be dry Desquamation (eg if post-maturity) Turgor Skin of back of lower leg or thigh or Fold of skin perSists for I of abdomen returns to its former several seconds after release position after release of grasp between B ac k thumb and index finger of examiner General Shoulders, scapulae, iliac crests on Malformations (eg. spina Appearance same plane with each other bifida) Abnormal curvature of spine Spine straight and easily flexed Pilonidal dimple over coccygeal area Pilonidal cyst or sinus Hair over shoulders and back, Tufts of hair anywhere over the spine, especially in premature infants especially over sacrum (eg. spina bifida) Anus Patency Proven by adherence of meconium Anus may be irritated by frequent Imperforated anus on rectal thermometer rectal temperatures Fissures, bleeding The CanadIan Nurse March 1976 25 A PRACT CAL GU DE TO SUCCES3FUL BRFAST-FEEDING Although lactation is a normal human function, most mothers need some assistance in establishing a satisfactory routine. The information in this guide is provided 10 nurses who undertake to offer this important support and understanding. .. . '. " .. 26 The Canadian Nurse March 1976 Marie-Elizabeth Taggart Mothers who choose to nurse their babies need to understand, not only the anatomy and physiology involved, but also the proper procedure for breast-feeding. It is not unusual in obstetrical units, to find nursing mothers with a variety of physical complaints, including dorso-Iumbar fatigue after feeding, sore nipples and painful engorgement of the breasts. Unfortunately, these discomforts have not always been predicted, explained or alleviated by the nurse involved and many mothers as soon as they return home, give up their attempts to breast-feed. Inadequate instruction by medical or nursing personnel is not the only reason that these setbacks occur. Success or failure in breast-feeding depends upon many factors, including contemporary social and cultural attitudes. To illustrate, nursinq mothers are . 1 \ I , , (" - often anxious about their ability to maintain an adequate milk supply, even though it has been established that the vast majority of women (85 percent) are physically capable of lactating for six months or longer. Usually, the failure of physiological mechanisms involved in milk secretion and ejection can be traced to psychological barriers that are the result of stress and anxiety. Evidence also indicates that social attitudes play an important role In determining the success or failure of breast-feeding. Urbanization and industrialization have been accompanied by new social values. Iii fact, it could be said that industrialization has transformed breast-feeding into an outdated, archaic practice, at the same time that it has elevated artificial feeding into a positive symbol of economic slatus. In today's society, the breast is too otten perceived as primarily a sexual symbol. Some mothers have developed a negative body image concerning breast-feeding; for them, this procedure is a disgusting or degrading act. The attitude of members of the immediate family and close friends also affects the success or failure of the program. Recently, there have been indications of a trend towards renewed interest and enthusiasm about breast-feeding College or university -educated women, along with advocates of "natural foods," are among the strongest advocates of a return to this method of nourishing the baby. Some of these supporters have been influenced by publicity surrounding possible long-term harmful effects of artificial feeding on the baby's metabolism. Studies have been released suggesting that these include: neonatal hypocalcemia; overtaxing of the baby's kidneys with electrolytes as a result of the too early introduction of semi-solid and salty preparations; and the early appearance of a taste for sugar and consequently a long-range risk of tooth decay. In view of this renewed interest, it is the responsibility of today's nurses to equip themselves to provide new mothers with understanding, support and education. Although lactation is a normal human function, most mothers need some assistance in learning how to breast-feed successfully. The aim of this article is to help nurses and, indirectly, mothers become more knowledgeable in this area by describing the main stages of an educational program on breast-feeding. This includes a brief discussion of the advantages of breast-feeding and suggested educational approaches appropriate for each stage in the maternity cycle: I) prenatal, II) in-hospital, and III) at-home Advantages Breast-feeding offers certain advantages over artifical feeding that should be explained to the mother. For example: . The beginning of lactation triggers a hypophysial reflex that induces an ocytocic hormonal action on the uterus. This causes contractions that.in turn, facilitate its involution and help to effect a return to its normal state. . The mother's milk contains various anti-infective properties that ensure the baby's protection against intestinal infections causing diarrhea, especially those caused by Escherichia Coli. Moreover, the mother's milk seems to provide a degree of protection against pathogenic agents such as poliovirus and enterovirus. In addition, epidemiological studies conducted in developed countries Show that the Incidence of upper respiratory infections is lower among breast-fed babies. . Pottenger and Krohn (Ashley MontaQu 1971) found that breast-feeding facilitated adequate development of the peri-buccal muscles and the dental arch so as to help prevent the protrusion of teeth that would eventually require orthodontic repair. . It has been proven that the incidence of colic, food allergies and eczema is lower among breast-fed babies. . Psychologists agree that breast-feeding provides the baby with maximum oral gratification and establishes irreplaceable bonds of affection between mother and child. Pre-Natal Instruction About the middle of the second trimester, or at the beginning of the third, the nurse responsible for prenatal teaching may begin to provide some general advice, a brief theoretical explanation and some illustration of the procedures involved In breast-feeding. Some helpful suggestions The mother contemplating breast-feeding needs to know, for example, that during pregnancy, the size of the breasts will gradually increase and that this will necessitate buying progressively larger brassiere sizes. These bras should have wide shoulder straps for adequate support; should be washable and have properly fitting cups. They should not be rubber-lined, strapless or I boned. Brief air or sunbathing may be recommended to strengthen and toughen the nipples. A terrycloth facecloth or towel may be used to rub the breasts vigorously night and morning. During her daily bath the prospective mother should wash her breasts first using plain water and avoiding soaps or perfume that The Canadian Nurse March 1976 27 II nay dry out the aerola and eventually cause I 'happed nipples. A body oil. containing I ,molin, cold cream or baby oil, or one )rescribed by the doctor may be applied to .eep the nipples and aerola flexible. Mothers who have chosen to breast-feed heir babies should have their breasts 'xamined by either the nurse or doctor in order 10 ensure that the nipples are tractile. since ';uccessful breast-feeding depends to a large xtent on the baby being able to draw the lipples against his hard palate when sucking. Postpartum is hardly the time for a mother to discover, to her painful surprise, that her breasts are not suited to breast-feeding Most nipples are tractile when held between the thumb and index finger. This means that the Ilipple begins to harden and swell when subjected to stimulation with the fingers. Some women, however. have retractible nipples that contract rather than swell when stimulated. In such cases, the exercises that will be described later may be useful. The mother wIth retractible nipples can be helped by wearing Woolwlch cups (available from the La Leche League) for at least eight hours a day These cups follow the shape of the breasts very closely and force the nipples to protrude. Mothers hoping to breast-feed their babies may wish to join the La Leche League Association to obtain free advice and encouragement Physiology of Breast-feeding In order to successfully breast-feed her baby, the mother must grasp the basic concepts involved in the anatomy and internal functioning of the breasts. If this explanation is provided in straightforward and simple form, the mother will understand the lactation process and will be less anxious about her ability to nurse her baby. Patient teaching should include: . Examination of the outer aspects of the breast (figure 1). This description should I I I I I I I I I I / Fig. 1 - external view of breast A Papilla B openings for milk to flow (nipple) C Montgomery s glands (glandulae areolares) include an explanatiOn of Montgomery's Tubercles. the small fleshy globules on the aerola that secrete a substance to keep the nipple and aerola tractile. Mothers should be warned of the possibility of infection if these globules are squeezed or handled roughly. The 15 to 20 openings at the tip of the nipple through whiCMìnilk eventually flows should be pointed out tothe mother. Invariably, this information relieves the mother who had been under the impression that there was only one opening for the milk. . An explanation of the internal functioning of the breast This serves to reassure mothers of their capacity to produce milk. Figure 2 provides a simple explanation of the "reservoir B. A .,,1 Â: -g .. D Fig. 2 - cross-section of breast A lactiferous ducts leading to milk reservoirs B openings of lactiferous tubules C ampullae (milk reservoirs) D alveoli (where milk forms) aspect" of the milk supply and establishes that the breasts are always full and ready to feed the baby. Preparatory Exercises During the third trimester of the pregnancy. the nurse may suggest the following exercises to assist the mother. Nipple Protrusion Exercises: roll the nipple between the thumb and the index finger; or stimulate the nipple between the two thumbs in a vertical or horizontal direction, with some stretching action on the areola (figure 3). Fig. 3 - nipple protrusion exercises A stimulation of nipple between thumb and index finger B stimulation of nipple between two thumbs on an even plane C pressing areola toward base of the nipple 28 The Canadian Nurse March 1976 .. . -. .. ... These exercises are to be done, beginmng in the sixth month of pregnancy, at least twice daily. Massage: The breasts should be massaged and pressed for one or two min utes twice daily, six to eight weeks before delivery (figure 4). Fig. 4 - breast massage A starting position B the hands slide toward the areola while exerting continued pressure C the hands are cupped around the breast Tnese two exercises are useful In instructing the mother in emptying the breasts manually, and thus preventing engorgement. They also facilitate a better milk ejection reflex once the mother begins to breast-feed her baby and allow her to become familiar with handling her breasts so that she is more confident postpartum. II In-Hospital Instruction This phase completes the information given during the prenatal period and it would be useful to emphasize the following points: Hygiene Meticulous washing of the breasts and hands is necessary before each feeding in order to avoid infection. Alcohol and soap should not be used on the breasts since they cause chapping. The nurse should show the breast-feeding mother how to clean her nipples before and after each feeding with sterilized water and absorbent cotton or compresses. Cleaning before each feeding removes any trace of creams that may have been applied earlier. After feeding, cleaning protects the nipple and the areola, for whether they are dry or dripping with milk, they are ideal places for the growth of bacteria. Position It is essential that the mother be in a comfortable position. Research has shown that the sitting position is best for efficient draining or emptying of the breasts. If she can, the mother should follow the recommendations given in figure 5. Or, for the first few days following an episiotomy the mother may prefer to breast-feed her baby while lying down(figure 6). D Fig. 5 - nursing in a sitting position A pillow under the arm supports the baby B armrest to support the arm C feet raised for relaxation D the spine supported against the back of Ihe chair Fig. 6 - nursing while in a lying position The mother and child are parallel to each other. The mother's shoulder is on the bed, a pillow supports her head. Schedule In general, nurses should place the baby at its mother's breast while still on the delivery table (the baby having at least an Apgar of 8 to 10). This precocious sucking stimulates the secretion of milk, prevents postpartum hemorrhage, and by means of ingestion of colostrum, promotes a better intestinal peristalsis which helps the child to empty the meconium. Another reason for early breast-feeding is that colostrum is less irritating to the esophagus than water and o glucose. Colostrum produced during the firs twelve hours following delivery contains a higl" concentrationof Vitamins A and E, as well as antibodies. During this period, the child should be allowed to nurse whenever it is hungry, In most hospitals, breast-fed babies arE put on the same schedule as those who arE bottle-fed, (i.e_ q4h). Little consideration is given to the fact that the mother's milk is digested by the baby in two to two-and-one-half hours. If rooming-in is not permitted in the hospital, breast-fed babies should be placed on a three-hourly schedule including night feedings. According to Applebaum's recommendations (1970), the nurse should explain to the mother that durin! the first day the baby must suck for five minutes on each breast in order to facilitate 0 promote the milk ejection reflex. On the second day, the feeding time should be ten minutes per breast, and on the third day, fiftee minutes per breast. Total feeding time shoul, not exceed thirty minutes. The mother shoul, not take hypnotics because these lower her basal metabolism and consequently the secretion and excretion of milk will be reducec Feeding Once in the proper position, the mothe needs to be shown how to support and offe her breast to the child by taking the areola an the nipple between the index and the middl fingers in order to project the nipple (figure 7) a Fig, 7 - offering the breast to the infant The areola is gripped between the index and third fingers to facilitate milk flow from nipple. She will thus be able to stroke the baby's mouth or cheek so that he turns his head towards the mpple by himself. Never try to tur the baby's head in the desired direction The CanadIan Nurse March 1976 29 I because he will automatically turn his head I towards this touch, It IS important to remind the mother that the nipple and part of the areola must be inside the baby's mouth in order for him to suck properly without injuring the nipple. While the baby is sucking, depending on the shape and size of the breast, the mother will lower it gently With the index finger in order to enable the child I to breathe (figure 8). Fig, 8 - to keep the baby's nose free to breathe, I I the mother presses her breast lightly with her index finger. , Tne nurse should try to encourage the mother to be calm and relaxed while breast-feeding her child. She should also be careful to avoid all negative behavior when in the presence of breast-feeding mothers. When the baby begins to take in less milk, that is to suck with small irregular lunges at the nipple, the nurse will demonstrate to the mother how to use the alternate !l1assage method. She will help her massage one section of the breast after the other in order to soften each region of the breast with her fingers (figure 9), and do so without removing Fig. 9 - breast divided into imaginary quadrants. The mother massages each quadrant in turn during lactation if the Infant has a sluggish sucking reflex. the baby from the breast. This massaging promotes the draining of the breast and it enables the child to begin to suck more vigorously in the middle of a feeding. Drainage In order to avoid engorgement of the breasts and to ensure better drainage, the mother, with the assistance of the nurse, should put into practice the exercises learned during the prenatal period - that is, the manual massaging and pressing of the breasts. This should be done after each feeding as long as the baby does not succeed in sucking for half an hour. It is the draining of the milk and not its production which is the "sine qua non" of successful breast-feeding. If the mammary gland is not emptied by the baby, excessive milk-induced pressure builds up in the ducts and alveoles of the breast. This results in flattening of the secreting cells of the alveoles and consequently in a significant decrease in milk secretion. In order to facilitate the milk-ejection mechanism, doctors prescribe ocytocin in the form of nasal spray a few minutes before feeding. The nurse should show the mother how and why this is used. III At-Home Instruction The nurse responsible for postnatal classes or for at-home visits (6-8 weeks postpartum) may include the following recommendations in her instructions to breast-feeding mothers: Drug Use In general, mothers who breast-feed their babies should not take drugs because, once in the mother s milk, they may have different effects, such as blocking the activity ot some enzymes in the baby, interfering with normal physiological functions, or provoking hypersensitivity reactions in the infant. Many factors come into play once drugs are taken: the ionization of substances (PH), their concentration and their administration. The way a drug is administered, for example, is important with respect to the drug s level of concentration in the mothers milk. The level of concentration is always higher when a drug is taken intravenously (Catz and Giacoia, 1972). Certain drugs should not be taken by breast-feeding mothers: anticoagulants, antithyroid drugs, laxatives, narcotics, bromides, tetracycline and metranidazol (Flagyl). Concentrated alcohols such as cognac and whisky are also to be discouraged. According to Catz and Giacoia(1972), drugs which are not as yet contraindicated if used in small doses are aspirin, insulin, caffeine and clgarettes(not more than four per day) These do not seem to bother the baby. Schedule Studies have shown that the baby drinks 90 percent of the milk he needs during the first seven minutes of breast-feeding. No feeding should last longer than 30 minutes. Lactation increases according to the baby's needs. The more he drinks, the more milk is secreted. The ideal situation would be breast-feeding on demand, since this method would be based on the baby's needs. Also, according to Illingworth and Stone (1958), it would help prevent problems such as engorgement of the breasts and cracked and ulcerated nipples. Most mothers take four weeks to get accustomed to breast-feeding. If demand feeding is too difficult or a source of anxiety, the nurse can suggest a three -hour schedule for the first six weeks of breast-feeding. With this schedule, or even wIth feeding on demand, it is found that the baby will rarely feed more than six or seven times every 24 hours. Instead, the number of feedings decreases gradually according to the baby's appetite down to four to six teedings per day. Most babies continue to requi re night feedings until about ten weeks. Once the mother is at home, she should at first give one breast per feeding in order to completely empty each breast in turn, At the next feeding, she will begin with the other breast. Ifthe baby is very hungry or if he IS very small, the mother will continue to give him both breasts on each feeding and will begin the next feeding with the breast offered last during the preceding feeding, It must be emphasized that the baby must never be given additional or complementary water or milk bottles. The use of a bottle requires less sucking effort. This will weaken the baby's cheek muscles and make him lose the ability to squeeze the breast with his lips, tongue and cheeks. An infant may be fed only at the breast until he is tour or even six months old. Weaning and Solid Foods Weaning must always be gradual one at a time, breast-feedings are gradually replaced by bottle-feedings. Weaning should normally last three weeks in order to avoid physical discomfort to the mother (engorgement of the breasts). This method has the added advantage of stopping the secretion of milk very gradually. During the weaning period, the mother should reduce the quantity of liquids she drinks during meals. and wear a good brassiere even 30 The CanadIan Nurse March 1976 at night in order to avoid sagging of the breasts. Breast-fed babies double their birth weight by 14 to 16 weeks. Pediatricians favoring breast-feeding introduce solid foods around the third or fourth month, for according to studies such as those conducted by Beal, salivary secretion. which helps the digestion of food, begins only towards the third month. Barkwin in his study states that before they are three months old, babies reject food with their tongue, and it is only towards the third or fourth month that they begin to introduce food in the back of their mouth. With the early introduction of solid foods and cow's milk, the child consumes ten times more salt than he should and thus increases his susceptibility to hypertension later in his adult life. Solid foods recommended towards the third month are mashed ripe bananas, precooked baby cereals enriched with iron, and egg yolk. If the mother breast-feeds her baby up to six months, she may, when weaning, introduce the baby directly to the cup without the use of a bottle. Infection Cleanliness of the hands, breasts and brassiere is essential in the prevention of breast infection. Maternal compresses must be changed frequently when wet. If a mother complains of localized pain or sensitivity of the breast, the nurse may recommend the following: . doubling the number of feedings from the sore breast in order to drain it more completely (every two hours); . frequent application of moist hot compresses for a few minutes daily before breastfeeding; . alternation of breast-feeding postures (sitting and lying down); . longer rest periods: . a mild analgesic prescribed by the doctor to relieve the pain and facilitate the milk ejection reflex: . Do not, under any circumstances, stop breast-feeding. Diet Mothers who breast-feed their babies must eat a well-balanced diet, consisting of cooked fresh vegetables, fruits, meat, fish, dairy products and whole grain cereals. The nurse may recommend Canada's Food Guide. Gunther (1955) noted a relationship between the mother s diet and the composition of her milk. For example, an increase in carbohydrates in her diet increases milk secretion, while an excess of lipids/fats decreases it. Mothers who breast-feed their babies are often thirsty. It is a good idea to recommend that they drink 2,500 ml-3,000 ml of liquids in order to quench their thirst, increase their milk secretion and stimulate their milk ejection reflex. Too much of some foods such as asparagus, cabbage, onions or rhubarb gives a specific flavor or taste to the milk. Game or wild fowl are not recommended because of the toxins carried by these animals. A balanced diet that is varied and nutritional is the obvious solution. Above all, mothers must not be made anxious by unnecessarily complicated dietetic recommendations. Activities It is recommended that the mother avoid fatigue. If possible, she should rest for one hour every afternoon. It is obvious that following delivery a young mother will tire quickly. Her body must regain its balance, and in order to do so she must lead a calm and non strenuous life. A young mother will need at least six weeks before becoming accustomed to her new pace of life. Birth Control The contraceptive powers of breast-feeding have been studied by many authors who have arrived at different conclusions. Some, like Gioiosa (1955), Udesky (1950) and Douglas (1950), noted a 95 percent decrease in the incidence of pregnancy among women who breast-fed continuously and intensively until the sixth month following delivery. However, after a symptothermic study of the ovulation mechanism, Pascal (1971) found that with abundant and prolonged breast-feeding, the first ovulation never occurs before the sixth week following delivery. From this she concluded that the period of absolute sterility covers only the first five weeks following delivery, provided that the child is only breast-fed. These authors agree that the more additional solids or feeding-bottles are introduced at an earlier date, the higher the incidence of ovulation and pregnancy. Therefore, given that breast-feeding is not a safe method of birth control, the nurse who gives at-home instruction or postnatal classes may, depending on the wishes of the individual couples, reinstruct them in the various methods of birth control. Methods such as IUD's and condoms may be suggested to couples who wish an alternate method to oral contraceptives. The nurse may recommend IUD's because their rate of spontaneous rejection is lower when inserted eight weeks after delivery, which generally coincides with the postnatal medical examination. Conclusion The success of breast-feeding depends on three interdependent variables: 1) parental motivation; 2) a healthy child with a good sucking reflex 3) a competent nurse. It is the author's hope that this article wil help nurses become more successful with respect to the third variable. Mane-Elizabeth Taggart (R.N., B.Sc.N., B.A, Dipl. Public Health, M. Sc. N., University of Montreal) is assistant professor, Faculty of Nursing, University of Montreal. The matef/al in this article is based on information contained in her master's thesis. and on extensive experience in community clinics and public health nursing. '" Bibliography 1 Applebaum, R.M. The modern management of successful breast feading. Pediatr. Clio. N. Am. 17:203-205, Feb. 1970. 2 Brazelton, T.B. Psychophysiologic reactions in neonate. PI. 2 Effect of maternal medication on neonate and his behavior. J. Pediatr. 58:1 :513-518, Apr. 1961. 3 Call, J.D. Emotional factors favoring successful breast feeding of infants. L'enfant 3:269-270, 1960. 4 Catz, S. Charlotte. Drugs and breast milk, by...and George P. Giacoia. Pediatr. ClIO. N. Am. 19:151-166, Feb 1972. 5 Disbrow, Mildred A. Any women who really wants to nurse her baby can do so? Nurs. Forum 2:3:39-48, 1963. 6 Douglas. J.W.B. The extent of breast feeding in Great Britain in 1946. J. Obstet. Gynaecol. Br. Commonw. 57:335-361, June 1950. 7 Evans, T.R. Exploration of factors involved in material physiological adaptation to breastfeeding, by...and et aL Nurs. Res. 18:1 :28-33, Jan.-Feb. 1969. 8 Gloiosa, Rose. Incidence of pregnancy dUring lactation in 500 cases. Am. J. Obstet. Gyneco. 70:162-174, JuL 1955. 9 Goldman, Armand S. Host resistance factors in human milk, bY'hand C.w. Smith. J. Pediatr. 82:1082-1090, Jun. 1973. 10 Gunther, Mavis. Instinct and the nursing couple. Lancet 1 :575-578, Mar. 19, 1955. 11 Gunther, Mavis. Diet and milk secretion in women. Proc. Nutr. Soc. 27:77-82, Mar. 1968. 12 Pascal, Juliette. Quand de I'amour surgit la vie. La maîtrise de la fécondité. Paris, Édition du Centurion, 1971. 13 Population Reports Family Planning Programs Series J, Number 4, Jul. 1975. 14 Udesky, LC. Ovulation in lactating women. Am. J. Obstet. Gynecol. 59:843-851, Apr. 1950. "The CanadIan Nurse March 1976 31 FREEZING BREAST M LK AT HOME "'-, ... - ' ....... ...... '" '5 Ë: d. , \.. l ,. . ør G4. :! 1 .:.7 , cnyse Theberge-Rousselet The consultant on breast-feeding is often called upon to leach mothers how to store and freeze breast milk. Breast-feeding is regaining popularity among new mothers, and they often nurse their babies for a long time. Thus, they need a reserve of frozen breast milk for use during their absences from home. Following are guidelines for the storing and freezing of breast milk at home: 1 Use jars that are of convenient size for freezing; baby food jars are a good example. 2 Sterilize jars, lids, containers for the milk collection, and breast pump (if used) either by washing them in a dishwasher (one that has a sanitizing cycle or where household water reaches 60 c C.), or by boiling them for 3 minutes, after thorough washing. 3 Wash hands thoroughly before expressing milk. 4 Collect milk by manual expression, or by a hand or electric breast pump. A freshly sterilized jar should be used for each milk t'" collection. 5 Refrigerate the milk immediately. Once cold, place it in the freezer. It is recommended to freeze milk that will be used more than 24 hours after expression. 6 When adding freshly expressed milk to a partially filled jar of frozen milk, cool the fresh milk first by placing it in the refrigerator or freezer for a few minutes. This prevents the warm milk from thawing the top layer of frozen milk. 7 Do not fill jars or cap them too tightly when freezing milk, expansion caused by freezing may crack the jars. 8 Mark the dates of collection on the jars. Milk can be kept frozen for 2 to 3 months, and up to 6 months under good freezing conditions. 9 Before thawing the milk, loosen cap slighlly. then place jar in a pan of tepid water; Refrigerate the thawed milk until ready to use it. Before feeding the baby. shake the milk as cream rises to the top, leaving thin, bluish skim milk below. Denyse Rousselet (M. S. (Community Health Nursing), M.A., California State Uniyersity, San Jose). former instructor of pediatric nursing, De Anza Community College, Cupertino, California, is an accredited teacher of the American Society for Psychoprophylaxis in Obstetrics (Lamaze) She is presently teaching at the CEGEP Montmorency in Laval, Quebec.4I 32 The Canadian Nurse March 1976 lF1E TR TMENT OF MASTITIS N NURS NG ìr -MOTHERS --- ., Denyse Theberge-Rousselet Considerable uncertainty still surrounds the question of the treatment of choice for mastitis (the name generally used to describe any inflammatory prùcess of the breast). Some doctors order a mother suffering from mastitis to wean the baby immediately, or, alternatively, to temporarily refrain from nursing from one or both breasts. Two principal reasons are cited for this advice: 1. the possibility that the baby will be harm d by the transmission of infection or antibiotics prescribed for the mother throug the milk . supply; 2. the possibility that the Infection will heal more slowly if the mother continues to nurse the baby. Nurses on hospital obstetncal units often receive telephone calls from worried mothers who have encountered this problem on leaving the hospital and returning home. In hospitals where a consultant in maternal feeding is available, these nurses look to her for advice in determining what treatment to recommend. They are upset by these calls and anxious that the controversy be settled so that they can be sure they are recommending the most effective treatment. Recent studies suggest, for example. that the reasons cited above for either weaning the baby completely or decreasing the number of feedings, are not valid. It has even been proven that the mother will recover more quickly if these restrictions are not imposed and if, in fact, feedings are increased rather than discontinued or decreased. Physiopathology Mastitis and breast abscesses (these can occur at any time, not only during pregnancy or lactation) are almost always caused by staphylococcus aureus originating from the mother's skin or the nasopharynx of the nursing baby. An important factor in considering the source of the infection is stasis of milk following the let-down reflex or following attempts to suppress lactallon. 4 In theory, the ducts distended by the milk provide a favorable environment for bacterial growth. 2 Symptoms The first indication of the problem to health personnel occurs when a woman calls the doctor or the nurse and complains of discomfort in the breast. Sometimes this. discomfort is accompanied by a low fever. 1 If the woman is breast-feeding her baby and the breast or part of the breast becomes firm, red, swollen, hot or sensitive, mastitis should be suspected. 3 The nurse must be familiar with these svmptoms because she will often need to refer the woman to her doctor. Treatment Formerly, treatment was conservative and consisted of termination of breast-feeding and a minimum of breast manipulation or pumping of milk. Weaning, however, has never been necessary; above all, one should never stop breast-feeding. 1 It is more logical to attempt to reduce stasis of the milk. The most effective method of doing this is to allow the baby to continue to breast-feed. 2.4 The mother should nurse twice as often, but for shorter periods of time, especially from the affected breast. 1 2 Supplementary treatment includes bed rest,34 good support for the breasts,4 and hot compresses 2 .4 changed every hour, or intermittent cold compresses .4 used in combination with an analgesic to alleviate the pain. Antibiotics are sometimes administered.1 1 ,2.3,4 Vhen a general infection of the breast localizes into an abscess, surgical incision and drainage is indicated. 3.4 Resu Its Studies done by the four authors cited in this article reveal that the majority of subjects continued to nurse successfully during and after mastitis. No babies were weaned because of mastitis alone 2 After studying 71 cases. Dr. W.P. Devereux suggests that the implementation of prompt treatment is important in preventing abscesses. 2 Dr. E.Robbins Kimball suggests that an abscess is often prevented without resorting to antibiotics if the woman consults her doctor as soon as symptoms appear. 3 There is no evidence that any of the babies studied suffered secondary effects as a result of the inflammation. 2.3This was true even for babies who were breast-fed immediately after incision and drainage of the abscess. Implementation of this treatment shortened the duration of the disease - often by as much as one-half or one-third. In addition fewer of these women developed a breast bscess than those who stopped nursing. Conclusion When a mother reports symptons of mastitis to the nurse, she must be made aware of the importance of communicating this to her doctor with a view to preventing a more serious infection, or even an abscess. It is to be hoped, from a nursing standpoint, that most women being treated for mastitis will continue to nurse. This has the advantage of being both the most efficienf treatment and also the easiest to initiate. At the same time. it allows the mother to continue feeding her baby in the way she has chosen. Denyse Rousselet (M.S. (Community Health Nursing), M.A, California State University, San Jose). formerly instructor of pediatric nursing, De Anza Community College, Cupertino, California, is an accredited teacher of the American Society for Psychoprophylaxis in Obstetrics (Lamaze) She is presently teaching at the CEGEP Montmorency in Laval, Quebec. '" References 1 Applebaum, A.M. Mastitis in the lactating mother. The modern management of successful breast feeding. Pediatr. Clio. N. Am. 17:1 :203-225 Feb. 1970. 2 Devereux, W.P. Acute Puerperal mastitis: Evaluation and its management. Amer. J. Obster. Gynecol. 108:78-81, Sep, 1, 1970. 3 Kimball, E. Robbins, Unpublished research Nursing mothers' Council's Medical Advisory Board. Glenview, III., 1973. 4 Newlon, Michael, The normal course and management of lactation, by , . . and Niles Newton Clio. Obstet. Gynecol. 5:1 :44-63, Mar. 1962. ;;; " , .g c Ö Õ .c II. .. . " The Canadian Nurse , \ t o \ . - March 1976 33 . 34 The Canadian Nurse March 1976 A guide to drug use during breast-feeding BABES AT R SK? , t Denyse Theberge-Rousselet \ I In recent years women have increasingly chosen to breast-feed their offspring with the result that a growing number of babies have become the passive recipients of drugs, prescribed or otherwise. To date, however, little research has been done on the presence of drugs in breast milk and their effect on the young recipients. Although it is generally agreed that any substance taken by the lactating mother will, to some extent, be found in her milk, not enough is known of the necessary precautions or the amounts that may have a harmful effect on the baby. When he has to prescribe drugs to the lactating mother, the doctor must weigh the drug's benefits and the need for the drug against the known and unknown risks to the child. In many cases, risks may be reduced if careful consideration is given 10 the choice of drug and the explanation given the mother. If possible side effects in the mother and baby are also taken into account, risks are even further reduced. The nurse who is in contact with mothers who breast-feed their babies must be familiar with types of drugs that may cause problems and are, therefore, to be avoided. She should also know certain principles considered by doctors in prescribing drugs to these women. Some of these factors include: 1 Type of drug: some drugs are excreted in the mother's milk in greater quantities than others. 2 Dosage: the baby's age as well as the quantity of milk consumed daily must be considered. 3 Duration of drug treatment. 4 Method and liming of administration in relation to the baby's feedings: a smaller quantity of the drug will be found in the milk if medication has been taken immediately after Ihe previous feeding. 5 Cumulative effects of the drug. 6 Development of the baby's organs; immaturity of hepatic and renal functions may decrease the excretion or inactivation of drugs and thus increase the concentration of a drug in the infant's bloodstream. 7 Hypersensitivity of the infant. 8 Possible secondary effects on the mother's behavior, for example, drowsiness. 9 Possible secondary effects on the quantity of milk. Oral contraceptives, for example, are known to influence the milk supply. Many drugs taken by the mother affect her breast-fed baby. The list that follows is based on the most recent medical literature, but only the most common drugs are mentioned. Information on a variety of less common drugs may be found in the references cited in this article. Analgesics These are the most commonly used drugs. Occasional therapeutic doses generally affect neither the quantity of milk produced nor the baby. However, mothers who take large doses for prolonged periods (for example, mothers being treated for rheumatoid arthritis) have not been studied and, consequently, data on these women are not available. 1 Aspirin appears in the mother's milk in moderate quantities. 11 may produce a tendency to bleed either by a decrease in the quantity of prothrombin in the baby's blood or by interfering with the function of blood platelets. 2 Codeine does not significantly affect the baby when taken in therapeutic doses. 3 Heroin appears in relatively high concentration in the breast milk when the mother is addicted to the drug. 3 Thus, it will prevent withdrawal symptoms in the newborn addict Meperidine (Demerol) has an insignificant effect when taken in therapeutic doses. Morphine has little effect when taken in therapeutic doses. 3 However, it is found in sufficient concentration in the milk of an addicted mother to prevent withdrawal symptoms in the breast-fed infant. Nisentil has a sedative effect on the infant when taken in therapeutic doses. Darvon has little effect on the baby when taken in therapeutic doses. 3 Antacids These drugs are rarely absorbed in appreciable amounts and should present no problem unless the mother develops an electrolytic imbalance. Anticarcinogenic Drugs These drugs may inhibit formation of bone marrow in the baby. They should be a contraindication to breast-feeding. 2 Antimetabolites (methotrexate, mercaptopurine) may be secreted in the milk and breast-feeding should be avoided. Anticoagulants Oral anticoagulants should be avoided because they have not been sufficiently studied They have been reported as causing severe bleeding in the infant. 2 ,4 For other anticoagulants, both mother and baby must be watched very carefully in order to avoid hematomes and hemmorhage in the baby. Antihistamines These drugs are often taken to alleviate colds and allergies. They generally reduce the production of milk, but this is not always noticeable if the drug is taken intermittently and in small quantities. They lead to vasoconstriction in the mother and limit the quantity of oxytocin reaching the breasts. The decrease in milk supply may be minimized if the mother's intake of fluids is greatly increased. Benadryl has a more marked effect than Chlor-Tripolon which, of the whole group, has least effect on the production of milk. Antimicrobial Agents and Antibiotics Studies have shown that these drugs pass into the mother's milk in small concentrations. In addition, the presence of these substances in the mother's milk may alter the baby's intestinal flora; normal intestinal flora are Important in the early development of immunities. 1.2,3 Ampicillin is secreted in milk and may cause allergy and/or diarrhea. I The Canadian Nurse March 1976 35 What are the known and unknown effects on the breast-fed Jaby of drugs consumed by the nursing mother? Chloromycetin may cause the "gray syndrome" in the newborn and may also damage the bone marrow. 2 Erythromycin, although secreted in milk, may be used. but may cause allergy to the drug. Kanamycin requires the baby to be watched : carefully for signs of toxicity.4 ,Penicillin is secreted in milk, but may be used. However kernicterus may develop in the newborn, Streptomycin IS secreted In milk. It may be used but may cause toxicity.5 Sulfonamides may cause kernicterus in the newborn J and also hemolytic anemia,2 Sulfapyridine has caused cutaneous eruptions. 4 Sulfathiazole may be used in therapeutic doses. 4 Gantrisin may cause kernicterus in the newborn and should be avoided during the first two weeks postpartum. 4 Tetracyclines may cause dental stains in the baby and retard bone growth. 2 Oral Contraceptives Recent research seems to indicate that smaller doses of oral contraceptives do not I significantly affect lactation in the majority of women, once the supply of milk is well I established (6-8 weeks). If the mother has imtial difficulty in establishing a good milk supply for her baby, even small doses of oral contraceptives may add to her problems. Large doses of oral contraceptives suppress lactation and even usual doses can decrease the milk supply. The immediate anc' long-term effects of oral contraceptives on the baby are not known. Other methods of contraception should therefore be encouraged during the entire period of lactation. S Corticosteroids These appear in milk and may hinder growth, interfere with the endogenous production of corticosteroids, or cause other undesirable effects. Breast-feeding should be discouraged. 2 Diuretics These drugs should be used with caution during breast-feeding. No secondary effects have been reported in the literature cited here. but diuretics seem to inhibit lactation by dehydrating the woman. Diuril may cause thrombocytopenia in the baby.2 Hyponotics and Tranquilizers Several sleep-inducing drugs contain bromides. Such drugs should not be taken as the baby's reaction to them may vary from cutaneous eruptions to drowsiness. 3 Chlordiazepoxide (Librium) may be used in therapeutic doses. 5 Chloral hydrate may have some sedative effect on the baby, but may be used in therapeutic doses. 3 4 Chlorpromazine is secreted in the mother's milk but no effect was found in babies even with large doses. It may cause galactorrhea. 5 Diazepam (Valium) in large doses sedates the baby.2 It may cause hyperbilirubinemia and its use is not recommended during lactation. s Meprobamate (Miltown, Equanil) requires that the baby be watched carefully for signs of toxicity. 5 Phenobarbital has a sedative effect on babies with hypnotic doses of 100 mg. It is possible that there is no effect with sedative doses (30 mg t.í.d.),21t may also affect the endogenous production of corticosteroids in the baby or have other undesirable effects. 1 2 Secobarbital Sodium (Seconal) has no effect on the baby with sedative doses: however, there may be some effect with hypnotic doses. Laxatives The forms that are not absorbed, such as castor oil, Dulcolax, mineral oil. and standardized senna concentrate (DSS) do not cause any problems. Cascara causes increased intestinal activity in the baby with habitual doses. Rhubarb has no ill effects when taken in small quantities but large doses increase intestinal activity in the baby. Senokot and Doxidan can cause loose stools in a baby. Drugs Affecting Endocrine Glands Thyroid preparations are not harmful to the baby when the mother takes them in habitual doses. It is believed that they sometimes increase the amount of milk produced. Radioiodine is passed into the mother's milk in large quantities and may significantly suppress thyroid function in the baby_3 Propylthiouracil and thiouracif3 5 have effects similar to radioiodine. However concentrations of thiouracil in the mother's milk are higher than in the urine Or blood and may cause goiter in the baby or agranulocyfosis. 4 Drugs Affecting the Autonomic Nervous System Atropine may reduce the amount of milk produced when large doses are taken: it is -1 not secreted in appreciable amounts in the milk. It may cause atropine poisoning in the baby.23 Ergot (Cafergot) may cause various symptoms in the baby, from vomiting and diarrhea to a weak pulse and unstable blood pressure. 34 Other Agents Stimulants, depressants. narcotics, and psychedelics have not been studied in relation to breast-feeding. They are believed to be secreted in the milk in appreciable quantities and should not be used. Alcohol if used moderately. has no harmful effect on the baby. Large quantities may cause sedation in the baby or inhibit the milk secreting reflex In the mother. 2 J S 6 Certain foods have been found to cause allergic reactions in the baby: white beans, Indian corn, egg white, chocolate, seafood, peanuts, wheat, and gherkins. 3 Methadone is not passed in significant quantities to the breast-fed baby whose mother takes a daily dose of this drug. Tobacco (nicotine) affects the baby if the mother smokes heavily. Effects may vary from diarrhea, vomiting, and tachycardia to agitation. s Vitamins that are fat soluble must not be taken in large doses. One study reported anomalies in the baby when the mother had taken large doses of Vitamin D during pregnancy. Vitamin D may also cause hypercalcemia. 47 Conclusion Because so many factors are involved in choosing drugs for the lactating mother, and because so little conclusive research has been done in this area, it is difficult for the doctor to advise the mother. In general, the best advice would seem to be to avoid the use of drugs If at all possible. ... References 1 Catz, C.S. Drugs and breast milk, by . . . and G.P. Giacoia.Pediatr. Clin. NorthAm. 19:151-166, Feb, 1972 2 Drugs in breast milk. Med. Letter Drugs Ther. 16:6:25-27. Mar. 15. 1974. 3 Knowles, J.A. Excretion of drugs in milk-a review. J. Pediatr. 66:1068-1082, Jun. 1965. 4 0 Brien. Thomas E. Excretion of drugs in human milk. Am. J. Hosp. Ph arm. 31 :9:844-854, Sep. 1974. 5 Arena, J.M. Contamination of the ideal food. Nutrition Today 5:4:2-8, Winter 1970. 6 Cobo. E. Effect of different doses of ethanol on the milk-ejecting reflex in lactating women. Am. J. Obstet, Gynecol. 115:817-821, Mar. 15, 1973. 7 Goldberg L.D. Transmission of a vitamlO-D metabolite in breast milk. Lancet 2: 1258-1259. Dec. 9, 1972. - ... . I:.. .......... Ca-e ............ ...... M. D - - -- . _...... ..,, ..... - \ .\ .... 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LIPPINCOTT 488 Pages/lllustrated/1975 $15.75 " I @ s MANUAL OF DIAGNOSIIC , PROCEDURES FOR PAIIENI lEACHING For constant day-to-day reference, this handbook, places at the nurse's fingertips two types of important information (1) a general description of the purposes and means of performing a wide range of clinical tests (more than 70) and (2) clear direc- tions on what to tell patients to expect, in order to spare them unnecessary anxiety. Many of the procedures discussed are very new ones and may not be familiar to all nurses. Helpful information on preparation and aftercare of the patient is featured. Edited by Barbara Skydell, R.N., M.S., and Anne S. Crowder, R.N., M.A. LITTLE BROWN 248 Pages/ 1975/ Paperback $6.95 . @)INIENSIVE CARE This is the first complete reference on the dramatically expand- ing field of intensive care. 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LIPPINCOTT 1473 Pages/Profusely IIlustrated/1974 $21.50 @PRINCIPLES AND PRACTICE OF INTRAVENOUS THERAPY 2nd Edition Extensively revised and updated, this leading text includes technological advances in intravenous equipment and tech- niques, the latest findings on asepsis and hazards of contamina- tion, and practical rreans of ensuring safe, successful care. A new chapter on total parenteral nutrition has been added, as well as valuable information that IV therapists need in order to integrate their contributions into the total care program of the patient with optimal results. Also included is essential guidance for nurses involved in organizing and administering IV depart- ments and their personnel. By Ada L. Plumer, R.N. LITTLE BROWN 348 Pages/l/lustrated/1975/Paperback $6.95 Clothbound $10.95 J. B. Lippincott Company of Canada ltd: Please send me the books I have circled. 1 2 4 3 5 6 7 8 9 Name Address City Prov, Postal Code o Payment enclosed. ship postage and handling paid o Charge and bill me o Use my Chargex master charge o Use my Master Charge Position LIPPINCOTT'S NO-RISK GUARANTEE: Books are shipped to you ON APPROVAL; if you are not entirely satisfied you may return them within 30 days for full credit. Prices subject to change without notice. Lippincott J. B. LIPPINCOTT COMPANY OF CANADA LIMITED Servmg the Health Professions in Canada Since 1897 75 HORNER AVE, TORONTO, ONTARIO MBZ 4X7 (416) 252-5277 38 The Canadian Nurse March 1976 . . . "I never did meet a nurse on the obstetrics ward who had children. . . I had no idea what kind of care to expect as a patient, or what was MATlF1EW MY SON: I. ' 1 þ r _ -- " ......... 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" /l' jr I ;. \ \'-\ Prepared childbirth at the General Iii o '6 0> c; o 0> >- .c '" Ë 0'" <: o c: z o : E.ri 0>...... 0.(7) É - -OIL 0> - Elii . 0>0 a::, Beverly MacLellan The promise: On the day that I gave to my first child, my husband wrote an exam for a McGill Faculty of Medicine course in human growth and development. During that course, the return to more "natural" methods of childbirth and infant care - breast-feeding in particular - was enthusiastically praised as logical, scientifically superior and. . . well, natural. There was no need to convince my husband - he and I were already enrolled in a prepared childbirth training program - but I found it encouraging that the sentimen1s of the faculty staffing the hospital where I was to have my baby were in accord with our own. The prepared childbirth program includes much the same material covered in my husband's school course, he said, but also a great deal more. Its purpose goes far beyond simply teaching a little physiology. The main idea is to take the surprise and uncertainty out of childbirth by teaching you in advance everything that is going to happen, everything that you will see and feel both physically and emotionally. You visit the labor room ahead of time, and you see pictures of the room in which you're going to have your baby. You know the beds, the chairs, the clock on the delivery room wall before you arrive. The frightening array of machines and instruments have all been explained, demonstrated and demythified and are now almost old friends. You know the mental states you re going to go through: the exhilaration, the despair, the depression. And in the end, you go through them all, just like stops on a train. You gain greater control over your body with a series of exercises so that you can forego drugs during delivery and thereby participate more fully and lucidly in bringing your child into the world. No amount of exercise can offer you delivery without pain. but you learn to deal with the pain. You practice dissociating yourself from it, to look at it from a distance. You try and keep one part of your body separate from another, so that when there is tension in one part, or pain, the rest of your body can be calm and relaxed. It's all hard to believe, but you feel yourself getting better and better as the days go on. Through it all, your husband is the coach, the trainer, the man who knows your capabilities almost as well as you do. During the delivery, he will be at your side. When the time came to go to the hospital, we felt we were ready. The practice: Everything began rather well. When my doctor announced to those in the case room that we were "a prepared childbirth family" there was only a second's pause to look us over - and then a helpful flow of encouragement and strength that continued throughout the delivery. Good news. The bad news was that I was having a back labor - occiput posterior :- and that all the labor training exercises we had done every day for months were largely for naught. As I had learned in our course, the pattern of contractions in a back labor is so unusual and prolonged that it is very difficult to anticipate them and remain in control. " was, in the end, simply a case of "doing the best you can." After six hours of the best that my husband Keith and I could muster - and some deft mid-delivery forceps work by the obstetrician - son Matthew was born. After it was over, I lay awake in my room, staring at the ceiling, overcome. After nine months, emptiness. Keith was gone, off writing his exam, Matthew was gone, my stomach was gone, my last bit of energy - all gone. I was empty. And I was full to bursting. The totality of the experience was overwhelming and I longed to talk about it with someone who could understand. "Do you have any children?" I asked the nurse. But she shook her head. I never did meet a nurse on the obstetrics ward who had. In the end, I just tried to adjust to the routine day of those around me. I quickly found out that there was something my study hadn t prepared me tor, I knew' was to expect The CanadIan Nurse March 1976 39 xpected of me . . . What I did find justifiably jistressing, however, was the state of the .e lurses' knowledge about breast-feeding." Ijiscomfort at first. and fatigue. and perhaps jepression But I was dismayed to realize how ;ompletely helpless I was. When breakfast came, because of the jiscomfort of the episiotomy, I found it ,mpossible to sit, or for that matter to move nost of my body at all. I finally ate lying down, :eeling foolish, but I couldn't think of a better "lay. Then, breakfast over, I waited for i;omeone - anyone -to come. Several hours ,lad elapsed since the delivery. but I had not lad a chance to wash myself or change my ':Iothes. and it was clear that I wouldn t be able ,0 do these things alone. My purse layout of each; other things I needed were in the closet. : hated my dependency. So I had to face the question of the bell. It 1ad taken me the better part of the morning to figure out what it was when I had first found il. Now I was quite hesitant about using it. 'I assumed the staff functioned as a matter of course. My requests certainly seemed I routIne : perhaps the light was for emergencies lonl y . I had no idea what kind of care to expect as a patient, or what was expected of me. 'Perhaps they were understaffed. Perhaps they forgot. I pulled the cord. A little later a phone call beckoned me to come and feed my son. I asked if he could be brought to me, just as I saw happening to mothers all around me. "Impossible," the woman on the other end assured me, as Matthew was in intensive care. Intensive care: Up until that time I had no idea that anything was wrong. I got someone to wheel me there as quickly as I could, but my mental state was in a shambles when I arrived. The nurse now explained that Matthew was fine, that he was only in intenSive care awaiting apro forma checkup by a pediatrician because forceps had been used during the delivery. Finally, and with great relief, I saw my son for the second time. As I fed him, I began to fear fhat, after a successful delivery. things in the hospital were not going to go according to ptan. During the next four days they never picked up much. Partly because I was sore and tired, I think but also because, in contrast to the smooth teamwork of the case room, the ward doesn t really have it all together. Whatever the professors teach in their courses, the ward is not really qeared to mothers who want to breast-feed and have their babies live in. Ideally, I would have liked to keep Matthew in my room at all times except for visiting hours, but this proved impossible. He didn't stay all night until the last because of my lack of physical mobility, but our crackingly efficient nurse made it difficult to keep him in the room just for the evening. She had very definite ideas, most of them about germs, and for this reason, I think, she disapproved of rooming in. She also disapproved of my husband for much the same reasons, I guess, after she discovered him on the bed one day surrounded by the Sunday paper. The first time I tried to take visitors to see Matthew I found out that when he wasn t in my room, he wasn t in the nursery either. He was kept in another little room by himself, apparently because of the contamination of rooming in. Fair enough, I respect the hospital s concern about germs and about possible contamination from the outside, but it did seem a little hollow when I discovered one of the professors teaching a class of sixteen students in the nursery itself. What I did find justifiably distressing, however, was the state of the nurses knowledge about breast-feeding. I had read several books on this practically forgotten art before coming to the hospital, and spoken to several women who had successfully breast-fed their children. but I supposed a nurse must know what an infant s nutritional requirements were. and how the lactating breast best functioned. Surely, I thought, all this would be a part of every nurse's education. But I guess they all went to different schools. My day nurse insisted that, in addition to breast milk. Matthew needed formula; my night nurse was an avid believer in glucose and water; and the apparition that borr him to me at two in the morning assured me he didn't need any supplement. There appeared to be a consensus on one point only: nursing should be limited to three minutes at each breast to begin with, and the time slowly increased over a period of days. This is apparently a hospital policy designed to prevent sore nipples. based upon the assumption - usually accurate - that most North American women will not have prepared their breasts for nursing in advance. Unfortunately, according to what I read, and confirmed, it seems, by my own experience, this seems to be bad physiology. It apparenlly takes about three minutes of sucking before the "let down" reflex makes milk available at the nipples -oxytocin and all that. So after inadequately short spells of nursing, the child either goes away hungry, or is given a topping up of glucose and water. But thiS, ( am told, is the start of a vicious circle. Unlike the breast, the botlle requires little sucking before it delivers its milk. The liqUid flows easily into the baby s mouth. His cheek muscles weaken and his desire to nurse diminishes. Poor sucking leads, in turn, to poor milk production and letdown, and finally to milk tension and engorgement. As the breast tissue swells, the infant can grasp only the nipple instead of the areola, and the chewed nipple becomes very painful. All this seems to exacerbate fhe psychological factors that influence milk let down - anxiety, fatigue, and pain. The point is that I knew the mechanisms they were suggesting were wrong. I had the advantage over most mothers. I had been warned. But it didn't matter. When the time came, I was in no position or shape to resist, and I began to doubt. I thought they really must know. I fumbled through each nurse s regimen in turn, and the predictable result was painfully engorged breasts and a very poor start at breast-feeding. I can only speak from my own experience. Perhaps I was destined to have trouble initially with breast-feeding. But it does seem that the obstetrics ward could be a positive educational force rather than an added source of confusion on the subject. As I think back now, I'm very pleased I had the training in prepared childbirth. I don't think the delivery could have been so successful without it. They had promised me no surprises and there had been none. Still, I realize now that the words don't exist that could really prepare you for such an overwhelming experience. And as for life on the obstetrics ward - well, it's clear my training was no match for thaI. I don't know if any really could be. Finally, the fourth day and check out time arrived. I was convinced that things would be better at home - as they eventually proved to be - and I was anxious to leave. My husband put Matthew in my arms and we started down the hall slowly. still doing the postpartum shuffle. It was feeding time, and we passed the women standing like sentinels in the doorways, waiting for their babies. .. . - . Bow down to her on Sundays, salute her when her birthday comes. . ,.. My thoughts were interrupted by two nurses, who anxiously asked where we were going. "Home. ' I said, rather defensively. Not without having our name tags officially cut, we weren't. Finally, we walked down the corridor toward home. As we approached the door, the cleaning woman who had been standing watching us, mop in hand, shook her head. As she resumed mopping she said, "If I was you and that was my baby, I wouldn t have no one telling me what to do." Indeed. Beverly MacLellan is a Montreal artist, mother, and wife .. 40 The Canadian Nurse . .......#iiW .liiiliiJi;Wît{t.iftfþ] March 1976 det Rat sOY . . ,,)f e""" c",e Berna. O\'\SI\)I\W . . \ta.\\\J e ,,,,,,",,,,atW' '": "" .."" .d", 0<13' ",.0'. . . 1""""''''' ';'5 I 0< I<'/S"' os .-",e' ,ee""o<"'" Ç>etSo\,\\'\e g ó Ç>fess\\'\9 ot tea.S a. te G oo,ø.."e'w,""e s '0 0"'''' se';'s """" s ':' :: . pt """ ,es",,"s ,ee' ..." e''''' . s"og "" "","" ""g",o",g '0, "" """ ",e ,o".og cO""Ó's. 19\,\ot eó \ o ea.\\'(\ ca. te \a.\'\\'\ OS\\IO\'\ \0 W "'c\"" ;s .,e ;""0,,, ;.J.s """ """lit""'" \0 ': ",.'0\3'0 e"" , ,,,,, e ,,>eo" '",I"e",e o ' "" "' . ecI"". . . ,,,", ""e I . t 'lJot\(. \S 9 te a. \'(\e \a.cI\W es . t \'(\ e\\ec\l\Je\'\es ó S Zó co\,\\a. c \ 'lJ\\': :s a.\,\ó a. te r\Jí\ \J a. ó e'/.\e\1 a.\\'(\ se.. 1 \'\ \'(\e c\ose a.\1 tS 0\ e'/.\s\\\'\9 '(\e'lJ'(\o \a.\\ \)e\'lJ ee \'(\e\t cP\'\sù({\e Ç>etSo\'\s \(. eeCa. ùse ...",e 0\ "",sO . c.,e "",..., . 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'/ e. ts 0 ^""o.", ."",5 ,0'\31 ðß",aQe ce<',e,e, _e' '0 ,t<<\' e ,,,,.,,, 10' "" ,eg."''''' .5 ,0',e ooSs 0\ ,"" I'" e .",,,,,,. , e det),<ß 0 < ø \IeW. 10 ct e .'" · d"" . ,c\es '0 '. e'" .",d 0\ '0 .,,,,,,, "" . sO 0\ ,,," \3",1, ""co"""" ,otJ''''''' , ' ;oS" """" \0 I" , e.g. . ,c,\es aI'I'.,e o ' d,,",: 0"'''' "",,,,,,"5 c "".", 0<0,,"'" ",,,,, e d "" ,0 0<>'" ,t<<\',e ss '" s.,ó""" 0\ """'ó a. \\oOó Ó o .,.... e . l . ".{CotS. g" ^^,^ec,esstW \0 _ate".1 ",., .. 10< """",ts, .. ""s..es . 0 .. .. ,gO<..... 55'" "ø)-ots.. \Ots. e . c . ",,"d''''' . d cIO'e"O . "" I cO"",. I s\te, .."""" "' '0' .d",015'" "",e "" e cId"" "" 0\ .."",e e' . 0 "os"",,, 5\3' >''' '::"'; ..,;\1"" .""o ""ø .5 ""c3"sO ","'" tl'jse ts '0 ",e .ct o '''' ,ß. I ot<' 0'''"' .- ':'e '0 0<"'" \0 cO ,..",e ,0sw ctO e Det)"" 0 0 ' .,p"" ",.,,,,,,'' eÓ "" ''''''5. eo,,,,g "" ",e"" ><; o",s,,,,,.,Jo"" ""d \3""" '0 ""cøce '0 sO o\O · D"el V,e s ",e ,otJ"",. 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'n'1" ",e''"o V " 01'1""""". o a\\et Ó \Of CÙ\\CIS a(\ . "\,,a\ \"e lt nteÇ>a te \' e ó \0 \'rI I (\ .",.as... . , ... '00<'0 00<1 '" "" 1 00 ",at" o" ",,,.o" ",," ' as ,0< ø"""'" ",.as ... ,. '0 01'1""\\<"'" a ""a" 0' ""'" e O\IO(\ \ 'lJ ot \'rIe ca(\ 'oe 'rI0 Ó O {\\ ca(\ 'oe \I e e(\\ 'lJ'I\'rI \'rIOs e 'lJ U(\Óets\a(\ó, \\ e. e,e Ç> ot Ó O {\\ 'lJ a ,:\ \0 \a\<.e \\ e \0 u(\Óets\a(\ uteauctaCles \\a\ ".",.",,,"'. . ,. 'oo\,,\I\/e e '{ out tesPO(\ ,oe" ",. , a ,"" '0'.""" '11 "a". a catlt. "'. ,,,,,a'. .' "...". ,0" "" ",0<1\. ,,,, "" 00(\ \ e\/ 'rI0'lJ\\\ Ó O ,,,e ",,,,,,,,, 'cJ.",," " '" cceV"" """ "0 ",. ",0<\'-' "", ",.a "a' "":"'",:o"Og ". ,.'" \,J'J'rI e (\ . \O'lJ atÓ I P e 1\OSOÇ>'rI \0 ,"" a,e ",0<\'-''''' "a". ,,,. """. ';,., ,,,,,,,"" 0"'." .a a"".' ". . "",g ",,,0 ".W,eev so<"eo<'. "" . 0'. 0'."'''' "oC' V. o" .,. ",. """,g "" . 0 1 ,0<>' ",,\I ,a,. "'''' . ,,,.," 1"" ". ",," ,eO.",,,, {\\ 'lJe c'rla(\9 'lJ'rIe(\ \\ 9 to 'lJ S ';0\1"'" ,o"ea'.' WI'/.',"h ' ø ",....' %. %;i""- ...:-:$ .. ..:- :...:...!. . -.. . . a Ç>a\\e(\\ S\.1{'{\{'{\a{'l . \ see to\e as 5 \'rI e It> ","0'"'''''' '."" "",,,,, ,,,. "' J. '" "atI \. sa I(\9 \ . \ ....e'lJ efe .. "I aó oca\e, Ó 'rI\ se\ I \' Ó \a I\lat . . . Va "eO' ",0"" 0'0'" ",. SO"o 0 0 ,,,,,"0""'" "'. ,ç<>"' ...."gW,a ".o""' sC"',,,,,, '" \(\\e tes \I(\9 (eP\ \(\\0 \'rI IS cJ. ou""'" "a' ';.o'Og. ,,0 "a""". ".aII" oa'. oca'. ,cJ... , a" ' '0'0 a ..I.. \(\ \'rI e g (\ cO(\SiÓ eta I (\S\Óeteó 'o oeeP' """ ",,"'';., ,,,., 0"" '00 c """'" e",,,09 """,a oe V,o<)". "'. Vo"'.' '" 0 ",e; DUKE INGLISH @ t!J Þ :D :D Z G> --< o z L ;1 \ <- (I) :R2 'E ë:<(I !!!Z i!i '" .. Ei: .. c: :> (I) (I) à: cr: 0> !!! Õ > o à: >- TI (1)<0 c.'C CJ) (I) .õj iõ Q 0> 0 0 ïõEoo õò) on ó III GI .!! c .2 ñi .. Ui .Õ\ " a: Q) .c UJ E oe( 'C Z U ü5 o 0 C! 0 o on Q (1)('1 -w ... ::...c.. 1t3('1 Q. .... Q) 111 't):t ê5S Õ c - 0>- E 111 :t ð Q)"i:, g.o Q)GI ..c::.r. 0- ....0 ::)11) o . ::"'c .Q - c y 0 0 Q.III ::) III 0<( o. ",III -_ GI ..c::1II - .. c:: :ï Z -c m (1)'6 '" 111 It3c ïið 44 Ntl111PS The Canadian Nurse March 1976 ;:\)1(1 F;:\ces Lecturers appointed to the faculty of the school of nursing, Lakehead University, Thunder Bay, Ontario, include: Elizebeth Marie Clarke (R.N., St. John's General Hospital school of nursing, St. John's; B.Sc.N., Lakehead University) who has nursed at the Oshawa General Hospital, the McKellar Hospital and Port Arthur General Hospital in Thunder Bay; Joanne 51. Germain (R.N., St. Joseph's school of nursing, Thunder Bay; B.Sc.N., Lakehead University) who has been a staff nurse at St. Joseph's General Hospital, Thunder Bay; and Frances Marie Welch (B.Sc. N., Lakehead University) whose most recent appointment has been that of lecturer at McMaster University school of nursing, Hamilton, and who is currently working toward a master's degree in education. ..... ..... . - -. _" .... - ..IÌ' 'I. . Jannice E, Moore (B.Sc.N., University of Saskatchewan) has won the t975 Canadian Liquid Air Ltd. award of $1,000. She was the top student in the first year of the University of Alberta's health services administration program during the academic year 1974/75. Lorreine Dawson (R.N., University of Alberta Hospital school of nursing; B.Sc.N., University of Toronto) has been appointed to the employment relations staff of the Registered Nurses' Association of Ontario. Her career includes positions in hospital nursing service and staff development She also brings 10 her new position experience in collective bargaining both as a member of a nurses' association and as a supervisor. Lorraine Mills(R.N., Hotel Dieu school of nursing, Edmundston, N.B.; B.Sc.N., University of Ottawa; M.A., Columbia University, New York) has been named associate executive di ctor, patient care services, at the Dr. Everett Chalmers Hospital, Fredericton. She has worked as a head nurse, operating room nurse, supervisor, in service coordinator, and director of nursing in hospitals in Canada, the United States, and France. Prior to her current position, she was a nursing consultant with the New Brunswick department of health. Yvette Loiselle of Montreal has become the first woman to be appointed Deputy Chief Commissioner for the St. John Ambulance Brigade in Canada. She will assist the Chief Commissioner, Dr. AI Harrop of Winnipeg, in his duties as head of the close to 13,000 St. John Ambulance Brigade members throughout the country. Loiselle is an administrative officer with Celanese Canada Limited and is well known in the Montreal business world as an expert in administrative and employee relations matters. Her association with Sf. John Ambulance began in 1944 when she joined the Brigade as a nursing member. She advanced 10 serve as Divisional Superintendent and in 1959 became Provincial Superintendent (Nursing) of the Brigade in Quebec. In 1972 she was appointed Chief Superintendent and assumed responsibility for the general organization, administration, efficiency and discipline of all St. John nursing members in Canada. Jean Back of London, Ontario succeeds Loiselle as Chief Superintendent. Back was involved with St. John Ambulance during the war in her native England. Her association with St. John continued on her arrival in Canada where she has held various positions within St. John. In 1952 she was admitted to the Order as a Serving Sister. In 1953 she led the Canadian Cadet contingent to the Commonwealth St. John Cadet Camp in England for the celebration of Queen Elizabeth's coronation, She was promoted to Officer in 1955, Commander in 1966, and Dame of Grace in 1972. \ .,.... . I .. ..... ., ."'1.,... .- \ ,........ Carrol Ann Hartin, (R.N., Brockville General Hospital regional school of nursing) has accepted a two-year tour of duty in Honduras with MEDICO, a service of CARE. Prior to jOining the MEDICO team based at the 186-bed Hospital del Sur in Choluteca, Hartin spent six weeks in Guatemala studying Spanish She will instruct classes in obstetrics for Honduran auxiliary nurses in a hospital school which was established by MEDICO. She has worked in the obstetrical unit at Lady Minto Hospital in Cochrane, Ontario and in the burn unit, pediatrics, at the Hospital for Sick Children in Toronto. Ann Taylor has been appointed assistant executive director of the Registered Nurses' Association of British Columbia. She was formerly director of public health nursing of the Borough of East York Health Unit in Toronto, prior to which she was executive assistant to the director of nursing at the Vancouver General Hospital. George Feilotter was recently named administrator of the Cornwall General Hospital. He joined the teaching staff of the hospital's school of nursing in 1965, shortly after which he became assistant director of nursing services. In 1968 he became director of nursing, and a year later, assistant administrator. Following his basic nursing education, Feilotter studied nursing at the Manitoba Rehabilitation Centre, earned a B.Sc.N. in nursing education from the University of Ottawa, and completed the hospital organization and management course from the Canadian Hospital Association. The Hospital for Sick Children Foundation, Toronto, has awarded nearly half a million in grants and fellowships. June Kikuchi, R.N.,M.N., has been granted $27,000 to study for 3 years at the University of Pittsburgh She IS to work at a doctoral level in the area of nursing care of children. Monique Foisy has been appointed public relations officer with the Order of Nurses of Quebec. Her nursing career has included emergency care, research, and intensive care; and she has been on staff at the LaSalle General Hospital and the Montreal General Hospital. Foisy earned her nursing diploma at Hôtel Dieu in Montreal and a certificate in public relations at the University of Montreal. She is currently working toward a degree in public relations. . "9 ..... -.. L'Ecole des Infirmières de Bathurst School of Nursing, Bathurst. N.B.. will offer a nonintegrated bilingual nursing diploma program, with classes scheduled to commence in September, 1976. In effect, two programs, one in French and one in English. will be offered. Constance Morrison, (R.N., Hôtel Dieu Saint Joseph school of nursing, Bathurst, N.B.; B.Sc.N., University of Moncton) has been appointed Director She has had experience as a general duty nurse, head nurse, supervisor, and private duty nurse. In 1965, she became associate director of the Hôtel-Dieu Saint Joseph school of nursing, Bathurst, N.B., and was its director from 1968 until its closure in 1975. ,Æ \ r, \ \ ' '( \ \ J ---------- Style 131 PantSuit Polyester/Nylon Corded Jersey Knit-White Lace Trim White-Blue- Pink- Yellow Sizes 3.15 $30.00 ,.. }.:.. \t. - .," . t. #0(04 .:; \ 7 r., \ ' \ .. ) , \ Style 814 PantSuit Polyester Textured Wrap Knl. White-Blue- Yellow.lc r ,t Sizes 6-18 $28.:0 the MJ GI(: I J (:iICN sleeve UNIFORMS REGISTERED 778 KING ST WEST, TORONTO, ONTARIO M5V 1 N6 AT BETTER rol J THROUGHT CANJ.,...A -fl" ' ,f F s... ., j , I .. II , , /6\ l . - \ Style 138 PantS, F ' v .. -.. - 46 The Canadian Nurse March 1976 'Vlltlt S Ne\y J..:j . . P t 1 ... ,ìp " T- I Q Q Vernitron Sorenson Mobile Aspirator Vernitron Medical Products, Inc., has introduced the new Model # 181 0 Sorenson Mobile Aspirator. The unit is equipped with the patented Visi-Dome Lubrication System that guards against pump damage from inadequate oil supply, and with an airvent overflow cut-off that protects against pump damage through flooding. It has additional features: enclosed motor and pump to control noise factors and assure dust-free operation; vibration-free motor mounts; vane type pump; visible oil supply; visible dial gauge flush-sunk into front panel; and hospital-grade safety plug and built-In cord storage, For information, write: Vernitron Medical Products, Inc., 5 Emptre Blvd., Car/stadt, New Jersey, 07072, U.S.A. Face Masks Two lightweight masks to protect against cold air and pollen inhalation have been introduced by 3M Canada Limited. The 3M Air Warming Mask provides prOlectlon against Inhaling cold, dry air and remains easy to breathe through and comfortable. When tested at sub-zero temperatures (minus 29 0 C) the mask warmed and mOistened the air to at least 16 0 C and 90 percent humidity It is reusable. The disposable 3M Pollen Mask protects against pollens that can cause hay fever and helps keep allergens and dust from nasal passages. For information, write: Consumer Products Division, 3M Canada Limited, Box 5757, London, Ontario, N6A 4 T1. Hot/Cold Food Cart Brochure Crimsco, Inc., manufacturers of airline and health care dietary equipment systems, announces a colorful, illustrated brochure, "Model ER, Meals-on-wheels, Hot and Cold Food Carts," which deals with the versatility and economics of employing the ER Hot and Cold Food Cart in hospitals and nursing homes. It describes how to convert to a central patient tray assembly system in existing kitchen space and use as few as 3 persons to perform all patient tray assembly operations. For further information, write: Crimsco, Inc., 5001 East 59th Street, Kansas City, Missouri 64130. . Weighted Wrist Exerciser Chick Orthopedic Company has developed a new weighted wrist exerciser. The shot-filled, 5-pound exerciser is used to exercise muscles of the phalanges, wrist, elbow, shoulder, and shoulder girdle. One size fits any adult on either the fight or left hand, a Velcro closure assuring snug fit. Made of vinyl, the Chick Wrist Exerciser is easy to clean. For further information, write: J. Stevens and Son Co. Ltd., 2050 Kipling, Toronto, Ontario. Specimen Collection Systems Brochure Sage Products, Inc. has prepared a four-page brochure illustrating and describing their full range of specimen collection containers. Containers have been designed for all patient specimen requirements - urine, stool, sputum, tissue, and kidney stone. All containers are completely disposable and designed with hospital, lab and patient in mind. For copies of this brochure write: Sage Products, Inc., 1300 Morse Avenue, Elk Grove, IL 60007. Burn Spray Time lost at wo!'1( due to burns and scratches is effectively reduced by G-63, the pain killer in an aerosol can. One spray of G-63 isolates the affected area with an invisible protective film, helps reduce painful swelling, speeds natural healing through analgesic action, and guards against secondary infection. Neither a cream nor ointment, it does not require bandaging, G-63 is packaged in B-ounce spray cans and distributed for export to industry by General Scientific Equipment Company, Limekiln Pike and Williams Ave., Philadelphia, Pa., 19150, U.S.A. Requests for descriptive literature (Bulletin G-63) are invited. Emergency Trauma Kit The Cryopac Emergency Trauma Kit offers immediate and effective on-site treatment of injurieS, sprains and bruises. The cold compress completely surrounds the injury. combining constant pressure and low temperature to assure comfort and reduction of shock. A built-in automatic pressure regulator prevents overinflation. Compresses are reusable, have indefinite shelf life, and are X-ray transparent. The complete kit is available in a convenient carrying case containing six cans of cryogen, a valve and hose assembly, a boot, glove, and a wrap-around. Additional information is available from Safety Supply Company, 214 King Street East, Toronto, Ontario M5A IJB. Q " - -- I ":1 "'-. Teletrace Telephone EKG System Medtronic's Teletrace Telephone EKG system uses the public telephone system to provide pacemaker implant centers and fOllow-up clinics with follow-up data from patients with implanted pacemakers of any manufacturer. From pacemaker patients TeleTrace provides precise digital rate and interval readings from pacemaker activity as well as a quality electrocardiographic trace. It is also used for monitoring patients for arrhythmia detection, and postinfarct patients for potential rhythm changes, and for interhospital telephone transmission of patients' electrocardiograms for immediate diagnosis of cardiac rhythm disorders. For information, write: Medtronic of Canada Ltd., 6733 Kitimat Road, Mississauga, Ont., L5N 1W3. Shock-Guard Packages Eyeglasses - hearing aids - fragile electronic components move safely through the mail in Poly-Foam's "Shock-Guard" mailers. Because of polystyrene's extremely high shock absorbent qualities, breakable products are completely protected. Also, packaging and postage costs are reduced in many cases. The closed packages, available in two sizes, are molded with slotted edges for positive closure. The Shock-Guard packages may also be ordered with additional urethane pads cut to size. The packages are sealed with either 3" paper or 1/2" filament tape. For additional information, write: Poly-Foam, Inc., Lester Prairie, MN 55354. right... henever the potential for infection i evident or where infecti n is present · ull Bactericidal Dressing effective agai nst both Gram-positive and Gram-negative infections of the skin-including pseudomonas Remains Active even in the presence of blood I pus and serum Soft pliable Not Messy the significantly increased lane-paraffin base is Just Right Indicated In burns ulcers wounds ROUSSEL Â Rouue! (Canada) Ltd.lLt.. 153 Graveline I 48 The CanadIan Nurse March 1976 11()ol:s Critical Care Medicine by Wilbur W. Oaks. New York. Grune and Stratton. Inc., 1974 473 pages. Reviewed by Elizabeth Weber, Coordinator. Post-Diploma Program in Adult Intensive Care Nursing. Ryerson Poly technical Institute. Toronto Ontario Cnllcal Care Medicine is composed of forty articles covering a range of subjects. all related to intensive care areas. These articles are the product of the fwenty-eighth Hahnemann Medical Symposium and have been organized into six main headings: Shock and Trauma: Cardiovascular Management; Pulmonary Management; General Intensive Care Unit: Neurologic Emergencies; and Musculoskeletal Emergencies. Under each main heading, a wide variety of topics are covered. For example. the section on Cardiovascular Management Includes tOpiCS which run the gamut from the clinical applicallon of monitoring equipment to the mechanism and treatment of pulmonary edema and congestive heart failure. An article on heart block presents a brief look at temporary and permanent pacemakers explaining the indications for pacing. the types of pacemakers available, modes of insertion, and management concerns A concise review is also given of the pathophysiology and management of cardiogenic shock. Finally. the mechanism of action of the commonly used diuretics is clearly presented in an article on fluid and electrolyte balance in heart failure. A positive feature of this book is a well-annotated bibliography at the conclusion of each article that gives the reader a wealth of resources from which fo do further readings. Good use is made of charts X-rays and diagrams to clarify significant points. The major drawback is the brevity of each article, which severely limits the depth attainable Thus, few articles cover the background pathophysiology of a condition before delving into the specifics of medical management, or reviewing related research findings Some articles take the form of a brief overview of many aspects of a topic, while others zero in on only one aspect, attempting to ensure depth but tending to limit general appeal. This book would be of most benefit to experienced intensive care nurses who are seeking further information on topics about which they already have a good understanding. As well, students in postgraduate education and educators may benefit from these readings. Pain: Clinical and Experimental Perspectives, edited by Matisyohu Weisenberg. Sf. Louis, The C.V. Mosby Company, 1975. 385 pages. Reviewed by Dianne Schultz, Teacher, Toronto General Hospital Campus, The George Brown College of Applied Arts and Technology, Toronto. This is an excellent publication with a multidisciplinary approach to the phenomenon of pain. The emphasis in terms of the experimental view lies in the measurement of pain, its correlates and the variables used to manipulate the pain reaction. The clinical aspect emphasizes measuremen1, surgery, and clinical techniques independent of drugs for the relief of pain. The selected readings reflect a comprehensive expression of this problem from various points of view. Section one deals with concepts of pain reactions including the physiology of pain and the psychological aspects. SecllOns two and three deal with the cultural and social factors and how these influence pain percepllon, e.g. how children perceive pain, and studies on selected ethnic groups. Section five provides information on the laboratory manipulation of pain perception. Of interest in Section six is a current account of hypnosis and acupuncture In the control of pain while Section seven is dedicated to surgical Intervention Selected diseases and pain associated with them are dealt with in Section eight. This book will prove invaluable to researchers, clinicians and anyone interested in increasing their knowledge of and ability to control man.s problems of pain and suffering Guide to Diagnostic Procedures by Ruth French. New York, McGraw-Hili Co., 1975. 357 pages. Reviewed by Sheila Money, Teacher, Humber College of Applied Arts and Technology, Health Sciences Division, Weston, Ontario. This book was formerly entitled .The Nurses Guide to Diagnostic Procedures" but the shorter title is more appropriate, for indeed the book can be used by a variety of health care professionals. The guide is concerned with explanations of fundamental principles, definitions of the common terms associated with diagnosis, the role of the nurse In each of the diagnostic tests, and interpretation of results. The book is divided into twelve major dvisions. The various procedures are presented under the following headings: urological, hematological, biochemical, specific functions, immunological, immunohematological, microbiological, cerebrospinal, miscellaneous, radiological, and radio-nuclide examinations. The author has done a thorough job of researching the book and it covers all the diagnostic procedures known to this writer. Other texts of diagnostic procedures are often organized according to body systems but in this book the material is well-organized and the excellent index makes it easy to find the desired information. Since the book will be used in areas where the Celsius scale is used, it would have been helpful if the author had included Centigrade readings when discussing temperatures. One outstanding improvement in the text is that the normal range for the various tests are given immediately after the heading. This book would be highly recommended for any unit which does extensive diagnostic testing. ....\udio\"hnu\1 . Health Promotion King Size This 7-minute amusing animated film is intended for youngsters but carries a message for adults as well Anything can happen, and does, including a visit to the kingdom of King Size where "No Smoking" is forbidden. Produced for Health and Welfare Canada and available from regional offices of the National Film Board. A Fight For Breath - Emphysema This is a 12-minute, color 16mrr film produced by the National Film Board for the Non-Medical Use of Drugs Directorate of the Department of National Health and Welfare. The film features illustrations on the effects of pollutants, e.g., cigarette smoke on the human lung. The theme messagE is that one out of every seven Canadians suffers from a chronic obstructive lung disease. The film is available to Canadians from any of the regional offices of the National Film Board. For Those Who Drink This is a 39 minute black and white film produced by Health Films Limited, Canada. Dr. R. Gordon Bell, recognized authority on drinking and alcohol problems, narrates this film dealing with drinking and those problems associated with drinking. Some suggestions for a solution to thi: complex problem are presented in thi filmed lecture. To request this film contact the Canadian Film Institute, I 303 Richmond Rd., Ottawa, Ontario I GENEROUS NEW GROUP DISCOUNTS on an Items shown, for group purchases. graduation gifts. favors, etc 6-11 Same Items, Deduct 10"10; 12,24 Same Items, Deduct 15 0 ,," 25 or More Same Items, Deduct 20 0 ,," G :'1L 7Z,v...;- r-------------------------------------. . IT'S EASY TO ORDER REEVES NAME PINS FOR YOURSELF OR FRIENDS! . I f.:::t C::r w:J.ed ne"s rac:. Pé' : e :,:r:: :O Ê SA lt tlirtirDE 1: ' .a: t =,,::. I box" on chart, clip thiS section nd attach to coupon "'... . cay.' I'N. . . LETTERING.______________________ 2nd LlNE._______________ : S11lE IEseøTlOM 1IfTN. I IEIAl' I UTTER"" PIICtS IIØ COlOR AIIISH 0'IaIbc1 COLOR I L.t EIIIWM 2 L-. . ALL "ETAL Smoorn rounded 1 0 Ouotone Does 0 Black 0 . PIn 2.09 O. p.n 3.2S I ;c g : sa Iß. or B Gokt 0 Polished not 0 Ok Blue I ba4;...,roundwlthPohsheded Silver OSatin apØly DWhrt D .:' D 5 . 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Chrome ani)'... 3.25 No. 102711." size, Chrome onl)'. ..3.75 FOr enlnved imtials add 5Ot: per instrument 5Vz" DPERATING SCISSORS Polished Stainless Steel stralgf1t blades No. 705 Sharpl Blunt point. . . . 2.95 NO. 706 Sharp/Sharp poinr.... 2.95 No. 710 4 2' IRIS Sci... Stroillhl. . . 3.75 For enlraved initials add 5(h per mstrument 3' '" 4". 5". JY.."" KELLY FDRCEPS 0..--- So hand)' for every nurse1ldeal for cJarnpil1l .- off tubing ete Stainless st!el. 5Y:J:"" No. 25.72 Stroillht. Box Lock.. . . . 4.49 No. 725 Curv.d, Box Lock. . . . . . . . 4.49 No. 741 Thumb Dr...ini Fo",op, S.rrat.d, Strliiht, 5'," . . 3.75 For enlf3ved mit.als add 5Ot: per mstrument MEDI-CARD SET Handi..1 refer ence ever! 6 smooth plastic cards ß!h" I 5Yz""J crammed With Il1fOnRibon. Equm- lencles of Apothecary to MetrIC to Household Yeas. Temp_ ac to F. Presccip. AbbJ, Unß- 01"... Bod, Chem , Blood Chem ,liver Tests, Bone Marrow Disease Incub. P!rlods. AIiIlt Wgb , etc. In wtnt! vln)1 holder_ No. 289 Card Set. . . 1.50 ea. :".SaJ:I:c;: amped an back of ;G] \ ',-. POCKET SAVERS PreY!nt stains and wear! Smooth. þli. .ble pur. ..M. ..n,1 Ideal 100H:0S1 I"OUII gifts Of f...... MI. 21M ""r loft). two comportments p k rÒ' :$ Cl>(1 4 \(1 (>>I.t iH(a lilt>> 11 tH .Iberta gl..l..rltCl Nur... requred lor 70-bed accredlled active Ireatmenl sp al. Fulltme and summer relief All AARN personnel poI,aes ply In wrrtlng to lhe. O1rector 01 Nursmg. Drumheller General HosPI- Drumheller. Alberta. ritish Columbia ector - Hospnal School of Nursing - a 9SO-bed acute hOspnal 'res a Doreclor lor theor 200 sluden' School 0/ Nursing. A Masler s gree '" Nursing IS requred Successful applicant musl have bOlh Inlstratlve and leaching eJ!.perlence. Ability to work effedlve(y wdh r community educatlOnal,nstnullons '" lhe development 01 new rammes IS essential. Salary commensurate with quallficahons d experience. Doree' appl,catlonS or requests for further InlormatlOn Dorector or Personnel SerVIces, Royal Jubilee Hospnal. 1900 Fort leel Vlctona, Bntlsh Columbia. V8R IJ8. !sd Nurse requred for obstelncaJ unit Posdlon aVailable immedls. y. Apply 10 Direelor 01 Nursing, Pnnce Rupert Regional Hospllal. 05 Summil Avenue. Pnnce Rupert. Bntish ColumbIa, V8J 2A6 'gl..leregi,,'eren Ie contour de I'ulcère pour rédulfe Ie risque de sensl- blhsatlon et pour ne pas deborder sur I'eplderme 8flVrronnant Pr'..nt8tlon: Pansement de gaze tegere, perafflnée, conlenant 1'110 Oe sullate Oe framycet.ne B P Solra.Tulle conloenl également 9 95% de lanoline anhydre D.sponoble en unites simples stenles de 10 em sur 1 0 em baites de 10 et 50 et en umtés simples sténles de 10 em sur 30 em, bai- les de 10 Conserver à Ia lemperature ambtante contròlee Registered Nurses Your community needs the benefit of your skills and experience. Volun- teer now to teach Patient CarE In The Home and Child Care in The Home Courses. 0 contaC(! 1 " St. n bulance The Canadian Nurse March 1976 Memorial University of Newfoundland School of Nursing Memorial University of Newfoundland School of Nursing, St. John's, Newfoundland, Canada, has faculty positions available September 1, 1976 or January 1, 1977 for teachers with knowledge of Curriculum Development and competency in Nursing of Children, Maternal-Child Nursing, Psychiatric Nursing, and Community Nursing. There are also opportunities for joint appointments with the appropriate nursing departments in the City. Masters degree preferred. Direct applications to: Margaret D. McLean Director, School of Nursing Memorial University of Nfld. St. John's, Newfoundland. The Montreal Children's Hospital Registered Nurses Nursing Assistants Our patient population consists of the baby of less than an hour old to the adolescent who has just turned seventeen. We see them in Intensive Care, in one of the Medical or Surgical General Wards. or in some of the Pediatric Specialty areas. They abound in our clinics and their numbers Increase daily in our Emergency. If you do not like working with children and with their families, you would not like it here. If you do like children and their families, we would like you on our staff. Interested qualified åpplicants should apply to the: Director of Nursing Montreal Children's Hospital 2300 Tupper Street Montreal 108, Quebec Nursing Instructors Required Beginning May - June 1976 For Two Year Independent Diploma Program in Nursing Enrollment - 270 students Openings anticipated in Fundamentals of Nursing Psychiatric Nursing Qualifications: Baccalaureate Degree with at least one year's nursing experience. Courses in education desirable, Contact: Anne D. Thorne Saint John School of Nursing Beaverbrook House Coburg Street Saint John, New Brunswick Phone No. (506) 658-2203 POSEY QUALITY PRODUCTS ,(, j-,;, "' () "'I Posey "Swiss Cheese" Heel Pro- tector - simplitied design, gener- ous coverage of heel and ankle. Hook and eye fastener to keep it in place. Synthetic fur; washable. #6121 ... fo, , I Posey Body Holder - popular in hospitals and nursing homes, this is an all-purpose Posey for bed or chair security. Available in sturdy canvas with flannel padding or quick drying nylon. S, M, L, wash- able. #1731 (cotton wlties) " ... : ---- - Posey "Cinch" limb Holder - all purpose, mild limb control with maximum comfort 36" strap al- lows degree of treedom desired, #2528 ,....{:; ( POSEY II y Send your order loday! Enns and Gilmore 2276 Oixie R""d Mississ.1up Ont"-"o. C;anada L4Y 115 (416) 2ï4-2 7 The Canadian Nurse March 1976 Director of Nursing Director of Nursing required for a 32-bed active treatment hospital located In Southern Alberta. Major renovation program scheduled for 1976-77, Previous experience desirable. Duties to commence June 1, 1976, Please forward complete resume of experience and qualifications to: The Administrator Macleod Municipal Hospital Fort Macleod, Alberta TOl OZO Assistant Director of Nursing Assistant Director of Nursing required for an accredited 130-bed General Hospital with a major expansion project underway. The city of Grande Prairie is located 285 miles northwest of Edmonton and is well serviced by bus and air. Preference will be given to applicanl with practical experience at the senior administration level combined with baccalaureate degree and/or other formal education in the field of admìnistration. Salary commensurate with education and experience. Position available by May 1 st 1976. Please apply to: Director of Nursing Grande Prairie General Hospital Grand Prairie, Alberta T8V 2E8 North Newfoundland & Labrador requires Registered Nurses Public Health Nurses International Grentell Association provides medIcal services for Northern Newfoundland and Labrador We staff four hospitals, eleven nursing stations, eleven Public Health units. Our maIO 180-bed accredIted hospital is situated at 51. Anthony. Newfoundland. Active treatment is carned on In Surgery. Medicine, Paediatrics, Obstetrics, Psychiatry. Also, Intensive Care Unrt. Orientation and In-Service programs. 40-hour week. rotating shifts. living accommodations supplied at low cost Public health has challenge of large remote areas Excellent personnel benefits include liberal vacatIon and sick leave. Union approved salaries start at $810.00. Apply to: International Grenfell Association Assistant Administrator of Nursing Services St. Anthony, Newfoundland AOK 4S0 63 , t. __-.:J When you are asked about nursing care..a Health Care Services Upjohn Limited can assist you and your patients by providing qualified Health Care Person- nel for: . Private Duty Nursing . Home Health Care . Staff Relief We are a reliable source of nursing care with whom you can trust your patients. Our employees are carefully screened for character and skill, then insured (including Workmen's Compensation), bonded and made subject to our high operating code of ethics. Your patients' care and well- being are our business. If you would like more informa- tion about our services, call the Health Care Services Upjohn Limited office nearest you. .'I-- . Health Care Services Up john Limited (Operating in Ontario as HCS Upjohn) Victoria. Vancouver. Edmonton Calgary. Wmrnpeg . Wmdsor . London St Cathannes. Hamilton. Toronto West Toronto East. Ottawa. Montreal Trois RlV,ères . Quebec. Halifax 64 Guelph General Hospital Fully accredited - 220 beds Requires Head Nurse For Obstetric Department The Obstetrical facilities are presently being expanded and renovated to provide a modern Labour and Delivery area, new Nursery facilities and a new Post Part urn SUite providing for 1,500 deliveries annually. Pleasant UniverSity City of 65,000. One hour from Toronto. Apply to: Personnel Department Guelph General Hospital 115 Delhi Street Guelph, Ontario N1 E 4J4 Telephone: (519) 822-5350 Ex,: 203 Operating Room Supervisor . required for 650-bed fully-accredited hospital . management experience and advanced preparation in Operating Room technique and administratio'l.. required Please apply giving full resume to: Director of Personnel Lions Gate Hospital 230 East 13th Street North Vancouver, British Columbia V7L 2L 7 Registered Nurses and Nurses Assistants required for 11 O-bed hospital for chest diseases situated in the Laurentians, 55 miles north of Montreal. Salaries are now being updated, Excellent fringe benefits. Quebec language requirements do not apply for Canadian applicants if registered in Quebec before July 1976. Apply: Director of Nursing Mount Sinai Hospital P.O. Box 1000 Ste-Agathe des Monts, Quebec J8C 3A4 The Canadian Nurse School of Nursing Assistant Director required in a 2 year English language diploma Nursing program Qualifications Master's degree in Nursing Education, preferred. with experience in Nursing Education. Administration and teaching and at least one year in a Nursing Service position. Eligible for registration in New Brunswick. Apply to: Harriett Hayes Director The Miss A.J, MacMaster School of Nursing Postal Station A, Box 2636 Moncton, N.B. E1C 8H7 Co-ordinator Co-ordinator required for a 340-bed acute care hospital in Central British Columbia to be responsible for the related serviæs of the O.R., PAR., Daycare Surgery and Emergency Departments. The position will include both clinical and administrative responsibilities. Salary per RNABC Contract. For further information contact: Director of Nursing Prince George Regional Hospital Prince George, British Columbia V2M 1S9 Nursing Opportunity in a Progressive Hospital Supervisor - Operating Room and Recovery Room We offer an active staff development program in a 310-bed General Hospital involved in Acute, Extended and Mental Health Care. Competitive salaries and fringe benefits based on educational background and experience. Apply, sending complete resume, to: Director of Personnel Stratford General Hospital Stratford, Ontario N5A 2Y6 (Area Code 519,271-2120, Extn. 217) March 1976 Registered Nurses Required For a 138-bed Active Treatment Regional Hospital in Medicine, Surgery, Paediatrics, Obstetrics, and qualified R.N.'s for a 5-bed I.C.U.-C.C.u. Salaries according to Provincial Salary Guide Usual Fringe Benefits Residence accommodation available The Hospital is located in the beautiful Annapolis Valley which is a one-hour drive to the Provincial Capital of Halifax Apply to: Director of Nursing Blanchard-Fraser Memorial Hospital 186 Park Street Kentville, Nova Scotia B4N 1 M7 General Duty Nurses Required immediately for acute care general hospital expanding to 343 beds plus proposed 75 bed extended care unit. Clinical areas include: medicine, surgery, obstetrics, paediatrics, psychiatry, activation & rehabilitation, operating room, emergency and intensive and coronary care unit. Must be eligible for B.C. Registration. Personnel policies in accordance with R.N.A.B.C. Contract: Salary: $850 - $1020 per month (1974 rates) Shift differential Apply to: Director of Nursing Prince George Regional Hospital Prince George, B,C. Foothills Hospital, Calgary, Alberta Advanced Neurological- Neurosurgical Nursing for Graduate Nurses A five month clinical and academic program offered by The Department of Nursing Service and The Division of Neurosurgery (Department of Surgery) Beginning: March, September Limited to 8 participants Applications now being accepted For further information, please write to: Co-ordinator of In-service Education Foothills Hospital 1403 29 SI. N. W. Cafgary, Alberta T2N 2T9 Georgian College of Applied Arts and Technology Health Sciences Division Requires Faculty for Diploma Nursing Program in Owen Sound, Orillia and Barrie and Ambulance Attendant Program based in Orillia New, progressive, integrated curriculums. If you are a creative and innovative teacher, if you believe in self-directed learning, we would like you on our staff. Starting date August 17, 1976 with 2 weeks orientation. Please write or telephone: , Miss CoM, Brown Nursing Administrator Georgian College of Applied Arts & Technology 43 Colborne Street West Orillia, Ontario. L3V 2Y5 Téléphone: (705) 325-2705 I McMaster University School of Nursing Nurse faculty members required for the 1976-77 academic year for a School of Nursing, within a Faculty of Health Sciences. The School is an integral part of a newly developed Health Sciences Centre where collaborative relationships are fostered among the various health professions and clinical appointments can be arranged. Requirements: master's or doctoral degree, with clinical specialist preparation or experience and/or preparation in teaching preferred in adult health, medical-surgical or pediatrics. Application, with a copy of curriculum vitae and two references to: Dr. D. Kergin Associate Dean (Nursing) Faculty of Health Sciences McMaster University Health SCiences Centre 1200 Main Street West Hamilton, Ontario L8S 4.19 The Canadian Nurse March 1976 65 "Meeting Today's Challenge in Nursing" Queen Elizabeth Hospital of Montreal Centre A Teaching Hospital of McGill University requires Registered Nurses and Registered Nursing Assistants . 255-bed General Hospital in the West of Montreal . Clinical areas include Progressive Coronary Care, Intensive Care, Medicine and Surgery, Psychiatry. Interested qualified applicants should apply in writing to: Queen Elizabeth Hospital of Montreal Centre Director of Personnel 2100 Marlowe Ave., Montreal, Quebec H4A 3L6 SUMMER IN THE ARCTIC? / Medical Services, Northwest Territories Re- gion, is offering a number of term positions for Qualified and experienced nurses to serve Canada's northland during the period of May through September. Why not see the Arctic and experience the challenge of frontier health care? Interested? Please fill out the attached cou- pon and mail to: Personnel Administrator, Medical Services, Northwest Territories Region, Health and Welfare Canada, 14th. Floor, Baker Centre, 10025 - 106 Street, Edmonton, Alberta. T5J 1H2 or call collect Area Code 403 - 425-5698 NOTE: Permanent positions with Northern Health Services are also available. \ -.: .. ,,' ." . .. . ,: - 'V .. 16 Healrh and WeUare Canada Sante el Blen-elre social Canada ' is ' .... ' ,. . NAME STREET CITY ,. PROVINCE POSTAL CODE 66 Western Memorial Hospital Corner Brook, Newfoundland. Vacancies Staff Nurses For a 350 bed fully accredited, acute treatment, Regional General Hospital serving a population of approximately 100,000, scenic City with modern shopping, housing and education facilities Salary Scale: $ 9,724.00 - 11,986.00 per annum 10,324.00 - 12,586.00 per annum 1st April, 1976 10,800.00 - 13,110.00 per annum 1st August, 1976 Service Credits recognized Shift Differential - $1.50 per shift. Charge Nurse - 3.00 per shift. Uniform Allowance - 90.00 per year. Educational Differential - Extra three steps on salary scale for B.N. Degree, four steps for Masters Degree. Annual Vacation - Twenty days. Statutory Holidays - Eight plus Birthday. Residence accommodation available $35.00 per month. Transportation available. Applicants please apply to: Canada Manpower Centre 4 Herald Avenue Corner Brook Newfoundland A2H 6J7 The Canadian Nurse March 1976 .... ./ -... -7:-:- /-:' : -:" :7::'= : .;...... .0 -- 'ox:, 'YI>_ -.- . I"":'-:! ... p . ....::.'" , ;.- ..J/ _ ..... . 0;-" - !''' I "', ..., .... ,.11. "'Jo- ".' r r General Staff Nurses required for Regina General Hospital openings in all departments Recognition Given For Experience Progressive Personnel Policies Apply: Personnel Department Regina General Hospital Regina, ßaskatchewan S4P OW5 HUH 'ESS> E illJ requires 'Ðirector. QUO Vadis Campus Duties Successful Candidate will be responsible for the aca- demic administration and development of a unique diploma nursing program for adult nurse learners within a peer-oriented setting, the development and administration of formal and informal continuing edu- cation programs for registered and non-registered nurses and registered nursing assistants and the effec- tive operation of the Quo Vadis Campus. Qualifications The successful applicant will be a nurse registered or eligible for registration in Ontario and will have a graduate degree and broad experience in adult educa- tion, nursing and/or education administration. Pre- ference will be given to candidates with recent ex- perience in developing programs for and working with adult learners. 'Ðirector. Osler Campus Duties Successful Candidate will be responsible for the aca- demic administration and implementation of the nursing diploma program on the Osler Campus, pro- viding leadership in educational design and teaching/ learning approaches, the effective operation of the Osler Campus and the management of the residence. Qual ifications The successful applicant will be a nurse registered or eligible for registration in Ontario and will have a graduate degree in nursing, education or administra- tion. Preference will be given to candidates with re- cognized experience and expertise in curriculum deve- lopment and/or educational leadership. Apply in writing with resume to: Personnel Relations Centre Humber College of Applied Arts & Technology P.O. Box 1900, Rexdale, Ontario M9W 5L7 We are interested in Male and/or Female applicants The Canadian H..... March 1976 I I;D '. "\ ; ) l ifyaucar.e, , þ-,/,':i!V'. ':fj k send thIs --( !ïí,',, caupan taday. ,-N /_________ I ./ - I :;, -:.--:-/ Medical Services Branch I I ' . 1'- Department of National I i' - Health and Welfare I 'í. Ottawa, Ontario K 1 A OK9 I I I I Please send me more information on nursing I I opportunities in Canada's Northern Health Service. I I Name: I I Address: City: Prov: I ------------ ___ J . . Heatth and Welfare Sante et Bien-étre SOCial Canada Canada The Canadian Nurse March 1976 Index to Advertisers February 1976 Abbott Laboratories Limited Cover IV Bata Shoes 4 The Canada Starch Company Limited 15 The Clinic Shoemakers 2 Designer's Choice 9 Health Care Services Upjohn Limited 63 H ollister Limited 17 ICN Canada Limited 57 L'eggs Products Intemational Limited 10, 11 J.B. Lippincott Company of Canada Limited 36, 37 M edoX 61 Mont Sutto n 59 The C.V. Mosby Company Limited 50,51,52,53 Nordic Pharmaceuticals Limited 15 m Reeves Company 49 Roussel (Canada) Limited 47, 62 Sen eca College of Applied Arts and Technology 55 W.B. Sa u nders Company Canada Ltd 1 Three (3)M Canada Limited 7 Uniforms Registered 45 Uniform Specialty Cover III White Sister Cover II Advertising Manager Georgina Clarke The Canadian Nurse 50 The Driveway Ottawa K2P 1 E2 (Ontario) Advertising Representatives Richard P. Wilson 219 East Lancaster Avenue Ardmore, Penna. 19003 Telephone: (215) 649-1497 Gordon Tiffin 2 Tremont Crescent Don Mills, Ontario Telephone: (416) 444-4731 Member of Canadian Circulations Audit Board Inc. mE 7& The Canadian Nurse L 7.JV F J l. ,\ 1 .' L ,.) 1 f '( U,.. L r T \'1 .A "'" Ir l ..AKY TT l.T....I"IC Kif\, oN5 . \ .. "- < f , , .. -- ""'" . , , I , "" . / .. \ 4 " t / / 'j tl :11 ',. : ,: {It 'I! í . I I I , t I f I A & B) Style No. 46592 Sizes 3-15 Pristine Royale 100% Textured Polyester Warp K White, Blue - 3 piece suit About $35 C) Style No. 6525 Sizes 8-16 Pristine Royale 100% Textured Polyester Warp K White About 524 A ""HITE SISTER CAREER APPARI":L See our new line of Whites and Water Colours at fine stores across Canad1 Now there are two versions of MILLER &: KEANE"s Encyclopedia &: Dictionary of Medicine and Nursing. EnCYclopø' and Dictl Medicine ' - .....".- , , , . , , t C f f C f t EditiO I1 '\ S tu del1 The I,. eSt. J'} ,.O" O/ . 70J'} MILLER & KEANE's Encyclopedia and Dictionary of Medicine and Nursing: Published March 1972. 1089 pages. 122 figures plus 16 color plates, Standard Edition: flexible binding; thumb index; will remain available. Order #6355-9. Student Edition: hard cover; no thumb index. $11.30. Order #6356-7. On April 1 , 1976 a Student Edition of MillER & KEANE's Encyclopedia and Dictionary of Medicine and Nursing will finally be available. This Student Edition is a hard cover version of the well known reference. While the Student Edition is not thumb indexed like the Standard Edition, once you look inside the cover, you'll find that the Student Edition provides the same comprehensive, accurate information on modern nursing practice and medical terminology. Over 453,111 of your colleagues have already discovered the value of this precise, professional reference. You can too! By the late Benjamin F. Miller, MD; and Claire Brackman Keane, RN, BS, MEd. !! ! !!!! l!!. lTD. r---------------------c I I I I I I I Full Name I I Home Address I City I On 30-day approval, please send me a copy of the Student Edition of Miller & Keane, $11.30. #6356-7. o Payment enclosed, ship postpaid. 0 Bill me. 0 Send C.O.D. Province _ Zone , o , 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, Zincofax is economical, even more important now with a new baby at home. .. \ V '- ... .... I " I - ... \c .. -\ ..A .... 4t' ...... f , keeps a family's smooth skin smooth 115g , . Zincof 1 RBABYSSJ!.I . , _:--- t cot )( h Cd 1'SS<'" In . FoR øAØ ' 508 -Trade Mark W-3056 Wellcome Burroughs Wellcome & Co (Canada) Ltd Montreal, P.O. .4 76 Input News Books Library Update The Canadian Nurse The official journal of the Canadian Nurses' Association published monthly in French and English editions. 6 8 47 47 Volume 72. Number 4 A Nursing Challenge: Replantation of a Severed Arm Ticket of Nominations 1976-78 CNA Convention Program CNA Financial Statement CNA Resolutions A Conversation with the Executive Director That Cup of Tea B. Geyer 19 24 35 38 41 F. Warren 44 46 \ . ""1 r, þ , . r' .., -- \ '-\ ... ! CNA member associations will name 249 voting delegates to officially represent their membership at the national association s Annual Meeting in Halifax this June. For these nurses, it will be business before pleasure when the time comes to voice the wishes of the people they represent. The cover photo of voting delegates at a previous CNA meeting is by David Portigal of Winnipeg. The views expressed in the articles are those of the aulhors and do not necessarily represent the policies of the Canadian Nurses' Association. ISSN 0008-4581 Indexed in Intemalional Nursing Index, Cumulative Index to Nursing Literature, Abstracts of Hospital Management Studies. Hospital Literature Index. Hospital Abstracts. Index Medicus. The CanadIan Nurse is available in microform from Xerox University Microfilms, Ann Arbor, Michigan, 48106. The Canadian Nurse welcomes suggestions for articles or unsolicited manuscripts. Authors may submit finished articles or a summary of the proposed content. Manuscripts should be typed double-space. Send original and carbon. All articles must be submit1ed for the exclusive use of The CanadIan Nurse. A biographical statement and return address should accompany all manuscripts. A Canadian Nurses Association, 50 The Driveway, Ottawa Canada K2P 1 E2. Subscription Rates: Canada: one year, $8.00; two years, $15.00. Foreign: one year, $9.00; two years, $17.00. Single copies: $1.00 each. Make cheques or money orders payable to the Canadian Nurses' Association. Change of Address: Notice should be given in advance. Include previous address as well as new, along with registration number, in a provincial nurses association where applicable. Not responsible for journals lost in mail due to errors in address. Postage paid in cash at third class rate Montreal, P.Q. Permit No. 10,001. C Canadian Nurses' Association 1976. , 4 .-e'-SI)eetiye The CanadIan Nurse April 1976 Three years ago, when doing some reading in the area of the probable fate of professional associations as an organized entity, I happened across a comment by a North American sociologist that "the danger for many associations in existence today, lies in the very distinct possibility that they will not adapt themselves sufficiently to survive the coming decade." And right here I must admit that. in 1973, the threat that a good many of the professional associations that existed at that time, would simply not be around in the eighties did not seem either very immediate or very ominous. After all, change has become an accepted characteristic of our contemporary conditiion. A degree of introspection is a healthy sign and adaptability is the mark of the well-adjusted institution or individual. Professional associations had been around for a long time and would probably continue to meet the needs of their members in one way or another for a long time to come. But now, in the Spring of í976, our association is faced with a crisis that threatens its very existence. Can we change fast enough to meet the challenge not just of new social attitudes and scientific advances, but also of an economic turnaround that directly or indirectly affects everyone who gives or receives health care services in this country? And this is precisely where the problem lies. Funding for the 1976-78 biennium has become a critical issue for this association. And, right now (not 3 years ago or even 4 years from now) is the time the nursing profession stands most in need of the kind of strength, leadership and direction that can be obtained only by collective action at the national level. Recently, it has become apparent that the lip-service that has been given publicly to health promotion, illness prevention, and the need to find viable alternatives to acute care, IS gOing to have to be replaced by concrete action. The implications for the nursing profession of this revolution in our health care system, are profound. Very soon, we could be looking at broader nu(slng roles, new responsibilities, more independent professional recognition, more group practice, more inter-professional cooperation, more opportunities for promotion and, potentially, a very real increase in the "political clout" that the profession can command. But (and this is a very big but) the only way that nursing can achieve, on a national scale, the kind of scientific expertise, information retrieval and dissemination systems, and climate of public confidence that will allow this to happen is by pooling its resources and working collectively for the advancement of the profession as a whole. Today, there IS more truth than ever in Robert Merton's comment that "in the professions, each practitioner is his brother's keeper." The future of the future is the present. For CNA, that present is as close as June 22, 1976_ On that day, you or your representatives will decide the future of organized professional nursing in this country. Are you ready to assume that responsibility? -MAH. lit>> lee i 'I Editor M. Anne Hanna Assistant Editor Liv-Ellen Lockeberg, Carol Thiessen Production AssIstant Mary Lou Downes Circulation Manager Beryl Darling Advertising manager Georgina Clarke CNA Executive Director Helen K. Mussallem ... .. . The wistful face above belongs to little Theresa Bakx who lost her arm in an accident. A first-person account by one of the nurses involved in the subsequenl replantation is on page 19 of this issue. Next month, what happens when a patient in your hospital dies? Who is responsible for helping the family over the inevitable hurdles they face in the first shock of their bereavement? What happens when no one accepts this responsibility is the subject of one of next month's articles. Also next month, an examination of the nursing care involved in transportation of the sick neonate - the steps you can take during and before this move to reduce the risks to the patient. Just before press time, members of the program committee were able to provide some last minute information on the JUl'le CNA meeting in Halifax. (see pages 35-37 of this issue). Participants In Monday's debate, in addition to those named, will include: Brenda AUt, assistant executive director, Patient Services, Halifax Infirmary, and Denise Lalancette, chargé d'enseignement, Centre Hospitalier Universitaire, Sherbrooke (in favor); Margaret McLean, director, school of nursing, Memorial University, St. John's, Nfld. and Suzanne Brazeau, doctoral candidate, University of Chicago, (against). Ruth May, assistant professor, Outpost Nursing, school of nursing, Dalhousie University, will also be a member of the group of nurses that Patrick Watson will interview. Participants in the panel discusSion on the quality of life in the work world O' the nurse will also include André Payeur, lawyer, who will discuss "Uncertainties regarding the nurses' legal protection." :ROM desi!!ner's choìc WURLD UI- tA "IUN - t ,..' _ r. I-' .".-- f , j. )) ;r.- I . - , . r- ., . p , ,> "<:r . I . ..t-f .. -. " o. . , , c. .'f., t, . if: :\ i. 41- ofF- .. . c ! -' \j l ,. . .. ..,., ....' -. ' . 'Ji.> '.>.:I: 1". Í : 1f;c+.1 .. .: ,,!. .', .. r--# ";' :.. ....45:- . c ..: , 'II -'I: " . "i ? . .;>'l .y;- .. y " .Jk--* ,irJ . !to _ , '\.. . .,- . - L> 0 \ 1 õ s::. Il. Registered Nurses Association of Ontario (RNAO). CUNSA was formed in 1970 to stimulate communication between nursing schools. By 1974 all of the 22 university schools of nursing were represented at the annual conference. Since then. the University of 'JIontreal and Laval University have .r'\tJdrawn to concentrate on the pro' \s peculiar to nurses in QUdition, UNSA hopes to regain their mjing 2 \hip in the future. \ \ \ 12 When learning is what matters most. . . let Mosby texts help you initiate interest and clardy concepts medicaVsurgical 6th Edition. MEDICAL-SURGICAL NURSING First to effectively combine medical and surgical nursing, this classic text continues to focus on individualized care of the total patient. Throughout this new 6th edition, you'll find increased emphasis on physiology, nursing assessment, and pathophysiol- ogy. New material has been added on cardiac disease and family planning counseling, including physiology of reproduction and contraception. New chapters provide thorough and current information on ecology and health, neurologic disease, musculoskeletal dis- orders, and injuries. Other features include a new larger format and new easy-to-read type. By Kathleen Newton Shafer, R.N., M.A.; Janet R. Sawyer, R.N., Ph.D.; Audrey M. McCluskey, R.N., M.A., Sc.M.Hyg.; Edna Lifgren Beck, R.N., M.A.; and Wilma J. Phipps, R.N., A.M.; with 28 contributors. 1975, 6th edition. 1,032 pages plus FM I-XVI, 8Y2" x 11",608 illustrations. Price, $17.80. A New Book! CLINICAL IMPLICATIONS OF LABORATORY TESTS I This valuable new guide provides a step-by-step approach to the clinical significance of laboratory tests. Unit I, Routine Multi-System Screening Panel, covers sequential multiple analyzer (SMA 12) tests, hematology screening panel and urinalysis. This is followed by an important table of potential variations of normal values that compares specific entities found in the routine screening process. Unit II describes in detail evaluative and diagnostic tests that should be 1 . 'Jsed to confirm the diagnoses of abnormalities found vie z rc. the routine screening panel. ec. . the . . 6e,., arko M. TIIklan, M.D. and Mary H. Conover, R.N., B.S.N.Ed. ber, 1975. 232 pages plus FM I-XVI, 6W' x 9W', 42 I :rations. Price, $7.90. / , I ) A New Book! NURSING MANAGEMENT OF RENAL PROBLEMS A clear presentation of the physiologic and psychologic bases for nursing intervention, this unique text approaches nephrology as a vital subsys- tem of the whole body system. It offers in-depth discussions on normal and pathologic renal function; causes of renal disturbances; body responses and acute renal failure; medical therapy; and nursing intervention. Methods and processes of renal restora- tion are carefully detailed, with special attention to dialysis and transplantation and the psycho-social aspects of each. By Dorothy J. Brundage, M.N. January, 1976. 204 pages plus FM I-X, 6W' x 9Y2", 20 illustrations. Price, $6.85. IVIOSBV TIMES MIRROR THE C. V MOSBY COMPANY, l TO 86 NORTHLINE ROAO TORONTO, ONTARIO M4B 3E5 fundamentals/basic science New 13th Edition! PHARMACOLOGY IN NURSING Now available in a new 13th edition, this leading text outlines current concepts of pharmacology in relation to clinical patient care. Written by a nurse for nurses. the text features updated discussions on mechanisms of drug action, indications, contraindications, toxicity, side effects and safe therapeutic dosage range. Two new chapters examine antimicrobial agents and the effects of drugs on human sexuality, fetal develop- ment, and lactation. By Betty S. Bergersen, R.N., M.S.. Ed.D.; in consultation with Andres Goth, M.D. February, 1976. 13th edition, 752 pages plus FM I-XIV, 8" x 10",143 illustrations. Price, $13.60. New 9th Edition! TEXTBOOK OF ANATOMY AND PHYSIOLOGY The most widely adopted anatomy and physiology text is now available in an updated new 9th edition. New features include: three chapters on the nervous system; new information on brain waves, conscious- ness, biofeedback training; expanded discussions on liver functions, reproduction, circulation, and much more! By Catherine Parker Anthony, R.N.. B.A., M.S.; with the collaboration of Norma Jane Kolthoff, R.N.. B.S. 1975, 9th edition, 598 pages plus FM I-X, 8" x 10", 336 figures (145 in color). including 239 by Ernest W Beck, and an insert on human anatomy containing 15 full-color, full-page color plates. with six in transparent Trans-Vision<< (by Ernest W. Beck), Price, $13,95. New 10th Edition! WORKBOOK OF SOLUTIONS AND DOSAGE OF DRUGS: Including Arithmetic An effective, self-teaching guide, this workbook relates basic mathematics to common solutions and dosages, and provides information essential for proper calculation, preparation, and administration of drugs. Updated throughout, material places more emphasis on the metric system and includes many new problems. The totally rewritten appendix contains drug standards and legal regulations; metric doses and apothecary equivalents; dosage rules for chil- dren; and more, By Ellen M. Anderson, R.N., B.S., M.A. and Thora M. Vervoren, R.Ph., B.S. January, 1976, 10th edition, 168 pages plus FM I-VIII, 7V." x 10V2", 11 figures. Price, $6.60, New 11th Edition! MICROBIOLOGY AND PATHOLOGY Extensively revised and updated, the new edition of this popular text provides basic information and current knowledge on microbiology and pathology, both general and specialized. Informing your students of the latest scientific advances, the text features new discussions on: serologic diagnosis of protozoal and metazoal diseases, evaluation of cell-mediated im- munity, immunotherapy, and more! A new unit on microbes, details on lab methods, and rules for specimen collection are also included. Review ques- tions accompany each chapter, By Alice Lorraine Smith, A.B., M.D" F.C.A.P.. F.A.C.P. April, 1976. 11th edition, approx. 720 pages, 8" x 10",563 illustrations, with 2 full page color plates. About $15.70. New 3rd Edition! THE FOUNDATIONS OF NURSING: As Conceived, Learned, and Practiced in Professional Nursing Reflecting new dimensions in present day nursing, this updated text helps acquaint students with responsibilities, opportunities, and changes in profes- sional nursing. Discussions focus on such timely topics as: patients' rights, nurses' rights. abortion, euthanasia, and health care delivery systems. New material examines death and dying, changes in nurse practice acts, transitional problems from student to practicing nurse, individual licensure vs. institutional licensure, and more! By Lillian DeYoung, R.N.. B.S.N.E., M.S., Ph.D,; with 3 con- tributors. April, 1976. 3rd edition, approx. 336 pages, 7" x 10",14 photos, 29 illustrations. About $10.00. critical care New 2nd Edition! A COMMONSENSE APPROACH TO CORONARY CARE: A Program This important new 2nd edition reviews all major problems associated with acute myo ardial.infarction, Completely revised and expanded diScuSSions cover anatomy, electrophysiology, chemical imbalances, complications, and more, New material discusses hemodynamic monitoring and drug therapy for shock and heart failure, By Maflelle Ortiz Vinsant, R.N., B.S.; Martha I. Spence. R.N., B.S., M.N.; and Dianne Chapell Hagen, R.N.. B.S. October, 1975. 2nd edition, 228 pages plus FM I-XVI, 7" x 10",439 original drawings by Marcellino Obaya. Price, $7.65. J \ New 2nd Edition! NURSING CARE OF THE PATIENT WITH BURNS Written by an experienced burn nurse-clinician, this text is a concise yet detailed resource for burn care. from first aid treatment to prolonged care of burn patients. Updated and expanded, it includes a new chapter on fluid therapy, and increased emphasis on pathophysiology, causes, and prevention of complica- tions. It includes information on the importance of nutrition and special needs of young and older bl.rn patients, By Florence Greenhouse Jacoby. R N. January, 1976. 2nd edition, 186 pages plus FM I-XII. 6V2" x 9Y2 , 18 illustrations including 2 color plates. Price, $7.30, 14 critical care A New Book! TECHNIQUES IN BEDSIDE HEMODYNAMIC MONITORING This new guide is the first comprehensive text on continuous bedside hemodynamic monitoring. It provides current, detailed information for noninvasive and invasive monitoring of cardiovascular function - with special emphasis on the critical care setting. Each chapter includes a review of physiological principles and problem and solution tables. By John Speer Schroeder, M.D. and Elaine Kiess Daily, R.N. February, 1976. 212 pages plus FM I-XII, 6W' x 91f2", 137 illustrations. Price, $7.60. behaVIOral (ier , A New Book! CHRONIC ILLNESS AND THE QUALITY OF LIFE This unique text delineates the psychological and social problems faced by patients afflicted with chronic disease, and offers specific information on how to help patients adjust to their condition. Topics include management of crises, family stress, handling of regimens, social isolation, and much more. Case studies clarify the principles presented, By Anselm L Strauss, Ph.D. June, 1975. 160 pages plus FM I-XIV, 6:Y4" x 9:Y4". Price. $6.05. A New Book! BEHAVIORAL METHODS FOR CHRONIC PAIN AND ILLNESS I Explaining the basics of behavioral analysis, this new text is the first to discuss control of pain by behavior modification techniques. Discussions present current information on: concepts of pain; how pain may become conditioned; methods for analysis of chronic pain; behavioral technology in relation to treatment p anning; and treatment by behavioral techniques, It al ,o provides important guidelines for the support nurses can offer patiel"ts' families. By Wilbert E Ford}'ce, Ph. , February, 1976.236 pages plus FM '7' ,. x 10",31 U"",,,U n,. Pri>"-H - , >-\" f , J " \. I) . Nurses across Canada can expect to hear more from their provincial associations about good health and fitness as a result of a two-e Canadian Nurse April 1976 19 0\ (j0 'l> . 'ò.<' '!::' 0.,0 · ø Ú qj. . Ôj. O C:J v )0.. fl; I 0 '"tt( I Ib- '" o Ò ø ø ?J0 =' "It was a year ago today, " said Theresa's father as I sat visiting with them while they waited to see the surgeon. "I can't believe a year has gone by since the accident .. A year before, Theresa Bakx was a happy, normal two-year-old living on a farm with her parents and brothers. She enjoyed following her brothers into the fields but on this particular day had grown tired of trying to keep up and had decided to lie down in the hay to rest. Seconds later the hay mower severed her left arm at the elbow and severely lacerated her left leg. When her father realized what had happened, he acted quickly and with remarkable presence of mind. He squeezed her upper arm as tightly as he could. and after several minutes succeeded in controlling the bleeding. He then picked up Theresa and her detached arm, and rushed to the house. He wrapped the arm in a towel and took her to the hospital in the nearby town of Rimbey. By that time the bleeding had stopped and arrangements were made immediately for an ambulance to take her to Edmonton, about 90 miles away. In Emergency Three hours after the accident Theresa was admitted to the Ernergency Departrnent at the University Hospital in Edmonton, She was conscious, her vital signs were stable, and she appeared to have withstood the ambulance trip very well. (Theresa's father remarked that during the trip she kept asking if the doctor would be able to fix her arm.) In emergency, an I.V. of Ringers Lactate, to run at 60 mllhr, was established in Theresa's right wrist. The stump was checked, cleansed with saline and rewrapped in a sterile towel. The detached arm was examined, cleansed, and placed in a sterile plastic bag with ice to preserve its viability. The large laceration on the anterior aspect of the lower left leg was also cleansed and dressed. Following evaluation of Theresa's condition, a team of doctors decided to attempt a replantation of the left arm. Theresa met Malt and McKhann's classic criteria for replantation, parphrased as follows: 1 - Is there a life-endangering injury involving the contralateral extremity? - Is the amputated part in good condition? - Are the nerves capable of regenerating and the muscles and tendons functioning? - Is the amputation through the upper extremity? - What is the patient's age? - Are the resources of the hospital adequate to carry the patient through the long and tedious postoperative course? - Does the patient actively desire replantation and is he likely to possess the psychological stamina for rehabilitation? In considering these questions some particular factors weighed in Theresa's favor. If the amputation involves a lower extremity, replantation is rarely indicated. but replanted upper extremities are likely to be more functional than a prosthesis. Replantation is especially favored for children because they have a relatively shorter length of nerve to regenerate and they have more time available for rehabilitation. 2 In addition the Charles Camsell Hospital, where she was transferred for the operation, is equipped with facilities for a postoperative program, including progressive physiotherapy and occupational therapy departments and an active play program in the nursing unit. Mr. Sakx was warned that several operations might be necessary if the replantation was attempted and that he and his wife would be required to participate in a long-term rehabilitation program for Theresa. He understood the implications of the operation and agreed with surgeons that a replantation should be attempted to restore the function in her arm. Preoperative Care Preoperative medical treatment included x-rays of the left stump, the left detached arm and the left leg. Hypertet (Tetanus Immune Globulin) 250 u., Tetanus Toxoid 0.5 ml and Penicillin G (Benzylpenicillin) 200,000 u. were administered to protect against clostridial and other infections. A Foley catheter No, 8 was inserted. A CSC, electrolytes, urinalysis and crossmatch for 3 units of blood were done. Theresa's vital signs remained stable. She was given nothing by mouth and was on hourly output. Q.R. Preparations The two nurses on call for the Operating Room (O.R.) had only 45 minutes to prepare the theater and select and sterilize the instruments for the procedure. An R.N. who had previous experience in microsurgery in Australia selected the instruments, 20 The Canadian Nurse April 1976 . t-.. Å.. I?';:'.. ",I? . ", 'c..,'? J''::7-;;:'" L? ..ø .c; .. ,i . .. .. -:;;.. many of which were normally used in orthopedic and eye surgery. A separate table was set for the debridement of the detached arm. The surgeons also requested an electric saw and a microscope. The microscope was to be used in the initial debridement and identification of the nerves and muscles. as well as in the actual replantation procedure. Several containers of normal saline were available for the debridement. Since this was to be the first time this particular surgery was performed at Charles Camsell Hospital, the order of the procedure was not clearly defined. The two teams planned to work simultaneously on the debridement of the stump and the debridement of the detached arm. Following debridement and the pinning of the humerus, a separate table was to be set for use in repairing the laceration on the left leg. Theresa was to be placed on the cardiac monitor and the anesthetist planned to make frequent checks of her temperature, pulse and respirations. While the O.A. was being prepared, the anesthetist talked to Theresa in simple terms about the anesthetic. Surgical Procedure The surgeons began with initial debridement of the proximal stump of the left arm. This included complete and careful removal of all foreign material (mostly hay from the mower), and irrigation with large amounts of saline. The patient was then prepped and draped, and further debridement of foreign material, necrotic muscle and bone fragments was done. The biceps and triceps tendons and the median. ulnar and radial nerves were identified and tagged for further repair. The brachial artery and its two veins were also identified. Debridement of the distal stump was carried out in a similar manner on a separate table. The orthopedic surgeon then removed one inch of the distal end of the humerus so that the blood vessels could be repaired without tension; this would also ensure that an adequate length of peripheral nerve beyond the area of trauma would be available for suturing. 3 : I . Following the debridement, the patient was re-prepped and draped for the first.step in the actual replantation procedure. The stumps were first matched as closely as possible; then the humerus was united by placing two K-wires 0.062 across the fracture site. The plastic surgeons then proceeded with neurovascular repair, utilizing a recently developed neurovascular suturing technique. This method requires a skilled surgeon and, although slow, is the most reliable. The technique utilized 10-0 nylon suture, a special microvascular needle and microvascular clamps. The veins (brachial and cephalic) were repaired first to prevent blood loss from an unchanneled venous return. 4 Microvascular clamps were used so that the veins could be repaired without tension. The brachial artery was anastomosed utilizing the same technique and circulation in the extremity was reinstated 9 hours and 15 minutes after the accident. The next step was to suture the previously identified nerves. In this type of operation nerve repair can either be done during the first operation or left for a second operation. The advantages of primary nerve repair include simpler identification, no possibility of scar fixation, and prompt commencement of regeneration. 5 Particularly in a small child, the nerves are so tiny they are not readily identified, and may become locked in scar tissue if left for a second operation, To prevent infection the devitalized soft tissue was debrided, ensuring that the vascular anastomoses were covered with only healthy, viable tissue. 6 The muscles were then approximated and the skin loosely closed. As there appeared to be a tightness in the forearm, an anterior compartment decompression was done through an S-shaped incision. The dressing on the am was completed using Sofra-tulle* and a plastl slab. The elbow was maintained at approximately 90 0 flexion. While the plastic surgeons were repalrir the arm, the orthopedic surgeon repaired th laceration on the left leg. The leg was also debrided and irrigated, and the torn tendor were sutured. A short leg cast was applied Theresa's condition remained stable throughout the procedure. One hundred ar sixty ml of whole blood, plus 480 ml of LV. solution were infused through the cutdown si in the right ankle. Other medications administered during surgery included; . Decadron (Dexamethasone) 4 mg, LV . Aspirin (Acetylsalicylic Acid) supp. 10 rectally for anticoagulation . Sodium Bicarbonate 25 mg, upon opening of artery . lasix (Turosemide) 10 mg, LV. Total time in the operating theater was 7 houl and 5 minutes. Recovery Room Theresa's condition was satisfactory 0 admission to the Recovery Room. Her vita signs were checked every 10 minutes and remained stable. Her catheter was draininç amber urine. Fifteen minutes after admission There was conscious and responding. Frequent ci rculatory checks were carried out on both tt left arm and leg; circulatory return was evide in the fingers of her left hand. The dressing w dry and intact. The toes of her left leg were pé but warm to touch. Immediate Care on the Nursing Uni Theresa arrived on the pediatric unit é 0350 hours. She was awake and responsiv Circulation to her left hand and foot was goo Her blood pressure was 96/64; respiration 28; apex beat 102; and temperature 37" . St- was placed in a single room on separate technique. During the next 12 hours Theresa wa! carefully observed for any change in her condition. Hourly checks included vital sigr \ . .-,-- "'- 'Solra-Iulle IS a registered Irademark ", Roussel (Canada) LId The Canadian Nurse April 1976 21 ... /'. . h ' . .-/1.. . "' ''''7 '/J .... 4... . (/ .. ,=,, . .... " - ---- . i: å. -> 7 .V . l ake and output and circulatory return. No dation was necessary until nine hours )stop when she received Codeine lethylmorphine) 30 mg for discomfort in her 1 arm and fingers. A small amount of fresh mguineous oozing was apparent on the lessing on her left arm. The dressing was linforced. Theresa slept following the lalgesic until her parents came to visit at >00 hours. Postoperative Nursing Care A nursing history was obtained from her uents during this first visit. Theresa was the Jungest sibling, with three brothers aged 11, and 5 years. She ate well: fed herself table 'ods and particularly liked cereal. milk, juice ld tea. She occasionally had an afternoon 3-p and went to bed at 1900 - 2000 hours. Illowing a bath. She was toilet trained. Herimmunization was up-to-date and she 3-d already had both measles and chicken JX . She had no known allergies to food or ledications. At present she had a "ringworm" Inga l infection on her face. When the nursing history and other lailable information had been gathered, Jrsing staff met for a conference to decide on ... ......." " " "" a nursing care plan. Theresa's postoperative care was designed to meet the following nursing objectives: . To prevent shock (a frequent complication following such a major injury) by checking her vital signs hourly during the first postop day, then once each shift . To maintain fluid and electrolyte balance by accurate hourly measurement of her intake and output. by maintenance of I.V. sites. and by offering frequent sips of juice, milk or tea to encourage oral intake . To prevent postoperative wound infection by checking and reinforcing the dressing, by administering LV. antibiotics as ordered, and by placing Theresa on separate technique to reduce the risk of cross-Infection . To maintain adequate circulation in limbs by hourly circulatory checks and by ensuring that she received her A. S.A. as ordered (it was found that Theresa would take her pills if they were dissolved in tea) . To prevent the formation of edema in the replanted limb by keeping her arm elevated dbove the atrial level at all times and by ensuring that the dressings were not compressing her arm . To maintain the function of her left arm by positioning the arm with elbow at 90 flexion utilizing a plastic slab, and by passive flexion and extension of her fingers every hour . To assist Theresa in expressing her feelings about the accident and to reduce the trauma caused by sudden hospitalization by providing quiet one-to-one play activities, reading stories, and allowing her to watch her usual T. V. programs. She spoke openly to the nursing staff about the accident and required frequent reassurance that the doctor had "fixed her arm." Progress in Hospital Theresa's hemoglobin was 7.7 g two days following surgery_ She received 150 ml of packed cells and 60 ml of salt-free Albumin 25 percent. The Albumin was administered to maintain adequate circulation, draw fluid from the site of the injury, and prevent tissue edema.7 On her fourth postoperative day Theresa developed mild phlebitis in her right leg proximal to the cutdown site and the Intravenous had to be moved to the left leg The site of the phlebitis was then dressed. The same day she also had a brief cyanotic episode, possibly due to a mucous plug in her lung. She was placed in a croupette with oxygen for 24 hours. Aside from these complications, Theresa recovered rapidly. On her fifth day she was up in a wheelchair and was socializing with the other children in the playroom. She celebrated her third birthday in hospital with her parents ten days following the accident. The dressing on her arm was changed daily and her arm responded well to splinting and passive exercises. She returned to the O.A. for a split thickness skin graft to the incision on her left arm, and for removal of sutures in her left leg and application of a new below-knee cast. One month after admission to hospital the graft dressing and the leg cast were removed. She began walking with assistance. but experienced difficulty du to foot drop. This was assisted by a pick-up splint. Most of her time was now spent in the Physiotherapy Department where she received passive movements to all joints In her fingers and hands, When she was out of bed, her arm was " , å. 22 The Canadian Nurse Apnl 1976 @ @ kept in a sling except for short play periods to encourage active elbow movements. To strengthen her left leg she rode a tricycle. Theresa"s parents and brothers visited as often as possible. Prior to her discharge her parents were instructed regarding her care at home. They were taught to do daily passive movements of all joints in her elbow and hand, as well as daily massaging of the scar on her forearm. Theresa was to have two hour-long play sessions each day without her sling to encourage active movements of her elbow and fingers. Her parents were warned about the lack of sensation in her arm and hand, particularly to hot and cold temperatures Although there was a public health nurse in Rimbey, Theresa's parents were strongly motivated to carry out this part of the treatment on their own. An appointment was made for Theresa and her parents to return to the hospital in ten days. , Follow-Up On their first VISit, the physiotherapist and the occupational therapist found that Theresa's parents seemed to be managing well at home. She appeared to have active movement of her arm using her biceps and triceps. The skin across the front of her elbow was tight and she complained of pain In this area when her fingers were massaged. She could passively extend her fingers, but her thumb opposition and index and middle fingers were still tight. Her parents were encouraged to continue, and one week later they proudly reported that Theresa had begun to actively move her fingers. One month later, Theresa appeared to have good wrist extension and she could flex and extend her elbow actively. There was still a Fig. 1 - Example of venous anastomosis with running everted mattress stitch. In the lower vessel, two small veins have been joined to form a single large one. Reprinted with permission from illustration, JAMA, vol. 189, p. 720. Sep 7, 1964. (91964 American Medical Association. slight tightness in her index and middle fingers. Theresa continued to visit the hospital monthly. A new splint was made by the occupational therapist, and with It her fingers became more supple. All her active movements increased in range and strength She appeared to have sensation in her hand, although this was difficult to test. Eight months following the accident Theresa had active wrist flexion and extension. She could pinch using her thumb and all her fingers. On July 15. 1975, exactly one year after the accident, Theresa was using her arm functionally. Examination by the physiotherapist showed the following: . shoulder - full range of motion . elbow - extension 15', flexion 115 . forearm - pronation - full range of motion: supernation - 15' . wrist - active - extension 50: flexion 45' with no active radial or ulnar deviation . fingers - flexors tight - difficult to extend if wrist in extension . space from tip of thumb to tip of Index fingers measured 5" in right hand; 41 /2" in left hand ,. On the occasion of her follow-up visit one yea after the accident, I had the opportunity to visl with Theresa and her father while they we" waiting in the doctor's office. Although she is a quiet girl, Theresa answered my questions about her arm and was happy to show me what she could do. /J one point, I offered her a lifesaver: she took il and, using both hands, opened the packag, and helped herself to one. Theresa spoke positively of her experience in the hospital. During earlier follow-up examinations she had gone back t the ward to visit, and this time still asked aboL the other children on the ward. Theresa now has good function of her leI arm. She can lift well, and can dress hersel though she still has some problems with buttons. She plays actively outdoors except i extremely cold weather, but does protect he arm when falling or being bumped. Her fathE feels she has adjusted well to her replan tel arm and is optimistIc about the future. ,. / 1? 1? Barbara Geyer (R. N., University of Alberta Hospital School of Nursing: B. Sc., Universil of Alberta) was Pediatric /Obstetric Supervisor at the Charles Camsell Hospital i, Edmonton at the ttme of the replantation. The author wishes to thank Dr. Lobay, who performed the surgery: Jean Newman, Director of Nursing: and the nursing staff in th O. R. and on nursing station 32A at the Charle Camsell Hospital for the/f suggestions and support while writing the article. ... References 1 Eger, Mikalos.Replantation of LIpper extremities, by...et aIAm.J. Surg 128:447-50. Sep. 1974. 2 Paletta, F.X. Replantallon of an amputated extremity. Ann. Surg. 168:720-7, Od. 1968, 3 Malt, Ronald A Replantation of severed arms, by...and Charles F. McKhann.JAMA 189:10:716-22, Sep.7, 1964. 4 Ibid, p. 719. 5 Ibid., p. 720. 6 Ibid., p. 721. 7 Rowe, Marc I. The choice of intravenous fluid in shock resuscitation, by...and Abelardo Arango Pediatr Clin. N. Am 22:2:269-74, May 1975 Bibliography Balderson, S. In orthopedic surgery children nee extensive careAORN J. 19:5:1046-52, May 197. Enger, W.O. Replantation of extremities, by ...an CA Harden.J. Surg. Gynecol. Obstet. 132:901-11 May 1971. Harvey, J. Paul. Replantallon of an upper limb in 43-year old woman, by et al. Clin. Orthop. 102:167:73, Jul.- Aug. 1974 Malt, Ronald A Long-term utility of replanted a/rr by...et al. Ann. Surg. 176:334-42, Sep. 1972. Rosenkrantz, Jens G. Replantation of an infanf arm, by... et al. New Eng. J. Med. 276:609-12, Mé! 16,1967. I The Cønadiøn Nurse April 1976 23 Share your ideas, make friends and enjoy yourself in the land of seafarers, fun and informality. Beautiful Nova Scotia Annual Meeting and Convention, Canadian Nurses' Association June 20 - 23 1976, Hotel Nova Sc tian, alifax Theme: The quality of life . . .. \ , . \. . The Canødlan Nurse April 1976 24 -< President Canadian Nurses' Association , I -< ,.... Ticket of nominations , -< 1976-78 Mandate -< - -< \ -< President elect: Alice Baumgart (1 to be elected) -< Joan M. Gilchrist B.N., M.Sc., > (McGill) -< Vice-presidents: Margaret McLean (2 to be elected) Sheila O'Neill Present Position: -< Shirley Stinson > Professor and Director, School of Nursing, McGill University, Montreal. > -< Member-at-Iarge, Marguerite Bicknell Association Activities: nursing administration: Marion Jackson > CNA- president-elect (1974-76), (1 to be elected) Brenda Kelleher presently member of special committee on nursing research; Barbara Racine CAUSN - member of Council of -< > Deans and Directors. chairman of Member-at-Iarge, Lisette Arcand committee on structure; discussant, > national conference on nursing nursing education: Myrtle Crawford research, Edmonton, Alberta (1975); (1 to be elected) Helen Glass tutor, Health Care Evaiuation Seminar at Dalhousie U. (1974): Marilyn Marsh discussant, National Colloquium on Margaret Page > Nursing Research at McGill U. (1973); formerly active in ANPQ: has Joanne Scholdra published numerous articles and -< papers and given many addresses. Member-at-Iarge, Lorine Besel The role of an organized profession in nursing practice: Elizabeth Greene health care today is multifaceted. It (1 to be elected) Judith Hindle makes decisions and takes action > relevant to many spheres of Dorothy Pringle responsibility. In general, however, its Therese Schnurr concern is to provide the framework > within which desirable changes are Vera Spencer identified, innovative structures for their attainment are evolved, and Member-at-Iarge, Margaret Bentley > individuals are prepared and motivated to carry out responsive and social and economic welfare: Linda Gosselin goal-oriented actions. (1 to be elected) Anne Toupin Crucial in shaping this role In nursing as a collectivity is the articulation of one central principle upon which national policies are predicated. This principle is simply that nursing is accountable to the people of Canada and is, therefore, responsive to the human need of all Canadians for health care. -< > To achieve health services that are comprehensive in nature and It -< universal in reach, and to exploit educational structures for the preparation of new members, an ability and a willingness are needed or the part of nursing leaders to acquire rt vision and accept risk. During the past biennium, your Association has embarked upon a broad program incorporating a Jmber of activities and prOjects of >ntral concern to Canadian nurses ld nursing. These comprise, for resident Elect .,,-1U" cr.. .. ..... . Alice Jean Baumgart, B,S.N. (U. of IBritish Columbia), M.Sc. (McGill) 'Present Position: Grad:.Jate Student. Department of Behavioural Sciences, Faculty of Medicine, U. of Toronto. Associate Professor, School of Nursing, University of British Columbia. (On sabbatical leave since Sept. 1973). Association Activities: RNABC - chairman-joint committee on the expanded role of the nurse in the provision of health care (1972-73), second vice-president (1969-71); CNA - member of ad hoc committee on testing (1973-4), - chairman of committee on nursing education (1970 -72), member of CMA/CNA joint committee on the expanded role of the nurse, member of special ad hoc committee on testing service, formerly member of board of directors and executive committee, formerly member of CNA/CHA joint committee for extension course in nursing unit administration; Canadian Conference of University Schools of Nursing - president (1968-70); member of vanous committees concerned with the planning of the Health Sciences Centre (U.B.C.); author of numerous articles for The Canadian Nurse and other health-related publications and many addresses to profp.ssional groups. The continued growth of nursing associations in Canada over the next few years, indeed their very survival, requires a renewed sense of purpose and vitality. First and foremost, this calls for imaginative thinking and action to improve and defend the practice of nursing. Organizations such as CNA must be in the forefront in monitoring the quality and efficiency of nursing services. They must lead the way in promoting research on patient care. They must involve themselves in improving the methods, techniques and systems of nursing practice. They must be.!. the burden of proof that nursing is an essential public service I believe that it is also time for CNA to come to grips with how the practice of nursing can be made more satisfying or rewarding. Past approaches to dealing with the frustration, turmoil and futility felt by so many practising nurses have proven to be failures, New mechanisms are needed to capture the enth usiasm and support of our members and help them feel a professional commitment to improving the health care of Canadians. Candidates: Vice-president . ........... - Margaret D, Mclean, B.Sc.N, (U. of Western Ontario), M.A. (Columbia U.), post-master's study in administration of schools of nursing and of nursing service. Present Position: Director and professor - Memorial U. of Newfoundland School of Nursing, John's. Association Activities: CNA - 2nd vice-president (1974 - 76), (1968 - 70). chairman of committee on nursing service (1966 - 70) and member of many other committees at national and provincial levels. "I believe the profession of nursing has a great opportunity to make its optimum contribution to the well-being of individuals, families, and communities. Nurses have said they are responsive to the health needs of people. We must really be so now if nursing is to achieve its potential in the health care system. This will necessitate great changes, but the time is npe for the organized profession to respond to the heallh needs ofthe people in helpful ways, to demonstrate what excellence in expanded nursing practice can do, and to work in colleagueship with other health professionals and consumers in the promotion, retention, attainment, and restoration of hëalth and well-being." This is what I believed two years ago and it is my belief today. In the current biennium we have made a beginning in the development of standards and criteria for evaluation of practice. There is much to be done yet but we are really on the way. It is an exciting time for CNA and the provincial associations. I have accepted nomination as vice-president because I believe in people, in nurses, in nursing, and that, by working together in CNA we will achieve our optimum potential. , 1'7" Sheila O'Neill, B.N. (McGill), completing MoSco in nursing at McGill University. Present Position: Nursing Director, Medical Pavilion, Royal Victoria Hospital, Montreal Association Activities: ONQ - first vice-president (4 yrs) and member of Bureau (6 yrs), member of task forces on Bill 65, Bills 250 and 273, co-chairman of professional services committee, member of committee on quality of care; CNA- member of board of directors as non-voting observer (3 yrs), member of committee on socaal and economic welfare. When colleagues asked me to be a candidate for election to the Board of CNA, I accepted because I believe it is important to the further development of nursing in Canada that there continue to be a forum where nurses from across the country may meet to discuss mutual concerns and share ideas about where the organized profession should be going. It IS by continued strong representation at the national level that we as a group may participate in the development of governmental policies and programs that directly or indirectly influence health care systems at the provincial level. I do not believe that any organization, especially in these days of budgetary reslraint, can be all things to all people simultaneously. If I am elected,l will do my best to help articulate the needs perceived by the nursing profession, and particpate in the establishment of priorities and the search for solutions. .- "- Ó Shirley M. Stinson, B,Sc, (U. of Alberta), M,N. (U. of Minnesota), Ed. D. (Columbia U.) Present Position: Professor, School of Nursing and Division of Health Services Administration, and Graduate Program Coordinator. U. of Alberta. Edmonton. Association Activities: CNA - member-at-Iarge for nursing education (1974 - 76), chairman and then member of the special committee on nursing research (1971 - 75), member of steering committee on the development of a definition of nursing practice and developmenl of standards for nursing practice (1975); project director for the 1975 National Conference on Nursing Research; member of the Health Industry Committee of the Economic Council of Canada; has served on several committees related to health services and the expanding role of the nurse; and has given numerous addresses and consultations. National nursing organizations, like other large bureaucracies, tend to become sell-satisfied, inbred, and inflexible. In my view, one of the best antidotes if not cures for this kind of organizational disease lies in electing representatives who are attuned to the realities of nursing and the health care field, who can look at the scene critically and who can come up with practical solutions. As a CNA Vice-President, I would try, to the best of my ability, to be this kind of antidote. LÐ Candidates: Member-at-Iarge, Nursing Administration . L 1 ..., M. Marguerite Bicknell, B.N, (McGill), M,S.H.A. (U. of Alberta) Present Position: Assistant Executive Director of Nursing, Brandon General Hospital, Brandon, Man. Association Activities: MARN - chairman of legislation committee (1974 - 76), member of board of directors (1970 - 71); member of Canadian College of Health Services Executives. In the developing health care systems, the traditional emphasis on illness has been replaced by a broader focus on health promotion and maintenance. Nursing, as the largest of the health professional groups, has a crillcal role to play within the context of this new health perspective. My acceptance of this nomination for member-at-Iarge nursing administration, is based on the belief that nurse administrators, as facilitators of change, must playa key role in effecting these changes at all levels of decision making. Further, I believe that our national professional body, the Canadian Nurses' Association, assumes a prime leadership role in advancing the cause of nursing in the developing health care systems. The key is unity, therein lies the strength. For these reasons, I would consider it a privilege to serve on the Board of Directors, CNA at this crucial time. I I' . ... :to .. }. J t i ., -1 _:! r Marion RuthJackson, B.Sc.N. (U. of Saskatchewan), M.S,N. (U. of British Columbia) Present Position: Assistant Executive Director, Saskatoon City Hospital, Saskatoon, Sask. Association Activites: SRNA - Presently member of standing committee for registration and admission to membership and chairman of committee for approval of nursing education programs in Saskatchewan, past member of board of examiners (1968-71), chairman of subcommittee on publicity and information for the 1968 biennium in Saskatoon; member of Saskatchewan Association of Hospital Administrators (1975); affiliate member of Canadian College of Health Services Executives (1975); field representative for the CCHA (1974); author of many articles published in The Canadian Nurse. The approach to Nursing Administration must follow from one's basic philosophy of nursing. Furtherto this, the successful nurse administrator must depend on continual feedback from the general duty staff nurses, head nurses and nursing supervisors. These are the nurses who determine the standard of care given to the pallent. I believe the nurse administrator assists and coordinates the setting of standards of care, and should provide the optimum environment and leadership to attain high standards, but will achieve this only through free dialogue with all members of the nursing staff. In accepting this nomination, I would work diligently to encourage health care agencies to press provincial and federal governments for increased funding for nursing personnel which would provide for improved orientation and continuing education programs for the practicing nurse. It is my belief that many of our beginning nurse practitioners are placed in impossible work situations. This has been explained by some nurses as "impoverished work situation, heavy patient work load, unable to give Tne C;ana(lIan Nurse April l!l/b optimal care, frustration because they cannot give the kind of care they were taught to give." There is a gap between the beginning practitioner and the practicing nurse who is able to take the knowledge she has learned and combine it with the psycho-motor skills she has gained in order to make sound nursing judgments. I would also encourage health care agencies to recognize the nurse administrator as a vital member of the administrative team, equally as important as the Medical Director, Finance Director and such other administrative positions that may exist. - ... ..'"t ? i..,' .. ... .. ,\.1M. - "It .. .. .. ,..,.." ... Ii'........ . " t . "'. . '4t-1 ';,. ."..._, . t" Brenda Kelleher,.B.Sc.N. (U. of Windsor), M.Ed. (Adm.), (Memorial U. of Newfoundland) Present Position: Systems Analyst, Watertord Hospital, St. John's, Nfld. Association Activities: ARNN - chapter president for the past two years, I believe that the ultimate goals of nursing service include the prevention of disease where possible and/or care of the patient from the moment of sickness until cure and/or optimal rehabilitation. In order to achieve these goals,the role of nursing service administration is to ensure the provision of continlJous individualized service to the patient, both physically and psychologically. The absence of a knowledge of administration results in confusion of responsibilities, and the dispersion of authority. This leads to the wasting of resources, low morale and the defeat of expected levels of patient care. .' " }:- 7" " . "' .... .,.. Barbara Ann Racine, BoSco, M.S,H.A. (U.of Alberta) Present Position: Assistant Executive Director, Nursing Practice, Royal Columbian Hospital, New Westminster, B.C. Association Activities: CNA - member of special committee on nursing education (1973); CNF- member of selection committee (1972 - 74); Victorian Order of Nurses, member of board of directors (1973- 74); AARN - member of ad hoc committee on long range planning (1972 - 74), provincial council (1972 - 73); Chairman of north central district executive (1972 - 73); CAUSN - member of executive for Edmontor chapter of Western Region (1972 - 73); associate member of Canadian College of Health ServicE* Executives (1975); has given numerous addresses to health workers. I believe that nursing has a unique role in providing and promoting efficient and effective health care services. The challenge of nursing administration is to provide an environment in which nurses may function and to assess, plan, implement and evaluate the processes or ways in which health care could, should, and will be delivered, all the time working with thE individual nurses in developing attitudes that are conducive to high quality care. ;andidates: ember-at-Iarge, Jursing Education "'. t '.... {!', 1--- - , .... .. ";;:', .isette Arcand, M,N. U, of Montreal) ;)resent position: )irector of continuing education )rograms for nurses at the Extension )ivision and Assistant Professor at the School of Nursing Sciences, Laval Jnivers,ty, Quebec City. A.ssociation Activities: 'ONQ dunng the past five years, member of the following committees: Icommittee on research and Idevelopment on nursing, committee Ion nursing care and subcommittee of public health and home care nurses, committee on schools of nursing. I committee on continuing education I (president 1975-76), numerous ad hoc committees concerning a plan for nursing education in Quebec, reports such as Operation SCiences de Ja Santé. Le College and others; Laval University - committee on contmumg education, committee on family medicine, president of the committee responsible for admission to the Certificate in nursing (extension), president of committee on nursing program, president of multidisciplinary steering committee for the Certificate In nursing (extension), president of evaluation committee for demonstration projects in health education to the population, member of board of directors of the school of nursing sciences; federal government - member of national committee on health manpower: has published many documents and given numerous conferences. - ....... c. , Myrtle Evangeline Crawford, BoS,N. (U. of Saskatchewan), M,A. (Columbia U.) Present Position: Professor of NurSing and Assistant Dean, College of Nursing, U. of Saskatchewan, Saskatoon. Association Activities: Member - Board of Nursing Education - Saskatchewan (1973 - ): CNA - member of board of directors (1963 - 65), formerly a member of committees on nursing education. school improvement program, nursing affairs and committee to study the task force report on health services: SRNA- past-president (1965 - 67). president CNA (1963 - 65), 1st vice-presIdent (1962 - 65). I have accepted this nomination because I believe that I have a good background of experience to bnng to discussions that deal with current nursing issues. The Canadian Nurses Association as the vOIce of the largest body of nurses in Canada should be speaking out on some of these issues. My major experience and knowledge is in the field of nursing education but it is not my only concern. I am aware the education of practitioners is only relevant if it is in close touch with the realities of the service situations in which the practitioners will be working I would look forward to participating in the discussion of nursing issues at a nationalle'/el. ... \ Helen Preston Glass, R.N" (Royal Victoria Hospital. Montreal, Que.) B.S, M.A.. M.Ed., Ed.D. (Columbia U.) Present Position: Director, School of Nursing, U. of Manitoba, Winnipeg, Man. Association Activities: MARN - chairman of committee to prepare a position paper on nursing education (1974), chairman of ad hoc commIttee on nursing research, (1971). president. member of board of directors (1966 - 68), chairman of ad hoc committee on the development of nursing education in Manitoba (1963-68), formerly chairman of committee on accreditation, education. careers; CNA - member of ad hoc steering committee for the development of a definition of nursing practice and development of standards for nursing practice (1975 - ), member of special committee on nursing research (1970), member of board of directors (1966 - 68), member of subcommittee on nursing education (1964 - 66!. It IS my belief that nursing stands on the threshold of its greatest contribution to society, provided we recognize the necessity of a sound educational base for nursing. In keeping with the movement from illness and cure orientation to illness prevention and the promotion of health for all Canadians, nursing education at all levels must prepare practitioners capable of assisting Individuals and families to attain health and to prevent the depletion of a healthy state in aU circumstances. Nursing education must concern itself with setting new goals, and the means of achieving these in society. This includes enabling practitioners to develop social and political skills that will be effective in bringing about change and credibility with the public through superior service. The foundation for this IS educational strategies developed in conjunction with nursing service, and with other health and service professions. As member-at-Iarge for nursing education, I would work toward a reduction of ad hoc programs preparing a vanety of types of practitioners; concentration on the development of diploma and baccalaureate nurses: the development of graduate education; and continumg education at all levels. I would encourage the development of improved programs for teachers of nursing, giving equal attention to adequate funding for their preparation. I would strive toward process-onented curncula based upon health-nursing models, with emphasis on the process of nursing based on a solid research foundation. I would also encourage the development of educallonal standards which would ensure our accountability to the public and to the student through responsive evaluation, so that we may know how well we are serving bolh of these groups. I believe that with my background of preparation, my involvement with many committees of the Canadian Nurses Association, the Canadian Assoclallon of University Schools of Nursing. the Manitoba Association of Registered Nurses and other associations concerned with education and health care, I will be able to serve effectively, the nurses of Canada __ ?-oo. ... - - Marilyn Marsh, B.N, (Memoriat U, of Newfoundland), currently studying towards master's degree in education. Present Position: Lecturer School of Nursing, Memonal U. of Newfoundland, St. John's. Association Activities: ARNN -formerly 1st vice-president, 2nd vice-president treasurer. served on many ad hoc committees; worked on committees to prepare briefs. I.e. Miller Report, Hall Report: Memorial U. representative to ICN in Mexico. I have accepted nomination for the position of member-at-Iarge representing nursing education 211 because I feel that nursing, along with other professions is moving into a new era of rapidly expanding knowledge that places new demands on its practitioners. Consequently, professional groups are requiring their practitioners to keep their knowledge and skills up-to-date. In addition to this, nurses must be better prepared to research their field so that a data base can be secured for nursing practice. Nurses must be able to give quality nursing care in collaboration with others in the health field. Indeed, a commitment to lifelong learning is the mark of the truly professional person. Therefore, I would like to be involved in nursing education for the future. - - -- j Margaret Ruth Page, B.Sc.N., (Lakehead U.), M.P.H. (U, of North Carolina) Present Position: Associate Professor, Lakehead University, School of Nursing, Thunder Bay, Ont. Association Activities: RNAO - member of advisory committee to the president (1975), member of planning committee for conference entitled Collaboration for Change (1975), past president (1964-65); CAUSN - member of committee on constitution and bylaws (1973 - ); Ontario Council of Health- member of subcommittee on nursing education (1967 -70); College of Nurses of Ontario - member of educational advisory committee (1965 - 68); CNA - member of socio-economic committee (1965 - 66), member of board of directors (1964 - 65)_ I Nursing education is responsible for preparing practitioners who can function in a health care system buffeted by social change. Hence the Canadian Nurses Association must be attuned to the political climate, to the demands of society for well prepared nurses in a variety of nursing programs: this includes nurses with technical expertise, generalist preparation and clinical specialization. Incorporated into all the programs must be the incentive for the development of characteristics such as creative thinking, flexibility and inventiveness. To ensure the practitioner the competencies to practice and function in a collegial fashion with the other members of the health team a sound base of scientific knowledge and skills is a prerequisite. The current changes also demand that efforts be directed in intensified programs for continuing education for professional nurses, interdisciplinary learning opportunities and greater involvement with service personnel in the educational process. We must constantly be aware of the cost of education and health care and tailor our nursing program accordingly. in order not to sacrifice excellence and quality forthe learners. It is my belief that the Canadian Nurses' Association has a responsibility for stimulating new concepts and supporting research in nursing education; improving working relationships within the nursing community, externally with public and private organizations, of citizens, and of other professional practitioners who are concerned about the quality of health care for the people of Canada -T 'V' '- .. ,t''{) , " '\ Joanne Dolores Scholdra, B.S.N, (U, of SaskatcheV{an), MoN., Ph.D. (U. of Washington). Present Position: Chairman, School of Health Services, Lethbridge Community College, Lethbridge, Alta. Association Activities: AARN - member of nursing education/ nursing practice committee (1975 - 76), member of nursing research committee (1976), chairman of provincial nursing education committee (1967 - 68); The Canadian Nurse Apnl 1976 member of Alberta task force on nursing education (1975 - ); University of Alberta - member of advisory committee. department of continuing education (nursing division); (1974); University of Alberta Co-ordinating Council - member of nursing education committee (1974); member of the Alberta task force on nursing education (1975). The planning, implementation and evaluation of nursing and health care is a process which can be learned during the basic nursing program and subsequently deepened and enriched as the nursing practitioner takes part In orientation, in-service, continuing education, and graduate programs. This growth and enrichment presupposes motivation and the availability of formal and informal programs to Increase the level of competency of nurses throughout their working lives. In view of the explosion of knowledge, the complexity of man s health problems, the increased expectations of the consumer of health services, and the development of various health-care delivery systems. it becomes apparent that the future health care professional requires a broad educationarbase and an armament of fairly sophisticated skills. Recognizing the need for depth and breadth of knowledge and expertise it is my belief that baccalaureate preparation for all professional nursing practitioners must become the base and the goal to assure continued professional growth and improved nursing practice To this end the Canadian Nurses' Association and provincial nursing associations will be required to provide increasing leadership to government departments and associations responsible for post-secondary education and the setting and monitoring of educational standards in nursing_ Through the development of nursing practice and nursing education standards and the ultimate development of a national accreditation system. the CNA would promote a gradual adjustment of the system to the increased educational requirements The nursing practitioners of the future must take their place amongst health care professionals whose minimum professional preparation is at least a baccalaureate degree. Candidates: Member-at-Iarge, Nursing Practice ,-- .. \ "'- -/ Lorine Besel, B.N" (McGill) M,S. (U, of Boston) Present Position: Director of Nursing, Royal Victoria Hospital. Montreal, and Assistant Professor, McGill University, School 01 Nursing, Montreal. Association Activities: CNA member-at-Iarge for nursing practice, member of ad hoc steering committee on development of a definition of nursing practice and development of standards of nursing practice, member of ad hoc committee on standards for nursing care (1970 - 72) represented CNA on national committee of mental health professions (1972), member of ad hoc committee on standards for nursing service (1966 - 70); ONO member 01 advisory committee to board of management (1971 - ). I have agreed to be nominated for the position member-at-Iarge - nursing praclice - for the CNA Executive Committee of the Board. Nurses, as individuals and as a professional group, appear to be facing many contradictory pressures and pulls: specialization and narrowec expertise versus generalization and broad knowledge base, illness versus health focus, expanded nursing role versus restricted resources. Can we be all things to everybody? -- .... I:lizabeth E. Greene. R,N, (General iospital School of Nursing. St, oM's, Nfld.) 'resent Position: .C.U. Supervisor. General Hospital. t. John s, Nfld ssociation Activities: RNN - presently member of >ducatron committee, restructuring 'ommittee (1975), nominating ;ommittee (1975), member of council 1974 - 76); Newfoundland TB and RD Association - presently member ::Jf board of directors, past-president of lurses section (1974 - 76); INewfoundland Heart Foundation - presently member of board of directors; Canadian TB and RD Association - advisory committee, Ichairman of planning committee to set lup a one-week course in RD nursing I for Eastern Canada. II accept the nomination for member-at-Iarge, nursing practice I because I am concerned for the total care of our patients, thelrfamilies, and for the nurses giving that care. I believe thaI the nursing profession must concentrate, not only on the patterns of education, but on the changing patterns of nursing practice. As research brings about more sophisticated medical treatment. so must the practicing nurse be prepared to adapt in order to help make this highly technical type of treatment more effective and successful. I be:ieve that continued evaluation 01 ourselves, our nursing procedures and our responsibilities are essential lor better patient care. That we as nurses must work as a member of a health care team. not merely to carry out doctors orders, but assisting doctors in carrying out their own orders and treatments. -- ...' Judith Karen Hindle, B.Sc.N., B.A., (U. of Toronto) Present Position: Currently studying towards M.A at U. of Toronto. Association Activities: RNAO- active member, 50th anniversary RNAO fellowship for graduate study; the Canadian Council of Cardiovascular Nurses - Ontario provincial res presentative to the public education committee. Much discussion in recent years has centered on the effects of change in the nursing profession in this country. In many areas of nursing practice these changes have unfortunately been viewed in largely negative terms. Here. deteriorating practice conditrons, pessimism about the future of both education and practice, and expressions of Individual powerlessness and loss of control punctuate conversations among nurses at many levels. The continumg attrition from nursing practice of productive. talented and once enthusiastic colleagues who have decided to opt out. rather than continue to .. struggle with the system" seems to lurther threaten the possibility of Improving the quality of what we do. The Canadian Nurses' Association, through its provmcial representatives and members-at-Iarge, is an obvious and important vehicle for collective action. I believe its current projects. directed at the study of human resources in nursing practice, at evaluation of practice, and at research in practice. are partlcularfy important in planning for changes that will occur in nursing practice in the next several years. I also believe ItS leadership role in predicting, promoting and guiding change In nursing. generally, is more important now than at any other point in our history. " I am elected as member-at-Iarge for nursing practice I would regard it a privilege, a pleasure and a responsibility to participate in that process. '1'" .....,_,u.... ...__ """,.. '''"V -- .... ...", 'Þo - Dorothy May Pringle. B,Sc.N. (McMaster U.), M.S, (U. of Colorado) Present Position: Director. Laurentian UnIversity School of Nursing, Sudbury, Ont. Association Activities: Active member of RNAO, AARN, and Canadian Psychiatrw Association. Improving the quality of nursing care to patients and the satisfaction 01 clinical nursing to nurses should be the ultimate and mutual goals of both nursing service and nursing education. Chronically frustrated nurses cannot be expected to provide nursing care of which they can be proud, nor to act as role models fcr students to emulate. Yet clinical nursing is where the action is and where the satisfaction is for most nurses. Unfortunately, the daily demands of this action frequently preclude clinical nurses from having the time and opportunity to develop a long-range perspective on their role, and from influencing where nursing is going. Education, on the other hand, lends to have the long-term perspective but mIsses the day-to ay clinical demands and timing. This can result in education being irrelevant and unhelpful when it comes to responding to the immediate needs of the clinician but it does put educators in a position to influence trends. As the fiscal situation deteriorates, both education and service will be forced to work more efficiently and to separate essentials from luxury. Neither the clinician nor the educator can afford to operate In Isolation from the other, but the mechanism lor bringing the immediate and the long-range views together for the mutual benefIt of both is less than satisfactory in most places. Marfene Kramer has identified the damaging effect this can have on new graduates and ultrmately on nurSing as a whole. As nurSIng evolved, service and education started as one, then separated to become two quite distinct entities and now the need and the opportunity eXist to create a new relationship that is based on colleagueship. This is essential. if nurSing as we believe it should be, is to survive. Service and education must rely on each other, lend each other their partIcular strengths and accept each other's judgment in their respective areas of expertise. This will lead to energy conservation for both and can result in both providing support to the staff nurse who carnes the greatest responsibility for care. \< M. Therese Schnurr, B,Sc.N. (U. of Seattle)M.N.(U. of Washington) Present Position: Director of Nursing Services. Registered Nurses' Association of British Columbia, Vancouver. Association Activities: CNA- member of ad hoc steenng committee on development of a definition of nursing practice and development of standards for nursing practice (1975): member of resolutions committee (1970). I accept the nomination as member-at-Iarge for nursing practIce. I am concerned about nursing practice in all areas of the health system and in this position it will be possible to work together towards the achievement of the essential goal, namely, the determination of the practice of nursing for the provision of quality care to Canadians. A concerted effort at the national level is essential to meet the challenge effectively. 30 The Canadian Nurse April 1976 ;;: - ...-::;:""'" I Vera Louise Spencer, B.N. (McGill), M.P,H, (U. of Michigan) Present Position: Public Health Nursing Consultant, Department of Health, Regina, Sask. Association Activities: SRNA - committee on legislation and bylaws (1975-76), president at chapter and provincial levels (1965 - 67); CNA - member of board of directors (1965 - 67); CPHA- national and provincial executive member (1974 - 75); Canadian Cancer Society - member of board of directors, Saskatchewan division (1967 - 69) My acceptance of the nomination as a member-at-Iarge representing nursing services gave me the opportunity to re-examine my concerns and beliefs in nursing. I believe the Canadian Nurses Association has provided and should continue to provide leadership and to be concerned with the maintenance and improvement of health care services for all Canadians. In pursuit of excellence, I believe it is the responsibility of each nurse, as a professional person, to maintain competency in whatever area of nursing they practice. I support and will encourage, not only the development of Canadian standards for nursing practice, but also accreditation of services in all fields of nursing so that efficient, effective, quality nursing care will be provided. Nurses have a responsibility to challenge the present health care system and to assume leadership in the development of the philosophy of health promotion, and to promote and practice healthful living. I I In a world which can be encompassed in ninety minutes it is necessary for nursing to continue to ensure the future advancement of health care services in all the communities of the world. The involvement of the Association in the helping role at the international level in my opinion, is essential if a successful worldwide nursing profession is to become a reality. When looking to the future, plans must be based on the knowledge and understanding of both the past and present. The leadership role of the Association in the past has bee:1 demonstrated and the Association must continue to assume leadership and initiate future changes in nursing. I would consider it a privilege to become involved in the concerns and responsibilities of Canadian nurses. Candidates: Member-at-Iarge, social and economic welfare "'" _.-" ;;;. Elinor Margaret Bentley, RN (Royal Victoria Hospital), P.H.N. diploma (Dalhousie U,) Present Position: Consultant, Personnel Services, Registered Nurses' Association of Nova Scotia, Halifax. Association Activities: Consultant to and secretary of the provincial committee on social and economic welfare; secretary of N.S Health Services and Insurance Commlssion/RNANS liaison committee; member ex-officio of various RNANS ad hoc committees; formerly member of board of directors (6 yrs) and past president (1972 - 73) of Public Health Association of Nova Scotia; member of Halifax Board of Trade Industrial Relations Committee; member of executive committee of Citizens' Advisory Board, Unemployment Insurance Commission. Through education, liaison with resource persons and through briefs presented on their behalf, nurses have made great strides toward becoming a unified, decisive, recognized group of professional people. There is still a lot of work to do. It is my hope that I can offer stimulus and leadership to nurses to encourage them to become more involved in those matters of concern to themselves and to Canadians in general. "'" '4 '" "" Linda Roberta Gosselin, RN (Toronto Western Hospital), B.Sc,N. (U, of Toronto). Present Position: Employment Relations Officer, Ontario Nurses' Association, Head Office, Toronto. Association Activities: RNAO - past member and now chairman of provincial committee on social and economic welfare, member of executive committee and board of directors (1974-76); formerly president, chairman, secretary and nurse representative of negotiating committee for the N'urses' Association of the Lakehead Regional School of Nursing. I accepted the nomination for member-at-Iarge, social and economic welfare. on the CNA Board of Directors because of my firm belief that nurses have the responsibility of being involved in the determination of their social and economic welfare. The area of social and economic welfare is much broader than the examination of salar\es and fringe benefits. It encompasses as well such issues as: hazards in the work environment, non-monetary working condillons which affect the quality and quantity of the care we provide for our clients and the satisfaction we derive from the provision of this care, the availability of ongoing educational programs to enable the nurse to maintain competency, the availability of programs to assist the nurse whose personal problems threaten the ability to practice. As a profession, we must monitor and mold the Influences on our social and economic welfare so that the practice of nursing will continue to be an attractive area of endeavor, so that the practitioners of nursing will enjoy security In the employment of their skills, and so that those nurses who have been engaged in laying the foundations for tOday's nurses can look forward to retiring in comfort. " c, . \ .'" Marie-Anne Toupin, B.N.(McGill), M.S.(U. of Colorado) Present Position: Administrative Assistant - Director of Nursing, Burnaby General Hospital, Burnaby, B.C. Association Activities: AARN - governing board(1974); member of ad hoc committee to assess genetic counseling needs for Alberta (1974); council representative, associate members United Nurses of Montreal (1967 - 69); ANPQ- chairman of public relations committee for Chapter XI, English chapter (1968 - 69); RNABC- member of task committee to review position paper on roles and function of registered nurses. In this time of economic turmoil, nursing must maintain the gains it has achieved in economic and working conditions in the last few years. While working toward this, nurses and the profession must continue In the task of defining their functions as a member of the health care team. The community can only receive a high level of care if the profession continues to emphasize the necessity of adequate conditions of work and an environment conducive to efficiency and individual satisfaction. I believe that the directions and goals for the profession in relation to social and economic welfare should be set at a national level to enable all nurses within the nation to benefit. For these reasons, I am pleased to accept the nomination for member-at-Iarge for social and economic welfare. horitativ' texts for todaY's stu · INTRODUCTORY FUNDAMENTALS OF NURSING The Humanities and the Sciences in Nursing Elinor V. Fuerst, R.N., M,A,; LuVerne Wolff, R.N., M,A.; Marlene H. Weitzel, R.N., M.S,N. The application of systems the- ory to nursing care is a feature of this edition, New chapters focus on community environ- ment and the nurse's role in promoting optimum sensory stimulation. LIPPINCOTT 5th Ed. 450 Pages $10.95 Illustrated. 1974 .., !{ri" 4, ,...1)"..9 f'l'...'\.'" " . .. -....,.. .. 1 - FUNDAMENTAL SKILLS IN PATIENT CARE LuVeme Wolff Lewis, R.N., M.A. This book contains "care" content that all nurses must master. _ LIPPINCOTT $9.90 2 495 pages 1976 paper SCIENTIFIC FOUNDATIONS OF NURSING Madelyn T. Nordmark, R.N, M.S. (N.E.) and Anne W. Rohweder, R.N" M,N, oOI'. o,""I/"lngI - ....- 3 This book is expressly designed to aid the student in developing a greater understanding of the relevance of science content to effective nursing care. LIPPINCOTT 480 pages $7.50 3rd Ed., 1975 MASSACHUSETTS GENERAL HOSPITAL: Manual of Nursing Procedures By Department of Nursing, M.G.H. This book makes available to all nurses a practical, compre- hensive manual from one of the leading hospitals in the United States. LITTLE, BROWN 389 pages $8.95 Illustrated, 1975 - ë 4 - ! t s- Is. PERSPECTIVES IN HUMAN DEVELOPMENT Nursing Throughout the Life Cycle Doris Cook Sutterley, R.N., M.S.N. and Gloris Ferraro Donnelly, R.N., M.S.N. It is a superb foundation for curricula built around the human organism as an open system within an ecological and social framework. LIPPINCOTT 331 pages $8.75 Diagrams and Charts, 1973 5 COMMUNICATION IN NURSING PRACTICE Eleanor C. Hein, R.N" M.S. LITTLE, BROWN 242 pages $6.95 1973 6 PERSONAL, IMPERSONAL, AND INTERPERSONAL RELATIONS - A Guide for Nurses Genevieve Burton, R.N" Ed. D. SPRINGER $6.50 304 pages 1970 7 A GUIDE TO EFFECTIVE STUDY By Edwin A. Locke, Ph.D. Typical student motivational problems are discussed with suggested corrective mea- sures. SPRINGER $4.50 ( .".. '7 ,..ToDDMØIId tW ToDDAIIIIÞCI ::;:: ...., I'fcM' TID"'" ::.... y_ . __.. tøf':""" ....'0 , 1JIeIInOI'Y.n...... cJ Sc*'klad'- PrøgrØ": Y04l' CoIIfØ1r1SWY . =- SOC: 9toðr ttcJIITO""" , A Guide 10 ElfectIW SIIJdY 1-"''- 200 pages 1975 . -- 'R1'''' gwd9 .".n-- ",rdT"'E-:' , ,.- -""'::. _- 10"'''- HØ6'TOc:...E1IO"I HØI' øødØto 'oc:øø- --...... ....... TOO ... 8 ASIC SCIENCES BASIC PHYSIOLOGY AND ANATOMY Ellen E. Chaffee, R.N., MoN., M.Utt.; and Esther M. Greisheimer, Ph.D., M.D. Redesigned with a handsome new format, this major revision of a well established text re- tains the successful organiza- tion of earlier editions. LIPPINCOTT 530 pages Illustrated, $12.50 3rd Ed., 1974 - .... 9 LABORATORY MANUAL IN PHYSIOLOGY AND ANATOMY Ellen E. Chaffee, R.N. M,N" M.Litt.; and Esther M. Greisheimer, Ph.D., M.D. LIPPINCOTT 264 pages Illustrated, 3rd Ed, Revised 1974 $5.75 BASIC MICROBIOLOGY Wesley A. Volk, Ph.D., and Margaret F. Wheeler, M.A. Extensively revised, reorganized for greater sequen- tiallogic, and updated to include recent research findings, the Third Edition meets all of the criteria for a one-semester course. LIPPINCOTT 592 pages $14.50 Illustrated, 3rd Ed., 1973 11 LABORATORY EXERCISES IN MICROBIOLOGY Raymond B. Otero, Ph,D. Designed for use with Basic Microbiology, this manual is adaptable for use with similar one- S2mester textbooks. LIPPINCOTT $4.95 10 165 pages 1973 12 BASIC PHYSIOLOGY FOR THE HEALTH SCIENCES Ewald E. Selkurt, Ph.D. Here is a complete basic textbook covering all phy- siology from the standpoint of the allied health pro- fessions, LITTLE, BROWN 612 pages Paper $11.50 Cloth $16.50 Illustrated, 1975 13 -- 14 PHYSICS FOR THE HEALTH PROFESSIONS J. Trygve Jensen, Ed. D. LIPPINCOTT 249 pages $6,95 2nd Ed., 1976 TEXTBOOK OF MEDICAL-SURGICAL NURSING Lillian S. Brunner, R.N., M,S.,; Doris S. Suddarth, R.N., B.S.N,E., M.S.N. Outstanding in its depth of scientific content and in the practicality of its applications, this leading text has been heavily revised and updated, with much new material. LIPPINCOTT $19.75 Illustrated, 3rd Ed., 197 s 15 16 CARE OF THE ADULT PATIENT Medical-Surgical Nursing Dorothy W. Smith, R,N., Ed.D.; Carol P. Hanley Germain, R.N.. M,S. A superbly useful tool for nursing education and practice, this well established text has been mas- sively revised, updated and expanded, and provides an authoritative basis for understanding the patient's therapeutic regimen. LIPPINCOTT Paper $15.50 Cloth $19.75 Illustrated, 4th Ed., 1975 j uthoritati Ie A GUIDE TO PHYSICAL EXAMINATION By Barbara Bates, M.D. An expertly-illustrated. "how-to" text that bridges the gap between anatomy and physiology and their application to the physical examination, LIPPINCOTT 375 pages $18.75 Illustrated, 1974 17 Also available. . . PHYSICAL EXAMINATION FILMS A series of twelve sound motion pictures, correlat3d with the content of A Guide To Physical Examina- tion. (Write to the Marketing Coordinator, A/V Media for information.) 18 PHYSICAL AND APPRAISAL METHODS IN NURSING PRACTICE Josephine M. Sana, R.N., and Richard D. Judge, M.D. Eighteen contributing authors, all experts in their fields, have written a comprehensive survey on all aspects of physical examination and appraisal. LITTLE, BROWN 402 pages Paper $9.50 Cloth $14.50 Illustrated, 1975 19 NURSES' HANDBOOK OF FLUID BALANCE Norma M. Metheny, R.N., M,S.: and William D. Snively, Jr., M.D., FAC.P. The nurse's expanded role in diagnosis, treatment and evaluation of lab findings is reflected in this edition. LIPPINCOTT 325 pages $8.75 lIustrated, 2nd Ed., 1974 20 ADV ANCED NURSING AMBULATORY CARE MANUAL FOR NURSE CLINICIANS Peter T. Capell, M,D" and David B. Case, MoD, This is the first book of its kind S written specifically for nurse prac- , tioners. The student is taught to interpret signs and symptoms on the bases of history, physical ex- amination and laboratory findings, and formulate a diagnosis. LIPPINCOTT about 400 pages about $15.00 June 1976 21 CLINICAL PROTOCOLS: A GUIDE FOR NURSE PRACTITIONERS Carolyn M. Hudak, R,N., M.S., et al S Designed for portability and quick reference in the field, this manual of clinical guidelines will fit con- veniently in the pocket. LIPPINCOTT about 300 pages about $9.00 May 1976 22 . tomorro 's nurses. CRITICAL CARE NURSING Carolyn M. Hudak, R.N., M.S.: Barbara M. Gallo, R.N., M.S.; and Thelma Lohr, R.N" M.S. With 21 Contributors. Unexcelled in scope and content, and holistic in ap- proach, this text deals with the physiological/emo- tional problems of the ICU patient. LIPPINCOTT 351 pages/drawings, charts, tables . 1 : Also available. . . WORK MANUAL FOR CRITICAL CARE NURSING LIPPINCOTT 99 pages/perforated and punched $3.95 1973 ., --- CARDIOSURGICAL NURSING CARE Understanding, Concepts, and Principles for Practice Rita K. Chow, R.N" Ed.D. SPRINGER 386 pages $12.50 lIustrated,1976 THE PATIENT IN THE CORONARY CARE UNIT Hannelore Sweetwood, R.N. SPRINGER 465 pages $13.95 IIlustrated,1976 6 ----- THE PRACTICE OF EMERGENCY NURSING J. H. Cosgriff, M.D. and D. M. Anderson, R.N. LIPPINCOTT 507 pages $15.75 Illustrated. 1975 7 INTERPRETING CARDIAC ARRHYTHMIAS - A BASIC GUIDE Mary Brambilla McFarland, B.S.N., M.S,N, SPRINGER 119 pages 8 $5.25 Illustrated. 1975 DIAGNOSTIC PROCEDURES - A REFERENCE FOR HEALTH PRACTITIONERS AND A GUIDE FOR PATIENT COUNSELING Barbara Skydell, R.N.. M,S., and Anne S. Crowder, R.N.. M.A. LITTLE, BROWN $6.95 !9 - PROBLEM ORIENTED NURSING F. Ross Woolley, Ph.D.. et al SPRINGER Paper $5.25 Cloth $8.50 O s 5 248 pages Illustrated, 1975 1 ì6 pages 1974 A TERNAL CHILD HEALTH EMOTIONAL CARE OF HOSPITALIZED CHILDREN An Environmental Approach Madeline Petrillo, R.N., M,Ed" and Sirgay Sanger, M.D. Techniques of communicating with children and their parents are presented in realistic and practical terms. LIPPINCOTT Paper $6.25 Cloth $8.50 1JI!I#iI'!J.liI' ? --- 259 pages Illustrated. 1972 1 þ NURSING CARE OF THE GROWING FAMILY: A MATERNAL NEWBORN TEXT S . Adele Pillitteri, B.S.N.. M,S., P.N.A. A basic comprehensive textbook of maternal and neonatal nursing designed for the student. LITTLE. BROWN about 700 pages about $16.00 May, 1976 NURSING CARE OF CHILDREN - 9th Edition Eugenia H. Waechter, R.N., Ph.D, S and F. Howell Wright, M.D. A new edition of the text that is without peer as a comprehensive, in depth study of pediatric nurs- ing. LIPPINCOTT about $16.75 about 700 pages May, 1976 MATERNITY NURSING - 13th Edition Sharon R. Reeder, R.N.. Ph.D., Luigi Mastroianni, M.D.: Leonide L. Martin, R.N.. M.S.. and EHse Fitzpatrick, R.N., M.S. Recent changes in the field of S maternity nursing have been start- . ling, The new edition reflects both these advances in knowledge and changes in family life styles, re- sulting in a truly family-centered te xt. LIPPINCOTT about 650 pages about $16.00 April. 1976 34 MATERNAL CHILD NURSING Violet Broadribb. R.N., M.S.; and Charlotte Corliss, R.N., M.Ed. A family-centered text, designed for combined maternal-child nursing courses. covering the entire maternity experience, and the child from birth to adolescence. LIPPINCOTT 702 pages $12.50 1973 FOUNDATIONS OF PEDIATRIC NURSING Violet Broadribb, R.N.. M.S, The text has been broadened and enriched to reflect nursing concepts stemming from recent findings in child psychology. and advances in pediatric medi- cine and surgery. LIPPINCOTT 500 pages Paper $8.95 Cloth $9.95 Illustrated 2nd Ed.. 1973 MENTAL HEAL T" BASIC PSYCHIATRIC CONCEPTS IN NURSING Joan J. Kyes, R.N.. M.S,N.; and Charles K. Holling, M.D. This revised edition focuses on the dynamics of the nurse's role and function, and facilitates student pro- gress from the theoretical to the operational level. LIPPINCOTT 600 pages $9.75 3rd Ed., 1974 32 33 35 36 37 Instructors are invited to write to our educational consultant NANCY C. CASHIN, R.N., M.Sc., concerning their requirements. 38 THE PRACTICE OF MENTAL HEALTH NURSING A Community Approach Arthur James Morgan, M,D. LIPPINCOTT 211 pages Pap er $5.95 1973 - NURSING OF FAMILIES IN CRISIS Joanne E. Hall, R.N., M.S., and Barbara R, Weaver, R.N., M.S. LIPPINCOTT 250 pages $6.95 197 4 THE NURSE AND HER PROBLEM PATIENTS Gertrud Bertrand Ujhely, R.N., Ph.D. SPRINGER 192 pages $5.50 Sixt h Printing, 1972 MENTAL HEALTH AND MENTAL ILLNESS- 2nd Ed. Mabyl K. Johnstone, R.N., B.S., M.S.Ed.. and Arthur James Morgan, M.D. S Emphasis throughout is on the kind of supportive nursing care required by patients suffering from mental and emotional dis- orders. 39 40 LIPPINCOTT about 350 pages 41 about $8.00 May. 1976 HUMAN DEVELOPMENT AND BEHAVIOR Psychology in Nursing Bernard D. Starr, Ph.D. and Harris S. Goldstein, Md., D.Med.Sc. This book delineates the major psychological concepts as they relate to the life cycle of indivi- duals in periods of health as well as illness. 436 pages 1975 S SPRINGER 42 $10.50 PHARMACOLOGY CLINICAL PHARMACOLOGY IN NURSING Morton J. Rodman, B.S., Ph.D. and Dorothy W. Smith, R.N., M.A" Ed.D. This entirely new text by the authors of Pharma- cology and Drug Therapy in Nursing offers quick, easy access to information needed for expert patient care. Essential scientific material is clearly, con- cisely presented. LIPPINCOTT 701 pages 43 $11.75 1974 included: NURSES' GUIDE TO CANADIAN DRUG LEGISLATION David R. Kennedy, Ph. D. This pamphlet outlines the history and application of the Food and Drugs Act and Regulations of Canada and the Narcotic Control Act and Regulations of Canada. LIPPINCOTT PHARMACOLOGY AND DRUG THERAPY IN NURSING Morton J. Rodman, B.S., Ph.D. and Dorothy W. Smith, R.N., M,A" Ed.D. LIPPINCOTT 738 pages $11.50 IIIustrate d,1968 - INTRODUCTORY CLINICAL PHARMACOLOGY Jeanne C. Scherer, R.N., M.S. LIPPINCOTT 367 pages $8.75 1975 44 45 PROGRAMMED MATHEMATICS OF DRUGS AND SOLUTIONS Mabel E. Weaver, R.N., M.S. 109 pages LIPPINCOTT Paperbound, $2.75 1966 Printing with Revisions 4E ARITHMETIC FOR NURSES Marilyn Ferster (Gilbert), M.A. SPRINGER $5.50 128 pages 2nd Ed., 1973 47 DIET THERAPY NUTRITION IN HEALTH AND DISEASE - 16th Edition Helen S. Mitchell, Ph.D., Sc,D., et al LIPPINCOTT about $12.00 NUTRITION IN NURSING Linnea Anderson, M.P.H.; Marjorie V. Dibble, R.D., M.S.; Helen S. Mitchell, Ph.D., Sc.D.; and Henderika J. Rynbergen, M.S. A compact text that provides the essentials of nor- mal nutrition and patient-centered clinical nutrition, withol1t extensive coverage of biochemistry research data, or food preparation. LIPPINCOTT $9.75 S about 700 pages May, 1976 41 406 pages Tables and Charts, 1972 4! J. B. Lippincott Company of Canada Lid: Please send me the book(s) I have circled 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 Name Address City Provo Postal Code Position D Payment enclosed, postage and handling paid o Charge and bill me D Use my Chargex D Use my Master Charge LIPPINCOTT'S NO-RISK GUARANTEE: Books are shipped to you ON APPROVAL; if you are not entirely satisfied you may return them within 15 days for full credit. J. B. LIPPINCOTT COMPANY OF CANADA LIMITED Serving the Health Professions in Canada Since 1897 75 HORNER AVE. TORONTO, ONTARIO M8Z 4X7 (4166) 252-5277 Tha CanadIan Nwse April 1976 35 Canadian Nurses' Association Annual Meeting and Biennial Convention Program Highlights ,tf . :;. , ' - .....r-, -;,i -l -J, J , -I . _J . t "... . "" :. ,-._ -- ""fl' ... -- -J 'to, ., - , ,'-- , .t i'_ - I I,.. J .>. .. i r It! J I.)!}' 'J . I - -. .... - , --:. 1 ry ' ,.;.-- .. - .' .íf-: . _... ... " . ).... _ .c,., . " 1.t" "'- . ..x.....,. ,} . . ...:" -..... ---.- - - 20 Sunday, June 20 1 2 :00 hours 14 :00 hours 19:45 hours 20;00 hours Registration Canadian Nurses' Foundation - Annual Meeting invocation - Sister Barbara Muldoon Opening Ceremony - Chairman - Huguette Labelle President CNA Minister of Health of Nova Scotia Mayor of Halifax - Edmund Morris Mayor of Dartmouth - Irene Stubbs Executive Director CNA Representatives - ICN, PAHO/WHO, ANA 21 :00 hours 22:00 hours Welcome - Registered Nurses' Association of Nova Scotia Guest Speaker - W.O. Mitchell Reception - RNANS Welcome to Nova Scotia Punch Party Place: Date: Theme: Hotel Nova Scotian June 20-23, 1976 The Quality of Life 36 The Canadian Nurse April 1976 " " .....i f,) 1\,. _.J , ì . . 'I .j, t' '( - :\, t L ..,.,... .,..." , -<<'?<'J'r. '" , j; .:- .'.. " .'1 -7 "1 . "". J "'Il . ",--- f4 --::"?:f", . ... . ;j: t f': i. \ "'. . 21 22 , "; .'1',.., r '",-:ft- 'J-._ t'-.); .\. ).>. " r .1' ':;. \ . ::.1..\. 4 :-4,.... - : '.' ... ... : J ... ,. . , ,X II:"'__ a-; ", .",,- , . .\ _'..r :tÅ '( "} . '": 't; >.[, ..... " 'Ì1'4: .\ - ._ . "-tt-'\: L 5 . -._ . , :Áot. ..,.. ... .-'-: .. _ _ it ",..- \ , .; . '- c. .. '" ( . '- ," , " " .,. r l - ':"'\:J . 'j . . \,\ S.,. , -...... '" Monday, June 21 08;00 hours 08:30 hours 08:45 hours 09;00 hours 14;00 hours 15;30 hours Registration Report of the Committee on Nominations Nominations from the floor (delegates) Report of the Arrangements Committee - RNANS Keynote Speaker - Ralph Nader Following the address there will be an open forum discussion with the speaker, - Debate "Resolved that nurses have a responsibility to take a stand to preserve life in the event of any decision by a patient. a family, or a professional to discontinue life-maintaining Intervention." Chairman; Apolline Robichaud Participants: At press time confirmation had not yet been received regarding participants Interview by Patrick Watson Subject: The impact of the nursing profession on the quality of life. Interviewees: Cathlyn Macaulay, Head Nurse, Palliative Care Unit, Royal Victoria Hospital, Montreal. Pamela Poole, Chief, Information and Evaluation Division, Research Program Directorate, Federal Government. Shirley Post, Health Care Consultant. Irene Desjarlais, Nurse-in-charge, Medical Services Health Centre, Fort Qu'Appelle Evening Recreation: Tour of Peggy's Cove or Water Tour of Halifax Harbour or Lobster Dinner and Ceilidh Tuesday, June 22 08:00 hours 09:00 hours Registration Opening Address Address, Huguette Labelle, President CNA Roll Call Reports; Executive Director Special Committees: Testing Service Treasurer's report Nursing Research Auditor's report Appointment of Auditor Mortgage burning ceremony Official admission of the NWTRNA Evening Recreation: Tour of Peggy's Cove or Water Tour of Halifax Harbour or Lobster Dinner and Ceilidh _...J- L. 23 Photos: Nova ScotIa Commun,cabons & In'ormabon Centre "" I ! \ """ 1'1 :.Þ. "'1rW,, ... .j--- .. '-. " .:, ç ,:.I -J' .... J.' .... , t :- . ) I 1-- 1 -I 1 , ... I . ,. L-f'" .. ....... ' .. ... ;;.10" ..... -..-, . Wednesday, June 23 08:00 hours 09:00 hours 11 :00 hours 14 :00 hours 16;30 hours 19;30 hours RegIstration First Session: The quality of life in the work world of the nurse Chairman;Jeannine Tellier-Cormier, President ofthe Order of Nurses of Quebec Specific Topics: a) The incompatibility between educational preparation and the practice setting -Ginette Rodger - Director of Nursing. Notre Dame Hospital, Montreal b) not yet confirmed c) The enforced proximity to stressors in the client en vi ronment - Mary Vachon - Mental Health Consultant, Clarke Institute of Psychiatry, Toronto. d) The social and economic pressures in the work environment of the nurse -Anne Gribben - Chief Executive Officer of the Ontario Nurses' Association Second Session; You and the quality of life - action for today This session will feature an artistic representation of the theme Report of the Resolutions Committee Report ofthe scrutineers Installation of Officers President's Reception All events held in the Hotel Nova Scotian Commonwealth Room unless otherwise indicated Coffee served daily from 10:30 hours to 11 :00 hours Lunch Recess at 12:00 hours daily Exhibits open at 09:00 hours daily from Monday, June 21 to Wednesday, June 23 at 13:00 hours ;<11 Tne LanaOlan Nurse Apr11 1976 Canadian Nurses' Association Balance sheet December 31, 1975 Assets Current assets Cash in bank Short term deposits plus accrued interest Accounts receivable Membership fees receivable Prepaid expenses 1975 1974 $ 148 , 119 $ 97,132 5 36,357 712,593 58,824 51,280 12 , 220 10,852 11 , 519 10 , 292 767,039 _ 882,14 Sund lY.Ê sse t Marketable securities - at cost (quoted value $12,868; 1974 $9,957) Loans to member nurses plus accrued interest 4,065 11 , 289 15,354 3,779 9 , 088 12 , 867 FIxed assets - note 1 C.N.A. House -land and building - at cost less accumulated depreciation on building Furniture and fixtures - at nominal value 488 , 066 1 488,067 $1,270,460 519,932 1 519,933 $1 , 414 , 949 Liabilities and surplus Current liabilities Accounts payable and accrued liabilities Defe rr ed revenue - subscriptions - other MOr1qaqe payable within one year $ 39 , 146 $ 20,863 21 , 900 27,500 306 324 , 534 20 , 235 385 , 886 68 , 598 Mortgage payable - 6 3 /4% due 1976 - payable in monthly instalments of $3,548 to include principal and interest (less portion payable within one year) Gra n ts for special projects - unexpended portion - note 2 Reserve for support to the Northwest Territories Registered Nurses Association - note 3 Sur plus 324 534 31,493 11 , 000 842 , 081 $1,270,460 15,000 1 . 006 . 817 $1 , 414 , 949 Approved on behalf of the Board: Mme Huguette Labelle, President Dr. Helen K. Mussallem, Executive Director ':;anadian Nurses' Association resting service '3tatement of income (ear ended December 31, 1975 I , Revenue , - --- Examination fees Interest earned _IIÇ' ""_:U'GUIIIII nUI:!M:::r ""..nn I ID 3" Canadian Nurses' Association Notes to financial statements December 31, 1975 1975 1974 $ 401,534 4 , 153 405,687 303,703 5,691 09,394 , Expenditures: : Sal aries and benefits Board and committee meetings Item writing Operating (data processing, printing, warehousing) Consultants Rent Trans lation Office supplies and stationery Postage and express Telephone and telegraph Travel - non-committee Equipment, maintenance and rental Books and periodicals Furniture and fixtures Miscellaneous Leasehold improvements Moving expenses Insurance 176 , 493 142 , 656 39,878 37,834 23,457 19,123 77,740 70 , 326 5 , 239 28,570 7,869 5,478 705 8,726 4,765 3,612 2,472 4 , 046 2,737 2,496 1 , 628 884 866 562 467 10,417 7 , 700 3,737 994 22,338 787 483 559 414 , 943 300,701 $ ( 9,256 ) $ 8,693 Surplus (Deficit) for year Ve have examined the balance sheet of Canadian Nurses' Association IS at December 31, 1975 and the statements of income and surplus for he year then ended. Our examination included a general review of the Iccounting procedures and such tests of accounting records and other ,upporting evidence as we considered necessary in the circumstances. 11 our opinion these financial statements presp.nt fairly the financial IOsition of the Association as at December 31, 1975 and the results of s operations for the year then ended, in accordance with generally Iccepted accounting principles applied on a basis consistent with that If the preceding year. Jeo. A. Welch & Company, ;hartered Accountants January 29, 1976 1_ Fixed assets It is the policy of the Association to expense purchases of furniture and fixtures in the year of purchase. The C.N.A. House is being depreciated over 20 years at the rate of 5% per annum. 2. Grants for special projects During the year Health and Welfare Canada and the Canadian International Development Agency advanced funds to the Association in respect of grants for special projects. The unexpended portion of these grants at December 31, 1975 totalled $31,493. 3. Special reserve In 1974 a special reserve of $15,000 was established for support to the Northwest Territories Registered Nurses Association. In 1975 a payment of $4,000 was made to the Association leaving a balance of $11,000 at December 31,1975. 4. Retirement income plan During the year changes were made to the Association's retirement plan resulting in additional benefits for past service. Actuaries have estimated that an annual amount of $38,500 for 15 years will be required to fund the past service benefits. 40 The CanadIan Nurse April 1976 Canadian Nurses' Association Statement of income and surplus Year ended December 31, 1975 Revenue ---- Membersh i p fees SUQscriptions Adv e rtising Sund ry income 1975 $ 9 55,238 38,922 339,604 7,196 1,340,960 1974 $ 888 , 904 40,820 299,264 8 , 127 1,237,115 Expenditures Operating expenses Salaries Printing a n.QJ:>.u blic ations Design and graphics P ostage on journal Computer service Committee travel Translati on services COl-rll'russion on advertising sales Affiliation fees - I.C .N. - Ca nadian Council on Hospital Accreditation Professional services Travel - non-committee Office expenses Books and periodicals al and aud it Building services Sun d ry Furniture and fixtures - - - Landscaping an Q irr1Q rovements Qgpreci ation - C.N.A. House Insurance Ge nEH 1 meeti ng Continqency for special proiects 759,924 245,436 14,399 118 , 773 44,894 36,272 33,546 65,707 5,000 14,121 22,347 36,614 10,238 5,2 00 88,398 13,725 2,954 189 31 , 867 6,295 1,661 303 1,557,863 NOrH>Peratm:q -e xpense s: 1974 convention Canadian Nurses' Foundatio n - aaministration 568,306 222,4 7,943 113,175 25,658 23,176 2,319 20,663 47,130 5, 000 9 , 725 12,061 35, 387 6 , 645 8,747 70,256 5,320 602 948 31 , 867 367 1,217 , 717 1,557,863 18,869 1,954 20,823 1,238,540 Surplus (Deficit) for year bef oreltems below Ç.i'J. A. Te st.i!:!9..Se rvice - perstatement Investment income ( 216,903 ) ( 9,256 ) 61 ,4 23 Surplus (De f icit) for y ear Sur p lus at be q innin g of y ear (164,736) 1 , 006 , 817 842,081 (1,425) 8,693 66,475 73,743 948,074 1,021,817 Les s reserve for Northwest Ternrories Reqistered Nurses Ãssociation Surplus at end of year $ 842,081 15 , 000 $ 1 , 006,817 The Canadia" Nur. April 1976 41 Resolutions of the Board of Directors to the 1976 Annual Meeting and Convention Changes in By-law 1, BE IT ENACTED as a By-law of Canadian Nurses' Association - Association des infirmières canadiennes (herein called "Association") that: I) The Association be and is hereby authorized to make application to the Minister of Consumer and Corporate Affairs for supplementary letters patent amending the letters patent incorporating the Association by changing the name from "Canadian Nurses' Association - Association des infirmières canadiennes" to "Canadian Nurses Association - Association des infirmières et infirmiers du Canada" and amending paragraph D from: "The membership of the Corporation shall consist of the tell (10) provincial associations: The Alberta Association of Registered Nurses, Registered Nurses' Association of British Columbia, The Manitoba Association of Registered Nurses. Association of Registered Nurses of Newfoundland, The Registered Nurses' Association of Nova Scotia, The New Brunswick Association of Registered Nurses, Registered Nurses' Association of Ontario, the Association of Nurses of the Province of Quebec, The Association of Nurses of Prince Edward Island, and the Saskatchewan Registered Nurses' Association, or their respective successors and assigns, and such other classes of members as the Corporation may establish by by-law from time to time:' to: "The membership of the Corporation shall consist of eleven (11) association members; Registered Nurses Association of British Columbia, Alberta Association of Registered Nurses, Saskatchewan Registered Nurses Association, Manitoba Association of Registered Nurses, Registered Nurses' Association of Ontario, Order of Nurses of Québec, The New Brunswick Association of Registered Nurses, Registered Nurses' Association of Nova Scotia, The Association of Nurses of Prince Edward Island, Association of Registered Nurses of Newfoundland, and Northwest Terntories Registered Nurses' Association, or their respective successors and assigns, and such other classes of members as the Corporation may establish by by-law from time to time." b) The directors and officers be and are hereby authorized and directed to do, sign and execute all things, deeds and documents necessary or desirable for the due carrying out of the foregoing, including effecting necessary editorial changes in the Association by-law. 2 Section B(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 (originally submitted by MARN) 3 Section 16 Powers and Functions: It shall be the responsibility ofthe board and the board shall have the authority (a) to establish the policy of the Association; (b) to revise the policy in the light of changing beliefs; (c) to appoint the executive director and delegate responsibility and authority for Implementation of Association policies to this position: (d) to ensure that Association policies are implemented satisfactorily; (e) to report fully to the Association at each annual meeting upon the business transacted since the last annual meeting; (f) to honour those who have made an outstanding contribution to nursing: (g) to make decisions and to take all such appropriate action as is necessary to further the objects of the Association 4. Section 25 Composition: There shall be a committee of nominations of three members elected at an annual meeting of the Association; one of whom shall be named chairman by the board. 5. Section 47(a) A special committee may be established by the board at any time for a short or long term and may be dissolved by resolution of the board of directors. The appointment by the board shall set forth in reasonable detail the subject matter for study by the committee, its composition and such other terms as the board deems fit. (b) an ad hoc committee may be established by the board for a specific purpose on precise terms of reference which shall provide that the committee shall cease to function upon completion ofthe specific task; the composition and other terms of reference of the committee shall be set forth in the board's appointment. (c) there shall be a standing committee, known as the Testing Service Committee, constituted by the board of directors. B. Others 1. THAT members of CNA be urged to initiate and conduct projects that will advance the discipline of nursing, (originally submitted by MARN) 2 THAT all CNA members be urged to support the CNF so that it can carry out its mandate, namely, (a) to provide bursaries, scholarships and fellowships to persons enrolled in educational institutions for the purpose of obtaining a baccalaureate degree in nursing and to nurses enrolling in masters or doctoral degree programs; (b) to provide grants in aid of or to undertake research in nursing science which may help to advance the knowledge and art of members of the nursing profession with a view to providing the best possible nursing care and attention: (c) to solicit, acquire, accept or receive gifts, donations, bequests or subscriptions of money, or other real or personal property, whether they be unconditional or subject to special conditions, provided any special conditions are not inconsistent with the above objects. (originally submitted by MARN) 3, THAT the CNA pursue with legal counsel the feasibility of trying to bring tobacco under the Food and Drug Act. (originally submitted by MARN) 4, Whereas nurses are concerned about the Quality of life; and Whereas nurses attempt to enhance the quality of life by their actions; therefore be it resolved: THAT CNA take action to have removed from the market such items that are detrimental to health: and further be it resolved THAT nurses bring such items to the attention of CNA for action (originally submitted by RNAO) 5, The RNAO supports CNA in its efforts to provide statistical data The CanadIan Nurse Apnl 1976 42 Resolutions related to registered nurses in Canada and recommends that every effort be made to: (a) maintain tables in a consistent manner so that their usefulness is maximized and trends can be monitored over time; (b) ensure a publication date that allows data to be available when it is still relevant to planning for the profession; (c) engage in a review of CNA's publication "C?un!down" it a view to publishing current statistical information In that onglnal format. (originally submitted by RNAO) 6. Whereas it is unlikely that educational programs established by each province to prepare nurse-midwives would be viable, RNAO recommends that CNA, in conjunction with provincial nurses' associations, develop a position statement regarding a realistic distribution of educational programs for nurse-midwives in Canada. (originally submitted by RNAO) 7 Whereas the Board of Directors has already allocated resources to the development of nursing practice standards in response to a resolution passed at the 1974 annual meeting and convention and, in view of the increasing need for national guidelines; be it resolved THAT the necessary resources continue to be allocated to ensure that the project on national standards for nursing practice be completed; and be it further resolved THAT this project be a priority in this biennium. 8 Whereas nurses are in a unique clinical role to maximize effectiveness and minimize side effects of pharmacotherapy: be it resolved THAT CNA seek funds to hold one or more symposia on the subject of pharmacotherapy to raise the level of awareness of nurses to their responsibility in this aspect of practice. 9. Whereas the Board of Directors has already allocated resources to the development of nursing education stan ards in response to a resolution passed at the 1974 annual meeting and convention, and in view of the increasing need for national guidelines; be it resolved THAT the necessary resources continue to be allocated to ensure that the project on national standards for nursing education be completed: and be it further resolved THAT this project be a priority in this biennium. 10 Whereas the CNA Health Promotion Program for Nurses was mounted in response to a resolution passed in 1974; and Whereas member associations have unanimously supported the Program; be it resolved THAT CNA seek funds to conduct a program in multi-risk health counselling for nurses in this biennium. 11. THAT CNA develop a policy statement on Consumers' Rights in Health Care, using the Consumers' Association of Canada document Consumer Rights in Health Care as a beginning point for discussion. OFFICIAL NOTICE Annual and Special General Meeting of the Canadian Nurses' Foundation In accordance with By-law Section 36, notice IS given of an annual and special general meeting to be held Sunday, 20 June 1976, commencing 1400 hours at the Nova Scotian Hotel. Halifax, Nova Scotia. The purpose of the meeting is to receive and consider the income and expenditure account, balance sheet, and annual reports. The election of the CNF Board of Directors for the 1976-78 term of office will be conducted during the meeting. Members will be asked to consider a by-law of the Board of Directors concerning acceptance of a bilingual name for the Foundation and a related change in By-law Section 1. All members of the Canadian Nurses' Foundation are eligible to attend and participate in the annual and special general meeting. - Helen K. Mussallem, Secretary-Treasurer, Canadian Nurses' Foundation \ \ 10V (,0 , 1\ ""' 01'5 'GS' tot J b '(O l:' \\e .313 l c. Suit Cord Jersey Top stripe Jersey skirt 50 Polyester. 40% Nylon Ite only S3S: 4 to 20 Sjgested retail: $27.98 I l, -- .' , '-- -G '" I -(; -(; -0 \ \ \ H.J. 309 2 Pc. Suit Warp knit Lacost Jersey with rib combination 90% Polyester, 10% Nylon White only Sizes: 3 to 15 Suggested retail: $34.98 H.J. 300 2 Pc. Suit Warp knit Lacost Jersey with rib combination 90% Polyester, 10% Nylon White only Sizes: 3 to 15 Suggested retail: $35.98 Manufactured by HAMPTON MFG. (1966) LTD. 125 Elmire St., Montreal ILABLE AT YOUR FAVOURITE STORE . fees? . d for an increase In . Q HoW o,g.nl is ,h'S n.. _so e"'''s cas" . IN 01'. "s ".<'1 0'9 00 ' "" I>'J "'. 00' 01 "'. ,.oJ. ,...",.s ",,, "" osod o ,ci' 01 ."","","''''.,' f. ci09 "" 0""","09' ,cO"ûo"'09 '0'1>"0 0 '<'1 b'. $A2 4 .(jYJ ",IS ,ear. "" "ea"" e"''' "',,, "" 0 0 ' ",...",05 '0 sob"""o"". s '0 "'. ",,\""0'" o",SO ... . Ò tesef'\ set'i ICe . \0 ptO"1 e? \ òòi\iOf'a\ \if'af'c l f'9' t from ",."",., ",,moo · d s tho indiV"o", no's. 9. Q. What ser.lIces De se reach her? - eNA .nd hOW do tho "". "", ",""'9''''. . ". eN" "",WloS bO'" '''': . _, ",s"". p'od"" " se""coS '0 .. ",.",b.'s., '0"""" ",""'''''' '" "'. "'. i"",n"" soo"'''''1''; iDo,n'" _""""o ' ,....;., ,""9""". 0' """",e. . '" """"IS "", _,o\OOos "","' e tS un_\O-òa\e 'oNI . . e "f'a òa ' 'oNI\n f'e'oN {'('e" ,u .... o\esSIOf' If' 0.., ' 'oN ""eel "'. 0",s"'9 '" 1" ,". .".,,,,,,,,1'1 0 o. 0"","'9 ,""'0""":' '" '0 eN" "b"'<'1 ...d """, 0",s\ll9 ",....",. \0,-' """"""o",oS. p"",IS".'" _ ",,," .",p ""'". . 0 ,act\CaI ;d.'s. ""d SO 0 ,". ,,,,,,,<'I s.""coS. 0 p Q\ cD>',SO. ",e,e oJe ., ""'s "",e """ 0."0 0 '''' 0,,'0"'"' '0' 'os,,,,,ce. "". Gao. d '? "0' e"''' 'J c09 f'iZ eò f'utSif'9 \IDtat'J .If' ."'tou 9 n if'\8t\iDtat'J te \ne set'i ICes ,I' {'('e{'('De t caf' u e eN!>. \,,\ou se . . \Oaf'. òite c \ {'('a l \ 0 \ ' . o.û""", s,,,,,sû eS _ce"':' e"''' alSO c" "" ","., ",,,, dO. ",".,1\'" '" '"S _ ",".'. ,"e, "",Õ<,. '''' 0".0'. ,0" "",,,". o ".,01 """caI\Oo 'so '"'S 's \0 P,oÒ,ct ",.,ds. \0' ':;'_SO s"ûs\\CS ar. , ;: "","e' .".,,,"""'. e)l.a{'('p\e, {'('OD \I\'J '. f' 9 af'Ò sa\a ties . d'S"''''''''''' '" 'os",,,''',,'' ròo< '0 .ssoSs "'" ,"., 1". '0""'9'_ ar. '" fO< ,os,,,,,ce. e"''' ."eeI "'. 0"''" '0 . d"",,.;: ;(;, o"'s,,'" proleSS"'o . a sttOf'9 \/Olce spea SIf' ? f'a\iOf'a\\'J' t h ' S dO for the indi\lidual nurs\ \ net Q. Wh el dOeS' . .,"''''.,s "",are ". The '0'\"''''"' o",SO ' s . ,001'1'1 """""s. "'. ,e s "'" ",oI oS """" ,ole ,od f"'" '" ",OII""'Og po"'s.s ,"., oIoeeò"" "0<1 ' ",as .ccort'pllS"oÒ I>'J 0",s"'9 as' pro'''''''o. ,ro 09 "0''''' "o,ce. "0 o",SOs s""....'09 0'" \II · s 01 ,0rÌ\"'''''''s """ s",,"" . ,,"'d"'" 0' . s",." 9'''''P "" ",,,.. ".". · s.""9 :'" b"" '0 0,'0< \0 "" ",...;')."", """"",,,go 01 "'. Ot9 a f'iZ a \ iO f' teptesef' If' """"'. cOoco<""". ",.0 ""s.10 """",,ce "", ßu\ eN!>. òo eS ote to\esSIOf', eNt>:s s.""9""'0 ,"e 0",s"9 o, act,,,,û oS 'oc,"". s"" ,0'oSs"",,,, .d"""- ,."e'oI"""'" 01 n"""" "",,'09 ",oieelS as """û"". 0",s"'9 "' s,,,,,,,'d s ,0< o,,'s'o "'. o",SO '0 ",e o>'J ,oSea"'"' "",ari "", cD>',SO. ,"e"" .,. b' c . alSO ,". "',,'s,"" ",,'0' o\\iC e set'iiCes.1nete I 44 I The Canadian N urse April 1976 .. -... coo"etS3t\OO ",,\th the e eC\1t\"e d\tect01 ee if'9 e{'('p\O'J{'('ef'\ '0' (;aI"'''''' o",s.s s , ,". "",,,,,s\OO pt09ta essiOf'a\ \/isi\S aDtO ' e to{'('o\iOf' 0< "'....,09 ",0. \J" ","'0''''''-''" P Id gO CO","" '" ",,,_9 0 . fO"""'\Oo -c\>. ,cO" \n e eaf'aÒiaf' Nu tS8S o . h n hOw can of' af'Ò of' . ' . ..moneY QuestiOn t e., ? Q r 0 got b.ck '0 th.. noC' its set",c 05 . CNA'S Iin.nd", SIO" O \':, sa\d ""''''.' e"''' ,aces !>. \f'a'oNotò,drastlcaI 4 IY. oo o òe\ici\ \0 catt'J Of'I\S . . \e\" a $42 . ., \n e sl\Ua\IOf' .91"0,""" :' IN'''' "s'09 ces.s. " . 0011> . pro9'aro s th's ,ea" "e IS 'ocreas"" s" or' """ ",O's"'" ,,"'.ss ''ê'";'.v.n oe co",e fro"" Q. Whore does CNA s .",,,,,,,,,,'0 ,ee s , ", . ",os' 01 " oo"'.s "'" '" ,$8."" "'" ",.",,,... '" ,.... eN!>. tecel\/es aDDU ptesef'\. t {'('Of'\n. .? abD'" 7' c"",s "" nt 'e. ...ebh-"od. , 0 Q "",en was thO pro"" 0 'ocrea"" \II ''''' pas' '0' gfß. Th.,e"as ""OO, . ces' 01 .""<'1"',,,9 "as '" '0'. as ,0" ,,,,,,,,. b."."e "'. oJ. ",.0 0 " '"sot' '",p;d". s,oc., " "'" ".. 0 0 ' "ad .0 \atg e assoCla\IOf' eats. If'ctease if' \n e \a d s \ n to recommend a fee Q. Isn't the Boar 9 incro es . in Jon.' b '" "."e ,od rIeÓ '0 , ;,, ; ;; ,, b ,, ';:oo, ee , $'5.0<> "0" base '01 ,9 td prod""" .".",go ""o,, o \o",,"I>"""'b ;:'$'0.0<>'0;9" "" ':;"'01 ,..s p.' ",.'" . ..,,,, 001 ">1'<,,," ",e pros. . '\918 E.\/ef' \n ls ,- If' . . ht fold? 'ò,"?; :.. 8M pcØ : .:. :; '09:% " Q\> ,,,,o,,1d ""pe . ",,01<"'9 0 ",SO '" "" \'Id Bot \ """.". "'" "'" Id "'."" "'" '0 "."e · o. \ ' ,\\" a\ 'oNn a \ 1\ 'oN OU \/et'J cate ...J . \iOf' d' 0'_" o"",oS as \ "'. indiVidoel cene ,." Q HOW would thiS a . . _ petnaps. tS nt . """ "", \0 al'S",."":, '::;"oI.SS""''' . , oo"",n oS "'".ro. ",s ".<'1 ",ea' '0 """'s". ssoci""'" 0' " 'W. 's "" 'me ",ortd ""'.,. f'U tse "",af'" couf'\t\es I,. _ af\ò \nete ate ",J \n is si\Ua\iOf' e s ffect nurses? {\ \n e Q. HoW does are "0"",.'0 o>. resu\t, I"U l"ursil"9 :I. e,ecauS able to . {'(\9 ro \le Ò ' 60' S , alsO, sla\ subl eC tiC, it \'J as òi9 10 {'(\a I \1" tn e C Ol"tW\le r I"Ò el"e r 9 \ uate tne Ò '1"9I'J \lel"t a to e\la: el"te il"cre al"cia\\'ý s ....i\ot 9ro\e?t \'Jell-ÒOC lle òri\le to s \'Jas I l"atiOI"a: Y illere IS arneaòe. al s'ýste{'(\ \aul"c ll a l"ursl,:9' tuò'ý sg e òucatlOI" scnoolS 0 tn at tillS s S il"tO tn e . e 01". as a e\liòel" \o{'(\a scn o\s still 9 0' l"i9 0 , tn ere l"trOÒUce {'(\o\le 19 I"tf'/. in ls \ 'ýe ars e ò - to " baSeò 0\ tn e cOu a{'(\9\e'. p.. estfoI"9\'ý ba s assistal"t'all"st tn e t>. tll irÒ e"f... t _ ra tner .. 9 1l 'ýsiC la ,: {'(\ stal"Ò a9 a\tn \iel ò {'(\o\le{'(\el" al tn \ie\Ò a Nt>. too\<. a \If il"tO tile n I"O tll at il"to tn e n {'(\oòel: C e\'J \'Jor\<.e r el" assure al"ò tile ol"tne\.\ 1" 0\ tillS II" \Nell \I b \lal"ta e aòersni9' il"tWÒ UC success\u e ....ub\IC s a ò eò \On\S e th ingS? In ò \'J as to t\. Y {'(\el" h ese al" \01" as el" cO{'(\ doing t small tlliS a C . I tiOI" n as b t without me just a p..ssocla CNA e)(ls NA be co ca{'(\e a could ould C \ CNt>. be Q. wordS, c uestiOI". I s\i\\ be a 01" other tariat? Ò i\\erel"t <\ . ,\Ò il"Ò eeò 'ò òeg e l"ò ecre \:s a e \'J o '-' OU\ sp... \Nell, tllaetar\at, :n er u t sef\li es I"Ò nu{'(\al" ò 101"9 s{'(\a\\ seCl' ssoÖatl?1" b e \il"al"cla e Stfu99\ 0\essiO': I"atiol"a\ at 0\ a\lal\ I" I"urses Il tn eir 0\'J1" 9 òol" tn elr tn e ey-tel" cal"a Òla {'(\al"ag e t to abal" resourc r tll ri9 ou\Ò al" al"ò Ila r ot \ntl"\<. al"ò \ d ositiOI'" 9 rese l" . what retanat, mall sec me a s s{'(\a\\ B ut if it did bbe acritic \ t>. b ca :\I:\.it \'JOu\Ò Q ve to ol"e. il"l{'(\a: r otn er . would a Òi\\iCU 1"9 at a \lef'/ \ ourl"a\s, .I" e<\ulreò II" t>.,ln a . t 0gera I l ò be 1"0 \'Jnat IS I"l"ua\ tana , \'JOu tnal". al" a se cre ",at tn ere \.tt\e{'(\ore no\ò l 1"9 NO {'(\eal" \sef\lices I"Ò e,'ý-Ia ' 0\ Oirectors 9 ' ey-ce9t currel" s patel". a e,oa r _ I"otnll" t"'e Letter Ò e\ectl1"9 ....ro\e ctS . f uture U' . 9 a l" ru I"OY Id1ts {'(\eetll" 1"0 \ibr " "iOl"s. hat w ou \ourl"a\s o{'(\{'(\ul"l a ser\lice, w 0(\i1"9' \i{'(\ite Ò he Testing . se l \-su?9 ther Q. And t '1" sef\lice I yoV thl K osom e ? be .' e l\ tile le S \ o l t;er tacK' a D r e alsO dOl d n ele\lance. t>. ". ' K an . nS . an . et's ta e socia tlO . \lalidltY al"ò Q. L 'onal as b vt their I.terature Itll'}. t>.\\ pro arching 9a\r {'(\ curre\ tnis is :::ò iC SO " e s \uÒ911" Ò \ be\ie\le "" , ect to 9 t, o cllal"ge \ . t>. 'al" e SU'-' aò'ý \ l"e\'J a , . {'(\el"\S, nOu\Ò b IÒ be re se\\-re . \n e cO{'(\ ociati.ss ol"cerl" re I" ISsueS r I" sOCla\ t>.. f\i9" . l"atiOl"a\ c e a stal"d {'(\eti{'(\es 0 tn e . iSSUe:s o. \t {'(\'!st t altll .al"ò s sg ea \<.il"9 \ r\'ý \'Jllel" 1t l"u rs' 1"9 l"urSll"9' sibillW 0\ . 9 a (\IC u . eY-t(8{'(\el'ý I"urses, -r"'e re s 9 0 1" 0\ l"u rs' 1"9, iSSUes,ls t b e ÒOl"e s \ \ I . SSIOI" ÒS 01" \\ {'(\u s isSue ' eÒ 9 ro \e b\iCS\al". a\iOl"s. òe<\u ate . or9 a l'" to ta\<.il"9 9u al"'ý i{'(\9 1 \C \e\e al"ò a I"SiÒeratlO co{'(\e S Ò na s {'(\ ':l.n co{'(\9 s al"ò cO 01"1'1 II" . ous al" e - I arel"es Ò ta\<.el". sel" y-ce\\eI"C ïn \ul l a tile s\al" ct al"ò tn \'Jitn e rcn, al" \'J\icatiOl"s.O 9 ai l" re s 9 ò e as e<\ua\ \'JI (8se a ture \{'(\9 eSSIOI" s\al" . 0\ tn e \u i\\ tne 9 rO tn e ri9 n \ to . about. It tniS a l"ce al"ò ear o\esSiO \ been talKln;iII ha\le a acce9t 91"1z.e ò 9 ha\le JUs legates otner r c of what w he v ting de I"sibili\'J' Q. In \lIe t in June, sl 'bilitY. "al"\ resÇ>Ü Id ing the sth a , P on . {'(\9 0 \ \ hO seem dO us res \re{'(\eI'J I they are tre'6;, 'ýeS. p..1" se: far as to but \Ilis ol"e t>., we gO ir ha n . doeS, Q. can f CNA In the a\ {'(\ee tl 1"9 I\le this future 0 f;.\lef'/ al"l"u bers will SO p... '(es. fe SO. I that me ? \Ie \a Ceò \l eI" {'(\O h O p efu I .......ee tlng . "'erS na \ <{'(\eò. e Y Ou nua I" {'(\e{'(\'-' as 0' . Q Are t the an CNp.. . a tiOI" \'J ' \I e \\"I\s . 1 m a . \" a{'(\' soc i 'n sOt p rob e ertall"',. tile p..s ille'ý \'JI t>. \ {'(\ost c \ {'(\S sll"ce Ò tne{'(\' al"'ý 9r \\'Ja'ýs so\\l e In e 'ý Ila toO Ol"e, 46 The CanadIan Nurse April 1976 Faith Warren I lay stretched out in a bed that was whiter than white, my nose in perfect alignment with the counterpane crease. All my working life, I'd either been at the top, sides, or bottom of the bed, and now I wasm it! The wristband showed my name and hospital number. Metal railings on either side of me reminded me that I had to stay in bed. But I wasn't at all comfortable. A nice cup of tea was what I wanted more than anything else in the world. Hot tea, in a china cup, with a little cream and sugar added. Maybe if I called someone, I'd get it. I tugged at the string beside my bed, and, momentarily, a bright light blinded me. My body had left the bed. I was in orbit but my soul stayed behind on that hard hospital bed. ell> 0' v ç 'l> connC!ction . .. Maybe this was what dying was all about? Suddenly I realized my new dentures were left behind in a stainless steel cup on my locker. I pulled at the cord once more, and the bright light went off. So I was back in my bed again, but my thirst remained. Had I made it into Heaven, maybe I would now be drinking crystal clear water from an everlasting fountain. I tried the other cord. A man in white stood at the side of my bed. He had long, golden hair with a beard to match, but no wings that I could see. "I'm thirsty," I said, "Couldn't I please have a cup of tea?" Sadly, he shook his head, and began to walk away. "Young man," I called,"surely, as a doctor you know I'm here to be cared for;' He now looked even sadder. "Lady" he said, "I'm no doctor, I'm the maintenance man checking the plugs." Well, better luck next time. A girl In pink came in and began wiping the top of my locker. "Would you raise my bed so as I can have a drink?" I asked. "Sorry, I'm not allowed to touch your bed. I'm in the building services department, and we have our union rules. " But she wasn't building, she was cleaning... "Then you must be a sort of housekeeper," I ventured. She put her hands on her hips and glared at me. "Indeed," she said, "I have my duties, but we aren't called housekeepers any more." So I tried the bell again, and a figure in a blue pantsuit came through the door. "Are you a nurse?" I asked hopefully. "Yes, I'm a grad." she answered. This was confusing. I expected every nurse to wear a cap and white uniform. "Times change!" she said and proceeded to lower one of my bed rails to sit on my bed. Before I could ask for a cup of tea, a backrub, my dentures in, or my hair combed, she had launched into the story of her life. She had worked shifts to put her husband through medical school. Now he had his degree, and she wanted to be a doctor, but he wanted her to be the mother of his child. "Does he think I'm just a baby machine?" she asked. She wiped her eyes with one of my tissues. "I'm a person!" she said, bouncing off my bed, and leaving me more thirsty than ever. Now that the railing was down, I could get out of bed and find the kitchen. But no sooner had my feet touched the floor than several figures rushed at me. I was hustled back into bed, and the railing imprisoned me again. With my tongue cleaving to the roof of my mouth, shouted weakly: "Alii want is a cup of tea!" What was the use? But I would try agair maybe this time I would get some help. A face appeared. It said, "You are to have an intravenous, nothing by mouth, so please be Quiet!" I demanded to see the head nurse. "She's at coffee," was the reply. She could have her coffee, and I couldn't have my tea A man in a clergyman's collar stood at the foot of my bed. "I'm the hospital chaplain am I'd like to pray for you." He opened his boo and recited from it. His visit had given me hope Maybe God would send one of his angel! to mimster to me. Surely this wasn't too much to expect? Weren't sparrows counted and lilie! of the field painted? How often had I comforted patients with the assurance that "God cares.' What was the advice our supervisor usee to give to new patients? Going back throug the years, I heard her voice. "Keep your bed tidy, Keep your bowels open, Trust in the Lord, And you will soon get home." Or did she put "Trust in the Lord first?" Closin my eyes, I tried to remember. I was a little girl again. With my best friend Mary Ellen, we had gone to a Gospel meetinç in a tent in the big field near the bend in the river. We had clapped our hands and sung about "Living Water." I opened my eyes and, surprisingly, felt much better ,even without that cup of tea. M hand fell heavy, and I couldn't raise it. Had had a stroke? Please God, NO! Someone touched my heavy hand. She wore a white uniform and a cap, and her shiny hospital pil winked at me. She said. ''I'm back from coff61 and have started an intravenous. This will make you much more comfortable." Then sh' smiled at me with such warmth that a wonderful feeling of relaxation flowed from m head to my toes. I smiled back, and tried to get my nose ir perfect alignment with the center fold of the counterpane. I was at peace with the world The head nurse had had her coffee, and I wasn't nearly as thirsty. Soon I'd be able to g. home and get that cup of tea. "Try to take. little nap," said the lady in white, touching m forehead. I closed my eyes and tried to think 0 myself as a sparrow sleeping in a bed of Iii' petals. God cares! I slept. <# The Canadian Nurse Apnl 1976 4 . IlcÞ()J'H Understanding Psychiatric Nursing by David Towell. Royal College of Nursing. Unlled Kingdom, 1975. Reviewed by Anne Sauchuk, Teacher, Psychiatric Nursing, St Clair College, Windsor. Ontario. This book is based on sociologist owell s PhD thesis in WhiCh he ,ought to examine what the \Jsychiatric nurse s work involved. 'Vhal understandings gUided the work Ilnd what student nurses learn from heir experience on the wards during heir training During his four-year study 1967-1971) he mixed with staff at all evels. he was a partiCipant observer vl1h a new class of students both in he class and on the wards, he onducted periOdic questionnaires :md activity studies: used staff nofes and Informal interviews: and he 1 3Uended nursing "handover meetings" and observed nurse-patient and staff interactions. His study included a two-month observation penod of the function of Jumor nurses in an admission and geriatric unit as well as in a therapeutic community which was being reorganized. The age of the study. the domestic activities involved and the apprenticeship system of training Bntlsh nurses prevent a direct translation of Towell's results to the Canadian situation. But the very human responses of the nurses caugh1 in the pressure play between Ireatment ideologies. centralized admims1rative directives. nursing hierarchy and the medical model of Institutional structure are also Canadian problems. Shortage of staff, the lack of acceptance of people labelled as personality disorders the dehumanization of genatric patients and the frustration and search for role identification in the therapeutic community are prevalent in Canadian hospitals as well. Towell s quotations of wntten reports and verbal interactions as well as his excerpts from observed interactions allows the reader a sympathetic. but objective view of the variety of functions ideologies, attitudes. prejudices and pressures to conform of the psychiatric nurse. The problems presented are not new but the book is based on good solid research and Towell s sociological analysIs clanfles problem areas so that nurses have the I.J I) '-;l'-JJ lTJ)(I.l t___ Publications recently received 10 the Canadian Nurses Association Library are available on loan - with the exception of items marked R - to CNA members, schools of nursing and other insti1utions. Items marked R Include reference and archive matenal that does not go out on loan. Theses, also R are on Reserve and go out on Interlibrary Loan only Requests for loans. maximum 3 at a time, should be made on a standard Interlibrary Loan fOrm or by letter giving author. title and Item number in this list. If you wish 10 purchase a book. contact your local bookstore or the pubhsher. BOOKS AND DOCUMENTS 1. Aladjem, Silvio ed. Risks in the practice of modern obstetrics 2ed. St. LOUIS, Mosby. 1975. 425p. 2. Anderson. Carl Leonard. Community health 2ed. St. Louis, Mosby. c1973. 389p. 3. Arnopoulos, Sheila. Regard sur nous-mémes: cinq portraits de femmes canadiennes, par.. . et al. Ot1awa. Information Canada, 1975. 231p. 4. --. To see ourselves: five views on Canadian women, by. . et al. Ot1awa, Information Canada, 1975. 225p. opportunity of formulating their own solutions. This book should be sludied and discussed by all psychlatnc nurses teachers and administrators The Human Heart: A Guide to Heart Disease 3ed by Brendan Phibbs. St Louis, The C.V. Mosby Company 1975. 272 pages. Reviewed by Candace Paris, Instructor, Niagara College of Applied Arts and Technology, The Mack Centre of Nursing Education, St. Catharines, Ontario. The author has wntten this book for patients with heart disease. His belief that "to the heart patient, accurate knowledge often means life."' promoted him to write a book in clear easy-to-understand terms. This up-dated third edition achieves this goal The first six chapters make it possible for the 'Iay person to understand the basic anatomy and physiology of the cardiovascular system These chapters are SUCCinct and amply illustrated with simple but accurate diagrams. All patients for 5. BaIley, Rosemary E. Obstetric and gynaecologicalnursing. 2ed. London, Baillière Tindal, c1975. 343p. 6. Books in pont 1975: and author-title series Index to the publishers trade lIst annual. New York, Bowker, c1975. 2p1s. in 4. 7. Boyd, Edmond. Health services in Cuba Washington, Pan American Health Organization, 1973. Iv. 8. Brown, Marie Scott. Ambulatory pediatrics for nurses, by. . and Mary Alexander Murphy. New York, McGraw-Hili, c1975. 468p. 9. Bullmer, Kenneth. The art of empathy: a manual for Improving accuracy of interpersonal perception New York, Human SCiences Press, c1975.140p. 10. Canadian Council on Hospital Accreditation. Guide to the accreditatIon of CanadIan mental health services Toronto, 1975. 59p. whom this book IS recommended must read and understand these chapters before continuing to learn about their particular cardiac problem All aspects of cardiac disease are then adequately outlined and illustrated in individual chapters Some of Ihese are Rheumatic Fever, Infectious Heart Disease, Hypertensive Heart Disease, Congenital Heart Malformations Cardiac Arrhythmias Pregnancy and Heart Disease, and Heart Surgery An excellent chapter on 'What To Do About a Heart Attack' IS also included. It not only descnbes the manifestations, but clearly outlines the emergency' on-the-scene treatment. This book is a valuable reference for medical personnel to recommend to cardiac patients Thepnceofthebook at$7.90 is not excessive. The pnnt IS large and easily read. and the complete Index makes locating specific areas of interest a simple matter. Medical personnel ought 10 familiarize themselves with this book as it can be an important aid in planning health teaching for the cardiac patient by focusing on the important facts and stating them in terms which the anxIous patient can understand. 11. Canadian National Operating Room Nurses Convention. 3rd, Montreal, May 3.1974. Proceedings. Montreal, 1974. 1v. 12. Chapman, Jane E. BehavIor and health care. a humanistic helpmg process. by. , . and Harry H. Chapman. St. Louis, Mosby, c1975 193p. 13. Commonwealth Nurses Federation. Educating nurses for community health servIces Report of all-Afncan seminar held in Mensah-Sarbah Hall University of Ghana Legon, Jan. 2-9th 1974 Prepared by M.A Brayton. London, 1974. 65p. 14. Conference des Nations Unies au sUJet des é1abhssements humains, Vancouver, 1976. Information au sUlet d'Habitat pour les ONQ. Ot1awa, Le Groupe de participation des ONQ canadiens, 1975 1 v. J - Uniforms. technical medical and general purpose hospital coats. designed for actIon-comfort as you work Seams are firmly sewn Fastenersstayon Fabncs wash or dry clean for professIonal wear .. þ: , ",. , "T.. rC" i ,/ r ./ ."... " STYLE 814 I.c r;.cl..;. c CAREER ClASSICS \ "-.. STYLE 810 STYLE 814 PantSUIt Polyester Textured Warp Knit WhIte Blue Yellow - Ice Mint Sizes 6 to 18 To retail $2800 STYLE 81 OA Polyester Corded Warp Knit White Sleeves Sizes 6 to 20 To retail $26 00 STYLE 810SS PolYf>ster Corded Warp Knit White Short Sleeve Sizes 6 to 20 To r ." / I , STYLE 888 \ STYLE 916 PantSuit Polyester Ribbed Double Knit White Sizes 8 to 16 To retail $3800 STYLE 888 Polyester Textured Warp Knit Lace Tnm White. Pink Yello Sizes 8 to 20 To retail $22 00 ff J' unifolml Icgi/leled 178 King St W Tor t Ontarlfl M5' A 1 GENEROUS NEW GROUP OISCOUNTS on all t ms shown, for group purchases. graduation gifts. favors. etc 6-11 Same Items, Deduct 10%; 12-24 Same Items, Deduct 15% 25 or More Same Items, Deduct 20% G Mte , iN'll .-------------------------------------. I IT'S EASY TO ORDER REEVES NAME PINS FOR YOURSELF OR FRIENDS! I I Choose styte you want. shown nlht Pflnt Nmt (and 2nd ttom ng"" Art"". eElr. she-tl Jut JttOfLJl pins I I ;;"": f :.ts::, . I:tt "=t lo:ndC'::c t :( :. : v::. ':. lounltAl PIMS.. .erl cOlrlenltat. I SlnI 110 IÆTAL toLOil I LETTERING,______________________ 2nd LlNE._______________ I METAl. IACK"OUND LlT1UIII& PIlUS FINISH :) COLDA úrr......1 L. EIpIØ 2 '-' _stlIPTlDN All MET At _ _ Smootn rounoecl oD""'_ Ooe$ o Black o ] Pin 2A9 o 1 Pin 3..25 æ )rT1f:ß. C Polished. Salin or o Gold o Polished "'" oDk Blue new Ouotone comb.nln. satin DSIM!!r o SoItln 0",,1y o White 02 Pn1S o 2 P,ns ".9 I back&round will"! pOhshed ed.-s I ...mt . PLASTIC LAMINATE...sl'mme.. I Does I Does OW"". i Black 0 I Pm US DIP,n 1.85 . broader, engraved thru surtac.e to not no! o G "l Ok Blue )f1tmt.nl' con color. ar..,.,1ed UOrMr miltches Iettef'lna- opoly opoly o Slue White 0 2 PinS 1.95 o 2 Pins 2.90 o Cocoa l.etter5only c , (-"'rwneJ ID METAL fRAMED.. Cla..,c o Gold POIIsheCI >WI,.. o Black DIPln 24g o I Pin 3_25 . . t"Sfg1!. snow- Ite pla$hc with os....., "ome only DOk Blue 0 ?Pln4i. 399 o 2 PinS 4.95 nooth. polished beveted frame '" r lID MOLDED PLASTIC. Simpl..s","", Does Does >WI,.. o BlaCk o lPln 1.25 o 1 Prn 1.85 . onQmlul Win never dl olor no! not only o Ok Blue 0 2 Pms 1.95 02Plns290 'nOOth rounded comers .nd ed.-s. opp/y -Iy Iwme J ,............ I' Finest Forged Steel. Guaranteed 2 yean. I ... . LISTER BANDAGE SCISSORS 3 '" .....,dull'. Tiny, hand1. slip into uniform pocket or pune Choose lewelen go:d or llearn.... chrome plate fißlsh <...Si! No. 3500 3'1," Mini. . '. . ". 2.75 No. 4500 4""" size, Chrome only, , . 2.95 No. 5500 5 11 2'" size, Chrome only. . . 3.25 No. 702 7Y.... size, Chrome onl)' . ..3.75 For enanved initials add 5Ot- per instrument 5Y2" DPERATING SCISSDRS .... Polished Stainless C:::teel, str.aulht blides. - No. 705 Sharp 'Blunt peints.,. 2.95 ,....... No. 706 Sharpl Sharp points. . . 2.95 No. 710 4"2" IRIS Scis.. Strailltl. . . 3.75 For enaraved initills add 5Ot- per instrument 3 1 1::1'" "'1 . 5""" 1'1..'" KEllY FDRCEPS So hin> Canada 89. Dept. of Industry, Trade and Commerce. The commercial printing industry in Canada. A statistical and economic analysis. Prepared by Stevenson, Kellogg Ltd. in association with CGGL, Conseillers en Gestion Inc. for the Department. Ottawa, 1974. 4v, in 1. 90. Government Specifications Board. Glossary of editorial terms in general use in the graphic arts. Ottawa, 1973. 20p. 91. Health and Welfare Canada. Distribution of dental manpower in underserviced areas in Canada: a survey by province 1974, By T.L Marsh. Ottawa, 1974. 13p. (Health manpower report no. 1-75) 92. --. Family planning: a resource manual for nurses. Ottawa, 1975. 1v. 93. Health and Welfare Canada. Non-medical Use of Drugs Directorate. Research on drug abuse. RODA Ottawa, Health and Welfare Canada, 1975? 1v. 94. Labour Canada. Women's Bureau. Women in the labour force: facts and figures. Ottawa, Information Canada, 1975. 315p. 95. Santé et Bien-être social Canada. Planification familia/e. Un manuel d'information pour les infirmières. Ottawa, 1975. 1v. 96. --. Répartition de la main-d'oeuvre dentalre dans les réglons défavoflsées du Canada: une enquete par province, 1974. Par T.L Marsh. Ottawa, 1974. 13p. (Rapport sur la main-{foeuvre sanitaire no. 1-75) 97. --. Comite spécial pour Conseiller la DGPS Relativement à Tous les Aspects de I'InnocUité et de I' Efficaclté des Contraceptifs Oraux Vend us au Canada. Deuxieme rapport. Ottawa, Information Canada, 1975. 47p. (Bulletin Rx vol. 6, supp. 1, 1975) 98. Santé et Bien-être social Canada. Direction de I'usage non médical des drogues. Recherche sur /'abus des drogues: PRAD. Ottawa, Santé et Bien-être social Canada, 1975? 1 v. 99. Travail Canada. Bureau de la main-d'oeuvre féminine. Les femmes dans la population active: faits et données. Ottawa, Information Canada, 1975. 317p. Ontario 100. Intermlnisterial Committee on National Standards and Specifications (Metric Committee) Education Subcommittee. Metric practice guide. Toronto, Ontario Interministerial Committee on National Standards and Speafications, 1975. 66p. 101. Law Reform CommisSion. A woman's name: a study. Toronto, 1975. 33p. (1 leaf tipped in front) Quebec 102. Régie de I'assurance-maladie. Rapport 1974-1975. Québec, 1975. 1v. United States 103. Dept. of Health, Education, and Welfare. Public Health Service. The challenge of cancer nursing. Bethesda, Md., National Institutes of Health, 1975? 28p. (U.S. DHEW Publication no. (NIH) 76-760) 104. Dept. of Health, Education and Welfare. Public Health Service. Teenage smoking: national patterns of cigarette smoking, ages 12 through 18, in 1972 and 1974 Washington, 197? 1v. (U.S. I;>HEW Pub. No. (NIH) 76-931) 105. Division of Nursing. The decimal role in baccalaureate & higher degree of nursing. Health manpower reference. Bethesda, Md., 1975. 59p. (U.S. DHEW Pub. no. (HRA) 75-11) 106. --. Source book: nursing personnel. Health manpower references. Bethesda, Md.. 1974. 239p. (U.S. DHEW Pub. no. (HRA) 75-43) STUDIES OEPOSITED IN CNA REPOSITORY COLLECTION 107. Bajnok, Irmajean. A comparison of the quality of care provided by registered nurses working the twelve-hour shift and those working the eight-hour shift in a large general hospital, London, 1975. 2pts. in 1. SPECIAL OFFER 18 DAYS INCLUDING AIRFARE & MOST MEALS **************************** . uxeEastfirican . if - ii' * * , 9 !? 1 ni ,' ÿ . : November 6, 1976. Nove_ 23, 1976 " . . . ,. 111{ MONTREAL. PARIS. NAIROBI. TREETOPS. ; I J -\ * T SAMBURU. LAKE NAKURU . MASAI MAR A . Alllnllu i\'I.' - '/. " 111{ SERENGETI. NGORONGORO. ARUSHA. Prill' From l\Iontrt'al I * T 2DAYSPARIS.MONTREAL 500 00(MinRa'ii'i) AIR FRANCE * . Mllet Konya Ministry 01 Health OIIicoals $.1 . . - . Luxur) Hotel! Il ' 111{ and !he Konya Nursing Association - 1\ IIIIIß1Um 6 I\>r.ons reqUired. Auomodal1011. * T Visit Rur. Hospitals at Nv!tri and Nairobi In, ludil Airlart' and alll11('""ls l'Xlt'pt in p...ris. @ * 111{ and Tanz..ia Ministry 01 Heolth OIf,aals T at Arusha Hospital. Individual _ings ..,1 .. Uk... A1 R CANADA * . Brochure ..ailable Irom: --. 111{ -- african "--I - -- 33 Bloor St..... East, Sui. 206, Toronto, 0..*'0 M4W 3H1 " f'j; * T - U ,, ....u Tel.: (4161967-0067 Cable: SAFARIS. T.x: 06-231127 I '.,.. ' ***************************** I (Thesis (M.Sc.N.) - Western Ontano.) R 108. Black, Stella H. An investigat'l of the approach to early detection breast cancer. Vancouver, Registered Nurses' Association of British Columbia, 1975. 12p. R 109. Fleury, Michel. Consideration /'évaluation en technique infirmier( au niveau CEGEP. Montréal, 1974 32p. (Thèse (M.A.) - Montréal.) F 110. Harman, Ron. Nursing servic, information system project. Final report. Edmonton, Misericordia Hospital. 1974. 1v. (various paginç R 111. Holder, Elizabeth L. Noise in intensive care unit, its sources ani annoyance to patients. Toronto, c1974. 70p. (Thesis (M.Sc.N.) - Toronto.) R 112. Ingenito, Françoise. MemOlre la pénurie d'infirmières presenté par. . et Suzanne Rollin-Lepage I patronné par I'Université du Quebl direction des études Universitaires dans I'Ouest québecois. Hull, P.Q Conseil de la Santé et des ServiCE sociaux de I'Outaouais, 1975. 150p. 113. Jenkinson, Vivien M. Thenursi standards project to establish tools measurement of the quantity and quality of nursing care at the Hospi, for Sick Children, Toronto. Report the Ministry of Health in the province Ontano. Prepared by . . . and Edwir Weinslein, Toronto, Hospital for Si Children, 1975. 77p. R 114. Lewis, Geneva. An investigat, into the health care needs of the elderly in senior citizen apartment by . . . Margery Boyce and Pauline Chartrand. Ottawa. Ottawa-Carletc Regional Health Unit, 1975. 72p. f 115. Proulx, Pierre-Paul. The labo. market for nursing personnel in Canada with special reference to shortages and partIcipation by registered nurses, by. . et al. Montréal, Centre de recherches e développement économique, 197 1v. (various pagings) R 116. Rakoczy, Mary. The thought and feelings of patients In the waiti period prior to cardiac surgery: a descriptive study Montreal, 1975 56p. (Thesis (M.Sc. (App.)) - Mc( R 117 Richard, Jeanne-Aimée. Perception de la performance de, infirmieres diplomees de C.E.G.EI Montréal, 1973. 169p. R I ne Lanao.an NurSe Apnl 111110 Nursing Instructors Required Beginning May - June 1976 For Two Year Independent Diploma Program in Nursing Enrollment - 270 students Openings anticipated in Fundamentals of Nursing Psychiatric Nursing Qualifications: Baccalaureate Degree with at least one year's nursing experience. Courses in education desirable. Contact: Anne D. Thorne Saint John School of Nursing Beaverbrook House Coburg Street Saint John, New Brunswick Phone No. (506) 658-2203 .. Northern openings for health professionals '\ Medical Services, Northwest Territories Region, is offering a number of permanent positions for qual- ified health professionals interested in serving at nursing stations, public health centre and hospitals throughout the north. Enquiries are invited from qualified applicants pos- sessing any of the following: Certificate or Diplo- ma in Public Health Nursing; B.Se.N.; or Advanced Obstetrics (midwifery). Interested? Please fill out the attached coupon and mail to: Personnel Administrator. Medical Services, North- west T erntories Region. Health and Welfare Canada, 14th Floor, Baker Centre, IOlJ25 - 106 Street. Edmonton, Alberta. T5J 1 H2 or call collect Area Code 403 - 425.6787 , -S ..._ , . (J" '- 'l( .... ......."':::: I. Health and Welfare Canada Santr el Blen-elre social Canada ---------------------------------------------- I .. NAME ADDRESS CITY "-- PROVINCE POSTAL CODE PHONE .... At Last... --f, Y" a ; .'; n supplier fex nurses needs No IIbouf CwIomI- Noduly tolØY. "I1:H E\ ER\ ORDER. f R f f "hitr viDyl POCKET SA \ ER lor ÐS. sd!thOr!i o e-tc. ('ht'C1f. box OD C:OUþOD. STETHOSCOPES :-'l R..t:<; .. TETHOS('OPES... 5 colov.n. ExceptrmtallOJlM tronsmis.ion. adj1Utabk Iig"l1æ.g"t bma..ra!I: replacement parr. m-'OIIßbú in Canada. 1/1,14 Siltier. 1U15 Gold. 1/.90 BIJU. ".92 Green, 1/.9. Red 19.00 e.-b. [ftClwe. ìmtiala engra:ved free. III AL Hf' AD STt:THOSC;OI'L. oJ. mpl.j!e. all freqlU!1U:ll!'. Bowln sf'ctima laa.a extra large daaphravm. AdJ....tabú C""mI. bma..ra!I #41$. n:;.9:; each. PHYG)IO'IA:\"O)IETER R..ggl!dandd.pendabú.ruitll oJ.nerOld ga..ge caLbroted to!JOO , m m Velcro to..c" and."uld ) ;:::- - .. ""tt Handsome Zippered coal! 10 year 9"'lrant.e. 1/115 " 12 .95 each. ....... IndJUles ;1IItrals f'7Igravf?d OTOSCOPE SET - f1 ;.!._ !if .-"" On oJ Gennany's fmest rn.stMtments Excepf.OJUJl .UlI.ml1latI01l. poll r/ul 71Iatl111jying lens. J standard lZe s cul.a Sue (" batlenea . dll.ded \It'taI carrying CQ.Sf t,ned with '''lt clfJtlt 11:/09 156.00 each. SCISSORS & FORCEPS '1 W 'I 11" n R 8\ ""\ F ..n.....'R... -t mll.stj"retery \urse 'lanuftJ("I Tf'd oj flllest stt'el and " Islaed 111 sanitary clarome # 99 . " 12.60 "700 51 13.00 #70 13.7:; III'FR \ r"t. ..ll....IIR<; :.j(amtt' Stt't'l. strtllght bJ&J I. lIi05 51 .. ....harp blunt S2.k5 e-a h "706 5" harp "iharp S2. e-at'h MilO -II r "IRIS ...ri '""ûr<;,; 13.65 e-ach. r , FIIR('f'I'<;. F,nest laln/ ss tt't'l 51Z' long !\.ell ' Forct'p' "72 Slra'l(hl. box lock 54.35 each Kt"II Fur("'t"p'" "";':!5 lurvt"d. box lock S4.35 each Thumh Drt"'colnK "7.11 Strai ht. st"rratt"d13.35 rach '\TRSES WATCHES 4. dt'pendabk. attructll.-t' watch. Full numbers 1m Ii Ititf' JUCf'. R d lueep c'IRd laand Clarome ("a.u'. .stainless tf'f!t tHu-k JelA.'eUed motJement. black t.atlaer strap. 1 yr_ gtUJrantf!t' II!JOO. 11\.50 'p/ru 93cenls;n Ontario I / " ) ) '" . 11 "..nTl no, \L:-.l R E : Write on yourCompan} letterht"ad for our 2-1 pg catalogue. Quantity discounts a" ailable. 50 cent handling chargE" for ordt"rs less than S5.00 ----------- Urder '0. Iu.om l"ol. QuaD. "'Î.l.e Prirt Hj\ In \IFUll' \1 "ll'l'l \ ('II. 1'.11. 1111'\ .. !6.... BRIIC!\.\ III F.II'T K6\ 5\ R. I I ......nd to: I ....rr r:: I l"ih: Prm, .: I I'o"tal C'ode _ _ .I ------------' S4 "The more you want from nursing, the more reason you should be Medox:' Virginia Flintoft, R.N., Staff Supervisor \ '", ..... Do y ou want to: . increase the variety of your work and gain experience to help you specialize? Work in a hospital, a nursing home or a doctor's office. Enjoy as- signments in a private residence, hotel or summer camp. Perhaps you want specialized experience in CC., IC or another field. Medox can give you more variety. . work for a company that takes special care of its nurses in every way, including pay? Medox employs the best people at the best rates of pay in the temporary nursing field. You owe it to yourself to contact Medox. . free yourself from too many mandatory shifts and shift rotation? Medox nurses get the best of both worlds: the assignments they want and the shift work they prefer. Because there are more as- signments available. . to take advantage of free-lance nursing without the paperwork? When you work with Medox, we look after all paperwork. We pay you weekly and make normal deductions. Medox is your employer: the times, shifts and assignments are yours to choose. trade the rigid schedules of full-time nurs- . ing for the flexibility of temporary or part- time work? . choose to work only one or two days a week? As a Medox nurse, you can ease off the strict schedules of full-time nursing, Cut down to a few shifts or split shifts a week: the choice is yours. As a Medox nurse, you can pick the days you want to work: you're automatically on call for the time you want. Medox nurses have more time to themselves, they can arrange as many "free" days as they want. . work shifts that tie in with your husband's work schedule? Wouldn't it be nice to work the same shifts as your husband; both home together and both earning good incomes? If his shifts change. Medox will arrange to change yours too. . retire from nursing, but not completely? If the idea of retirement appeals to you, yet not the thought of forced inactively, becomes a Medox nurse. Be retired on the days you want. 'i f .. A a registered nurse with more years experi- ence behind me than I care to think about. I know how important it is to keep growing in your job-to a\oid that awful feeling of being stuck in the same rut. Certainly what you're doing is tremendously worth-while, and heaven knows there is a desparate shortage of nurses. But your job must be worthwhile to you, or else youll e\entually want to drop out"". "That's why Medox has so much to offer a nurse today". "You see. at Medox, we supply quality nurs- ing staff on a temporary assignment basis to hospitals. clinics. doctor ' offices. nursing homes and private residences. We're a part of the world-wide Drake International group of companies and we operate in major cities acros Canada, the U.S. U.K. and Australia". .. As far as you're concerned, however. the key phrase i "Tem- porary Assignments". Because. as you can see by the chart abo\e. you can choose just about any working condition, or shift. or professional discipline you want". ..It comes down to this: if you want more from nursing than you're getting now. talk to Medox". "Write to me. Virginia Flintoft. R. N.. Staff Supervisor, Medox, 55 Bloor St. W.. Toronto, Ontdrio, or call the local Medox office". [MlmoX] . DRAKE INTERNATIONAL company If you care for people, you're Medox, Clllssi fïl-(I \(Ivl-I.. ÎSel11el1ts une 23 - 25. 1976 Seventh Annual Meeting 01 Ihe Canadian AssOCla- on of Neurosurg.cal Nurses to be held In Winnipeg Manitoba at the orthsrar Inn For IOformatlon wnte Myrna Dnedger. Program Coor- nator 500 Barker Blvd. Winnopeg, Manotoba, R3R 2C2 l\lberta UMMER VACATION: I-tave you conSIdered horseback ..ding and ampong In the Rodoe Mounlalns near Banff, Albena? Eight 6-day nps sponsored by a non proht ndlng club are planned lor Ihe summer 11976 For brochure wnle to Trail Riders 01 the Canadian Rock...s x 6742 Station D, Calgary. AIber1a T2P 2E6 . British Columbia =legistered Nurses and Nursing Supervisors required by a 100- lAd acute care and 4Q.be<]' eJ<.ended care accreål.ed hospItal Must 'E! ebglbJe for B.C registration Permanent and summer relief paSI- I()f"'S available for general duty and operating room. Experience pre- erred for operating room POSitionS. SUperviSOry apphcants muSi have !xpenence In administrative or supervisory nursmg R N s salary \104910 S1239 and Superlllsor s salary $1258 to 51481 (RNABC \greemenl-1975) Apply In wnllng to lhe Dnector 01 Nursing. G R '!aker Memonal Hospotal 543 Fronl Street Ouesnel. BnloSh Co/um- )la. V2J 2K7 EGISTERED NURSE requned lor Independenl Boarding SChOOl lor ,o1s 150 slodents ages 11-18 Resldenl pOSItIOn commenCIng Sep- mber 1976_ Apply In wntlng to HeadlTllstress Stralhcona Lodge nooI. Shawnogan Lake. B C_ VOR 2WO a:xperjenced General Duty Nurses requued for small hospnal NOr1h I.ncouver Island area Salary and personnel poliCIes as per RNABC "On'ract ReSl(Jence accorr,mod'allon 530 00 per monih Transpor1a- .un Dæd from Vancouver Apply 10 D"ector of NurSing 51 George s 3sPdal. Box 223 Alen Bav Bntl h Columbia VON 1 AO General Duly Nurses lor modern 41-bed hospital localed on ''''' .aslo(a Hlgnw3't Salary and personnel policies In accordance with RNABC Accommodal,on available In residence Apply D"ecIO' 01 . urslng. Fort Nelson General HOSpital. For1 Nelson British Columbia Exoerienced Nurses (eligible lOr Be reglstrahan) requred h... 41J:I-bed acule care leaching hospllal localed In Fraser Valley 20 Inutes by freev.'ay from Vancouver. and within easy access of vaned recreallonal facilities Excellent Qnenlahan and Contmulng Education I programmes_ Salary $1.049 CO 10 $1 23900_ Clinical areas Include MedICine General and Specialized Surget)' Obslelncs Pechatflcs Coronar't Care HemodIalysIs Rehabllliatlon Operating Room Inten- s,,'" Care Emergency Practical Nurses (ehglble lor B C Llcensel also required Appty to AdmlOlstratlve Assistant Nursing Personnel. Royal Columbian Hospital. New Weslmrnster Bnllsh Columbia V3L 3W7 Graduate Nurses lor 21-bed hospnal prelerably wnh obsletncal ex- penence Salary In accordance with RNASC Nurses residence Apol't to Matron Tofino General HosDltal. To',no Vancouver Island 8n11511 Columbia New Brunswick PosItions avaltable July 1 1976 'or 'our leachers who can Qualify as AssIstant Or Associate Professors In a baccalaureate program with 260 students One teacher needed with Master s degree and e){ nence In community nursing and one with Master s degree ancJ exoenence In medical arid surgtcal nursmg Other teacherS needed to gUIde basIc and Post-R N students In c. meal experience In hospitals and community Modern new curriculum well equipped self-Instrucbonallaboratory new community hospital beautiful sman CI!\ Write Oean Faculty of Nursing The University of New Br mswlck Fredericton New Brunswick E3B 5A3 Ontario Regis1ered Nurses for 34-bed General Hospllal Salary 5945 00 10 S 1 14:. JO per month plus expeuence allowance Excellent personnel pohcles App1't to Director at Nursing Englehar1 & Dlstricr Hospda' Inc Englehart Ontano POJ 1 HO Cn jrens summer camps In sceniC areas 0' NortlJern OntariO reqUire Camp Nurses for July and Au .1 Each 'Ias resident M D Contact Harotd B Nashmé'" CalT'r\ Services CO-aD 821 Egllnlon Avenue Wesl Toronto. Ontèf c r...:J1\. t:.t "'VIII lõ;IIIU ,,,, UNIVERSITY FACULTY: For basIc baccalaureate programme convnu",'y health nursing wnh special emphaSIs on parent/child, psychlatnc nursing and pnrnary care. slrong 10undatlOn desned In I"e sCiences. competence as chmclan required. master s degree reqUired prevIous expenence 10 university teaching preferred Academic rank and salary commensurate Wllh quallficallOns. Send resume and references - Dean, SchooJ 01 NurSing. Queen s University KlOgston Onlano K7L 3N6 Registered Nurses are reqUired .mmed.<:lely lor the 43.bed Wadena Unron Hospttal TnlS IS a modern attractive acute care hospl1al s ualed In Ihe 10wn 01 Wadena Saskatchewan a I"endly parkland coml'l11Jnlty wnh a pOpulation of 1500 AltraC1lve salary and I"nge benefits are provoded under the Saskalchewan Umon 01 Nurses ag- reement In eHect Please direct apptlcatlons to Adm., >Iralor Wadena UnIOn Hosp.lal. PO. Box 10. Wadena. Saskatchewan General Duly RegIstered Nurses lor 22-bed hospital snuated In South Eastern SaSkatchewan on the Trans Canada highway near lakes and Last Oal< Siu ReSOr1 Salary per SUN Agreement Please apply to. Director of Nursmg Broadv!ew Umon Hospital Broadvlew Saskatchewan. Saskatchewan Unfl/erslty 01 Saskalchewan - Faculty Posn,ons Term and regular appointments In Matemal-Chlld. pnmary Care. Community and Men. lal Health NurSing To teach In lour year basIC and Ihree year pOst- diploma programs and COn1nbute to curnculum revISIOn Quab'J(::a- tlons Master s or hlQher degree and expenence In clinical field for appointment at protesstQnal ranks: Baccalaureate degree and expen- ence lor appOIntment as lecturer Contact Dean. College 01 Nursing. "o of Saskalchewan Saskaloon, Saskalchewan. Canada United States Texas wants you! tf you are an RN. expenenced or a recent graduate come to Corpus Chnst,- Sparkling Qty by the Sea a oty bulkll ng tor a bener futl6e. where your opportlM1ltles for recreabon and studies are Ilmniess Memonal Medical Cenler 5CO-bed general leaching hospItal encourages career advancement and prollldes InserY1ce onentatlon_ Salary Irom $802 53 to $1,069 46 per month, commensurate with education and experience. Differential 'or evening shifts. available. Bene'lts mdude holidays. sick leave vacations. paid hospltahzatlon, health. life insurance. penSion program_ Become a volal pan 01 a modem up-to-date hospotal. wnteor call John W Gover Jr, o,re<:tor 01 Per.;onnel, Memona! MedIcal Cenler. P _0_ Box 5280, Corpus ChnsÞ Texas. 78405. Direc10r of NurSing: Immediate app11cahons are Inv"ed tor the POSI- lion of Director of NurSing m the 43-bed Wadena Union Hosp,1al Fringe benefJts Include Registered Pension Ran Group Life Insur- ance and Income Replacemenl Plan This IS a seven year otd wen- eq..pped hospnalln a town 01 1500 pOpulallon serving a large rural population Wadena IS centrally localed 130 ""Ies from each 01 Iwo major Saskatchewan centres SUperV1S0ry experience IS essential Nursing Administration course desirable Al1raC1lve salary seale w: a I sgp " c los :n 3x tos: =: SOA 4JO R.N:s needed Immediately lor a 31-bed aeule care hospnal ROIatlng shilts We will assISt In making arrangements to come to beautllul Wyomlng_ Call Collect o,rector 01 Nurses. Cheryl Karkheck - 307- 682.8811 REGISTERED NURSES: requlfed Immedlalely for the 22.bed Acule Care HosPlialln the Industnallown 01 Hudson Bay Saskalchewan. Hudson Bay IS slluated In a 10res1 regIOn wnh excellent fishing. hunÞng and recreational faCilities. Salary and fnnge benefits according to the SUN Agreement Please direct appftcallons 10. Mrs B Montgomery. o,rector 01 Nursing, Box 578 Hudson Bay Saskatchewan SOE OYO_ Two careers in one. . Have you ever thought 01 combinmg two careers in one? As a Canadian Forces nurse you could, because you would also be an officer eligible lor regular promotion, enjoying a mim- mum 01 lour weeks vacation your very hrst year, Iree transportation privileges to many parts 01 the world. early retirement including a generous liletime pension and a number 01 other bene- hts The Canadian Forces will give you every opportunity to continue your nurse's training, while using the skills you already have in one 01 the many military medical installations in Canada or overseas You might Quality lor flight nurse's training or even lor a complete doctorate study course II you're a graduate (Iemale or male I 01 a school 01 nursing accredited by a provincial nursing association and a registered member 01 a provincial registered nurses' association, a Canadian citizen under 35 with two years' post- graduate expenence in nursing, you owe it to yours ell to enlOY two careers in one Contact your nearest Canadian Forces Recruiting Centre or write to: Director of Recruiting and SelectIOn National Defence Headquarters P.O. Box 8989 Ottawa. 0 ntario ,.4..-.. K1A OK2 . . J! " , ß . ... - ....... t . 1 " . . . , . . . I -- ---- - .> . . . . CET INVOLVED. WITH THE CANADIAN ARMED FORCES. 56 The CanadIan Nurse April 1976 Georgian College of Applied Arts and Technology Health Sciences Division "Meeting Today's Challenge in Nursing" Queen Elizabeth Hospital of Montreal Centre Requires Faculty for Diploma Nursing Program in Owen Sound, Orillia and Barrie A Teaching Hospital of McGill University and Ambulance Attendant Program based in Orillia requires New, progressive, integrated curriculums. If you are a creative and innovative teacher, if you believe In seff-directed learning, we would like you on our staff. Registered Nurses and Registered Nursing Assistants Starting date August 17, 1976 with 2 weeks orientation. . 255-bed General Hospital in the West of Montreal . Clinical areas include Progressive Coronary Care, Intensive Care, Medicine and Surgery, Psychiatry. Please write or telephone: Miss C,M. Brown Nursing Administrator Georgian College of Applied Arts & Technology 43 Colborne Street West Orillia. Ontario. L3V 2YS Interested qualified applicants should apply in writing to: Téléphone: (705) 325-2705 Queen Elizabeth Hospital of Montreal Centre Director of Personnel 2100 Marlowe Ave., Montre l, Quebec H4A 3L6 Vancouver General Hospital Invites applications for Nursing positions in all clinical areas of an active teaching hospital, closely affiliated with the University of B.C. and the development of the B.C. Medical Centre. Regular and Relief General Duty For further information, please write to: Personnel Services Vancouver General Hospital 855 West 12th Ave. Vancouver, B.C. V5Z 1 M9 , Judy Hill Memorial Scolarship Applications are being received for this annual Scholarship. details of which are as follows: Value Up to $3.500.00 Purpose To fund post"9raduate nursing training (with special emphasis on midwifery and nurse practitioner training) for a period of up to one year commencing July 1 st, 1976. Tenable In Canada, the United Kingdom, Australia, and New Zealand. Applicants should possess the following qualifications: . Fluency in English; . . R.N. Diploma, or equivalent; . A desire to wor\( for the Government of Canada or one of its Provinces at a fly-in nursing station in a remote area of Northern Canada for a minimum period of one year following completion of the scholarship year. (Details of this wor\( will be forwarded on request.) And should submit: . A resume of their academic and nursing career to date; . Copies of the educational qualifications submitted on entry to nursing school; . Verification of their R.N. Diploma, or equivalent: . Their proposed course of study; . Acceptances and/or preferences for place of study; . Two character reference letters. To: Philip G.C. Ketchum, Chairman, The Board of Trustees, Judy Hill Memorial Fund, 829 Centennial Building, Edmonton, Alberta, Canada. BV: May 1st, 1976 The Scholarship is conhngent on the successful applIcant s beIng regIStrable by a nurSIng assooatlOn on one 01 the Canadoan prOVInces and meehng current Canadian Immigration requirements for landed Imrngrant status. A successful appflcant from outSide Canada will be asSisted by the Trustees In meeting these requirements. University of Toronto Faculty of Nursing Bachelor of Science in Nursing: The Undergraduate Programme leading to a B-Sc.N. degree involves two curriculae: 1. Four year course - the majority of students enrolled in !he course enter di rect from Grade 13, but a number with post-secondary education are also admitted. 2. Three year course - for graduates of diploma schools of nursing. The first and second yearol this course are also available on a part-time basis. Bo!h courses proVIde a professIonal preparation which includes Qualification for nursing in both the hospital and pub c health field. In bo!h cuniculae humanities and saences is assooa,ed with !he study of nursing. The four-year programme prepares the student for registration under the Nurses' Ad of the Province of Ontario. Master of Science in Nursing: Offered by the Faculty of Nursing through the School 01 Graduate Studies, this programme offers opportunity for the preparation of nurses to provide leadership in planning and giving high Quality care. Three areas of specialization are offered at present: medical-surgical, community health and mental health-psychiatric nursing Each candldate's programme is individually planned: electives in the functional areas of education and administration may be selected. A thesis is required and involves the investigation of a nursIng problem in !he area 01 !he student's clinical specializatIon. rne (;8n8018n Nurse April lV/I) ,,, 657 bed, accredited, modern, well equipped General Hospital, rapidly expanding... Saint John 'i j. General U \ \" GJfoÆPital ðaintGJohn,NH, CANADA ,...- .-' . 41 QUIRES: Genetãlðtaff N.yrses c;& Registered Nursing Assistants In a/l general areas: Medical, Surgical, Pediatrics, Obstetrics, Chronic and Convalescent, several Intensive Care areas and Psychiatry. . Active. progressive in-service education program, Speciat Attenlion 100rienlalion. Allowance lor Experience and Posl Basic Preparalion FOR FURTHtJR INFORMATION APPlY TO ERSONNEL DIRECTOR aintc:John General Hospital Po. BOX 1000 Saint John. New Brunswick ElL 4Ll m MEDICINE HAT COLLEGE INVITES APPLICA TrONS FOR PoslUon: NURSING INSTRUCTORS Qualifications: Master's degree preferred but not essential. Must have R.N. with a Bachelor's degree and previous teaching and nursing experience. Special preparation in Medical, Surgical, and Psychiatric Nursing will be an asset. Salary: Dependent on education and experience Range is from $11,000 to $23,000 . Location: Medicine Hat College has about 80 students in the Two Year Nursing Diploma Program. The College is ten years old and enJoys a new campus in a rapidly expanding city of 30,000 people. Starting date: July 1, 1976 Send full details of training, expenence, plus references to: Mr. C.L Dick Academic Vice-President Medicine Hat College Medicine Hal, Alberta 58 Brandon General Hospital School of Nursing Nurse Teachers for Two Year Diploma Program Positions Available July, 1976 in Nursing Content Areas of "Fundamentals" - "Maternal- Child" "Medical-Surgica1" - "Psychiatric Nursing" Qualifications Baccalaureate Degree in Nursing is required. Preference given to applicants with experience in Nursing and Teaching. Apply in writing stating qualifications, experience, references to: Personnel Director Brandon General Hospital 150 McTavish Avenue East Brandon, Manitoba R7 A 2B3 Registered Nurses 1260 bed hospital adjacent to University of Alberta campus offers employment in medicine, surgery, pediatrics, obstetrics, psychiatry, rehabilitation and extended care including: . Intensive care . Coronary observation unit . Cardiovascular surgery . Burns and plastics . Neonatal intensive care . Renal dialysis . Neuro-surgery Planned Orientation and In-Service Education programs. Post Graduate clinical courses in Cardiovascular - Intensive Care Nursing and Operating Room Technique and Management I' Apply to: Recruitment Officer - Nursing University of Alberta Hospital 112 Street and 84 Avenue Edmonton, Alberta T6G 2B7 The Canadian Nurse April 1976 The Registered Nurses' Association of Nova Scotia !nvites applications for the position of Executive Secretary The applicant should have a broad nursing background, administrative experience and university preparation, preferably at the Master's level. A background in professional association activities would be an asset. Applications for this position will be accepted until September 1, 1976. For complete information, including job description and salarv range, write to: President Registered Nurses' Association of Nova Scotia 6035 Coburg Road Halifax, N,S, 83H 1 Y8 [l]@ University of Alberta Hospital Edmonton, Alberta o Holy Cross Hospital Calgary The expansion of our Inservice Department has made it necessary for the creation of two new senior positions. The , positions are Instructor positions and are described as follows: Inservice Instructor - Acute Care The successful candidate will be responsible for the effective provision of inservice education in several clinical areas including Emergency, Acute Medical-Surgical, Intensive Infant Care, Orthopedics, Neurology, and Ophthamology. A B.Sc.N. is required with several years' progressive nursing experience with one year of teaching expertise. Inservice Instructor - Mental Health Candidates must provide documentation which indicates that they meet the profession I requirements of practice in the province of Alberta. A B.Sc. N. is required with major areas of concern in education and mental health. Applicants should have several years' progressive related experience with two years in the mental health field and one year of teaching experience. Interested qualified applicants should apply to: Hospital District No. 93 Personnel Department 940 Eighth Avenue SoW. Calgary, Alberta T2P 1 H8 The Department of Continuing Education, Kelsey Institute of Applied Arts and Sciences, Saskatoon, requires: Diploma Nursing Instructors For the purpose of establishing an eligible list of qualified candidates for anticipated vacancies in Saskatoon, North Battleford and Prinæ Albert, the Public Service Commission invites applications from Registered Nurses with a Degree in Nursing and supplemented by experience in teaching preparation, nursing education and nursing practice. Duties will include classroom teaching and clinical guidance of students in the first and second year of the Diploma Nursing program. Salary is commensurate with education and experience. Competition number: 501010-6-485. Please quote position, department and competition number on all applications and/or enquiries. Forward all applications and/or resumes to: Public Service Commission, 1820 Albert Street, Regina, Saskatchewan. S4P 2S8. The Canadian Nurse April 1976 S9 :.\ GENEIi-1l [j !2 <þ., '6 Ó -1'\t() C> ,, llACH\ Quebec's Health Services are progressive! So . . IS nursing at The Montreal General Hospital a teaching hospifal of McGill University Come and nurse in exciting Montreal r-------------------------------- !ii \UG The Monfreal General Hospital 1650 Cedar Avenue, Mantreal, Quebec H3G IA4 Please tell me about hospital nursing under Quebec's new concept of Social and Preventive Medicine. Name Address L_______________________________J 60 The Canadian Nurse April 1976 ': : . ; ; , . , f ...... (( /; ; y "7: v-.......c.. / . , ::T _ .'- "'To. ..:.. .- ,. :f:' :- f :: ';:" t.....,:- . ' ,ø ';:/.y>1 ,... '!'- - -.i#/ .... .y)' " - \';I -- General Staff Nurses required for Regina General Hospital openings in all departments Recognition Given For Experience Progressive Personnel Policies Apply: Personnel Department Regina General Hospital Regina, Saskatchewan S4P OW5 Apply to: Director of Nursing Ongoing staff education Montreal Neurological Hospital 3801 University St. Montreal, P.O. H3A 284 Individual orientation If Paris appeals to you . . . so will Montreal . Modern 700 bed non-sectarian hospital . Excellent personnel policies . Registered Nurses and Nursing Assistants are asked to apply . Active In-Service Education program . Bursaries available , . Quebec language requirements do not apply to Canadian applicants , Director, Nursing Service Jewish General Hospital 3755 cote ste. Catherine Road Montréal, Québec H3T 1 E2 North Newfoundland & Labrador requires Registered Nurses Public Health Nurses International Grentell AssociatIOn provides medical services for Northern Newfoundland and Labrador. We staff four hosprtals. eleven nursing statlOf1s. eleven Public Health unrts. Our main 180-bed accredited hospital is situated at St. Anthony Newfoundland. Active treatment is carned on in Surgery, Medicine, Paediatrics, Obstetrics, Psychiatry. Also, Intensive Care Unit. Onentation and In-Service programs. 40-hour week rotating shifts. Living accommodations supplied at low cost Public health has challenge of large remote areas Excel/ent personnel benefits include liberal vacalron and sic!< leave. Union approved salaries start at $810.00. Apply to: International Grenfell Association Assistant Administrator of Nursing Services St, Anthony. Newfoundland AOK 4S0 DONO RS BLOOD I . LIFE y.. - Sea RED CROSS BLOOD DONOR . .' University Nursing Faculty Positions Maternity, Paediatric, Medical-Surgical, Psychiatric Masters degree and teaching experience required. Excellent personnel policies and fringe benefits, Rank and salary commensurate with education and experience. Positions available' Fall, 1976. Write to: Dean Faculty of Nursing University of Toronto Toronto, Canada M5S 1A1 The Canadian Nurse April 1976 Canton Hospital Winterthur Switzerland (Near Zurich) For our modem well organized Physical Therapy Unit and for the Rheumatic Clinic we need Physiotherapists for various dulies associated with Rheumatological Surgery, Internal Medicine, Paediatrics and Gynaecology. We offer pleasant working conditions equitable hours of work and leisure, Salary in keeping with qualifications, living quarters provided. Applicants should apply directly to: Kantonsspital Winterthur, Personalburo, CH 8401 Winterthur, Switzerland Senior Public Health Nurse The Department of Health & Social Development, Community Operations, Portage la Prairie, requires a person who in a multi-disciplinary setting, co-ordinates area public health nursing. Plans and evaluates programs to fill community needs. Orients and develops new nursing personnel to provide quality service. Acts as guide and resource to own staff, plus learns in allied disciplines, outside agencies and community. B.N. plus four years related experience. SALARY: $13,680 - $19,836 per annum This position is open to both men & women. Apply in writing referring to#1128 on or before April 22, 1976: CIVIL SERVICE COMMISSION Recruitment & Selection Room 904 - 155 Carlton St., Winnipeg, Manitoba Registered Nurses and Nurses Assistants required for 110-bed hospital for chest diseases situated in the Laurentians, 55 miles north of Montreal. Salaries are now being updated Excellent fringe benefits. Quebec language requirements do not apply for Canadian applicants if registered in Quebec before July 1976. Apply: Director of Nursing Mount Sinai Hospital P.O. Box 1000 Ste-Agathe des Monts, Quebec J8C 3A4 61 OPERATING ROOM TECHNICIAN required for small, general hospital. Cast room experience preferred. Will also be required to care for anaesthetic and other equipment. Apply in writing to: Miss Catherine McFarlane Paddon Memorial Hospital International Grenfell Association Happy Valley, Labrador AOP 1 EO Nursing Co-ordinator Operating Room and Recovery Room Leadership and adrninislrative qualities desirable. B.Sc.N. preferred. Previous Operating Room experience essentiaJ Salary commensurate with qualifications and experience. The Thunder Bay area is well renowned for its many summer and winter recreational facilities all within minutes of the city. Apply sending complete resume to: Personnel Director St. Joseph's General Hospital Thunder Bay, Ontario. SOFRA.TULL.' Rouaa-' Fr.m1'cetln Sulphate BoP. Antibiotic Inclcat_, Treatment 01 ,ntec1ed or polentoaby .,Iecled burns. crush I"Ilures. &acerahons Also vancose ulcers. bed- 9:)res and ulcerated wounc::!i Conlratncllcatl_a: Known allergy to Ianoion or Iramyce- tm Cross-sensitization may occur among the group'OI slreplomyces-deo....d anllbtohCS (neomycin. paromomyc". kanamycin) of whICh framycetJn IS a member but ttus IS not lI'vðfl3b1e Pr__ut_, In mpsl cases absorpbon 01 the anhboot", IS so Shgnt 1I1al n can be dISCounted Where....'Y large body areas are "volved (e 9 30'16 or """e boóy bum) Ihe I>OSS' DIIny of O'OIO>'CI!y be.,g eventually prOduced Should be conS " ::';:: . .': \ ' . ',\ I -""',," ..,., " warth looking inta... \ , .- .. ..1.. !.: / 'ir.,/ : \ :>-.:::. :" ;'1'::::':>' ::{ ' rJ.;.' ":;:;", . .-:: 1-' r. (.. . ,/ ..... . '>_ .Ji' I ' ' ' , ''-rif' ': . :.' , ".1.',. Y I 6. r j . ".- -to: ." .' ; J '. ,:!!: . -':'. --J "',".: . .' . .: . ........ It.. :"'-. ""-. ',. / ,ir; I \/'. .-.. .": : ". . . .... .. ; necould become an R.N.A. and do the same thing? The situation is nearing that stage. I do not Intend, In any way, to degrade the work of R.N.A.'s - but. I believe that nurses (R.N.'s) need to stand up - they need to protect themselves. R.N.A.'s should protect themselves from lawsuits and refuse to take the responsibility of administering medications. I hope that readers will express their concern about this issue to their provincial organizations - stand up and fight for nursing. - L Cranston, Ottawa, Ontario. Unfair to Flo? Concerning Pat Barr's letter ("Input," 'March, 1976) I can only ask that she read Florence Nightingale. Cecil Woodham-Smith's book is, I feel, a fair View of the life and efforts of Flo. It was published first in 1951 and has been reprinted most recently in 197( by Collins, Fontana Books. After reading this account, I cannot help but disagree with some 0 the comments and interpretations tha Ms. Barr makes of Ms. Nightingale. - úse Kear, Huntsville, Ontario A Pat on the Back I feel I must congratulate you an, your production department on the outstanding renovations. Bravo! Would this be an inopportune time to suggest that a combined English/French edition of The Canadian Nurse would be of very great interest to us as advertisers? There are some precedents in the health area, as you know. In any case I do not want this thought in any way tc detract from the original purpose of this letter which was to commend ThE Canadian Nurse for such an outstanding change.- Charles W. Lindsay, Presidenr, J.B. Lippincott Company of Canada Ltd Toronto. Congratulations on an excellent issw of The Canadian Nurse (Feb. 1976). find the new style and format very appealing. Especially did I enJoy your editorial on assertiveness training fc nurses. I am more and more convinced that few changes In nurse and nursing are more urgently needed. Can we look forward to some dialogue on this concept in The Canadian Nurse? Keep up the excellent work. - Gloria Boerma, Reg. N.. B.S.N., Saskatoon, Sask. A case for life Vincent Adamklewicz (Februal') 1976) presents factual and scientific eVidence that the developing fetus i. indeed living and human from the moment of conception. How can we justify the number ( lives lost due to the seemingly simpl medical procedure called abortion? - Bernice Ward, R.N.. B.Sc.N., Edmonton, Alta. The CanadIan Nurse May 1976 7 As time goes by. the fundamental things ....ill always apply to nursing practice. Thompson: PEDIATRICS FOR PRACTICAL NURSES, New 3rd Edition The author's text considers pediatric disorders from both psychological and cbnical viewpoints. Organized by chron01ogic stages from fetal Me through adolescence. this book deals with common pediatric disorders. their impending emotional impact on both the chiJd and the nurse, and helping the child adjust to a hospital environment (A Teacher s Guide is available) By Eleanor Dumont Thompson, RN. St Joseph's Hospital School of Practical Nursmg. Nashua. N H About 380 pp.. 165 ill About $6 70 Ready June 1976 Order #8842-X. Jacob & Francone: ELEMENTS OF ANATOMY AND PHYSIOLOGY This beautifully illustrated new text by the respected author artist team of Stanley Jacob and Clarice Francone reveals current concepts of cellular physiology and the role of DNA and RNA In heredity and life-functions. Tissue structure. appearanæ and function are described: each of the body's primary functional systems is examined separately. Text headings such as. What Does a Neuron Look Like') focus attention on the concepts. By Stanley W. Jacob. MD, FACS. School 01 Mediane. University 01 Oregon Health Sc1ences Center. and Clarice Ashworth Francone. Medical Illustrator About 260 pp. 240 dl. 65 10 color Solt cover Aboul $7 75 Just Ready Order #5088-0. Simmons: THE NURSE-CLIENT RELATIONSHIP IN PSYCHIATRIC NURSING: Workbook Guides to Understanding and Management. New 2nd Edition This practical workbook shows you how to estabhsh a therapeutic relation- ship with the mentally ill patient This revised edition mcludes new guides on observation oj anxiety. assessing the miheu. theoretical approach. crisis interoention descriptive data. assessment oj the client's learning. and assessing oj the nurse's learning. By Janet A. Simmons. RN. MS. Filchburg Slale College About 240 pp Solt cover About $700 Jusl Ready Order #8286-3. Kron: THE MANAGEMENT OF PATIENT CARE: Putting Leadership Skills to Work. New 4th Edition Here's a modem look at the challenges of nursing leadership in the rapidly changing health care field It examines the responsibihties of the profes- sional nurse. the legal aspects of practice. ways to improve communication and understanding. the administrative and managerial responsibilities of nurses. methods of work improvement and leadership skills Particular attention is paid to defining the role of each mc"nber of the nursing team. By Thora Kron. RN. BS Aboul290 pp llIustd Solt cover Aboul $5.15 JUSI Ready Order #5528-9. Gillies & Alyn: PATIENT ASSESSMENT AND MANAGEMENT BY THE NURSE PRACTITIONER This brand new text is ideal for developing your skills in interviewing, physical examination. laboratory test interpretation. and protocol m the management of patients with chronic tllnesses such as hypertension. diabetes. osteoarthritis. arteriose/erotic heart disease. obesity. alcoholism. and chromc obstructive lung disease By Dee Ann Gillies. RN, EdD. Asst Dlreclor 01 the Dept 01 Educabon Health and Hospitals Governing CommissIOn 01 Cook County. IIbnois. and Irene B. Alyn. RN. PhD. Assoc Prol 01 Medical Surgical Nursing. Univ. 01111 College 01 Nursing 236 pp lIIustd Aboul $11 35 JUSI Ready Order #4133-4. Falconer. Patterson & Gustafson: CURRENT DRUG HANDBOOK 1976-78 You'li find the most recent clinical information on about 1.500 drugs in common use in the Current Drug Handbook. Its tabular format lets you grasp pertinent facts at a glance. and it's fully indexed by both proprietary and generic names. The drugs are grouped under 16 categories. such as Antiseptics and Disinjectives. Antihistlmmes. and-new to the 1976-78 handbook hemotherapy oj Neoplastic Diseases. By Mary W. Falconer. RN. MA, lormerly ollhe O'Connor Hospilal School 01 NursIng. H. Robert Panerson. PharmD. Prof. of Bactenology and Biology. San Jose Slale Umv . and Edward A. Guslafson, PharmD, Pharmacist Valley Medical Center 279 pp Solt cover About $6.70. Just Ready Order #3567-9 Howe: BASIC NUTRITION IN HEALTH AND DISEASE, New 6th Edition From chemical conversion of food-to modem diet planning. purchasing and storage-this text covers all the material necessary for a better understanding of basic nutrition. There's plenty of information on diet therapy. common misconceptions about food. and weight control: and the appendix includes an alphabetical listing of modified diets (A Teacher's Guide is available ) By Phyllis S. Howe, RD. BS ME. Nutnlional Instructor. Contra Costa and Diablo Valley Commumty Colleges. Catilorn.a Aboul 465 pp llIustd Solt cover. About $775 Jusr Ready. Order #4788-X. Mayes: NURSE'S AIDE STUDY MANUAL. New 3rd Edition Designed to equip the student aide with a working knowledge of good patient care. this book covers: basic nursing arts procedures. her ethical and legal responsibilities and limitatIons. what to do in emergencies. and basic anatomy and physiology (An Instructor's Guide is available.) By Mary E. Mayes. RN. lormerly Supervisor. Emergency Room. Ventura General Hospital Calilornia About 285 pp. 130 ill Solt cover About $620 Jusl Ready. Order #6191-2. _it .o r s o !' t NY CANADA LTD. Pncessublecl 10 change '- TO orde't;Ue s 30-d8rapprova' , 'der ::ber ::; hor: - - - - -;' e Pn - - - - - - - - - - - - ;;;1;;- - - --I I I I I I FULL NAME I I I I AU AU AU: POSITION & AFFILIATION (IF APPLICABLE) I I HOME ADDRESS I I I 1_ heck " d-Saunder s .ta _ nd C . O.D ._ _bill m _ _ _ __ _ _ _ _ _ PROVIN _ _ __ '=- __I r- 8 The Canadian Nurse May 1976 I II I) lIt Editor's note: The followmg open letter was submitted simultaneously to both the RNABC News and The Canadian Nurse. The author asks that it be published in this journal "since it is a topic which affects the membership [of the nursing profession) as a whole." t Handmaidens protest Yes, nurses must be accountable, not only as individuals, but as the Canadian Nurses Association. As a member 01 the Association, I am ashamed that we haven't taken a stand on abortion. I am not against abortion, providing it IS done in the first 2 - 3 months, before there is an audible fetal heart. What I am against, are abortions at four months gestation by means of instilling a hypertonic saline solution into the woman's uterus. Charting consists of 'fetal heart heard per doptone" - and then the procedure is charted - and we walt for that fetus to die and be aborted - hopefully it will be dead and not gasping for breath as it is expelled. Is this nursing as we pledged to carry it out - being "handmaidens'- to doctors that continue to do these ''fetacide-abortions?'' How can we justify this, when on the other end of the spectrum we hear a cardiac arrest call and we rush to breathe air into the lungs and massage the heart of a person that is dying? It doesn t make sense. In other words - are we being accountable? What suggestions have I got for this horrendous problem in today s society? First, we must through our Canadian Nurses Association bring pressure on the Canadian Medical Association to stop doing abortions when there is an audible fetal heart. I am sure there are many doctors that feel this practice is wrong and only require some stimulus to get them to stand up and be heard. Next, let's stop using valuable hospital beds for abortions and establish properly run abortion clinics. Thirdly, and I feel most important, let's press for well publicized, family planning and sex education clinics. Now I know there are those among you that will say - this is all very good, but if a woman can't get an abortion 'legally" (because there is a fetal heart) she will go to some back street abortionist often with sad results. It IS this rationalization, that has made these late abortions seem acceptable. It would be my hope that through Improved contraception education and abortion facilities that these advanced abortions would be eliminated. As it now stands, I feel every time there IS an abortion done on a woman with an audible fetal heart- the doctor and nurse who initiate the abortion are being used - used because society as a whole is no longer accountable. Let's try to alter this now, and we as nurses stand up In force through our Assoaation, and say we will no longer perpetuate an intolerable situation. Stop being "handmaidens' and show that you do have an opinion. Let's be accountable! - Marjorie P. Shier, North Vancouver, Be. Professional challenge h was with considerable interest and relief that I read the article by Dr. Adamkiewicz, "What Are the Bonds Between the Fetus and the Uterus?" There is currently a very blasé attitude amongst heahh professionals and educators concerning abortion - the opinion that it IS not a criminal act to destroy the life of the unborn fetus, a life which has the full potential of a human being. Under the rather weak excuse 01 wanting "to help women in trouble." we as nurses are contradicting a basIc, deep principle in in our philosophy of care, which is to preserve life As a concerned citizen and a teacher of future nurses, I agree with Dr Adamkiewicz that we must bring our skills, high ideals and Influence together to fight the current pro-abortion trend and provide the fetus with that community protection to which he is justly entitled - Carol Lawson, Pediatric Nursmg Instructor, Vanier College, Ste-Crolx Campus, Montreal. Demeaning viewpoint I found Viewpoint (The CanadIan Nurse, February 1976) inappropriate and objectionable for a professional journal. Dr. Adamkiewicz rambles in Irrelevanaes and reiteration of patently obvious factual data on a subject which he purports to understand. The title "What Are the Bonds Between the Fetus and the Uterus?" clearly Indicates evasion of the real issue in abortion debates. It is not the uterus which demands decision-making nghts, but the woman who happens to possess that organ Suggesting extraterritOllal status for the pregnant uterus is the height of conceptualization without reason. Publication of this demeaning and poorly "conceived" article coupled with an editorial challenge to nurses as health care providers seems unwarranted. Surely our editors could solicit a more objective and Informed viewpoint. - Bettie J. Scheffer, RN, Vancouver, B.C. Peripatetic profession I wish to add some weight to the side of the nurses who are unhappy with different provincial registrations across Canada. (The Canadian Nurse, January 1976) I feel there are two things which make this situation difficuh to work with. The first IS that people are in general more peripatetic. Not only nurses move about but also husbands and other family members. I find myself changing provinces to look after a Mom with lung cancer. This was not planned to suit registration times This brings me to my second consideration, which is fmancial. Since I have just paid $70.00 registration fees in Manitoba, $22.50 PHA fees. and $12.00 Associate fees to my home school (the AARN), my total registration fees this year will be over $200.00 if I pay $110.00 to the RNABC !!! Whew! -B.E. Gunn, R.N., B.Sc. P.H.N., West Vancouver, B. e. Gypsy in our soul I have always looked forward to The Canadian Nurse and have often received useful, practical, information from this journal. I am writing now to bring your attention to a problem that I share with a lot of nurses in our mobile society. I've just spent three hours completing forms, wntlng cheques and letters, and hunting for every thin, from school marks to mamage certificates. II IS an experience that WE all must face each time we change OUI province of residence and It doesn't make much sense. Why, in a country where each province has Identical registration requirements, don't we have a slngl Canadian RegistrallOn? It would sav the "gypsies' among us, and our vanous provincial associations a gre deal of time, money and frustration. I truly hope that a lime will COrT1l when I am a "Canadian Nurse' anc please let it be before I move again Dona M Penkala, Pasadena Nfld. Prisoners of conscience Thousands of men and women are being detained in Soviet pnson corrective labor colonies and psychiatric hospitals because of the religious or political beliefs. In contemporary Soviet law (penal) thf "infliction 01 suffering' is regarded a permissible and necessary. In more than 14 years of work or violations of human nghts throughol the world, Amnesty IntemallOnal ha accumulated a great deal of information on the treatment and conditions of prisoners of consclenc in the USSR. This Information IS nOl available with the release in five languages of "Prisoners of Conscience In the USSR: Their treatment and conditions. The documented evidence of maltreatmem by Soviet physlaans, psychiatrists, and paramedical personnel will be of particular intere to nurses. The report IS available frol Amnesty International for $2.50. - Mary J. Beattie, Amnesty InternatIOnal, 2101 Algonqum Avenue, Ottawa, Ont., K2A 1T2 New horizons I am writing this letter to ask you favor. I am 26 years old and would lik to correspond with someone interested in nursing. So. please bE kind enough to publish my address one of your nursing journals. -(Miss) Ramya Nancyakkara. No. 121/3, Lady McCallum's OrNe, Kandy. Sri Lanka. (Ceylon). (Continued on p. 11 L'eggs@ Nurse White Pantyhose available only by mail. Here's something specially for you, Famous L'eggs Panty hose in Nurse White. And they're available in Sheer Energy" Panty- hose to give your legs all-day support, or regular L'eggs Pantyhose. with their super- stretch, super-fit. As Nurse White panty hose is made espe- cially for nurses, it's available only through a mail order program. On larger quantities. we offer bonus savings-six for the price of five 12 pair for the price of 10. And we pay the postage. It's economical, prompt. and con- venient. And your satisfaction is guaranteed, If you're unhappy with the product for any reason, we'll refund your money or send you a replacement pair of L'eggs, whichever you prefer. All you do is return it to: L'eggs Guarantee, 1775 Sismet Road, Mississauga, Ontario L4W 1P9. How 10 order your Nurse White Pantyhose. 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Please do not send cash, (One cheque per order only.) Make cheque or money order payable to L'eggs Nurse White Mail to: L'eggs Nurse White, P,O, Box 8116 Toronto, Ontario M5W 1S8. MAIL THIS COUPON TODAY! p----------------------------------------------- !.. , . :a- I . . 'a , ::Þ .... "'" '- Nurse White only color available-See size chart Available Styles and SIZes 3 pairs 6 Pairs lor 12 Pairs tor TOTAL pnceof5 pnceoll0 l'eggs- Regular $ 4.47 $ 745 $1490 l'eggs-Queen5lze $ 4.77 $ 795 $1590 Sheer Energy -Size A $1197 $1995 $39_90 Sheer Energy' -Size B $1197 $19_95 $39 90 Sheer Energ -Queen5lze $1197 $19.95 $3990 (Chec tI' nght box) TOTAL PURCHASE Ontanoresidents add 7 sales tax SAl ES TAX CON N 576 TOTAL AMOUNT NAM F ADDRESS CITY PROVINCE-POSTAL COD F ----------------------------------------------- 10 The Canadian Nurse May 1976 Xe\ys Belt-tightening hits nurses, national outlook bleak When the federal government officIally put the lid on health care costs by Introducing Bill C-68, closely followed by announcement of a national anti-inflation program, most provinces reacted by initiating cutbacks and curtailments in their health services. Under Bill C-68, the federal government would limit future increases in contributions to medicare to 13 percent in 1976-77 and 10.5 percent in 1977-78. At the same time, the government served notice of its intention to end existing agreements under the Hospital Insurance and Diagnostic Care Act, through which each province recovers about half of its hospital expenditures. "Hold-the-line" budgets are fast becoming a fact of life in most provinces, with varying effects on the level of health services available and the personnel who provide them. Representatives of provincial nurses' associations were contacted recently by The Canadian Nurse in an attempt to obtain a national picture of the effect of these austerity measures on nursing manpower in their jurisdictions. Although the situation varies from province to province, and from one area to another in the same province, as well as seasonally, the general impression provided by these spokesmen, was that of a general tightening up in employment prospects, with pockets of serious unemployment becoming apparent in seve.-al centres. Short-term prospects are not generally encouraging for the recent graduate or for nurses with a definite preference for working in a particular city or hospital. Some of the comments follow: British Columbia Although jobs for registered nurses in British Columbia were in relatively short supply in late Winter, the situation was expected to improve by Spring, according to Registered Nurses Association of British Columbia Employment Referral Director, Marilyn Carmack. "The number of nursing jobs listed with us drops every year at this time," she says. "Things are tighter than usual, but the situation should change - despite budget cutbacks at some hospitals." A similar situation existed in 1970 and rumors then of a lack of jobs created a critical shortage of nurses in British Columbia that lasted nearly five years. The association's employment referral service listed nearly 100 job vacancies and about 65 new enrollees looking for work early in 1976. Comparable figures for 1975 show about 200 vacancies and 50 new enrollees. Many of the jobs go unfilled because they are outside the Lower Mainland, according to Carmack, and others may require nurses with hard-to-find clinical specialties. "The apparent lack of jobs should disappear," said Carmack. "Any other view of the situation is unrealistic." She notes that British Columbia trains only about 30 percent of its new registered nurses and must import the rest from other provinces and outside Canada. Alberta The registrar of the Alberta Association of Registered Nurses indicates that the supply of nurses appears "generally equal to the demand" although in certain sections of the province, some levels of unemployment are being experienced. A few vacancies still exist in northern areas. As of February 2, 1976, all graduates seeking registration in Alberta whose credentials meet the requirements for registration must pass either the Canadian Nurses Association Testing Service or the National League of Nursing examinations In medical nursing, surgical nursing, obstetrical nursing, and the nursing of children. Graduates of 1972 or later must also pass the registration examination in psychiatric nursing. c! . . ,- " J r . I . l , it . . "" .. ..'"J.. 1 J - . \ - .. .... . ... i . --1r. ..... ..' -4 " .... '\ Close to 750 Eastern Ontario nurses at a mass meeting in Ottawa heard Anne Gribben, chief executive officer of the Ontario Nurses' Association, warn that provincial health-care cutbacks threaten public safety as well as the jobs of hospital employees. Above, a member of the audience comments on the situation from her perspective. Saskatchewan A spokesman for the Saskatchewan Registered Nurses' Association indicates that the association is currently receiving "few requests for assistance in finding nurses for the city hospitals - i.e. Regina, Saskatoon, Moose Jaw. Many new graduates from Ontario have been employed in this province. Small hospitals are not requesting assistance as often as they were a year ago. There are fewer requests that we expedite the admission of foreign applicants. An official from Manpower and Immigration has also noted that there seems to be a fairly generous supply of nurses. The small hospitals are always short of nursing staff unless they have a "captive" supply living in their area. There is little to induce nurses to go to small towns even when the number of job opportunities is small." Manitoba In Manitoba, according to the registrar of the provincial association, "things are tight. .. and likely to stay that way for some time. She sees little chance for a change for the better in the near future and reports that new graduates are expressing a good deal of concern over the possibility that more positions will be cut. Officials of outlying hospitals In the province say that they are enjoying an unwonted bonanza, with more applications than ever before. Ontario The province hardest hit by the austerity program, at least in terms of the number of nurses affected, is undoubtedly Ontario. A mid-Winter government announcement heralding limitations on increases in some areas, freezing of costs in others and actual cutbacks in other areas, was followed by the forced closing of up to 3,000 hospital beds. Estimates of the number of hospital personnel - the bulk of them nurses - who will be laic off range up to 5,000. The CanadIan Nurse May 1976 11 Both the Registered Nurses ssociation of Ontario and Ontario urses Association have reacted to e situation with public statements dicating their dissatisfaction with ,wholesale and arbitrary reduction of Il edS and staffing' as a means of utting health care costs and offering ) co-operate with the government in etermining means of providing less xpensive primary care and 'Iiminating duplication and waste in "xisting services. Approximately 4,300 persons are xpected to qualify for Registered urses' certificates in Ontario this 'pring. They will compete for fewer han 200 job openings. An overall eduction of 15 percent in admissions o schools of nursing in the province's ommunity colleges in 1976 has been nnounced by the ministry of colleges nd universities In the meantime, oris Gibney. assistant executive irector of the Registered Nurses o.ssociation of Ontario says, .'the 'ituatlon is really quite acute. Any penlngs that do exist are for highly ualified nurses.' She sees little hope Jf improvement in the sltuallon in the 'lear future. Juebec Jobs are a httle easier to find in Juebec than in some other provinces. ccording to an Order of Nurses of Juebec spokesman. who says that ;hortages still exist in some specific ueas - for example, long-term care nd positions in outlying areas. Some xodus of nurses from the province las been noted in the past year, owing Jartly to concern over provincial anguage requirements and salary :lifferential. Quebec nurses, whose ;alaries have been under official evew for the past year, anticipate a TIajor Increase soon to bring them :Ioser to the national average. lIew Brunswick \lew Brunswick Association of egístered Nurses president, Simone :ormier, reports: "In recent months he employment picture 10 New 3runswick has changed from one of eographic pockets of shortage to the )resent sltuallon of no extreme ;hortage. This can be mainly ttributed to the Immigration of Ontario nurses who cannot find positions 10 their own province. In filling our vacancies with Canadian nurses, we presently do not have a need for out-of-country nurses. The closing of 300 hospital beds In New Brunswick will have some impact on the nursing manpower situation. although many nurses will be absorbed into other units or hospitals. As an association, we do have some concern regarding employment opportunities for the upcoming graduates of our nursing schools. " Nova Scotia Registered Nurses Association of Nova Scotia personnel service consultant, Margaret Bentley, points to several factors affecting the current situation in that province. The number of positions available has dropped sharply under a system of restraints that includes the freezing of staff as of December 31 last year. By late Winter there were only 16 vacancies 10 the entire province, all but three of these at one hospital. Unemployment Insurance Commission benefits were being collected by close to 200 nurses (not including those on sick or maternity leave) oul of the total work force of 5,723 registered nurses in the province. In early spring, directors of nursing were being swamped with applications from outside the province - (chiefly Ontario). "If restrictions are lifted" according to the RNANS personnel services consultant. ..these nurses may get jobs before our students graduate in August. Our fear at the moment is that when these students graduate they will not get employment in N.S'- Prince Edward Island The Executive Secretary of the Association of Nurses of Prince Edward Island, Laurie Fraser, comments, "it looks as though there will be a few vacancies for nurses this summer. With the relatively small number of staff positions here to start with, and a small turnover rate, there really have never been a large number of positions vacant. and so far here, there have been no bed or staff cutbacks. I would suggest though that there will be no employment opportunities come Fall, as any summer vacationing staff will have returned and approximately 50 graduates of the PEl School of Nursing will enter the job market. Many will seek jobs in other provinces. " Newfoundland Newfoundland, which has traditionally been faced with severe shortages of health care workers, is now undergoing a complete reversal of this manpower situation, according to a senior official of the province's department of health. Although temporary shortages may be experienced in some areas during the summer months, he expects that by September there will be sufficient nurses available to staff all of the province's hospital and health services. In recent months there has been a noticeable increase in applications from nurses in other provinces and most hospitals report a record number of applications now on file. The recent announcement of plans to close 200 beds in 1976 (out of a total of 3,000 in the province) will also obviously affect employment opportunities in the coming year. Northwest Territories One cheerful note to end on: the registrar of CNA s newest member association, the Northwest Territories Registered Nurses' Association, points out that there is still a serious shortage of nursing manpower in the North. Canada's last frontier needs experienced nurses, capable of working with a minimum of supervision. A word of warning though. Accommodation is tight, unless you're single and willing to live in residence If you're interested, contact NWTRNA Registrar, Mary Lou Pilling, Box 2757, Yellowknife, NWT. Canadian nurses to partici pate in international seminar Six Canadian nurses will join seven colleagues from the United States and ten from the United Kingdom at an International seminar in London, England, this summer to compare professional developments and experiences in the three countries. The event is the third King's Fund Seminar of Nurses, organized by King's Fund College and held in London, July 19 to 23, Inclusive. Its purpose is to contribute to the personal and professional development of members of the seminar and, indirectly, to the nursing services in the countries they represent. A report of seminar discussions is also published. Canada will be represented at the meeting by: Lorine Besel, director of nursing, Royal Victoria Hospital, Montreal; Dorothy Kergin, associate dean of health sciences (nursing) Faculty of Health Sciences, McMaster Health Sciences Centre; Huguette Labelle, principal nursing officer, Health and Welfare Canada; Ada McEwen, national director, Victorian Order of Nurses for Canada; Helen Mussallem, executive director Canadian Nurses Association and Shirley StlOson, professor, school of nursing, and division of health sciences administration, University of Alberta. The central focus of the 1976 King's Fund Seminar will be on leadership. John Garnett, CBE, director of. the Industnal Society, will make the Introductory address on 'The Nature of Leadership." Three other related areas will be explored during the discussIOns and speeches that follow. These are: the definition of the role and responSibility of nurses for leadership in a health care delivery system; the emergence of leaders and the evaluation of leadership performance. The first King's Fund Seminar of Nurses was held in 1972. It was o ganlzed by King's Fund College as a direct result of its activities in the area of international exchange of health service personnel. Five Canadian delegales participated in the last seminar, held in London in July,1974. 12 The Canadian Nurse May 1976 Xe\\-s Ontario nurse-midwives hold annual workshop The many faces of the nurse-midwife in Canada today were the subject of a recent day-long meeting in London, Ontario. The meeting, which was attended by approx imately 100 nurses from southwestern Ontario, was organized by the London and Windsor chapter of the Ontario Nurse-Midwives Association. A highlight of the day was a panel presentation by seven nurses, each of whom is involved in a different aspect of the maternity cycle. Participants included a family practice nurse from a local medical center, a perinatal nurse from a hospital high risk center, a postpartum nurse, an OB nurse practitioner working in a doctor's office, an inservice coordinator in Obstetrics and Gynecology, a prenatal coordinator in a local health unit and a nurse who had worked in a northern nursing station. The coordinator of the panel was Mary Cameron of Women's College Hospital, member of the RNAO committee forthe expanded role of the nurse, and one ofthe organizers of the National Committee of Nurse-Midwives. The activities. roles and functions of the seven nurse-midwives as they described them for the audience, ranged from teaching and support programs for the mother and family before birth, through the actual delivery, up to and including care and support of the mother, baby and family after birth. Panelists stressed the need for increased continuity of care throughout the maternity cycle and greater involvement of the patient in the health team. Speakers also criticized the tendency in North American society to place undue emphasis on the relatively short time span involved in pregnancy and delivery, compared to the need to provide professional assistance and support throughout parenthood. Two speakers from St. Joseph's Hospital in London addressed the annual workshop: Dr. Paul Harding, chief of obstetrics and gynecology, discussed "Current Advances in Perinatal Medicine" and Dr. Michael Hardie spoke on "Infection in the Newborn. .. Coordinator of a panel discussion on Coping with Parenthood was Karen Kaufman, clinical specialist in maternal child health, McMaster University Medical Centre. Members of the planning committee included Ontario Nurse-Midwives Association members Gaie Haydon, Jan Archer, Mary Mansell, Kay McDonald, and Mary Monoghan. RNASC members to explore professional attitudes The Idea that the nursing profession acts as "the oppressed majority" will be explored in general sessions of the 64th annual meeting of the Registered Nurses' Association of British Columbia, May 12-14 in Vancouver. The concept being developed is that, while nurses make up a majority of the health care work force, they are dominated by smaller groups and exhibit behavior patterns similar to those of oppressed minorities. Committee chairman Jo Ann Perry of Vancouver emphasized that the situation could be affecting nursing care, since "our attitudes towards ourselves and others in the profession ultimately influence how we deal with our patients. If we are becoming alienated by the process, our delivery of care can suffer." The committee's object is to provide a "consciousness-raising" situation to focus members' attention on the problem. Plans for the general sessions include group discussions, a panel presentation and a short talk by a sociologist-anthropologist who would relate typical nursing behaviors to those of minority groups. Elections will be conducted for new chairmen of RNABC standing committees. Voting delegates will also consider resolutions submitted by districts and chapters, as well as a series of major constitution and by-law amendments. The proposed amendments would restructure the association by establishing a new Labour Relations Division, allow student memberships and change voting representation at future annual meetings. Edmonton group receives charter A Pediatnc Interest Group that has been active in Edmonton for the past two years recently became chartered as the first affiliate group in Canada of the Association for the Care of Children in Hospitals. The Association for the Care of Children in Hospitals is an , interdisciplinary group that focuses on the psychological and social aspects of the care of hospitalized children and their families. Their objectives are: . to seek better understanding of the emotional needs of children in medical settings, to foster their well-being, and to develop sound programs of comprehensive care which will support these children and their families; . to provide a common meeting ground for all those who are concerned with children and their families in such settings; . to foster high standards of training and competence in all professions working within the pediatric setting; . to focus the attention of all health workers and the community at large on comprehensive pediatric care; . to cooperate with other organizations and agencies having related purposes; . to stimulate and support research related to these purposes. Membership is open to all those whose professional training and/or professional position is related to the above objectives, ". " I , .... .. I i \\ lavoie Photo Enrg. For more information, write M. Culp (President), Royal Alexandra Hospital, Edmonton, or Barbara Geyer (Secretary), Charles Camsell Hospital, Edmonton. ICN asks nurses to describe conflicts The International Council of Nurses is calling for nurses around the world tc submit written contributions for its forthcoming book related to the ICN Code for Nurses. The contributions should be real-life descriptions of ethical conflicts they have experienced or observed. According to Adele Herwitz, executive director of ICN, "as we approach the 21st century, ethical conflicts are of ever increasing concern for the nurse. There is an urgent need for nurses to be strong in their beliefs basic to nursing as expressed in the ICN Code for Nurses This book will provide a unique opportunity for nurses of different languages, cultures and beliefs to share their experiences. Nurses neec to know they are not alone in the problems they face and by providinç ICN with real-life stories we can hell each other." Nurses are asked to describe ar event which illustrates an actual problem situation. The anecdotes should pertain to ethical issues, not legal problems which may be specifi, only to the laws in one country. The setting and activity may be with patients, with other nurses, with othel health professionals or assistants, 0 with organizations or societies eithe professional or nonprofessional. ThE nursing action may be direct patient care, or other activities involving interpersonal relations, teaching, administration or community or professional organization activities. Nurses should submit the descriptions to the Nurse Project Director, FNIFIICN Publication related to the Code for Nurses, International Council of Nurses, P.O Box 42, 1211 Geneva 20, Switzerland before 15 August, 1976. Writers of descriptions will not be identified in thE publication but names and addresse should be included in case correspondence is needed for clarification. I I J ight ... whenever the potential for infection i evident or where inhction is present [iìsofra-tuIIEf Bactericidal Dressing effective against both Gram-positive and Gram-negative infections of the skin-including pseudomonas Remai ns Active even in the presence of blood, pus and serum Soft pliable Not Messy the significantly increased lane-paraffin bas- is Just Right Indicated In burns ulcers wounds ROUSSEL Â Roussel (Canada) LId ILlée 1 '\3 Gr"vAlrne ÆiillIi1 14 The Canadian Nurse May 1976 Xf!\YH Smallpox eradication program almost certain to succeed Laboratories around the world are beginning to destroy their stocks of smallpox virus as the World Health Organization concentrates its campaign to eradicate the disease in the one remaining infected country, Ethiopia. Some months have passed since the last known cases of variola major, the most virulent form of smallpox, were reported, and the milder strain that is still found in Ethiopia exists in fewer than 60 remote villages. WHO officials hope these foci will be eliminated within six months. If they succeed in their goal of wiping out the disease by 1976, it will be the first time man has made a disease extinct. WHO began its eradication program in west Africa a decade ago Officials hoped to conquer the disease with a mass vaccination program aimed at immunizing 80 percent of the population of affected countries using jet immunization guns. This strategy was limited by the number of experts required to supervise such a massive campaign, and by some problems with the immunization technique. The guns frequently broke down and spare parts had to be sent to vaccinating teams, in addition, they were difficult for untrained vaccinalors to use. WHO simplified the technique by adapting a short, two-pronged needle originally used to immunize fowl against viral diseases. Then, while working in eastern Nigeria it was discovered, by accident, that the smallpox cycle could be stopped by immunizing only half the population if vaccinating teams concentrated on areas where the disease was most rampant. By emploYing a new strategy of detecting and concentrating on outbreaks and following up with a surveillance system to take care of isolated cases, WHO was able to wipe out the disease in South America, Indonesia, Pakistan, Afghanistan and 15 countries in western Africa by October 1974_ With this strategy, when an outbreak was detected, infected cases were quaran1ined immediately and individuals who had been exposed to smallpox were quickly vaccinated. The countries most recently infected with smallpox were Nepal, India and Bangladesh. But since October 1975, no new cases have been reported in any of these countries, and WHO officials believe that the disease has finally been stamped out in Asia. Now the only country left to control is Ethiopia, and the 202 cases that were reported in December 1975 were of a much milder strain. Death rates are only 1 - 2 percent compared with 20 - 40 percent fatality rates for variola malor. Confirmation that smallpox has been eradicated requires two years of active surveillance after the last known case. After this period, WHO convenes a special International Commission to visit the country and carry out on-the-spot investigations, before they declare the country officially free of disease. Dr. Halfdan Mahler, WHO Director-General. has said that if eradication of smallpox can be confirmed by 1978, new global agreements could then be reached concerning vaccination for international travel. It is estimated that world governments have contributed $85 million to WHO over the last decade for its smallpox program. Clarke Institute creates widows' self-help agency An outreach program 10 help the recently widowed cope with this crisis stage in their lives has been established in southern Ontano. The self-help program, called Community Contacts for the Widowed. was developed by the Community Resource Service of the Clarke Institute of Psychiatry in Toronto, as the result of studies indicating that the needs of the newly bereaved were not being met by professionals or the community. Research by the Clarke Institute and other agencies indicates that widows are a "high-risk" population, particularly vulnerable to psychological, physical and social problems. Young widows. for example, experience three times as many hospital admissions in the year following bereavement as other women of similar age. In one study, 36 percent of suicide victims had been bereaved within five years of thèir death, and, in another, widows experienced a 12 percent increase in mortality during the first year of bereavement. Statistics indiC'ate that one in ten Canadian women over 14 are widowed (there are 96,000 in the Toronto area). That their special needs are not being met by other community resources was demonstrated by the overwhelming acceptance rate (88 percent) when widows were approached and offered assistance in the Clarke Institute project_ Community Contacts for the Widowed, fashioned after the Institute's initial pilot project, will be an autonomous incorporated agency based in the community, and will serve Metro Toronto with a central office and four satellite clinics. Through the agency, the newly bereaved will come in contact with widowed people of similar ages who have resolved their own grief. The staff can offer advice for concrete needs (legal, financial, medical, etc.) and are prepared to provide ongoing emotional support. Discussion groups on problems encountered by the widowed, and opportunities for socializing are also offered. The program is staffed largely by volunteers who have come through a similar crisis and wish to help others In need. However, a small core staff, also widows, will be paid to organize and maintain services in the five offices. All staff, paid and volunteer, are trained by a team at the Clarke Institute. Enough money has been raised within the community to cover the first nine months of operation. Contributions have been received from a broad range of sources within the community. including major religious denominations, the insurance industry, trust companies, private corporations and Red Cross. IORC investigates role of traditional healers An In-depth study that will attempt to uncover the secrets of African traditional healers In Zaire and possibly integrate them into the country's health services has been announced by the International Development Research Centre In Ottawa. Traditional medicine in Zaire and, in fact, all of Africa continues to serve a far greater percentage of the population than does modern medicine. In spite of this fact, little is known about traditional healers - their methods, medicines or effectiveness. The research will take Into consideration all aspects of traditional medicine, from medication and anatomy to etiology and therapy. Data on some 250 healers will be gathered through interviews and direct observation for a period of one year Patients will also be interviewed and samples of the herbs used for treatment will be collected systematically and stored in an herbarium. Ritual groups function on the basis that the patient is possessed by a spirit, and all of them have in common the fact that a permanent relationship exists between healer and patient. The majority of patients are people who suffer from psychic problems. In each of the groups the patient can proceed through a series of initiations and experiences that eventually leads to graduation as a healer. Groups are largely run for and by women. The IDRC grant of $133,200 over 18 months provides for training of personnel, compensation fees for the healers, one-day study sessions, production of two films and the services of two consultants in the fields of anthropology and information sciences. Another $162,325 is being contributed by the National Research and Development Board of Zaire, which will carry out the work, Including a survey of all aspects of traditional medicine among specific ethnic groups in rural and urban settings and an analysis of three major therapeutic rites. GENEROUS NEW GROUP DISCOUNTS on all items Sh01NT1, f r group purchases. graduation f",. favors. etc. 6-11 Same Items, Deduct 10%; 12-24 Same Items, Deduct 15% 25 or More Same Items, Deduct 20% G Me r-------------------------------------. I IT'S EASY TO ORDER REEVES NAME PINS FOR YOURSELF OR FRIENDS! I I Choose style you want. shown rlpt. Print name (and 2nd bottom Igl'tt Attach e.-fr. .shter 'Of addibona1 pins I I ::: ' :S: tl:"::sb=t:Jo:nclC :t :r: : =SJ . DENTICAl PINS... .Drl cOIIY'nlent. I I I I LETTERING,______________________ 2nd lINE._______________ I I S1.,p I I IffiAl I MrTAl I BAtlgOUND I LEmRIN; I PRICES I I n DESCRIPTION COLOR FINISH :I COLOR E.,.....I LiltIÚl......2 I A T =; or DGoId B == Does D8lack 01 Pin 2.49 0 1 Pin 3.25 DootOM' combmlnø satin 0 Silver 0 Satin not D o u ue 0 2 PinS 3.99 0 2 Pins 4.95 oackground with pohshed edges. apply (yme narnr (wme nM'Ie, . PlASTIC LAMINATE.__sllrnmer Does . = I c:, &'ve to not Dof'der matche$ lettenne- apply IIII!a. METAL FRAMED ..ClaSSIC o Gold IIiir n th. ==t tCf;::e DSlfvrer aD MOLDED PLASTIC.. - Simple. smart. Does . . ono.n-Uf. win never discolor not Smooth rounded comers aoo edaes. appty Does DWhltl! +-E Black 0 I Pin 1.25 DIPI" J.85 no! 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No. CT-2 (Pilon Cld.l. . . 2.95 pr, TO: REEVES CO" Box 719, C, Attleboro, Mass. 02703 ORDER NO. ITEM COLOR QUANT. PRICE ---I Use extra sheet for additional items or orders. . I I . INITIALS IS desired: _ _ _ I TO ORDER NAME PINS, '''' out øll information in box,top 'efl. clip out and attach to this coupon. Please add 50C handlinl/posta.. I enclose S , on Drders totallinl under $5.00 No COD's or billinl to individuals. Mass re..dents add 3% S. T. I Sendto. .. Street .. . C,ty . State. ZIp. r 16 The Canadian Nurse May 1976 f alell(lal. May 26 - 28, 1976 Annual Meeting of the Saskatchewan Registered Nurses' Association to be held at the Coronet Motor Hotel, Prince Albert, Saskatchewan. Theme: "Expectations - Yours and Others." Guest speaker: Dr. Jerome Lysaught, Professor of Education, University of Rochester, Rochester, New York. May 31 - June 1, 1976 Sixth annual nursing alumni conference at University of Western Ontario, London, Ontario. Theme: Quality of living. Contact: Alumni Committee, Faculty of Nursing, Health Sciences Centre, The University of Western Ontario, London, Ontario N6A 5B7. May 31 - June 4, 1976 Bilingual Health Care Evaluation Seminar to be held at the University of Montreal, Montreal. All participants are expected to be able to understand both spoken French and English. Information from: Hélène Chauveau, Coordonnatrice du séminaire, Département d' administration de la santé, 2375, Côte Sainte- Catherine, Montréal, P. Qué. May 31 - June 11,1976 Habitat, United Nations Conference on Human Settlements to be held in Vancouver, British Columbia. For information, write: Enrique PenaJosa, Secretary General, Habitat, 485 Lexington Ave., New York, N. Y. 10017, U.S.A May 31 - June 11, 1976 Course in "Organization and Techniques of Rehabilitation Medicine" at the Calgary General Hospital offered by the Department of Physical Medicine and Rehabilitation and the Department of NurSing Service. Information from Director of Physical Medicine and Rehabilitation, Calgary General Hospital, 841 Centre Avenue East, Calgary, Alberta. May 31 - June 4, 1976 Multi-Disciplinary Pediatric Rehabilitation Course to be held at Ontario Crippled Children's Centre, Toronto. Information from: Norma Geddes, Education Department, Ontario Crippled Children's Centre, 350 Rumsey Road, Toronto, Ontario. June 2 - 3, 1976 Seminar: Health Administration Forum. To be held in Ottawa. Information from: Coordinator, Continuing Education Program, School of Health Administration, University of Ottawa, 545 King Edward Avenue, Ottawa, Ont., K1N 6N5. June 2 - 4,1976 Canadian Association of University Schools of Nursing annual spring conference with Learned Societies is to be held at Laval University, Quebec, Que. Theme: a creative approach to aging. Contact: Colette Gendron, Program Chairman, School of Nursing, Laval University, Pavilion Comtois, Quebec P.Q. G1 K 7P4. June 3 - 4, 1976 Fourth Nursing Pharmacy Workshop to be held at Red Deer, Alta. Theme: Cardiovascular Disease and Patient Management. Information from: Continuing Nursing Education Division of Continuing Medical Education. Clinical Sciences Bldg.. University of Alberta, Edmonton, Alia. T6G 2G3. June 14 - 17, 1976 Workshop on the borderline student nurse to be held at University of Western Ontario, London, Ontario. Information from: Summer School and Extension Department, University of Western Ontario, London, Ontario N6A 5B8. June 16 - 18, 1976 Annual convention of the Canadian Hospital Association to be held at the Chateau Laurier, Ottawa, Ontario. Information from: Canadian Hospital Association. 25 Imperial Street, Toronto, Ontario, M5P 1C1. June 19, 1976 Kitchener-Waterloo Hospital reunion for Class of 1966 Information, from Hilary Bowers 196 Lyndhurst Drive, Kitchener, Ontario, N2B 1 C1. October 27 - 29, 1976 Annual general meeting of the Order of Nurses of Quebec to be held at the Queen Elizabeth Hotel, Montreal. 11I1)tlt continued.. Slip in time... There is one mistake in the article on Halifax (February, 1976) which I rather object to as it was not written this way in my copy. It is not "The Order of Good Cheer" - it is ''The Order of the Good Time" - this is the official name. I like the new format it's quite exciting and immensely different - almost takes a bit of getting used to. I particularly liked your January editorial! and I do hope you're having fun. - Dorothy Miller, Public Relations Officer, Registered Nurses' Association of Nova ScOtIa. Death with dignity Much has been heard recently, on T.V. and in the newspapers, about an individual's right to "die with dignity" There is a great difference between positive euthanasia and passive euthanasia; the latter is simply the withdrawal of extraordinary treatment, without which the patient would die a natural death with nature taking its normal course. The answer may be to have those who wish to do so write out a statement to the effect that if ever their life reached a point where it must be artificially sustained by extraneous mechanical means then they would wish to be allowed to die with dignity and peacefully.... - Alice Tester, R.N., White Rock, B.C. 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 Please complete appropriate category Postal Code/Zip o I hold active membership in provincial nurses assoc reg. no./perm. cert./lic. no. o I am a personal subscnber Mail to: The Canadian Nurse, 50 The Drivewav, Ottawa K2P 1 E2 PROTECTIVELY! .. , -.. . ... '\.-- , toe; , "-- ..... IVAC 230 Controllers Detect Most Infiltrations and Provide the Best Possible Patient Protection All medical-surgical LV.'s can be made safer, more accurately. New IVAC 230 Controllers provide unexcelled protection to any patient receiving an LV. Ideal for med-surgical floors where nurses cannot be with patients every moment. Protection is constant. Even when the patient is being transported, battery power provides uninterrupted coverage. This eliminates the fear of runaway LV.'s and the time consuming re-adjustments neces- sary when using only the LV. set clamp. Compact new IVAC 230 Con- trollers make it easier than ever to insure correct medication.,. not underdose or overdose. . drop rate selected is maintained. COST JUSTIFIABLE! Because tissue infiltrations are detected and most re-starts eliminated, the patient receives better medical care and at lower cost. Most hos- pitals find that the cost of additional sets used in re-starts alone, pays for the modest investment in the IVAC Controllers. Give your patients this reliable protection soon. Ask to see the new IVAC 230 Controller with built-in battery for uninterrupted protection. .Coggin, S Modern I.V. Technology Modern HospItal. March. 1973 IVAC DJ;;;; ; S TE ; :." 47 Baywood Road, Rexdale (Toronto) Ontario M9V 3Y9 IAi1 \ 7Aa_ 111 ... T......I........... ,c:,c:1., 111 , \ .. = - . J 2 0 . , \ '# . ) " -- ./' \.. 7 " , ..... -....... "-- --... I 0) . ) l) The 'Littmann' Series Portfolio of A. Y. Jackson drawings Free with your order Reproduction of A. y. Jackson drawings by special permission of the McMichael collection. Littman @ STETHOSCOPES · · · tru Iy the fi nest stethoscope a nurse æn own The Medallion Combination Stethoscope The highest quality bell and diaphragm chest piece, the stethoscope for nurses who practice in critical care areas. Choice of five tubing colours - goldtone, silver tone, blue green and pink. The Medallion Nursescope Colour co-ordinated in five jewel like colours. This stethoscope was especially designed for the nurse. Weighs only 2 oz. and fits neatly into uniform pocket. Group Purchase Package Your local selected surgical supply dealer handles the complete line of'Littmann' stethoscopes and will offer discounts on group purchases of five or more. Write us today! for complete details on: D The 'Littmann' stethoscope line D The Group Purchase Package D The 'Littmann' Series portfolio D A list of selected 'Littmann' dealers 3m (ANAD O ; I 3m POST OFFICE BOX 5757 LONOON ONTARIO N6A 4T1 - The Canadian Nurse May 1976 19 TRANSPORT OF NEONATES - a :matter of prevention Transport of the sick neonate by personnel unaware of his special needs may render the journey so hazardous that all efforts at the referral hospital become futile. The authors demonstrate that careful nursing and adequate preparation before and during transport can minimize the risks inherent in such a journey. Moya Johnson and Jamce Gash Moya Johnson, R.N.. B.Sc.N., is clinical instructor in neonatal nursing and Janice Gash, R.N., B.Sc.N., is research nurse in neonatal transport at The Hospital for Sick Children, Toronto, Ontario. Moya Johnson --..... Every year, approximately 12,000 "high risk" infants are born in Ontario, many of them in hospitals without facilities for the necessary intensive medical and nursing care. If they become critically ill, these infants must make a potentially hazardous journey to a neonatal intensive care unit In another facility. The story is the same in other provinces. Some units have a transport team (usually consisting of a neonatologist and a speCIally trained nurse) and are equipped with a transport incubator, cardiac and temperature monitors, and complete resuscitation equipment. The team tries to stabilize the baby's condition before transportation, and provides intensive care throughout the journey to the referral center. Unfortunately, few isolated areas and not all cities have access to such transport teams, and in some Instances there is no one with experience in neonataology who can accompany the sick infant. Also, a team may receive more calls than it can handle at a given time or, because of bad weather, may be unable to reach the infant. It happens sometimes, then. that a nurse with no neonatology training has to care for a sick newborn Infant before and during his transfer to a referral center. 1 This makes it essential that all nurses in outlying hospitals with maternity beds be aware of the special problems of the sick newborn 1 2.3 and of the measures necessary for their safe transport. All too often there is a temptation simply to place the critically ill neonate in an incubator and dispatch him as quickly as possible - a well-intentioned but misguided approach. 1 ThIs report provides some guidelines for nurses to help them understand the special requirements of sick newborn infants. The nurse should first of all obtain all available information concerning the infant in her charge - not only the disease or defect from which he suffers (its pathophysiology and possible complications) but also the maternal and family history, the gestational age, and general condition. Ideally, the nurse should have had previous contact with the baby. -- . ...;.-- Jamce Gash Thermal control It is of paramount importance to prevent loss of heat in the newborn. He produces heat by body metabolism and muscular activity and cannot shiver in response to cold, so must rely on nonshivering thermogenesis for heat production. This involves energy generation in brown fat (a highly vascular deposit of fat chiefly between the shoulder blades and around the neck). This tissue's ability to produce heat as a metabolic adaptation to cold is greatest in the newborn. However, the greater the demand for ItS activity the more quickly It is depleted. 4 Because illness depletes his energy. depressing his metabolism and decreasing body activity, the newborn may be unable to produce enough heat to maintain his body temperature,S Cold stress is traumatic, even life threatening. Mortality rates in small, premature infants increase markedly with each degree of temperature loss1.4 hence the importance of preventing heat loss. Heat is lost from the body through conduction (to a colder obiect in contact with the body), evaporation (fluid changing to vapor on the body surface), convection (to cooler air currents), and radiation (to a cooler, solid object not in direct contact).s In an air-conditioned case room or nursery, an exposed, wet, sick baby can lose a great deal of body heat very quickly Heat loss can be prevented in several ways, as shown in Table I These techniques do not, however, increase an infant's temperature, but only minimIze loss of body heat. Therefore, heat shields, Saran. bubble plastic, blankets, and foil should be used only on warm babies. Cold stress may result in the following complications: . decreased energy stores, leading to an increased likelihood of hypoglycemia: . decreased activity of enzymes concerned in production of surfactant; . increased oxygen consumption; . Increased metabolic acidosis, if there is accompanying hypoxia or shock; . increased risk of kernicterus in jaundiced infants: . increased risk of hemorrhage. Before transit: If efforts to prevent cold stress have been unsuccessful. measures must be Instituted immediately to rewarm the Infant A normothermic environment during transfer 20 The CanadIan Nurse , ay 1976 ----- enhances the chance of survival, and is much easier to achieve with proper equipment at a base hospital before transit. In view of the survival factor, the extra time taken to rewarm the infant before transit is not wasted. A radiant heater provides the most effective and safest means of rewarming a hypothermic infant. Many commercial models are available, most of them servocontrolled. The temperature gauge should be adjusted to about 1 0 C - 2 0 C above the infant's skin temperature. Rewarming should proceed slowly; too rapid rewarming can result in apnea and shock. An incubator is used in conjunction with radiant heat as neonates are less able to absorb heat by convection. An incubator may be used alone for a slightly cold baby whose temperature is 35.5 0 C - 36.0 o C.The servocontrol should be set to maintain skin temperature at 36.5 0 C. If the incubator is in a cold room or near an outside window much of the infant's body heat may be lost by radiation through the incubator shell; hence the temperature of that area of the nursery or case room is important. During transit: The transport incubator must be preheated (Table II) and must be capable of maintaining the appropriate temperature (in accordance with baby's weight) by its own power source. A specially designed model is the apparatus of choice. Nursing procedures should be carried out through the portholes, to minimize escape of heat. Bubble plastic is an ideal insulator for transport, permitting a clear view of the infant. When warmed blankets are the only available means of conserving body heat, the nurse must be even more vigilant to compensate for limited access and visibility. J ' --- . ,}-/- ! t1 rr . ...., -1 I l , 0. I .\ ;.\ ., r Figure 1 - Transport incubator with power source for light, heat and air-flow, as well as independent oxygen source. , ... - Figure 2 - Rectal temperature of baby is checked while he is lying on bubble plastic. Note open N /G tube in place and suction mucus trap at hand in incubator Figure 3 - Nurse and baby ready for transport. Note: I. V. on pole with I. V. 'Holter' pump for continuous infusion; oxygen analyser; adjustment of temperature control; baby wrapped in bubble plastic with N /G tube in place. Nurse, with stethoscope around her neck, holds case containing emergency equipment. i 1 .. -' I -.(\-' - ---=:-- ,. "- /" .... '11> t ",. ia, . '- "-- -- - .\ '\.. , 1 - " . . - 4 \ :... ' The CanadIan Nurse May 1976 21 Respiratory care Airway: Maintenance of a clear airway is ssential. Most infants require only gentle ,Llctionlng of accumulating mucous ecretions: but some may need intubation, :ither prophylactic (in case of apnea) or for :3spiratory complications. The endotracheal Jbe should be securely taped to maintain its 'roper position, and suction catheters should ,e used to maintain its patency. Air entry is Ihecked regularly with a stethoscope, over oth lung fields. If the breath sounds are I iminished, the chest does not visibly inflate: 'r if cyanosis develops, the tube may be out of .osition or (rarely) blocked. Vocal sounds from ,e infant will indicate that the tube is not in the 'achea. If you think the tube is dislodged, 9move it, and continue ventilating by mask. If 'ou think the tube is blocked. suction it. Since the motion of the ambulance could :ause the infant to aspirate his stomach 'ontents, the stomach must be emptied before Ie leaves hospital. Jxygenation: Having established that the iirway is clear, the nurse should attend to Jxygenation. The inspired oxygen :oncentration may need adjustment in infants Nith respiratory disorders. Hypoxia insufficient oxygen to the tissues) can result in ,"ocal necrosis and permanent brain damage, ,-iyperoxia (too much oxygen) can cause ::>Iindness in premature infants by disrupting normal developmental patterns of the retinal iblood vessels, Accurate assessment of individual oxygen needs is the only sure way to prevent deleterious oxygen effects, An arterial 02 pressure (POl) in the range of 50 - 70 mm Hg IS ideal for term or premature neonates. If blood-gas measurements are unavailable, the infant's color can be used as a rough guide. The flow of oxygen (liters per minute) is at best unreliable, as the 02 concentration (the amount breathed) will vary with leaks, the amount of ventilation, type of equipment, and method of administration, The 02 concentration required for each patient must, therefore. be determined. and the actual value must be measured and maintained at this appropriate level. A guide for oxygen administration. if blood gases are not known, is as follows; 1 Place the infant in 40 percent oxygen and assess his color. 2 If he is cyanotic, increase 02 concentration by 10 percent increments until he becomes pink: then reduce it by 5 percent. 3 If he is pink in 40 percent 02, decrease by 5 percent decrements until cyanosis appears; then Increase by 5 percent. It should be borne in mind that oxygen requirements may change during transit. Therefore, constant evaluation is necessary until arrival at the neonatology unit (an 02 analyzer is a valuable aid). Table I Methods of Limiting Heat Loss Equipment and Method Function Incubator ProVIdes flow of wanT! air Process leading to heat loss Convection Environmental humidity Reduces loss of fluid from body surface Evaporation Drying EvaporatIOn Prevents heat loss from evaporation of amniotic fluid Heat shield (Plexiglass) over infant inside Incubator Decreases heat radiation through incubator shell: insulates the infant Radiation and convection Bubble plastic. double- layer plastic wrap Insulates the infant Radiation and convection Saran: sll1gle-layer plastic wrap Prevents liquid -+ gas change at body surface Evaporation Warm blankets, aluminum foil Convection and radiation Insulate the infant (N.B.: Impair view of the infant; therefore. of limited value) Heating pad, hot water bottle Conduction WanT! surface In contact with baby (N.B.: May cause bums if temperature dIfference too great) . Aorcap. Bren' Manulactunng lid.. Mahon. Ontano Table II Incubator temperature during transport of sick neonates Body wetght "C Incubator temperature- 1,000 g 36 - 37 1,001 - 2,000 g 35 - 36 2,001 - 3,000 g 34 - 35 . Temperatures bted are gUK!e'nes only. Rectal temperature should be lTIOI'I,to,ed every 10 to IS monI.Ces, and \he ,"cubator temperature adjusted accordingly 22 The Canadian Nurse May 1976 ' - Ventilation: Even though an infant breathes spontaneously and is appropriately oxygenated, he may not be properly ventilated because, in addition to inhaling oxygen, he must exhale carbon dioxide. Rapid, shallow respirations are less effective than regular, deep respirations in ridding the body of CÜ2, and a decreased respiratory rate may create a buildup of C02. Since breathing uses energy, a tachypneic infant is more likely to tire. and may even become apneic. Rates of 40 per minute for a term Infant, and 40 to 60 for a premature one, are appropriate. Rates over 100, or less than 30 per minute, which are likely to be inefficient. may be supplemented with intermittent bagging (e.g., for tachypnea, bag for 5 minutes each half hour). When the rate is markedly diminished, bag continuously at 40 - 60/ min in conjunction with respirations. Before bagging by mask, aspirate the stomach with an orogastric tube, which must then be left open and in place to allow for decompression of accumulated air. Observe the infant for other signs of respiratory distress, such as grunting, indrawing, and flaring of the nostrils on inspiration. These, m addition to tachypnea and cyanosis, are signs of lung disease; record the time of onset, degree of severity, and change. Apnea: It is normal for neonates to breathe irregularly. However, cessation of respiration for longer than 20 seconds and/or accompanied by bradycardia, with or without cyanosis, is considered to be apnea and requires treatment. Apnea may be due to many factors, including overheating, immaturity, neurologic damage or depression, airway obstruction, C02 retention and hypoxia, hypoglycemia, or sepsis. 6 If an infant stops breathing, he may respond to stimulation during the first 20 - 30 seconds of apnea. Stroke the abdomen gently and flick the soles of his feet. If there is no response, quickly suction the naso- and oropharynx. In addition to removmg mucus, this may stimulate a gasp, followed by resumption of respiration. Suctioning must be brief: if prolonged it may result in hypoxia and pulmonary collapse. 2 If there is still no response, ventilate the baby with a bag and mask at 60 per minute with the requisite oxygen concentration. Give 5 or 6 inflations: if the color has improved and the heart rate is not below 120 per minute, pause to see if spontaneous respiration is resumed. In the continued absence of respiration, continue bagging and stimulating until respiration begins. ,t ........- - - , ... - , -.: ... , ......J- . \- " --- ,. r . , ) - -r -" 't f 1]1?' .""'. -.- . ... ...... ...ç l ....- - ì .Î ;- .- ":- ..... ./ --' Figure 4- Nurse adjusts oxygen flow on transport incubator as incubator stand IS lowered to fit into ambulance. Metabolic homeostasis Hypoglycemia: Low blood sugar i n infants is most common in those who are small for date and/or premature; cold-stressed, septic, and asphyxiated; babies of diabetic ortoxemic mothers; and those with Rh incompatability. A glucose level of less than 40 mg/dl, especially if giving rise to symptoms, may result in irreversible brain damage. Therefore, it is wise to check the blood sugar level with a heel-prick Dextrostix (Ames Laboratories) or a laboratory test before transport. The infant should be observed for signs of hypoglycemia, including: - jittery state, twitching, convulsions, exaggerated Moro reflex: - apathy or lethargy: - apnea and/ or cyanosis; and - poor feeding, decreased sucking reflex. If intravenous therapy is given to correct hypoglycemia, the flow must be kept constant. A battery-powered LV. pump will help to achieve this Acid/base balance Events such as hypoxia, hypothermia, hypercapnea, cold stress and hypoglycemia, and conditions stemming from inborn errors of metabolism, may alter the blood pH. This may severely disrupt the metabolic activity of cells. Therefore, it is important to stabilize the acid/base balance before transport and to try to correct or treat the underlying cause. (Normal blood-chemistry values are given in Table III.) Fluid balance and Intravenous therapy It is dangerous to overload the circulation with fluid, which can easily happen in a small, premature baby when the I.V. line is unobserved for even a short while. The fluid requirement for a newborn or premature in the first 2 to 3 days of life is approximately 75-150 mllkg of body-weight per day (for a 1 kg baby the LV. rate should be 3 - 4 ml/hr). It is difficult to maintain an LV. drip in a moving ambulance due to motion. lack of height for the pole, and the patient s activity. The LV. line must be securely fastened, and the site visible for assessment. This line may be invaluable for emergency administration of medication, both in transit and on arrival in the unit, henæ it must remain functional. The Canadian Nurse May 1976 23 Ambulance and equipment The ambulance should have its own p-'IIer source, unaffected by engine r.p.m. (12 t DC battery is best). The cab must be -tted to at least 26 C before the Incubator is :::ed in it. Heat turned on at the time of p -up is ineffective, as the cool Inside walls of > ambulance permit loss of radiant heat. The gen and suction facilities must be in rking order. The transport Incubator has specific wirements. It should have its own power urce for light, heat, and airflow and also an ependent oxygen source for use between lbulance and hospital, or when the lbulance supply has been depleted. The bulance power supply must be used for the Jrney as most Incubator batteries have a serve of only 1 - 2 hours and take many furs to recharge. The Incubator should be ed with a thermometer and thermostat ntrol. The light source must be adequate for ar observation of the infanfs color and nditlon; this can be supplemented by using a ong flashlight. The nurse requires a good working lowledge of the incubator, including how to mtrol the 02 concentration in the baby s wironment. Dunng transport, the baby must ? securely strapped down within the cuba tor. The best Incubator is only as good as its erator. Every transport should be provided with a It containing 1) bag. 2) mask, 3) lucus-collection trap and suction catheters, ) stethoscope. 5) thermometer. 6) oxygen nalyzer. and 7) flashlight. The quality of care enhanced if, in addition, the kit contains rugs for emergencies and an LV. pump. Special conditions Certain conditions warrant additional reparations for transport: neumothorax: A chest tube is imperative, referably attached to a one-way safety valve -teimlich valve, Bard Parker Co., lutherford, N.J.. U.S.A.) or underwater seaL It luSt not be clamped. I/aphragmatic hernia: The Infant s head and lJnk should be elevated, to relieve thoracic ressure. Since gastric distenSion would Icrease intrathoracic and embarrass spiration, an open oro- or nasogastnc tube j mandatory. Endotracheal intubation is commended in case ventilation is required in 'ansit, as mask ventilation increases gastric istension. 'hoanal atresia: An oropharyngeal airway. ecurely fastened In place, IS essentlal: rachee-esophageal fistula: (In 95 percent of ases a fistula joins the lower esophagus to the achea). These infants should be placed pnght, sothat gravity will prevent aspiration of Table 1/1 Normal blood chemistry values in the newborn Blood pH 7 34 - 7.45 Pa02 (mm Hg) 50-70 aC02 (mm Hg) 35 - 40 HC03 (mEq/liter) 19 - 22 Base excess -4 to +4 Blood sugar (mg/dl) Serum calcIum (mg/dl) 45 - 115 8 - 10 Serum electrolytes (mEq/Uter): Na, 140; K, 4; CI, 100-105 gastric contents Into the lungs. The upper pouch must be suctioned continually: this can be readily accomplished with a feeding tube and syringe. 2 Exposed abdommal or neural contents ( omphalocele. gastroschisis, myelomenglngocele, and bladder extrophy): Wrap the defect in warm, sterile. saline dressings, and further cover it with plastic wrap to prevent drying. (Vaseline gauze is not advised). Treat the entire infant with sterile technique (gloves, sterile linen. etc.). Nursing memo Before departure. 1 Ensure that the infant s identity band is securely attached and that the details are correct. 2 Check that you have the following documents: - maternal and family history (the neonatology unit may supply speCIal transport forms for referring hospitals). - maternal and cord blood (5 ml of clotted blood of each speCImen). I '1, . l' . I .... ---- -- , þ ...;1 \ ..r-f ....- I, "- I' . \ ,... \. ,.. ,I ....;-'" ... - I \ "- ( / Figure 5 - Nurse plugs incubator power line into ambulance power supply. 24 The Canadian N ur5e May 1976 - test results, radiographs, and so on. - photostats of nurses' notes and doctor's letter. - signed parental consent 3 Scrub hands and arms for 3 minutes before handling the infant. 4 If there is time, talk with the parents and allow them to see and touch their baby: your reassurance at this time will do much to allay their fears about the baby's illness. 5 Just before leaving, check: . Infant - clear airway; appropnate 02 concentration; correct body temperature; empty stomach; correct blood chemistry; and treat special condition(s). . Equipment - incubator; ambulance; emergency equipment; and oxygen supply. . Full data on baby and mother, and blood samples. During transport: If preparation is carefully carried out. the infant will be in a relatively stable condition and transit should require no undue haste. Upon entering the ambulance, adjust the voltage control and plug in the incubator to the ambulance power outlet. Change the oxygen source from the incubator to the ambulance cylinder and analyze the concentration. Observe the baby's condition, color, and activity and record his body temperature. Check the LV. flow rate and infusion site. After this initial review, the journey can begin. Throughout transit the nurse must constantly observe and monitor for changes in condition, take appropriate action, and record vital signs and other pertinent information. Lighting may be inadequate for accurate assessment, and noise levels may preclude adequate monitoring of apical heart rate and air entry. If uncertain of the baby's condition, ask the driverto halt the ambulance at the side of the road for as long as necessary. If medical advice is required Or a medical emergency occurs. use the ambulance radio to contact the referral Unit or instruct the dnver to proceed to the nearest hospital. If possible, inform the neonatology unit of your impending arrival, and the infant's current condition, via the ambulance radio. On arrival: However brief the journey from ambulance to ward, there must be continuity of observation and care. The incubator power and oxygen should be used; all necessary eqUipment should be available; monitoring should be continued. The transporting nurse should remain in the referral unit for a short time, to answer questions about the infant's history and his condition during the journey, and to obtain information for the parents and referring doctor. ;j , . , " t -....:, . " ^ . T .. Figure 6 - "Hope" bag and mask applied over baby's face for ventilation. Note bubble plastic, N IG tube open to allow for decompression of the stomach. Conclusion Special requirements and precautions are necessary for safe transportation of sick newborns. With proper care, further deterioration in a sick infant's condition during transit can be avoided. In fact, with proper attention to apparently minor details, the nurse will, in many cases, be rewarded by seeing her patient's condition improve. References 1 Chance, G. W. Transportation of sick neonates, 1972: an unsatisfactory aspect of medical care, by... et al. Canad. Med. Ass. J. 109:9:847 -851, Nov. 3, 1973. 2 Segal, Sydney ed. Manual for the transport of high-risk newborn infants: principles, policies, equipment, techniques. Sherbrooke, P.O. Canadian Pediatric Society, 1972.198 p. 3 Klaus, Marshall H. ed. Care of the high-fisk neonate, edited by...and Avory A. Fanaroff. Toronto, Saunders, 1973. Ch. 6. Transportation of the high-risk infant. p. 90 - 97. 4 Cardasls, CA The effects of ambient temperature on the fasted newborn rabbit, by...and J.C. Sinclair. I. Survival time, weight loss, body temperature and oxygen consumption. BioI. Neonate 21 :330-346, 1972. 5 Lutz, Linda. Temperature control in newborn babies, by...and Paul H. Perlstein. Nurs. Clin. North Am. 6:1 ;15-23. Mar. 1971. 6 Segal, Sydney. Oxygen: too much, too little. Nurs. Clin. North Am. 6:1 ;39-53, Mar. 1971. The Canadian N..... May 1976 25 connC!ction Jo Logan The Handmaiden is NOT Dead "Ie handmaiden is not dead, despite what )u read in current nursing literature. She is ive and well and residing in the hearts of 'ost physicians. This fact presents a problem "many new graduates, who are unaware of e discrepancy between how nurses think 'ey should practice nursing and how hysicians think nurses should nurse. lost physicians still feel the word nurse and le word handmaiden are synonymous. Jhether this fact is openly admitted or not, it ecomes obvious - often painfully so - to ny nurse who tries to slip out of her traditional :ìle while working in a traditional setting. She ; faced with a reaction on the part of the doctor :'hich ranges from frank outrage to ondescending amusement. Not only does the ,hysician emphasize the technical skills of the urse but he frequently and openly blocks any ,f her attempts to function in a way other than ,hat he considers to be her traditional role. "his difficulty will increase as nursing !ducation and nursing service continue to nove toward a different type of nursing based In the belief that nurses have a major 'ontribution to make to the health care of this 'ountry . Because of current and future changes in lurslng practice, nursing educators have nade necessary revisions in the curriculum md many traditional attitudes and skills have >een replaced. One concept that has been trapped from nursing education is that of 'handmaidenism." At first glance this would .eerT1 to be a step in the right direction but ithout the attitudes and skills of the landmaiden, the new graduate cannot play he "doctor-nurse game"l that is necessary for ;urvival in most work situations. This is specially true in hospitals, where most new Jraduates begin their career. Stein describes an important aspect of the joclor-nurse game as follows: "The nurse is to >e bold, have initiative, and be responsible for naking significant recommendations, while at he same time she must appear passive."2 I/urses are being taught 10 make judgments md act on their own conclusions but they are 10 longer taught the need to be passive. - Combine this change with the effects of the women's movement, and the result IS a new graduate who thinks of herself as a novice on the health team but with an equal and unique contribution to make as a nurse. Immediately, the novice practitioner must work with a physician who has a very traditional frame of reference regarding the nurse. The new graduate is quickly aware of how much she needs the doctor in an acute care situation but she does not know the rules involved in keeping this relationship functioning smoothly, This fact was clear during a recent orientation program this writer attended. Three-quarters of a group of new, two- and four-year graduates had had a confrontation with a physician before the three-week orientation was finished. They expressed astonishment because they did not understand where they had gone wrong. In most cases the difficulty stemmed from their inability to play the doctor-nurse game; they were just not aware of the nurse in a handmaiden role. Just as the neophyte becomes aware of her dependence on the physician in the clinical setting. the experienced nurse becomes aware of the power held by the physician in most institutions. If nurses must rely on physicians, then it seems prudent to consider their frame of reference. Any changes made In nursing practice will be slow, hard-fought gains until the relationship between the nurse and F. Jo Logan (R.N., Ottawa Civic Hospital: the physician changes. B.Sc.N. Ed., M. Ed., University of Ottawa) is Obviously the change in this relationship" teaching part-time at the Ottawa Civic should be initiated by experienced registered Hospital and at Algonquin College School of nurses, rather than new graduates. The Nursing. .. priorities of the novice are different, and revolutionizing nursing practice is not necessarily high on their list. The inexperienced graduate does not have the self-assurance of the seasoned nurse nOr the credibility so necessary to work any changes with physicians. It is difficult to change the rules of a game if you cannot play the game. There are a few examples of physicians and nurses cooperating to change the rules of the game 3 but these models are rare. Most of the changes will be accomplished in a less direct manner by experienced nurses who play the game skillfully but are aware of the limitations of this relationship and consciously set goals for a new type of nurse-doctor interaction. The efforts of the experienced nurse, supported by the Impetus of other social forces 4 will create a new and, hopefully, more honest relationship. Considenng that nurses need physicians, and that it is unlikely the new graduate will be in a position to change the nature of this dependence, nursing educators must retain handmaiden skills in the curriculum until they are not so urgently required. I do not suggest that a formal course "Handmaiden 204" for three credits be offered or that this concept slip back into the hidden curriculum, but certainly students should be made cognizant of these attitudes and skills. The handmaiden should be presented, not as a way of life, but as a skill to be utilized until it is no longer necessary. To ignore this need and assume that nurses can practice in a nontraditional way without first changing the nature of the nurse-physician relationship is naive. The handmaiden must disappear forever but this can only happen gradually as nurses evolve their new role to replace her. References 1 Stein, Leonard. The doctor-nurse game. Amer, J. Nurs., 68:1 :101-5, Jan. 1968. 2 Ibid., p. 101. 3 Thomstad, Beatrice. Changing the rules of the doctor-nurse game, by...et al. Nurs. Outlook, 23:7:422-7. Jut 1975. 4 Hoekelman. Robert A. Nurse-physician relationships. Amer J. Nurs.. 75:7:1150-2, Jut 1975. 26 The Canadian Nurse May 1976 WHAT DOES"THE QUALIT For criminologist Marie-Andrée Bertrand, truth is at the center of life. This year, the Canadian Nurses Association is encouraging serious thinking, and - who knows? - possibly even action on the "quality of life" in Canada. This is a vast concept; it is also a subject which is very difficult to gauge precisely and one which each person must deal with on his own terms. Indeed, sociologists, economists and political scientists have recently identified several scores of possible "quality of life" indices. These are factors which may be termed meaningful scientific or statistical clues in which some confidence can be placed when considering the notion of quality of life, in a given and related sociocultural context. In fact, there are economic indices, such as average annual income compared to a cost-of-living index. There are social indices, such as the organization of human and work relationships. Political indices may include, among others, strength of democracy, and power of individual and group expression. It is through these types of factors that members of one society can be judged to be living in more human conditions than members of another society. After all, "quality of life" involves those conditions of existence which let us be more human, more totally "ourselves," to be more involved citizens, and to be the most competent and professionally efficient individuals we possibly can be. Some years ago I had the pleasure of teaching members of your association on several occasions. It is in the context of these earlier and very enjoyable meetings, that I remember who you are, what your way of life is and what your problems are - so that I am in a better position to discuss the quality of life with you. Of course, my own current interests also have a bearing on these considerations. I refer specifically to the four years I spent as a member of the Federal Commission of Enquiry into the Non-Medical Use of Drugs, an experience which will, I hope, tie in with some of your own medical interests as they relate to the quality of life. In addition, as a criminologist, I will be referring to certain conditions of mankind - of equity, of justice -which I feel must be redefined in order to become more meaningful in our society. At the Le Dain Commission, after three years of hearings in 100 Canadian towns, three years of research, meetings and writing and editing, I finally came to understand the reality that 80 - 85 percent of all known diseases have no known cure and that doctors are too often satisfied with recognizing symptoms and relieving them. I also learned that several drugs which the Canadian population consumes by the ton (like drugs with a codeine base) or by the hundreds of thousands of pounds (barbiturates, minor tranquilizers) are just as dangerous as the so-called illicit drugs such as cannabis. I saw the representatives of the major pharmaceutical companies come to defend their Valium and their Librium, overthe products of other companies, assuring the Commissioners that their tranquilizers have fewer side effects than the others, and present less risk of creating tolerance and drug dependence. In an intensive study situation such as this, the quantities of lies and half-truths that were discovered day after day shocked me. For me, the quality of life in the health field is related to truth. It is related to the truth about the relative impotence of medicine; about the effects of drug therapy; about the fact that certain diseases are fatal: about the necessity of suffenng, which cannot always be avoided. The quality of life of certain women I know who drag out their neurotic anxieties in psychotherapy, in depression, certamly IS very poor. I do not think that they are truly alive. These women are trying not to see what they are and trying not to die. On the other hand, as a criminologist and in a different but not completely dissociated field, in my work on civil liberties committees, I have been especially concerned with the definition of crimes. When I say that I agree with the Criminal Code of Canada that murder is a very serious crime, I certainly am not saying that murder is the only serious crime. As I see it, racism, sexism, exploitation of the poor. and air, water and noise pollution are all extremely serious crimes, as senous as murder and much mOre serious than offences against property. Indeed, humans can be left with physical well-being, even after they have been deprived of their dignity through racism; their autonomy and freedom, through sexism: their chances for a decent life, through exploitation of the poor; or their environment, through pollution. As long as the attitudes of those who are engaged so ferociously in the selfish pursuit of unbalanced priorities remain so static as to exclude real crimes like thes from our criminal laws and our value system the quality of life certainly will continue to be myth. Compared with the immense social injustices noted above. nonviolent theft can hardly be considered a misdemeanor, yet, thieves are often impnsoned while the real criminals, such as the merchants who encourage persons with insufficient income to spend far beyond their means, remain free If a person's race, language, sex orsalar 'does not give him or her access to facilities te which the majority of Canadians have a righ then, racism, sexism, and exploitation of thl undereducated and poor do exist in Canada' society. These crimes are major obstacles te the quality of life, both of those who commi them, and of their victims. They spring frorr and feed on greed, profit at any cost, the exploitation of man by his fellow man, institutionalized scorn for people of other races, women and children. As long as the medical profession and their colleagues, the pharmacists, will not permit the destruction of the myth that they have fostered ... as long as they persist in perpetuating this myth by writing and filling prescriptions that do nothing to improve the health of their patients ... as long as the medical profession refuses to admit its impotence in the treatment of 80 percent of recognized diseases . it is hard to see how th quality of health and life of Canadians can bl improved. Nurtured as we have been, by lies and half-truths, and stuffed with medicines, toda we are becoming pitiable dazed half-citizens half-persons, sheltered, we think, from suffering, anxieties and insomnia ... Marie-Andrée Bertrand, who received her MA. in Social Work and in Criminology frorr the University of Montreal, obtained her Doctorate in Criminology from Berkeley University in Califorma. She is associate professor in the School of Criminology at the UniversIty of Montreal. From 1969 to 1973 she was a member 0 the Federal Commission of Enquiry into the Non-Medical Use of Drugs. She is cUrrently working on a book that will discuss the relatively minor involvement of the female se) in crime... The Canadian Nurse May 1976 27 )F LIFE"M&qN TO YOU? ;onvention planners. Glenna owsell and Lorine Bese/, tell vhy the association chose his theme. I -his year's convention theme, according to '3lenna Rowsell, is a highly individual topic that ,eflects many aspects of life. In its entirety, the ')rogram is intended to present a global view of 1uestions about the quality of life. "We want to mcourage nurses to see themselves, not just 'IS professionals, but also as citizens who are lware of the world around them." One evening during the convention will be 1evoted to music and art. "This is important," '3xplains Rowsell. "because the nurse is often 30 bogged down in her duties that she ends up joing the same thing day after day and 150metimes forgets about all the other ,mportant and enriching experiences that life 'has to offer." i Rowsell hopes the convention will Imotivate individual nurses to look for deeper limplications of living, not only for other people but also for themselves. She believes this will help each nUrse to see herself and her contribution to society more clearly. "There are many questions that nurses should be asking themselves but the most important is: Do I really identify with the effect that the nursing profession has on society and does that relationship have anything to do with improving the quality of life?" Rowsell feels that nurses are becoming too far removed from their primary function. 'The administrative ladder IS taking us further and further away from where we should be- at the bedside where the real rewards of nursing are found." 'So many young nurses say, 'I'm just a staff nurse.' Unfortunately, this attitude is becoming more common among nurses of all ages." The program chairman hopes the theme of the convention will help nurses to develop an increased awareness of the needs of the people they care for. "We must recover our sense of values," she says "and orient ourselves towards human beings, not effici ency ." Lorine Besel says "the quality of life" was chosen as the theme of the convention because "as nurses, we have a particular responsibility to see how patients are affected by their work and environment." She feels it is unfortunate thatthe nursing profession has not yet taken much responsibility in this area, "Our concern has been mainly with sickness. We need to become invo1ved at an earlier stage in :?< --------------------------- I I I Please register me for: I Annual Meeting, Canadian Nurses' Association Hotel Nova Scotian, Halifax, N.S., June 20-23 1976 and mail reælpt, admissIOn I card with convention kit ticket, details on procedure for registration and hotel I reservation card. I Name 1 I Address: I I Present position: : Registration no: I Registration fees I I CNA members I Students I I Please return this coupon with your cheque or money order payable to: I Canadian Nurses' Association, 50 the Driveway, Ottawa K2P 1E2 I order to help the population gather enough data to identify the real causes of health problems." When asked to give a more precise definition of the nurses' role, she stated that nurses should be activists in helping the population formulate action plans forthe study of specific problems. "They should also speak out in public, both as professionals, and as individuals." What about Besel's own philosophy on the quality of life?" I am concerned," she says, "that individuals should have the opportunity to choose the kind of life they want to live. The pressures of our society don't permit people to make many choices. Often, these people aren't even aware of being cheated of this freedom." How is CNA related to the quality of life? What is the Association's role in enhancing the quality of life for its members and society at large? Besel is convinced that it is the responsibility of the national association to speak out on issues that have a direct bearing on quality of life - such as abortion, euthanasia, commitment to the aged, etc. She hopes that, by choosing this theme for the 1976 convention, CNA will be helping nurses to become more aware of the contribution they can make to society..., , - \ - ,... ---'" Mane.Andrée Bertrand , v q' Y -.., Glenna Rowsell " .,. "' Ilr I I c f .- - ..,... Iþ. ...... 'I;, Lonne Besel Surname lirsr Provo of reg.: TOlal meeting $75.00 $30.00 Daily rate Specify days $30.00 $15.00 r 28 The CanadIan Nurse May 1976 H b - t t Canada may go down in history as the country where nev.. a I a solutions were developed for the world's growing human settlemenl problems. This is the goal of Habitat '76, the United Nations .. Conference on Human Settlements, being hosted by Canada in quality of hfe Vancouver, B.C., from May 31 to June 11. As providers of healt on a g lobal scale. care, nurses have a vested interest in the succe sful outcome of this conference Claire Marcus .:.:- : :;., -. . - "" . ".. . . .- , 4-._ )0_ _ . -. -\".. .t- -- ---er- .. ..... - '" '\ -- -::.. ... -..(. . a _ ...... .. . . :"l. -- ....... ......... -.... ':....fi 'IS., .. - -. "" ,,' ... ., r -- (" ..... . '--ij; l:, , .,-".. " . " '"1f" ' . , - 1-< I f.j1; ;;; , "i' t '. .. . . "I !' :.. :. I . I - - -, .... 1 . _ "1, " ;r \J -M 1-1' \ , ._-. . 'f \ .. ;r-:; "- , ... ,... \ I . - ...:.I, .. .. :J",! i" '. . ... -..... h.-: . '.......--.... """"'-- 1_..",." '" , '- . t .. ,;-- - _ ....... '"-- - f! __ -.:: -";.,.....::'>...,,, .0..:" - - -- j"....- ..,r.-,:"... n. :::: --:(- - _ , .. . ......... " '. ,. , .:- -} _... ,4',:- - , . - "'" -.--....-. .. . --..;.-. -..,,- ".t,- _ ...._ :;..: ..... .. .. Jo' .. '- 'Þ" . ' "< '-_;"O;I.. 1t'.-.E "._..,.. ëþ- '!" ; .- - ,. .:. . - . : U) 1:-:n1 .9 Q) ... ,g -- ÇJ · .":'> f Q..(/}a:-. _' t - 'iJ - - -..i .t. .i - r 1] . -, IÞ. , .. , . r f " ttJI ... .,. --- --- ----==-=-=---=-=- - --- ------ ---- \ ., . \ --. - ."o;a.-' --- .. --I . - , .... .t. c . I, . -: ...--.. '" .- ,',.,.. - "' ..... , "' '" .' - : - - .. - ..-b 1 '" -=]i=.=1 .....- "'- "'.a' : : ... ::= ::i? " ,.... e "' . .-.' "" I . .. . t,' .' ...... " "'-. ..... ,,. .... - - .. -. - ..r& ....... . .. ..... ..- ........ . . ...' - . '. \ .......... , - "'-:: ... ....---# > r ... ." -_... w ... .- _":''':'-': . '-.:i -..."...::..... ., ....--....':y -.-<;..a.: :2..- . ...1. If *4 lIP ", 'l'1I1Yf1"TJim ' .. " i .1 The CanadIan Nuraa May 1976 29 abitat - a word that means 'he lives' in Latin - will ing together up to 5,000 delegates, visitors and lurnalists from 142 member countries of the United Ilations. Another 7.000 or more persons are xpected to attend the parallel Habitat Forum, a 1>lated nongovernment conference and exposition. .0th are an outgrowth of the United Nations' 1972 onference on Human Environment held in .tockholm. Both have involved the years of reparation and strategy planning befitting a global roblem. The Hon. Barney Danson, Mimster of State for )rban Affairs. has described Habitat as a process as l1uch as an event. and one that will profoundly affect III Canadians. "Like all countries," he said recently, "Canada is 3Clng the challenge of accelerating change. Habitat epresents an opportunity for new initiative not only in neeting massive global requirements, but also in Iddressing the needs of our own communities." The problems are enormous. whether in Jancouver or Calcutta. It has been estimated, for >xample, that up to 7,000 people in Vancouver are Iving in slums or deteriorating housing, with little ;hance of moving to a better place. In Calcutta, 79 )ercent of families have to share living space. Except or Algeria, Libya and Iran, very few developing ;;ountries have mounted large housing programs to T1eet the growing needs for shelter created by rapidly ncreasing urban populations. This lack of planning 'or settlements creates health problems. Less than alf of Brazil's municipalities. for example. have a atisfactory water supply system and only 34 percent aye a sewage system. Solutions to these and related problems are the oal of Habitat. to ensure an improved quality of life or a global population that is expected to double by the end of this century. "Ideas come before bricks.' said Enrique Peñalosa, the secretary-general of ! Habitat. 'Delegations must go home from Vancouver with new ideas and practical plans." New models and approaches to settlement problems are being tned out in many parts of the world and could be applied successfully elsewhere if they were more widely known. More than 250 audiovisual presentations of such solutions will be shown by participating countries at Habitat. The result will be a unique film library, later available to the nations of the world. Canada's contribution will be film or slide show presentations on four topics: Management of Urban Growth and Land Use: Design Innovations for Settlements in Cold Climates; Governing Human Settlements: and Community Rejuvenation. Canada s preparation for Habitat included 14 symposia and 16 public meetings across the nation to enable groups and individuals to give their views and to hear those of specialists on settlement problems. The Canadian Nurses Association was represented at one of these planning meetings. held late in 1975, by the Executive Director, Helen K. Mussallem, and the President. Huguette Labelle. All provinces, through a Federal IProvincial Preparatory Committee, are involved in planning for Habitat. On the international front, Canada has been working in close cooperation with the U,N, and, through it. with the countries participating in the conference. International groundwork included a four-day symposium at Dubrovnik, Yugoslavia in May 1975, attended by 30 of the world's best-known architects. planners. environmentalists and related experts; four regional meetings in CaIro. Teheran, Caracas and Geneva in which more than 100 countries took part: and the work ofthe 56-nation preparatory committee, Plenary sessions of Habitat will be held in the Queen Elizabeth Theatre in downtown Vancouver, while the three committees that have the responsibility of developing recommendations for the plenary sessions will meet in nearby hotels. Technological installations provide for simultaneous translation Into six languages. as well as for the showing of audiovisual presentations. and local, national and global news coverage. Detailed strategy has been worked out for the provision of services such as accommodation, transportation, security. information, hospitality and health. To meet the health needs of the 12,000 visitors expected in Vancouver. registered nurses will man four first aid rooms at downtown hotels during Habitat. In each station. the nurse on duty will be the primary contact and will provide the necessary care or direct the patient to a doctor in the Habitat medical office. Should ambulance service or hospitalization be required, nurses will make the arrangements and advise the physician on duty at the medical office If dental or optical services are required. an appointment will be made and the patient directed to the appropriate offices. Dental services will be provided by Health and Welfare Canada while optical servIces have been arranged with a local optician situated near the main conference hotels. St. Paul's Hospital, in the downtown core of the city, will be the central receiving hospital for all conference attendees. and Habitat medical officers will have full admitting privileges there. With the conference arrangements planned to the last detail. what will it all amount to? What difference will it make in Canada or other parts of the world If thousands of people talk about human settlement in Vancouver? Yet how else can the world's settlement problems be tackled? Habitat organizers say that before the Stockholm conference, few governments gave pnonty to the envIronment: now virtually all do. Human settlement needs the same attention. There are skeptics in Canada. which is said to have an average of just over 0.7 persons per room, perhaps the lowest in the world. But despite this skepticism, Habitat will take place anyway, hopefully to develop a greater awareness of settlement problems. issues and new kinds of solutions. .,. The World Man HaMal 30 The Canadian Nurse May 1976 ,, r \)se c'èJ.(\ 'O : \\9 \ :(\ \O(\S.O \ e \s\O se ss Ó \\ . se s \ 5 \ e'èJ. 'èJ.\\e(\\ s\e((\ Q S {"" ",,'" - Susan Hill and MarcIa Hoch t Susan Hill (B.N., University of Mamtoba school of nursing) is primary psychiatric nurse therapist in the Outpatient Psychiatry Department, Health Sciences Centre, _ Winnipeg. Marcia Hoch (BN, University of Manitoba school of nursing; MS., Boston University school of nursing) was clinical specialist at the Centre when this article was written. The authors worked together as primary therapists on an interdisciplinary team at the Outpatient Psychiatry Department, Health Sciences Centre, Winnipeg. As members of this team, they saw several cases where time-limited short-term psychotherapy was used to good advantage. They consider it an especially useful techmque in helping persons deal with losses. They also found this approach a satisfying experience. since a specific goal is agreed upon and can be monitored for change during and on completion of the 12 sessIOns. The therapist can, therefore, readily evaluate her effectiveness. ., Time-limited short-term psychotherapy, used I as a treatment modality of choice rather than a treatment in crisis, is a relatively new concept I in psychotherapy. Some major issues Involved are: selecting and implementing the short-term therapy modality in light of indications and contraindications; factors to consider and even expect as therapy progresses; some implications for therapeutic intervention; and some relevant ideas related to transference and countertransference. The comments that follow are based I almost exclusively on the concept of short-term therapy developed by James Mann I and, more specifically, on his contention that short-term treatment should be confined to the time limit of 12 sessions. Although at least one other therapist, Peter Sifneos, uses a I time-limited treatment modality, he is not restricted to as definitive a time element as that advocated by Mann. Both writers, however, I seem to agree that there must be a clearly identified focus for therapy before a time-limited modality is selected. Limiting the number of therapy sessions I to 12 is not in itself magical, but Mann suggests that this number is most effective. since it I decreases ambiguity in psychotherapy by making the limitation of time constant in each case. Placing all patients within the same procedural framework makes it possible to assess the process and the outcome with some degree of consistency and reliability" . James Mann, Time Limited Psychotherapy, Cambridge: Harvard University Press, 1973, p. 115. . stribution of sessions can be flexible, but we efer the 12 sessions to take place each ek in 50-minute sessions. This seems to ovide consistency and render explicit the lplications of time and its meaning to the ocess of separation and loss. Major indications for selecting the 10rt-tenn treatment modality are: a goal that n be identifred and, hopefully, reached: and e therapeutic alliance that can itself be used focus on one or two items in therapy. or on e precipitating event. This form of therapy is perhaps most early indicated when issues involve dependence/dependence (patient has Ifflculty separating from family), healthy/low <>If-esteem (certain behavior that renders tient vulnerable), and unresolved or delayed ,ef (loss of a meaningful relationship through eparation or death). Short-term therapy is ntraindicated during an acute schizophrenic action, a deep depression where the patient suiddal or too depressed to participate in lerapy, a full-fledged manic reaction. or an rgamc psychosis. Process A thorough history of each patient and an Iccurate diagnosis are prerequisites In electing the short-term treatment modality. -he goal is then clearly identified and agreed 'pon by the patient and the therapist, and a erbal contract is made. The contract involves the number of .essions (12), their length (50 minutes or one lour), and their arrangement (12 one-hour 'essions per week; or 10 one-hour sessions er week, followed by a "free" month, after hich the remaining two sessions are held). rhe date of the last session is clearly set. The mportance of attending each session is ;tressed - a missed appointment is counted as a session unless the patient's excuse is ;alid. As audio- or video-taping and upervislon of each therapy session are of ;alue, these matters should be Incorporated nto the contract. We have used the short-term contract 'imarily for dealing with issues of loss and jelayed grief. The time-limited therapy has een useful for exploring feelings of loss and termination because the therapy itself implies Ian inevitable separation from the therapist. Feelings of sadness and grief are I reawak ned in us with each termination. Thus, by helping the patient deal with his feelings about the termination of therapy, the therapist IS indirectly helping him come to terms with the loss or losses for which he originally sought therapy. These are the major reasons for preferring a short-term treatment modality when grief work and loss are at issue. In short-term therapy, the therapist usually becomes active and directive early in ,n!C' .......,,,øu..... nU'-:Mr ....y I 'a the initial interview, encouraging the patient to concentrate on the focus of therapy. This is important as both therapist and patient must consciously try to stay on the focus agreed on if the goal is to be reached. During the therapy sessions, concerns and situations not directly related to the mutual focus of treatment may be brought up by the patient. The therapist then asks the patient to reflect on the relationship between the issue that has arisen and the original focus. If no relationship can be discerned by either therapist or patient. the issue is discarded or used as a goal for a later therapy contract. Problem solving A general pattern can be expected to emerge overthe 12-session penod. Dunng the first five sessions, the patient seems to improve markedly: anxiety and tension usually decrease and some of the presenting symptoms lessen. However. as therapy proceejs, the patient comes to realize that his problems are not all going to be solved. that one problem only is being worked on, and that even it may not be completely resolved. The therapist. too, may become discouraged as the patient realizes this but continues with the contract agreed upon. What becomes more apparent in the seventh, eighth, and ninth sessions, is separation from the therapist. All the onglnal symptoms may then reappear The patient may become more melancholy and even show anger toward the therapist: he may arrive late for appointments. or express fear that 12 sessions "will just not be enough." These and other concerns need to be explored but, in general, It is wise to proceed with the agreed-upon number of sessions. Perhaps the most significant issue dealt with in short-term therapy is termination, with all its ramifications of separation, loss and grief work. . Antoinetta B. Antoinetta a pretty, slim 22-year-old woman of Italian descent, came to the clinic with symptoms of depression: crying. inability to concentrate, feelings of low worth, and general misery. Recently separated from her husband of three years, she had just come from another province and was staying with her married sister until she could find an apartment. Pnor to leaving her husband. she learned of his Involvement with another woman. Repeated phone calls have kept the situation stirred up, but Antoinetta IS sure her marriage IS at an end and seems obsessed with gaining some understanding of where she has gone wrong. .., She and her husband have agreed that she file for divorce One year pnor to her marnage. Antoinetta's family had given her sister a lavish wedding. When her sister. six years her senior, left the household. her mother turned to the patient. her only other child, to fill the sister s place. The mother, apparently having entered her menopause at this time, became very demanding. Antoinetta admits this overwhelmed her at the time and she began to do things that were unacceptable to her parents, such as dating a non-Italian. The mother responded with much emotion, sometimes beating the patient and sometimes beating her own head against the wall. Antoinetta is concerned that she will be like her mother. and this frightens her. The eventual outcome of the conflict between the patient and her mother was that the patient ran away to marry. She feels her mother drove her to it. otherwise she would never have married this man. Antoinetta's mother then disowned her and had no contact with her for more than a year. They have now been reconciled, but Antoinetta feels she cannot go home to her parents because of all that happened. Antoinetta recalls an unhappy, lonely childhood. She was afraid her parents would die, had crying spells, bit her nails, and was shy. In spite of physical problems. which often kept her from school, she was on the honor roll in high school. She went on to junior college, where she met her husband. She continued to live at home until her marriage. From this history, several concerns emerged as appropriate for treatment: a hostile-dependent relationship with her mother, problems with independence and getting started on her own, and depressive feelings about the marriage breakup. The diagnosis was reactive depression around the dissolution of marriage. Short-term treatment was agreed upon as a therapy modality with the focus being gneving over the loss of husband and marriage. Following is a brief overview of the content of the 12 sessions and the major focus of each. Session 1 Patient is in tears most of session She talks of relationship with her mother. Recent difficulties began with separation from husband. Talks of guilt and how the marnage dissolution was her responsibility. Session 2 Talks of specific incidents in her marriage Sad. crying. Relates how worthless she feels. Misses friends she left behind , Session 3 Has begun to date a man but is afraid she will have the same relationship with him as with her husband. Is confused about the role of sex in her marriage. -- "" U"( S1:NG CAR"E N '[JJ 1 'rDREN o F C J:L . 9111 EDJ110N " ølØ C N" øccbtCr-- tcraJ1 ::---- ---- , '* . ;r";térø.itY 1Y . lltsJJ18 1,sJ1 J In Tune With TO-DA @ NURSING CARE OFTHE GROWING FAMILY: - A MATERNAL NEWBORN TEXT W Adele Pillitteri, B.S.N., M.S" P,N.A, A basic, comprehensive textbook of maternal and neonatal nursing designed to meet the needs of students who will be functioning in roles which have expanded considerably, and to ensure their adaptability as the scope of their responsibilities expands even further in the future. Following a generally chro- nological order, each unit discusses anatomy and physiology, pathophysiology, psychological and social aspects of parent- hood, and nursil"g care in normal and extraordinary situations. In a lucid, interesting and sensitive writing style the author introduces the students to assessment, monitoring, intervention and long-range planning techniques which are largely lacking in other older texts. The focus on the entire family unit is also in keeping with modern thinking. LITTLE BROWN about $15.00 700 pages May, 1976 I @ MATERNAL-CHILD NURSING Violet Broadribb, R.N.. M.S., and Charlotte Corliss, R.N" M.Ed. A family-centered text, developed by the authors for combined maternal-child nursing courses wherein students are being pre- pared to give direct care to mother and children. The first half of the text covers the entire maternity experience, labor and delivery as well as pre- and postpartum care. Current information on homemaker service, family planning clinics and parent education is included in the chapter on "Community Resources Available to the Family." Units Five to Twelve deal with child care from birth to adolescence. Delinquency, drug abuse, and similar problems are considered in discussion of the often difficult family adjustment of the older child. To aid student self-evaluation, questions and situation-type problems follow each unit. Answers to the questions may be found in the Appendix. LIPPINCOTT $12.50 702 pages 1973 @FOUNDATIONS OF PEDIATRIC NURSING Second Edition Violet Broadribb, R.N" M.S. The author, an experienced nurse clinician, has broadened and enriched the second edition to reflect nursing concepts stem- ming from recent findings in child psychology as well as ad- vances in pediatriC medicine and surgery. New or expanded material includes psychosocial development, genetic factors, the child as member of a family unit, care of the newborn in the intensive care unit, pediatric pharmacology, As in the first edition, material is presented according to age groups from birth to adolescence. The Appendix contains pre- parations for laboratory tests, common pediatric procedures, and a section on pediatric drugs, dosages, actions and effects. LIPPINCOTT 500 pages/illustrated Paperbound $8.95 1973 @ EMOTIONAL CARE OF HOSPITALIZED CHILDREN An Environmental Approach Madeline Petrillo, R.N., M.Ed., and Sirgay Sanger, M.D. This text is an outgrowth of the dedicated effort by a group of experienced clinicians to reduce the trauma in children, as well as parents. brought about by illnesses requiring hospitalization. The authors and their consultants reflect extensive knowledge of growth and development; the variables and forces of family and culture; and the diverse reactions to stress, loss and sepa- ration. In specific, realistic and practical terms they present the e INTRODUCTORY I) NURSING CARE OF CHILDREN Ninth Edition Eugenia H. Waechter, R.N" Ph.D" Florence G. Blake, R.N., M,A., and Jane P. lipp, M.D. Completely revised and expanded, this edition is without peer as an in-depth study of pediatric nursing. The text is organized by age groups, from infancy to adolescence, with emphasis on physical and psychosocial growth, development, and health care planning for each age, Major revisions reflect increased nursing responsibilities in assessment and management of the well child, children at risk. and the ill child. A completely new chapter on the role of the nurse in primary health care for in- fants and children includes specific measures in prevention and assessment of disease; interviewing; and anticipatory guidance with parents. An excellent presentation is provided on medical team management of disease and disorders in chil- dren. The latest information is included on management of specific problems-incidence and etiology, pathophysiology, clinical manifestations, complications, differential diagnosis, treatment and nursing care. Immunology and immunodeficiency diseases are covered in depth. 250 illustrations are new to this edition, LIPPINCOTT about $16.50 about 800 pages May, 1976 e Thirteenth Edition @MATERNITY NURSING Sharon R. Reeder, R.N., Ph.D., Luigi Mastroianni, Jr., M.D., F.A.C.S., F.A.C.O.G., Leonlde L. Martin, R.N., M.S., and Elise Fitzpatrick, R.N., M.A. This comprehensive edition of an outstanding text reflects the most recent advances in knowledge and changes in family life style. It integrates nursing assessment of both physical and emotional factors, applies evaluation and diagnostic skills, and provides thorough coverage of current concepts in maternity nursing, New and revised material covers society's changing attitudes toward childbearing in light of socio-economic fac- tors, physical problems and psychological stresses; recent ad- vances in maternal physiology, development and physiology of the embryo and fetus; and clinical aspects of human reproduc- tion,Updated material includes antepartal and postpartal care, patient education, normal and complicated labor, care of full- term and high-risk infants, emergency nursing, fertility, infer- tility, contraception, abortion, pain perception, and fetal moni- toring. A new chapter covers diabetes, renal and cardiac disorders, and enetic counseling. LIPPINCOTT about $15.00 about 650 pages May. 1976 aternal-Child Care. techniques of communicating with children and their parents. Preventive approaches to minimizing trauma are supported by analyses of actual clinical situations. LIPPINCOTT Paperbound $6.25/Clothbound $8.50 259 pages/illustrated 1972 AUDIO/VISUAL MEDIA HUMAN BIRTH FILMS In dramatic, live action. . . close-up, full-color (sound or silent) films of birth complications which students rarely have an opportunity to see in the course of their experience in the de- livery room. GROWTH AND DEVELOPMENT A Chronicle of Four Children This exciting new series demonstrates the full range of varia- tion in normal psychosocial and physical development during the first four years of life. Four children were filmed at three- month intervals from infancy to age four in natural but com- parable settings. In conjunction with an accompanying work- textbook, the films constitute a unique and extraordinary study program in growth and development. In preparation. For additional audio/visual information, please write. J. B. LippincoU Company of Canada Lid: Please send me the books I have circled. 1 4 6 3 5 2 ... Position Name.. Address City................... Prov............... .... Postal Code D Payment enclosed, ship postage and handling paid D Charge and bill me Dlilchargex Acct. No. D :=; Master Charge Expo Date LlPPINcon's NO-RtSK GUARANTEE: Books ar. shipped to you ON APPROVAL; If you are not entirely satisfied you may return them within 15 days for full credit. Prices subject to change without notice. Lippincott J. B. LlPPINcon COMPANY OF CANADA LIMITED Serving the Health Professions in Canada Since 1897 75 HORNER AVE. TORONTO, ONTARIo 1112 4X7 (411) 252-5277 CNS.71 34 The CanadIan Nurse May 1976 ú {è'(\o Session 4 Patient generally feels better. Thinks of moving from sister's home to her own apartment. Is planning around items she is to receive from her husband (kitchen utensils, furniture, and so on). Session 5 Has found an apartment. Has been in touch with husband by phone. Is feeling sorry for him because he is now alone too. Looks forward to setting up her own place. Session 6 Examining her feelings so closely makes her sad. States she feels uncomfortable with therapist. Disappointed that sister is not meeting her requests. Session 7 Feels close to therapist. Not sure if 12 sessions will be enough. Frightened that she will have to return for more therapy. Session 8 Sister and husband plan to move from the area because of job change - expresses anger and sadness. Angry with husband . Session 9 Will miss therapist and wishes therapy could last longer. Crying about the breakup of her marriage. Ambivalent about it. Session 10 Apartment shaping up. Has made a friend. Happy therapy is ending. More settled in her decision to get a divorce. SessIOn 11 Can hardly believe there IS only one more session. Wonders if she can cope when therapy ends. Finds it hard to concentrate at times. Session 12 Feels better, but sad at having to say good-bye. The 12 sessions covered a wide range of topics but all were concerned with helping patient resolve her feelings about the loss of her husband and marriage. Short-term therapy seemed most appropriate for Antoinetta because the focus of therapy was clearly defined. The first five or six sessions indicated that Antoinetta was making considerable progress. She was generally less depressed and more optimistic, and was involved in work and in setting up her own apartment. However, during sessions seven and eight, it became apparent that she had begun to feel the imminent termination with the therapist. The therapist interpreted Antoinetta's transference feelings of loss toward the therapist as reflecting her feelings about losing her husband. Sadness and anger were openly expressed and dealt with. The sessions ended on a positive note of growth and, in retrospect, short-term therapy had been effective. . Jane R. Jane IS a 24-year-old, single, grade three school teacher who lives alone in an apartment. She telephoned our clinic; "My boyfriend left me three months ago and I can't seem to get over it." A thorough history elicited important information about the patient. Five years ago her best and closest woman friend was killed in a car accident. Four years ago her father left her mother for another woman, and they are now divorced. Three years ago, Jane's grandmother, to whom she had been close, died suddenly of a heart attack. A year ago, a previous boyfriend whom she had dated for three years left her. This time she took a serious overdose of sleeping medication. Jane spent a week in a psychiatric unit, her only involvement with psychiatry. Jane is pleasant, cooperative, well-dressed and attractive. She showed no evidence of thought disorder in either content or process. She cried whenever she thought of her boyfriend and the details of their relationship. Her diagnosis was reactive depression; and short-term treatment of 12 session was agreed upon, with the goal of helping Jane work through her grief over the loss of her boyfriend. Following is a brief overview of the sessions and the main focus of each. Session 1 Patient cries when thinking about boyfriend. Feels empty and lonely. Spends most of session in tears. Session 2 More tears about boyfriend. Talks about losing her father, and how boyfriend resembles him. Session 3 Feels therapist cares. Her problems worth the therapist's time. Is angry at father. Relates mother's situation with her own, as both men left for other women. Session 4 Wants therapist to tell her what to talk about. Feels better. Afraid to get angry at people for fear of losing or hurting them. Session 5 Boyfriend has come back to her. Worries about what therapist thinks of it. Wants to continue therapy. Changes goal. New goal is to work through feelings related to loss of therapist. Session 6 Notfeeling well: "theflu."lsangry at boyfriend and afraid to show it because he might leave her. Talks about termination of sessions. Cries over losing therapist. Feels alone. Session 7 Sad it is the seventh session. All problems may not be solved: what if boyfriend leaves her after sessions end? Session 8 Not feeling well. Talks more intensely about death of woman friend. Session 9 Sad about imminent termination of therapy. Talks about angry episode with boyfriend. Tries to relate this to goal of separation from therapist. Session 10 Finds it hard to believe sessions! coming to an end. Expresses sadness rather: than anger. Wonders if therapist will be I available to her following termination. Session 11 Expresses more difficulty over I imminent termination. Several anxiety symptoms reappear. Attempts to relate curren I feelings to her pattern of dealing with losses. Able to be more assertive in relationship with I boyfriend. I Session 12 Doesn't feel she will say good-bYE I to therapist until therapy is over. Still wornes over boyfriend leaving her. Still wondering if I she will be able to contact therapist. I Jane is a young woman who has sufferec' many significant losses she has been unable to resolve, The loss of her second boyfriend precipitated seeking help through our clinic. Based on the major issue of unresolved grief 01 Iqss. a goal was negotiated between the patient and the therapist, and time-limited short-term therapy was agreed upon. During the first four sessions, Jane began to feel better and her symptoms disappeared. However, her boyfriend's return necessitatec changing the goal. A second goal related to loss (loss of the therapist) was agreed on, and the original contract of 12 sessions was retained. Jane was able to express her feelings about termination with the therapist. However, the goal was not resolved when the contract terminated. Summary The two cases cited illustrate how short-term therapy can be used to meet a patient's needs to deal with loss and grief. Although the goals as set out in short-term therapy contracts are not always fully achieved, this treatment modality, as delineated by Mann, IS valuable to psychiatry. Short-term therapy is not only a sound therapeutic intervention, but also a means of bringing psychiatric health care to a greater segment of the population. Bibliography Mann, James. Time-limited psychotherapy. Cambridge, Harvard University Press, 1973. SChafer, Roy. The terminallOn of brief psychoanalytic psychotherapy./nt. J. Psychoanalytic Psychotherapy 2:2:135-48 May 1973. Sifneos, Peter. Short-term psychotherapy and emotional crisis Cambridge, Harvard University Press, 1972. -. Two different kinds of psychotherapy of short duratIon. In Barten. Harvey H. Ed. Brief therapies. New York, Behavioral Publication, 1971. p. 82-90. Swartz, J. Time-limited bnef psychotherapy. In Barten, op. cit. p. 108-118." The CanadIan Nurse May 1976 35 II . . ..-" The author's name is known to The Canadian notify people living several hundred miles w-e.,,; Nurse but is being withheld away of the date and time. CAlI When the undertaker phoned on . .. II Several months ago my husband died and I am Wednesday, it was to let me know, as tactfully - .,. still bitter. My bitterness stems, not from his as he could, that he had had difficulty obtaining .. t:;6 , death, but from the attitude of the people who the body, and that, since no doctor was !. ., work in the hospital where he died. Hospitals available, he had had to ask the coroner to sign see death as the end of their responsibility, but the necessary papers. Because of the delay, .... a II for the survivors it is the beginning of a totally he wasn t certain whether the cremation would ,. new way of life. As a nurse, I have always be completed in time for the plane! This meant .: ti believed that the family of a person who dies in changing the day of the funeral from Thursday - .. hospital should be treated as well, after the to Friday and more long distance calls. For '" , t): event. as before, but experience has taught those taking time off from wor\( to do my . ., I) me that this is not always the case. husband honor, this change was most .. . f. My husband had problems with his heart disconcerting. 1 ".:... for some time. Eventually, our family doctor Nor was this the end of the matter. In my ". referred him to a cardiologist in a city 800 miles first phone call to the admission office I had ":- t). from here. He was hospitalized there and we asked that my husband s cousin be given all of .). .t:!> . kept in touch by phone. When heart surgery his personal effects. She made eight trips to -.,. . was planned, we agreed that I should stay the hospital before it was convenient for ! :C:tf. home with the children until he was anyone to accommodate her! Even then, she ;g " convalescent. was given his wallet with his credit cards but ", .... On the Sunday night before his operation not the thirty-seven dollars he had deposited in ø)" !.'.",f. was scheduled, he died. It was then the series the office. Finally, three months after my C ", J of events began that shattered the ideals I had husband died. I learned that the autopsy I had . ,. , C'- come to cherish in more than 25 years of agreed to. had not been done. I had agreed, , '. ø)..t nursing. not to help medical SCience, as we are taught II The doctor phoned early on Monday to say, but simply because I wanted to know morning to tell me what had happened. I why he died at that time. Now I never will. agreed to an autopsy and remembered to tell Two weeks after these events. I wrote a him that my husband had an eye bank donor letter of complaint to the hospital administrator. card with him. He asked me to send a telegram A month later. another hospital official sent me 1'1 to the hospital admission office giving them a letter of apology. This was the first tIme any .. -,', .- this information. I did so immediately. member of the hospital staff contacted me. He ...ti At noon that day, my husband's cousin. reminded me that they were short-staffed and -.. " his only relative in the city, phoned to enquire busy. He told me how dreadful it would have .,; about his operation. I had not yet contacted her been if someone besides myself were told that . , II since she works during the day and I didn't my husband was dead. I couldn t help but m know where to reach her. She was told curtly to remember that, when I learned of his death the get in touch with either me or our family doctor. first thing I did was to start notifying family and At supper-time I phoned to give her the friends. With a broken-hearted ten-year-old news myself and ask herto fmd an undertaker. son in my arms. what would I have given to ..... , .... When she phoned the hospital again she met have someone say "Ves, I know, . instead of ... . t!'="' the same response. She persuaded them she "Why, what happened?" i.:C;ff.. '-',: knew he was dead and was told the body As for the telegram. a tracer proved that .t - 4. - '.- "', -. would be released early the next morning. had been phoned to the hospital within an hour . . v _ ø).' On Tuesday, the undertaker was refused of my phoning it in to our local office. ø) .t. . the remains because "we don't have the Apparently a copy was then mailed to the 'V telegram." My own clergyman and another in hospital rather than being delivered in person. \ ,0 the city were asked to help. They got the same What legal status does a telegram have? - ê. story. I phoned the admission office. The Anyone can send one and sign any name he response was: "Maybe I'll leave a note for the pleases. Surely, It would be possible to . .L . day staff." 'Maybe I'd better contact the tape-record permission for an autopsy and I., r é V doctor'and "We can't release the body on your other similar consents. The human voice is as say-so." Naturally. I did not react calmly and distinctive as flngerpnnts. ., my replies were not as coherent as they might Legal counsel advises me that not ø have been. When I hung up. however. I carrying out the wishes of the next of kin It believed that the action I demanded would be amounts to negligence, but I have no interest ",.. carried out immediately. I phoned the in lawsuits. The past cannot be undone. My .. . .. undertaker and gave him that information. At concern now IS to try to prevent other people in .- home we proceeded to plan the funeral and similar situations from being subjected to the -.! 36 The CanadIan Nurse May 1976 4> II II II &I II II I) I) It emotional stress I endured. Why couldn't some person have been designated to contact me an hour or so after the doctor told me of my husband's death and tape-record the conversation? That person could have assisted me in locating an undertaker and found out what to do with my husband's personal effects. He or she could have taken phone calls, given out the information that he was indeed dead and arranged a suitable time for his effects to be picked up. The situation could have been handled without the mental anguish that resulted from the fact that, when my husband died, no one in that hospital accepted the responsibility of meeting the needs of his family in their time of bereavement. I am told that some of the policies in this particular hospital have been changed since this incident. What happens when someone in your hospital dies? When The Canadian Nurse approached the hospital where this incident occurred, a spokesman gave his interpretation of the "administrative difficulties" encountered by the author of "Why?" His answers to some of the questions she raised are as follows: Q. Why did the hospital not phone me? A. Our hospital insists that it is the duty of the attending physician to notify the next of kin when a patient dies. This is a traumatic occasion requiring an expert handling of the communication, understanding and often explanation. The patient made himself the client of the doctor for the management of his health care. It is only right and proper that the doctor communicate with the family when death occurs rather than leave it to a nurse or ward clerk who mayor may not communicate Iml in the appropnate manne, Q. Why could a relative not be told of a '" person's death - particularly when it concerns an out-of-towner? A. The inability of your husband's relatives to obtain information by phone about his death should be seen in light of the policies laid down for our staff in that department. This type of information can only be released by relatives (present) or the attending physician to avoid the next of kin learning about the death in a second-hand manner. II I) II Q. What protection does the patient or his family have from a telegram that passes through many hands, can be garbled, or as in this case ignored? A. We apologize for the tragic delay in communicating your consent for autopsy to our pathologist However, these are very important consents for which we have developed stringent policies. You can't imagine what the reaction would be of relatives if an autopsy was done without their consent. We must have in our possession the official written document, i.e., the telegram. before we can proceed. Although the contents of the telegram were phoned to the hospital, the telegram company put the telegram in the mail rather than delivering it by hand the same day as has been the practice. Therefore, it took two days before the telegram reached the hospital and the clerk in the Admitting Department was correct in saying the telegram had not arrived. I can assure you you that we have not had a similar incident in at least the last ten years. We regret very much that it happened in your case. Q. Are patients' wallets checked when they die, for such things as organ donor cards? A. The normal procedure in this hospital is to encourage all patients to leave valuables at home. Valuables brought to hospital are placed in safekeeping and released only to the patient on discharge or to the next of kin. Wallets are only opened for authorization permits when the patient or his relatives have indicated to us that he wishes to be a donor When the patient has been an accident victim the police go through his wallet for identification and find the donor authorization card. No changes in our polices have resulted from this incident but two areas of existing policy have been reinforced: Although our policy demands written consent for autopsy, we do state that when consent must be obtained from remote areas, we will proceed with autopsy on the verbal authorization of the next of kin. witnessed by two members of our staff. The staff member on duty in the Admitting Department was a summer relief person and she went "by the book" and failed to communicate the verbal authorization. For this we offer our apologies. Our policy in respect to phone communications is that courtesy and consideration must be extended at all times. This incident was forcefully brought home to our staff as an example of communications which obviously fell short of the recipient's expectations, If there are lessons to be learned from the unfortunate experience, feel free to publish anything in this letter that you deem of value The Executive Director, . . . Hospital. I) I) II II II It II II I) I) II II II The Canadian Nurse May 1976 Catherine Brown 37 t l i V I lln : (j 1 =,1 V I ,I, .- ""!!!"'!! ",; '![ T fl, ( C( ST ',f. I I : , C .--:: ' >-- =1 ,I II -= LJ ' . y ' ' r (j Ir R O ' 11 '" fl e ê i! \ ' L: q }, ;I /W\, II '. . .. .. . " \ . . Y. .. ... . .. ,- ..;.' ... , .- , .... ""'- .. .... agreed,"but aren't you glad those temble things don't really happen?" I sat silent among them thinking, "I'm different because those unthinkable things have already happened to my child, and I know that no evil eye, nor all my wishes, could have prevented them." My baby was born with cystic hygroma. an unusual condition in which his face is filled with cysts that swell and go down periodically, and are easily infected, until he is at least five or six years old. This condition also affects the tongue, causing it to swell, bleed, and, if badly enough infected, to cut off his breathing, so that a tracheotomy becomes necessary, In the city where I live, specialists in this field favor waiting the condition out, ratherthan surgically removing the cysts. For several reasons, they feel that surgery IS too traumatic for a young child, as well as ineffective in removing the cysts. The only treatment they prescribe is penicillin, when absolutely necessary, and waiting for five to six years until the condition becomes minimal. These are the technical details. They do not begin to express the agony a mother feels when her child's face begins to swell, her embarrassment for him when other children laugh and point nor her horror when he stops t ' 'ltll - .... fir , I Itì"f ., tì,. i \. p!t tl'( tIll ." t breathing. Not to mention the endless tnps to various doctors and her frustration as a mother in the face of their cool authority. 1 was wide awake when Stephen was born - glad to have gone through labor so easily and proud to have a healthy boy. My obstetrician said his face looked a bit "puffy" on one side, but dismissed it as a swollen gland and told me my pediatrician would check it out later. That night, after my husband and 1 had cuddled our new son adoringly, puftyface and all, my pediatrician came in to speak to me. He is a kind, sensitive man, but his words took my breath away. "1 want to talk about Stephen," he said. "I've just checked him, He doesn't show signs of mongolism, but he has a tumor that must be examined, so I'm sending him over to the children's hospital tonight to be analyzed. Perhaps your husband could take him over." I was so shocked at the words, "mongolism," "tumor," and "another hospital," that I could only nod my head in amazement. After he left, I sobbed in despair. Though Stephen was returned the next day, he was now pronounced "abnormal" with a "special I Clinical Data Cystic hygroma is a rare, endothelium-lined, cystic lesion of lymphatic origin which usually occurs around the neck and is encountered most frequently in infancy and childhood. It affects bot sexes equally and is discovered at birth in 50 - 65 percent of caseE About 80 - 90 percent of cystic hygromas are detected before the er of the second year of life; In rare cases, however, it has appeare< in the teens. Although the disease was reported as early as 1828, it was fir, named and clinically described by Adolph Wernher in 1843. Man I theories were advanced about its cause and relationship with th lymphatic system, but today it is generally thought that in the fetus' during the formation of the peripheral lymphatic system, a Pinchin,! off or sequestration of tissue of one of the endothelial sprouts 0 I outbuddings that extend from the primitive sacs of the Iymphati<. system, gives rise to an endothelium-lined lesion called a hygromël The lesions of cystic hygroma can vary trom 1 mm to 5 cm In I diameter but have in common a potentiality for increasing in size tl l an almost unlimited extent, and a tendency to penetrate and destre anatomic structures. The accepted explanation for their growth and propagation wa' advanced by Goetsch in 1938. He concluded that endothelial fibrillë I membranes sprout from the walls of the cysts, penetrate into surrounding normal tisstJes, then canalize and produce cysts fille with secretions from the fibrillae. The pressure from the larger cys may force the tumor to spread in the lines of least resistance, i.e. int' the planes or spaces between large muscles or vessels. Thus, the mass called cystic hygroma is composed of a thin-walled, endothelium-lined cyst (or cysts) which is filled by a condition," that might or might not go away. My first son had always been so healthy, that I took good health for granted. Matthew always slept through the night and the worst thing he ever had was a diaper rash. How could my children be less than p,erfect? Stephen's problem became evident during my stay In hospital. His enlarged tongue made it a struggle for him to breast-feed. What had been so natural for my first son was torture for Stephen, so I bottle-fed him instead. I wanted to deny that he had a problem, but from day to day, I could see that he did. It took longer for his umbilical cord to heal, his circumcision hurt and bled more and he slept less soundly than Matthew. As I came to realize these differences, I searched within myself forthe cause of his problem. What had I done wrong? Had I eaten the wrong foods while pregnant? Worked too hard? Been too upset? I had had spotting in the sixth month of pregnancy. Had this harmed Stephen? Had the delivery been wrong? Was it related to my father's illness? Though doctors assured me that none of these factors made any difference, it took me almost two years to overcome these feelings of guilt. The first few months were hectic-managing two young children and the house as well as being a companion to m husband. We were still on a survival level day-to-day coping. As Stephen got older, t developed a very engaging personality - warm smile, a cuddly, puppy-dog friendline an intriguing way of playing with his fingers- source of fascination and jealousy to his brother. We loved him passionately, Also, as Stephen got older, other aspec of his illness manifested themselves - endless colds, weak stomach, series upon series of antibiotics. Then In the spring, ou babysitter left the gate open at the top of tl stairs. Stephen. in his playchair, fell down 11 stairs, knocked a tooth out, pushed others ir his gums and bit his tongue the whole wa through. I rushed home from work, took or look at what was left of his mouth and race him to the doctor, who sent us to the hospita We were all crying. All the recriminatio my husband and I could make about the gat the babysitter, ourselves, made no differenc The fall touched off a mouth infection that p Stephen in hospital for nearly a week. He w in an oxygen tent and was given penicillin intravenously. I suppose I should have bee thankful that he was less badly off than thE lear. colorless fluid. The cysts may contain lymph nodules. muscle ibers, thrombosed blood vessels, or bits of fascia, depending on the ype of tissue entrapped by the tumor. Outwardly. cystic hygromas are characterized by their soft, laccld. "doughy" consistency and by their thin walls and translucent lippearance, particularly evident if they are large in size. The most common symptom is a soft mass in the posterior nangle of the neck. It is not attached to the skin but fixed to the deep ' issues. Patients rarely experience pain or local discomfort and, if the eSlons are small, medical advice is often not sought for many nonths. In some cases, a mild trauma or secondary infection is ollowed by rapid growth of the cyst and it is this series of events that rompts a visit to the doctor. Some hygromas Ire dormant or increase n size slowly, some grow rapidly and then appear to shrink. In ome cases respiratory obstruction occurs. Various treatments have been attempted with cystic hygroma, ,:;ome more successful than others. Many doctors prefer surgical 13xcision, but the extent of the tumor cannot always be anticipated '-nd, if the cyst involves vital nerves and vessels, portions of the umor must be left behind. In this case, there is a risk of recurrence, though this usually occurs within one year. Some doctors prefer to wait indefinitely, administering antibiotics when necessary, because of the tendency of a hygroma to undergo spontaneous regression. The danger with this approach is the high risk of spontaneous infection which may occur with even a mild respiratory inflammation and, if severe, may threaten the patient's life. Other treatment measures that have been tried include I repeated aspirations, irradiation and injection of sclerosing Ichemicals. None of these, however, has proven satisfactory. 1M JII l\'\i J!!J "\1 "!-I ,q Q fi\1 'll.f "II. {' -;;;... l J'! ì J" ..-- 11 -- 4' /4 I -:('ì;::::' ';::fr \!::=" -:::í .;::( ì = J ;::: \ ;';:::.( .. I';:::'; , :r. '\ . i!! ,,-.. ill! . /, i!! '" _i!! ïí!!'\.tf i!!\\,; !liii!!, iiíi!i. 4Å a & & other children in the burn ward. Some had such hopeless, woebegone faces, Alii wanted was to get him released as soon as possible. When Stephen came home, we felt that he would be all right again now that the warm weather was coming. We celebrated his first birthday in May, joyously hoping our troubles were over. A week later, we found him face down in the grass, turning blue. He had stopped breat'ling.1 whacked him on the back, i pulled his tongue down and gave him I mouth-to-mouth resuscitation. Since. then, we have become more I resigned. We treasure the times when Stephen i well, and brace ourselves for the I difficult times when he is sick. Of course, I try I every conceivable thing to help him - I elevating his mattress, putting a humidifier in his room, feeding him vitamin C. keeping hin. on antibiotics for the winter, seeking out another mother whose child also has cystic hygroma to pool our experiences. Always in the back of my mind is the hope that someone will find a solution, a cure, but gradually that hope is coming up against the stark reality of waiting out the next few years. Every mother must cope with illness in her children - part of her must always be a nurse. Stephen's condition could be much worse but because my other child is so exceptionally .. healthy, I find it hard to assume this nursing role. Stephen usually needs 24-hour-a-day care. Everyone in the family has had to adjust to his illness. The tension and sadness we sometimes feel about Stephen is naturally communicated to Matthew. We want him to have a normal life but he is beginning to ask why Stephen needs so much medicine, why he wakes up every night, why his face goes up and down, Because my husband works full time, I am usually the mediator between our family and the doctors and have to relay all the messages. Sometimes my husband takes out his frustration about Stephen on me and often I need extra support from my husband. Stephen faces the biggest adjustment. At 18 months, he is active, contented, self-confident, full of enthusIasm and spirit. But soon he will read the expressions on people s faces, feel hurt when they stare at him. realize that he is different. We can only cope day by day, working out solutions to problems as they arise and enjoying our two children as they are, while waiting for that elusive, perhaps nonexistent, time when Stephen will become, magically, normal. '- "'- .. "" , . '.0; . Catherine Brown, in addition to being the mother of Matthew (four) and Stephen (almost two), teaches family life education at Humber Community College in Toronto and is an active member of Aid. to New Mothers, a support group for mothers during the postpartum period. This group grew out of a Women's Health Group and has evolved into a cIty-wide organization that helps to bring together the work of public health nurses, hospitals and Children's Aid workers. She and her husband, came to Canada seven years ago as graduate students in English, .. Bibliography 1 Brooks, Jack E. Cystic hygroma of the neck Laryngoscope, 83:117-28. Jan. 1973. 2 Dowd, C.N. Hygroma cysticum coli. Ann. Surg. 58:112-32,1913. 3 Goetsch, E. Hygroma coli cysticum and hygroma axillare. Arch. Surg.. 36:394-479. 1938. 4 Gross, R.E. and Goeringer, C.F. Cystic hygroma of the neck. Surg., Gynec. and Obst. 87:599-610,1939 5 Sabin. F.R. The lymphatic system in human embryos with a consideration of the morphology of the system as a whole. Arner Jour. Anat., 9:43:91, 1909. Uniforms. technical medIcal and general purpose hospital coats. designed for action-comfort as you work Seams areflrmlysewn Fastenersstayon Fabrics wash or dry clean for professional wear '- 't.. /",r ....., 'C"i I .,/ ." .. \ *' STYLE 814 ..IC , r:I.I'I:I. C CAREER ClASSICS \ \ '--- \ 1-( t l \ I ......... ,,' I STYLE 810 YLE 888 STYLE 814 PantSuit Polyester Textured Warp Knit White - Blue Yellow - Ice Mint Sizes 6 to 18 To retail . $2800 STYLE 81 OA Polyester Corded Warp Knit White Sleeves Sizes 6 to 20 To retail STYLE 916 PantSuit Polyester Ribbed Double Knit White Sizes 8 to 16 To retail $3800 STYLE 888 Polyester Textured Warp Knit Lace Trim White, Pink, Yellow Sizes 8 to 20 To retail $2200 STYLE 810SS Polyester Corded Warp Knl White Short Sleeve'" Sizes 6 t 20 T unifolml ICgi/tCICd $26 00 -- . . II J' 778 Kmg St W Toronh Ontario M ;- N'11111es Tha Canadian Nurse M8y 1 g76 1111(1 Faces 41 '\ - "'- ..:::::.> he Ontano Occupational Health "urses' Association elected for the 976-1978 term of office the following: .resldent. Dorothy Schwab, Reg. N.. .f SI. Catharlnes: 1st vice-president oan Subasic, Reg. N.. P.H.N.. of Toronto; 2nd vice-president. Grace Blackwell, Reg. N.. of London; 'secretary, Gale Pearson, Reg. N., B.A., of Guelph, and treasurer, Sylvia Matchett. Reg. N., P.H.N.. of Mississauga. This organization, for registered nurses employed in the field of occupational health, is dedicated to the improvement of health services available to workers throughout Ontario via the promotion of educallOnal opportunities for the nurses involved. Gwynneth Paterson (R.N., Queen Elizabeth Hospital. Montreal) has been appointed Assistant Executive Director of Patient Services. at Medicine Hat General Hospital. Paterson has nursed chiefly in Ontario and Quebec, her latest position being Director of Nursing of the Montreal Convalescent Centre. She brings to Medicine Hat General many innovative ideas regarding nursing. She feels that nursing personnel must begin to work with rather than for other health personnel. In her judgment, Medicine Hat General is ready for change, and the staff involved have the potential. She wishes to develop nursing programs for patient care, rather than rely totally on existing doctors' programs for patient care. Paterson is at present working toward a master of sCIence degree in administration from McGill University Peggy Overton (B.Sc.N.. M.H.S.A" University of Alberta) has been appointed assistant professor, full-time research, in the division of health services administration at the University of Alberta. Her responsibilities center upon pure and applied research with reference to effective and efficient health delivery especially, but not exclusively, related to nursing, and involve participation to the multidisciplinary team research of the Division. \' ... h --- -- Overton was a recipient of a National Health Research and Development research training fellowship_ She was formerly a surgical supervisor and nursing project coordinator at the University of Alberta Hospital, Edmonton. Catherine MacQuinn, (R.N., Highland View Hospital school of nursIng, Amherst) a public health nurse who works among the Indian people in Cape Breton, has been presented with a 25-year pin and certificate from the Medical Services Branch, Health and Welfare Canada. For several years, MacQuinn lived on the Eskasoni Indian Reserve where, early in her stay, she often delivered babies by the light of a kerosene lamp. Over the years she has seen the self-development of the Cape Breton native peoples; their changing attitude toward education, their improved health and housing. Jacqueline Sue Chapman, R.N., Ph. D., is pnnClpal investigator of a federally funded study: "Effect of Hospital and Home Planned Stimulation on Development of Short Gestation Infants," to evaluate the relative efficacy of selected interventions in the nursery previously found to facilitate the development of short gestation infants. The longitudinal aspect of the study is to develop a program (in consultation with Institutes of Child Development on this continent) to maximize the potential of the child who may be developmentally and/or economically disadvantaged. Pamela E. Poole (R.N., Queen Elizabeth Hospital school of nurSing, Montreal; B.N., McGill University: B.J., Carleton University, Ottawa: M.S., University of California, Los Angeles) has been appointed chief of the information and evaluation division, ResearCh Programs Directorate, Health and Welfare Canada. She is responsible for the planning, development. and direction of a program of completed research funded under the Natonal Health Research and Development Program. She is also engaged in planning, development and direction of a research information program that deals with dissemination of research findings and the provision of statistics and other data on health care research. Poole joined Health and Welfare Canada in 1965. She IS a former assistant editor of The Canadian Nurse. Anne S, Gribben, Chief Executive Officer of the Ontario Nurses. Association, was appointed a part-time member of the Ontario Labour Relations Board. an honor that gives her official recognition as a leading member of the labor relations community. It is the first appointment to the board of a woman, and the first time a union as young as ONA has received Ihis type of official recognition. Gribben was formerly director of employment relations of the RNAO '- Dorothy Fulford (R.N., Winnipeg General Hospital school of nursing: P.H.Dipl., University of British Columbia: B.A., Carleton University, Ottawa) has been appointed employment relations officer with the Ontano Nurses' Association, Ottawa office. She brings to her position a rich experience in public health nursing, having been with the Victorian Order of Nurses in Winnipeg. Toronto, and Burnaby; the Toronto Department of Health: the Ottawa Board of Education: and the Ottawa-Carleton Regional Health Unit. She also has a background of collective bargaining, having been on the negotiating committee for the Institute of Professional Personnel of Ottawa-Carleton Barbara McWiliiams(R.N., St. Paul s School of Nursing, Vancouver: B.Se.N., University of British Columbia) has been appointed assistant director of education services with the Registered Nurses AssoCIation of British Columbia. She will provide counseling services to members and others and participate in various commil1ee and departmental projects. McWilliams was formerly a public health nurse in Burnaby and has worked as an occupational health nurse, in the office of a family practitioner. and as a staff nurse in intensive care. 42 The CanadIan Nursa May 1976 Information IS supplied by the manufacturer; publication of this information does not constitute endorsement. "llt\t s Xe,y - ,. .;" 50 ,1.' ;1 ...4t..I111' " . ;... : " : .. i,\": ::..-'.. ..::. C!: ;&:::. .::...:.. __J ',' : ".'. 1'.... "'I ':' ::i': ..f;::':'. .::: :;. ,.-;. ; ",' '.: " \ øt!o ,.....,t.'. ,ee.f'" t.O......'.f f t ,t,:,::;,;::, Flame-check for Children Hospitex "Flame-chek"" children s pajama sets and gowns are available to hospitals for children up to age 6. These flame-retardant children's pajama sets and gowns are lightweight or flannel-weight, are colorful. and are a real patient morale builder. For informatIon write: Amencan Hospital Supply, 1076 Lakeshore Rd. E, Mississauga, Ontario L5E 3B6 Hinged Knee Prosthesis Orthopedic Equipment Company s brochure in color describing the new OEC hinged Stanmore total knee replacement. This implant utilizes an ultra-high molecular weight polyethylene bushing for interphasing between the femoral and tibial components. The flexibility and weight-bearing jOint stability of the bushing renders the Stanmore knee joint particularly suitable for total knee replacement when rheumatoid/osteoarthritic knees have virtually no ligamentous stability. The brochure is available from: OrthopedIc EqUIpment Company. 1011 Haultain Court. Mlsslssauga, Ontano L4W 1W1. Thomas Traction Kits Thomas traction kits from Orthopedic Equipment Company provide for quick, emergency Thomas leg splinting. The deluxe kit (No. 3034-10) contains two sizes of Thomas leg splints, two sets of splint straps. two heel rests, two foam-padded ankle hitches and a Redi-Trac traction device - all arranged for quick access in a sturdy case that is carned directly to the accident victim. The foam-padded, vinyl-covered carrying case can also be used as an insulated emergency blanket when laid out flat, with all eqUipment removed. Two smaller kits are also available: Kit No. 3040-04 contains one large Thomas leg splint, plus accessories; Kit No. 3040-02 contains one small Thomas leg splint, plus accessories. For further informatIon wnte: Orthopedic Equipment Company, 1011 Haultain Court, Misslssauga, Ontano, L4W 1W1. \ . " 0, - I- .1' ,- " Stylish Safety Vests New color print vests to help prevent patients from falling out of bed or sliding forward in wheelchairs, have been designed by the J.T. Posey Company of Pasadena These vests are in three styles: the Poncho Vest for gentle support; the Comfort Vest, a difficult to remove model, and the standard safety vest. Each style comes in red, blue, yellow, and pink and IS available in small, medium and large sizes. Posey products are available in Canada from Enns and Gilmore Ltd. 2276 D,XIe Road. Mississauga. Ontario L4Y 1Z5. Washing Equipment Catalog The operational and design features of AMSCO washing equipment are highlighted in a new eight-page catalog. Described are 3 different utensil washers, a portable flask washer, a hospital cart washer and a glassware washer and dryer. Productivity of the units and the resultant benefits to the user are also detailed for each piece of equipment For a copy of AMSCO Catalog IC-615 on washing eqUIpment write: AMSCO/American Sterilizer Company, AttentIon: Market Communications Department, 2425 West 23rd Street Erie, Pennsylvama 16512. Disposable Ear Plug The Bilsom Propp ear plug provides comfort, safety, and effectiveness and is nonallergenic. This disposable. ready-made plug can be inserted when needed, then thrown away. It reql::Jires no special fitting procedures as it is made of soft. permeable, down-like matenal. Propp s convenient pocket pack of 20 plugs means lost or soiled plugs can be replaced right on the job. The Proppomat dispenser, loaded with a bulk pack of 1,000 disposable plugs, precisely cuts a pair of hygenic Propp plugs ready for use and releases them automatically at the touch of a button. Placed at the entrance to noisy working areas, at the time clock, In the changing room or any accessible area, the Proppomat provides continuous availability of heanng protection for everyone Wearing Propp plugs blocks dangerous and harmful noise from sensillve heanng organs so normal conversation can proceed without noise interference. Bilsom Propp, made of mineral fiber spun Into microscopic threads softer than cotton, provides excellent attenuation with cleanliness, comfort, and convenience. For information. write: Product Manager - Canada, Bilsom International AB, c/o Swedish Trade Commissioner, 920 Yonge Street, Suite 820, Toronto, Ontano, M4W 3C7. -- j -r ' . --'. ::! l' - " Hand Gym The Hand Gym makes possible vanety of exerCises, including I isometric exercises, to improve and i maintain agility and dexterity and to I develop muscle strength in hands affected by disease or injury. It alsc helps to arrest development of ham deformities. I An '.'sometric Hand Gym" is available for people with normal hanc that may have stiffened with age an I for people to whom hand dexterity , particularly important (musicians dentists, sportsmen, for example). Hand Gyms are available from Hand Gym. Inc., P.O. Box ",, Po;' Lookout, New York 11569, U.S.A. Shoulder Immobilizer The Westfield Shoulder Immobilizer is designed to provide secure, effective immobilization of th shoulder and to apply controlled tension to the acromioclavicular are I An elasticized tension strap, padded with soft velvet foam on bot. sides for comfort, applies downwar'i pressure on the clavicle and upwar I tension on the forearm. The tensior strap is easily adjusted by means of pressure-sensitive Velcro closure. The padding on both sides of the tension strap permits the Westfield Shoulder Immobilizer to be used or either the right or left shoulder. For further information, contaci Orthopedic Equipment Company, 10 11 Haultain Court, Mississauga, Ontario, L4W 1W1 POSEY BODY HOLDER At Last... .} The Posey Body Holder is one 01 the many products which compose the complete Posey Line. Since the introduction of the original Posey Safety Belt in 1937, the Posey Company has specialized in hospital and nursing products which provide maximum patient protection and ease 01 care. To insure the original quality product, always specify the Posey brand name when ordering. The Posey Body Holder may be used in either a wheelchair or a bed to secure chest, waist, or legs. There are sixteen other safety belts in the com- plete Posey line. #5163-1731 (with ties), - , - -... The Posey Hand Control Mitts pro- tect patients from injury to them- selves if their hands and fingers are not restricted, This mitt is one of fifteen limbholders in the complete Posey Line, #5163-2811 (cotton), þ The Posey Tie-Back Vest ties in back making it difficult for the patient to remove and has shoulder loops which may be used to prevent the patient from sitting up or sliding in bed. There are eight safety vests in the complete Posey line. #5163-3533, a Canadian supplier for INlISeS needs . No ltbouI Cwbns- Nodufy foPllY. \Hm E\ ER' ORDER. f R II \\ hit. viDvl POCKET SA \- ER for peon!j. .8Ci!i r!IJ. rtc. fh k box OD coupon. 4 . ./ - STETHOSCOPES 'I R"FS STETHOSCOPES", S COWvTl. Ezceptionalaovnd Ira......i..l0... od]1Ulable lightweighl bina..raú: replacemenl part. avadable in Dmadß. 1I 1 S,lver, 1I 15 Gold, 1I 90 BIIte_ /I 9f v.e.,., /I 9 Red 19.00 neb. 1....lttde. m.lialI t''lJgNJved free. m -\1 Ht.:-\D TFTHI''''CUPF -1.mpllJlt's aUfrequl'J1Cu: . Bout af!ctwn hat,' .rtra large JI(Jphragm 4dJlldabk chrome h,nallraú /l4/J. 515.95 .ach. SPHYG:\IO :\IAXO IETER 4- Ruqg.d and d.p.ndnble, Wllh A ne roiJ gauge calibrated to JOO m J7I \. I!lcrfl touch-and.-hold :;:- IIIIIIIIIWI. C1J.(( Handsume zippered Call' 9-:'.'" lO1Je6r!J1'6TØ7llee_ /1115 _ IU.95.acb. .... - IndlLdes i,..taall f>ngroved ----'a.- "..... , , '" OTOSCOPE SET IJ.ne ofGerman,,'s/tnest mst m nls. È:rceptuJ1UJl f ,UMmmatlon. ptJu-er:.ful - .n_ maqrufYlnglens.3stalldard.üe J)'fHTlLla S':f' C boltenes ncllld tl \It'tal carrying can ...0.. I ".d U Ilh .ufl c1..lh_ //J09 - 156.1MI.ach. CISSORS &. FORl'EPS I ,..TFR B-\ 'IHGF ...n......IIR... " 1 ' .-1. rnMst fore ery ,oursf'_ \,,,. "'fJnll.fad urt:'d of finest stt'el and tinrshed n sanitary chrome. 1tt>Q9 .JI r 12.60 "-;00 51." 13.00 ... _70'.! 7',- 13.75 IIPFR-\TI'\G ...n......IIR.. , Slfun/f.'''' ."iteel. strwqht b/ßde:i. 7U5 5 sharp blunt 12."5.arh _7Ob 5" _harp _harp 12."5 each 1:1710 .jllo'IRIS ..('i s(lr'" S3.65euh. HIRn.p.... "'''1. t ta;nless Steel 51 .'10119. ".11, For..ps 7.! Slral!(hI. box-lock 1-1.35 each ....t'liv Fon.t>po;;ltì25 Cuned. box lock .....35 each Thumh Pre mK 117-1 J Stra;Kht. .:oerraledS3.35 ruh The Posey Patient Restrainer with shoulder loops and extra straps keeps the patient from falling out of bed and provides needed security, There are eight different safety vests in the complete Posey line. #5163- 3131 (with ties), .. t: :\l'RSES WATCHES ..J. IJf'fH'11I1ublt'. ultrod f' l,i'Gtch Full nurnbt'rs 1m 11: hilt' j(Jl' Rl'd n t'p Sf' fmJ hand Chrume ('ose, stmnle., t..t'/ hack Jell elkd mOl ement, bliJelc ("ath..r stmp_ I yr. gu.aranl".. It!JO()_ 1'''.50 9J cenls In Ontan(J 0;) 12. .. The Posey Safety Vest in Breezeline is an all purpose vest which can be used to prevent a patient from falling out of bed. or a wheelchair, #5163- 3312 (with buckle), 1',.,TlTI III" -\1 "l R!oot.:": \\nle on yourCompan) I('U rhrad for our 24 pg. ('atalo (', Quantity disC'ounts a.... adabl . 50 cent handling chargE' for orders less than 15.00. ----------- IIrd.r "0. It.m l'ol. QUaD. Siu Price 5end for the free new POSEY catarog - supersedes aU previous editions. Please insist on Posey Qua/ity- specify the Posey Brand name. p o 08EY E V Send your order today! Enns and Gilmore 2276 Dixie Road Mississauga, Ontario, Canada l4Y lZ5 (416) 274-2575 9.0 HII In \\FIIII \.1 ...lPP11 (II P_II. RII'\ 72ti-"_ ßRII{'I\ \ III'" "' T. 1\6\ 5\ S. I I ....tond to: I "'(rH't. I ('in. Pro, .: I Posta] (,OOE': - ;;I ----------- HS 702 Plain Warp Knit 90% Polyester 10% Nylon Colours: White only with screen print of roses Sizes: 4-16 Suggested Retail $40.00 r,..... HJ 319 Plain Warp Knit I 90% Polyester 10 0 / Colours: White only I screen print of rose!' Sizes: 4-16 Suggested Retail $33.00 (\' I, HT 001 \ Plain Warp Knit \\ 90% Polyester 10% Nylon \\. Colours: White, Blue. Pink, Canary, Sherbet, Mint Sizes: 4-16 Suggested Retail $22.00 MAYTIME FROM o White Cross Manufactured by Hampton MFG (1966) Ltd., Montreal, P. a., 125 Elmire St. I .J C) White Cross / A Q AVAILABLE from UNIFORM WORLD (Mail Order Division) P.O. Box 296 Renfrew, Onto K7V 4A4 /1 or shop in our branch stores TORONTO SCARBOROUGH OTTAWA 641 Bay St. 691 McCowan Rd. 226 Bank St. InquIre from our mail order division in Renfrew about our "Mail Order Shopping Service" \ A HS 756 Fancy Pleated Top Plain Warp KnIt 90% Polyester, 10% Nyton Colours: White, Mint, Sherbet SIzes: 3-15 Suggested Retail $38.00 While S3IILOO CoIouNl B HJ 316 Fancy Pleated Top Plain Warp Knd 90% Polyester, 10% Nylon Colours: While only SIzes: 4,16 Suggested RetaIl $35.00 C HJ 302 Double KnIt tOO% Polyester Colours: Yellow, Mint, Blue, PInk Sizes: 4,16 Suggested RetaIl $36.00 D sa 1200 3/4 Sleeves Also available In short sleeves PlaIn Warp KAt - T ucl>(1 \(IYl-I-t is___III___II.S I Iberta IMMER VACATION: Have you conSidered horseback ndlng and Implng In tt'e Rockle Mountains near BanH. Alberta? EIght 6-day JS sponsored by a non-proflt ndlng club are planned for'he summer ',976 For brochure wnte to Trail Riders 01 the Canadian Rockies. I>X 6742. Station '0 . Calgary. Albena T2P 2E6 ritish Columbia I eglstered Nurse or Registered Psychiatric Nurse lor challenging )5,lIon In a therapeutic pre-school. Requited training - expenence I let training In family therapy: and experience. mterest and aptitude In orl"ng w h pre-schOOl age children with emotional disorders. Apply. dmlnlstrator, Mental Health Services. Burnaby, 3405 W"hngdon Ave- .Ie Burnaby. B C V5G 3H4. I 'Kperienced Nurses (eflglble for B.C regIStration) required I n ;9-bed acule care, leaching hospflallocaled In Fraser Valley, 20 I Inules by freeway from Vancouver and wl1hln easy access of vaned creationai facilities EJo;cellenl Ortentahon and ContinUing Educahon I rogrammes. Salary $1 049.00 to $1.239.00 Chnlcal areas Include. edlclne General and SpecIalized Surgery. Obstetrics. Pedlatncs. I Dlonar y Care HemodialysIs Rehabll11ahon. Operating Room. In1en- ve Care, Emergency Practical Nurses (ehglble lor B.C lIcense) .so required Apply to. Adrmnls1ra1we Assrslanl Nursing Personnel. oyal Columbian Hospllal. New Wes1mlns1er. British Columbia. 3l 3W7. leneral Du1y Nurses for modern 41-bed hospItal localed on 1h laska Hlgnway Salary and personnel policies In accordance wl1h 'NABC Accornmodahon available In residence. Apply Director of .urslng. Fort Nelson General Hospl1al. Fort Nelson. British C01umbla ;eneral Duty Nurses for modern 35-bed hospllallocated In south- ;rid B rs nd a e w cg : I 1 e nB a f ; u"e s home Apply Orrector 01 Nursing. Boundary Hospllal Grand 'orks Bntlsh Columbia, VOH IHO Ontario legistered Nurses 10' 34-bed General Hosp al Salary $945.00 10 , 145 00 per monlh p1us expenence allowance Excellent personnel ",IICles Apply 10 Orreclor of Nursing. Englehart & Olslncl Hospital nc Englehart, Onlano, POJ 1 HO Nurse Practitioner for community dlnlc Start June 1. If possible. Conlac1 Bea1f1ce Baker a1 438 LewIs Street. Ottawa or call 1-613-233.2167 8'hddrens summer camps In scenic areas of Northern Onlano reqUire Camp Nurses lor July and August Each has resident M O. Conlact arold B Nashman, Camp Services Co-op 621 Eglinlon Avenue West, Toronto. Onlarro, M5N IE6 Saskatchewan r>irector 01 Nursing requrred for modern. fully eqUipped 28-beask SOG 2S0 University of Saskatchewan - Faculty Pos,t,ons Term and regular :itpPolntments In Ma1emal.Chlld pnmary Care CommuOity and Men. tal Health Nursing. To teach In four year basIc and three year post- :hploma programs and contnbute to curnculum reVISion Qualif,ca- Ions Master s Or higher degree and experience In clinical held fOf PPOlntment a1 professional ranks Baccalaureate degree and expen. Etnce for appointment as lecturer Contact Dean. College 01 Nursing. Unf\lerSlty of Saskatchewan. Saskatoon Saskatchewan, Canada S7N OWO 1 he Canaølan Nurse Saskatchewan Three Registered Nurses required tor twelve-bed hospital. Salary and Irlnge benefits according to S.U.N contract An opportunity lor a prom011on to Director of Nursing after a short period of time. Please direct appllcallons or call collect (356.2171) to Mrs. M Rechen. macher. Drrector of NurSing. Dodsland Union Hospital. Dodsland, Sask REGISTER EO NURSES: requrred ImmedIately lor the 22-bed Acute Care Hosp alln the Industnal town of Hudson Bay, Saskatchewan, Hudson Bay IS situated In a torest region with e)(cellenl fJShlng. huntmg and recreational faCIlities Salary and fringe benefits accordmg to the SUN Agreement Please dorect apphcatlons to Mrs. B. Montgomery. Otrector 01 Nursing, Box 578, Hudson Bay. Saskatct'ewan. SOE OVO United States Texas wants you! If you are an RN. experienced or a recent graduate, come to Corpus Christl SparklongCity by the Sea. . a CIty bUilding for a better future. where your opportunitieS forrecreat.on and studies are limitless. Memorial MedIcal Center, 500-bed, general, teachmg hospital encourages career advancement and provides inservlæ orrentatlon Salary Irom $802.53 to $1.069.46 per month. commensurate with education and expenence Differential for evemng shifts. available Benefits include holidays. sick leave. vacations. paid hospitalization. health. life insurance. pension program Become a vItal pan 01 a modern. up-to-date hospllal, write or eall John W. Gover, Jr., Director of Personnel, Memonal MedIcal Center. P.O Box 5280, Corpus Chnsh, Texas. 78405. Switzerland Experienced Nurses for Operating Room and our Intensive Care Unl1 In Muensterllngen/Swltzerland reqUired. ThiS modern hospital (470 beds In all) budt In 1972, an hour s nde Irom lunch. .s Slluated next to Ihe beautllul Lake 01 Constance. There are 160 general Sur- gery beds and exællent working conditIons. The spoken language is German. but fluency IS 001 reqUired. as lessons are available at the language school In the next town LIVIng In accommodation,s availa- ble on request Apply to. DIrector 01 Nursing Service. Kantonsspltal Muenslert.ngen. CH-8596 Muensterhngen. Switzertand Canton Hospital Winterthur Switzerland (Near Zurich) For our modem well organized Physical Therapy Unit and for the Rheumatic Clinic we need Physiotherapists for various duties associated with Rheumatological Surgery, Imernal Medicine, Paediatrics and Gynaecology. We offer pleasant working conditions equitable hours of work and leisure, Salary in keeping with qualifications, living quarters provided. Applicants should apply directly to: Kantonsspital Winterthur, Personalburo, CH 8401 Winterthur, Switzerland May l .fb SOFAA- TULLE' Aou.... Framycetln Sulphate B.P. AntibIotIc IndlcatloM: Treatment 01 Intected or potentoally ,nlected burns crush Inlures Lacerations Also vancose uacers bed- sores and ulcerated woundi Contralndk:atlona: Known afergy to lanolin or tramyce- IIn Cross-senSl1lzatlon may nccur among 1he group of strep1omyces-dem,'ed antibiotiCS (neomycin. paromomycin. kanamycin) of whÞCh framycef,n IS d member but this IS not Illvanable Prec:.ut.o....: '0 most cases absorption 01 the antibIOtIC 15 so slight that n can be dIScounted Where very Large body areas are Involved (e g 30% or mOTe body burn). the poss'- blhty of ototoxlcny being evenrually pr""uced should be considered P[o)Qnged use 01 antibiotiCS may resu" In the overgrow1h of nonsuscept,t>ae organisms Including lungl Appropnate measures Should-\><, taken d thIS occurs Do..g.: A SIngle layer to be applied dlrectfy 10 the wound an(j covered with an appropriate dreSSing If exudative. dressmgs Should be changed at leasl daøy In case ot leg ulcers cut dressing accurately to sIZe of ulcer and when ,nfected stage has cleared replace by non-rnpregnaled dressing Supplied: A lightweIght. paraH," gauze dressing ,mpreg- . )1 ::J '^' th 1% tramycetlO SUlphate B P Sofra-Tulle also contalOs anhydrous Lan011n 9 95% AvatLabae In 2 SizeS 10 em by 10 cm stenle SIngle units canons 0110 and 50; 10 cm by 30 crn srerde s,"gle UOitS. cartons of 10 S10re at controlled room 1empera1ure MANITilBA DEPARTMENT OF HEALTH AND SOCIAL DEVELOPMENT The School of Nursing Selkirk Mental Health Centre is offering a Post - Basic Course in PSYCHIATRIC NURSING for Registered Nurses currently licensed in Manitoba or eligible to be so licensed. The course is of nine months duration September through May and includes theory and ctinical experience in hospitals and community agencies, as well as four weeks nursing of the mentally retarded. Successful completion of the program leads to eligibility for licensure with the R.P.N.A.M. For further information please write no later than June 15/76 to: Director of Nursing Education, School of Nursing, Box 9600, Selkirk, Manitoba R1A 285 Community Psychiatric Centre DOUGLAS HOSPITAL CENTRE Opportunity for NURSES To join the team on a new observation unit for anglophone and francophone population of Verdun, LaSalle, Ville Emard and Pointe St-Charles. For further information, please contact: Mme. Micheline Leblanc PERSONNEL NURSING 6875 LaSalle Blvd. Verdun, Quebec H4H 1R3 Tel: (514) 761-6131, ext, 112 58 NOTICE To all graduates of "Hotel-Dieu I'Assomption" and "Dr Georges L Dumont Hospital" School of Nursing. There will be a reunion of "L'Amlcale" Place: Moncton, N.S. Date: July 3, 1976 For more information and registration forms, contact: Mrs. Diane Benoît 76 Lefurgey Ave Moncton, N,B. Registered Nurses only Required immediately For a 90 bed Active Treatment Hospital in Medicine, Surgery, Pediatrics and Obstetrics Salaries according to Provincial Salary Guide Usual Fringe BENEFITS Residence Accommodation available. Apply to: Director of Nursing Digby General Hospital Digby, Nova Scotia BOV 1 AO Foothills Hospital, Calgary, Alberta Advanced Neurological- Neurosurgical Nursing for Graduate Nurses A five month clinical and academic program offered by The Department of Nursing Service and The DivIsion of Neurosurgery (Department of Surgery) Beginning: March, September Limited to 8 participants Applications now being accepted For further information, please write to: Co-ordinator of In-service Education Foothills Hospital 140329 St. N.W, Calgary, Alberta T2N 2T9 The Canadian Nurse Nursing Home Director of Nursing A new eighty bed home opening October, 1976 with a staff of fifty-five located In a residential area In the immediate proximity of the new Saint John Regional Hospital needs a Director of Nursing. The successful applicant will be responsible under the Administrator for the day to day provision of nursing, personal and supervisory care to the residents. Employment will commence in early summer 1976 and the successful applicant will be involved in planning and policy making decisions. Salary negotiable. The Church of St. John and SI. Stephen Home Inc, of the Presbyterian Church in Canada P.O. Box 218, Saint John. N,B. E2L 3Y2 Director School of Nursing The University of British Columbia The above position becomes vacant on July 1, 1977, on retirement ofthe present Diréctor. The School has 70 full-time faculty members and enrolls 480 students in d 4-year undergraduate program and 50 graduate students. The Director is the Chief Executive Officer of the School. An applicant should have a doctorate Or equivalent, adequate administrative and academic experience and be a Registered Nurse. Each applicant should send a curriculum vitae and the names of three referees by May 31. 1976, to: Dr, W. D. Liam Finn, Dean, Faculty of Applied Science, The University of British Columbia, 2075 Wesbrook Place, Vancouver, B,C., V6T 1W5. Challenging Positions In a progressive Southwestern Ontario Health Unit serving an urban and rural population of nearty 300,000. Excellent fringe benefits. Assistant Director of Nursing to be primarily responsible for inservice education and program development This is a new senior position within the nursing division of this agency. Applicants should have a minimum of five years nursing experience, including some in public health nursing. Bachelor's degree considered, Master's degree preferred. Salary competitive. Supervisor in Public Health Nursing to be primarily responsible for public health nurses in group-oriented proQram. For further details contact: Mrs. Dorothy M. Mumby. Director of Public Health Nursing, Middlesex-London District Health Unit, 346 South Street, London, Ontario N6B 1 B9 May 1971; Fishermen's Memorial Hospital requires One (1) "Shift Supervisor" Rotating in various nursing units with OR experience a necessity. One (1) "Operating Room Nurse" Registered Nurse General Duty OR PG desirable, however, all applicants will be considered. Please address all inquiries to: Director of Nursing Fishermen's Memorial Hospital Lunenburg, NoS. Co-ord i nator Co-ordinator required for a 340-bed acute care hospital in Central British Columbia to be responsible for the related services of the O.R., PAR., Daycare Surgery and Emergency Departments. The position will Include both clinical and administrative responsibilities. Salary per RNABC Contract. For further information contact: Director of Nursing Prince George Regional Hospital Prince George. British Columbia V2M 1 S9 Head Nurse with preparation and/or demonstrative competence in Psychiatric Nursing and Management functions. required for Head Nurse appointment. To be responsible for participation in the organization, initiation, and the management of a New Psychiatric In-patient Unit. Please apply, forwarding complete resume to: Director of Personnel Stratford General Hospital Stratford, Ontario NSA 2Y6. Department of Health Province of Newfoundland Canada Nurses Applications are invited from graduate nurses for appointment as STAFF NURSES in Cottage Hospitals with bed capaCities ranging from 20 - 60. Applicants must be eligible for registration with the provincial nursing association. Salary is on the scale $9,963. - $12,282 per annum. April 1, 1976, $10,563- $12,882. Uving-in accommodations are available and laundry services provided. Financial assistance towards relocation expenses IS available on a contractual basis. Applications should be addressed to: Director of Nursing Cottage Hospitals Division Department of Health Confederation Building St. John's, Newfoundland Associate Executive Director Applications are invited for the position of Associate Executive Director, Canadian Nurses AssoCIation, Ot1awa Candidates must be members of the Canadian Nurses' Associahon, have a master's degree or equivalent. have at least five years administrative experience, and be bilingual. Interested applicants are asked to submit their curriculum vitae in conlidence. to: Executive Director Canadian Nurses' Association 50 The Driveway Ottawa. Ontario K2P 1E2 The Canadian Nurse May 1976 59 "Meeting Today s Challenge In Nursing" Queen Elizabeth Hospital of Montreal Centre A Teaching Hospital of McGill University reqUIres Registered Nurses and Registered Nursing Assistants . 255-bed General Hospital in the West of Montreal . Clinical areas include Progressive Coronary Care. Intensive Care. Medicine and Surgery, Psychiatry, Interested qualified applicants should apply in writing to: Queen Elizabeth Hospital of Montreal Centre Director of Personnel 2100 Marlowe Ave., Montreal, Quebec H4A 3L6 1+ Health and Welfare Canada Sante et B.en-être socIal Canada 't'" tor lJectQ4 4_ - A . c:-.:' to C>> - -- ; ".... . - g ,... "... ,"._ 'X._..,,_ ""f!!'. ., ,, m .. - Medical Services, N0I1hwest T erntones Region, IS seeking Qualified personnel to fill a number of public health positions in locations throughout the NWT. Jt; For detailed Information on available posllions, .. Interested applicants .. are invited to complete Clip and mad this coupon today the attached coupon r-----------I - I ' ame I Personnel Administrator \1edlcal Services. I ddress I Northwest T erntones I c ty I Region. Health and Welfare Canada I' oVince 114th Floor. I ' )stal Code I Baker Centre, 10025 106 Street I Iephone . Edmonton, Alberta I T5J 1H2 or call Olflcers, X -Ray and. I t;ollect Area Code laboratory Technicians .- - - _ _ _ _ _ _ _ _ _ 403 425-6787 We have openings for physicians, nurses in possession of a Public Health Nursing Cel1ificate or Diploma, Environmental Health The Canadian Nurse May 1976 School of Nursing The Registered Nurses' Association of Nova Scotia Research Unit in Nursing and Health Care POSITIONS AVAILABLE nvites applications for the position of Nurses with basic baccalaureate or master's preparation are required to work in new types of primary care settings to demonstrate the nurse clinician function in family nursing. These openings are part of a large research and evaluation project to implement and test a model of nursing. The opportunity of a lifetime for nurses with clinical expertise who are able to communicate in our two lan- guages. Send curriculum vitae and references to: Executive Secretary The applicant should have a broad nursing background, administrative experience and university preparation, preferably at the Master's level. A background in professional association activities would be an asset. Applications for this position will be accepted until September 1, 1976. Mr. I. Rosenfeld School of Nursing McGill University 3506 University St. Montreal, Quebec H3A 2A7 For complete information, including job description and salary range, write to: President Registered Nurses' Association of Nova Scotia 6035 Coburg Road Halifax, N.S, 83H 1Y8 If Paris appeals to you . . . so will Montreal . Modern 700 bed non-sectarian hospital . Excellent personnel policies . Registered Nurses and Nursing Assistants are asked to apply . Active In-Service Education program . Bursaries available . Quebec language requirements do not apply to Canadian applicants Director, Nursing Service Jewish General Hospital 3755 cote ste. Catherine Road Montréal, Québec H3T 1 E2 University Hospital of the West Indies Nursing Vacancies Applications are Invited from suitably Qualified Registered Nurses for the following posts at the University Hospital of the West Indies which is a Teaching Hospital of 500 beds and also conducts a School of Nursing with a complement of 300 students. I A. Sisters 1 Operating Theatre 2 Paediatrics (For Surgical Ward) 3 Dermatology Applicants must: 1 Be dual trained and hold post-graduate certificates In the relevant specialist field. 2 Have managerial experience and/or evidence of post-graduate managerial training. Salary in the scale of: $4440 x 240 - 5640 per annum B. Staff Nurses Intensive Care Unit Applicants must be registered or registrable Nurses with special training in Intensive Care. Salary in the scale of: $3240 x 180 - 4500 per annum Applications stating full details of Nationality, age, marital status, Qualifications and experience should be sent to the: Director of Nursing Services, University Hospital of the West Indies, Mona. Kingston 7. The Montreal Children's Hospital Registered Nurses Nursing Assistants Our patient populallon consists of the baby of less than an hour old to the adolescent who has just turned seventeen. We see them in Intensive Care, in one of the Medical or Surgical General Wards, or In some of the Pediatric Specially areas. They abound in our clinics and their numbers increase daily in our Emergency. If you do not like working with children and with their families, you would not like it here. If you do like children and their families, we would like you on our staff. Interested qualified applicants should apply to the: Director of Nursing Montreal Children's Hospital 2300 Tupper Street Montreal, Quebec, H3H 1P3. TwO careers in one. Have you ever thought of combining two careers in one? As a Canadian Forces nurse you could, because you would also be an officer, eligible for regular promotIOn, enloying a mini- mum of four weeks vacation your very first year, free transportation privileges to many parts of the world, early retirement including a generous lifetime pension and a number of other bene- fits The Canadian Forces will give you every opportunity to continue your nurse's training, while using the skills you already have In one of the many military medical installations In Canada or overseas You might Qualify for lIight nurse's traimng or even for a complete doctorate study course 1\ you're a graduate (female or malel of a school of nursing accredited by a provincial nursing association and a registered member of a provincial registered nurses' association. a Canadian citizen under 35 with Iwo years' post- graduate experience in nursing, you owe it to yourself to enjoy two careers in one Contact your nearest Canadian Forces Recruiting Centre or write to: Director of Recruiting and Selection National Defence Headquarters P.O. Box 8989 Ottawa,Ontario.4 K1A OK2 'W h \.t J} . ,. * . -- -- ..... . . . , . . , . . . , II . . I GET INVOLVED. WITH THE CANADIAN ARMED FORCES. Ff "" L '\ " .".. " 4 Nursing Education at Royal Prince Alfred Hospital Sydney, NSW, Australia Royal Prince Alfred Hospital is Australia's largest teaching hospital (1532 beds) and the most highly specialised acute hospital in the country. It is also a teaching hospital of Sydney University, which it adjoin . Graduate nurses at RPA get wide clinical experience in the most modern and advanced medical environment available in Australia. They also under- go continuous in-service education to ensure that their theoretical knowl- edge .keeps pace with their clinical expenence. Post-Graduate Education: RPA of- fers trained nurses a choice of seven post-graduate courses in nursing: ob- stetrics, gynaecology, neo-natal inten- sive care, intensive care, neurology and neurosurgery, cardio-thoracic, and operating theatres. Since the courses are heavily booked, early application is invited. Basic Nursing Education: Each year some 400 young men and women come to RPA to train as nurses on the 3-year course which prepares them for the final examination of the Nurses' Registration Board of New South Wales; this qualification is recognised throughout Australia and in many hospitals overseas. If you would like to join Royal Prince Alfred Hospital either as a graduate member of the staff or as an entrant for either the basic training or post-graduate courses, please write to or telephone: Ms Margaret Nelson * DIrector of Nursing Royal Prince Alfred r.. !'t3:l. \ Hospiral '7f t J I Camperdown, NSW 2050 >" Tel: Sydney 51-0444. Australia, 62 ""-- ç , ".., ...do......... , I I f ,1. Df ' o CJ c:: o ... -- U Di rector Of Community Health Nursing The City of Vancouver Health Department. a member of the Metropolitan Health Service of Greater Vancouver, is seeking a Community Health Nurse to plan, develop, admimster, supervise and evaluate a comprehensive community health nursing program for a population of 500,000. The successful applicant will be expected to continue in the development of innovative programs and work in conjunction with other professionals to improve the preventative health services to the community. The requirements for the position are a Bachelor's Degree in Nursing, including or supplemented by training in community health nursing and post-graduate courses at the Master's level in administration, and supervision in community health nursing. Preferably a Master's Degree with content in supervision and education and a major in administration. Considerable experience as a Community Health Nurse, especially in the various administrative and supervisory levels The monthly salary for this position is $1833 to $2246 per month (1975 rates), depending upon qualifications and experience. This position will become vacant in late 1976 or early 1977. All applications should be made on "Application for Employment" Form Pers, 35 and returned, as soon as possible, preferably together with a detailed resume, to the Department of Personnel Services, 453 West 12th Avenue, Vancouver, B.C. V5Y 1V4, Please quote competition number R-1501. This position is open to both male and female candidates. Government of Newfoundland & Labrador Mental Health Nursing Consultant Applications are invited for the vacant, established post as Consultant in the Mental Health Division of the Department of Health. The Nursing Consultant will work with a multi-disciplinary group of Consultants in the Division. The duties and responsibilities will be oriented towards the administrative. clinical aspects of nursing in programs relating to prevention, treatment, rehabilitation and the continuity of care. The Consultant will be concerned with existing mental health services in hospitals, and community clinics and with the mental health components of other community agencies, the schools and special services such as programs for the aged, the retarded and other developmental disorders. Opportunities will be provided for involvement in university teaching, and research and in the development of new mental health services through the province. Salary, effective August 1,1976, within the range $17,866- $22,119. Qualifications - eligibility to register in Newfoundland. A Master s degree in psychiatric nursing or some equivalent combination of education and experience. Full pUblic service benefits apply with annual and siCk leave wlih pay, provincial statutory holidays and contributory pension. Financial assistance towards re-Iocation is available. Applications and/or requests for information should be forwarded to: C. H. Pottle, M,D., F.R.C.P.(C,) Director Mental Health Services Department of Health Chimo Building Crosbie Road St. John's, Newfoundland The Canadian Nurse May 1976 Vernon Jubilee Hospital Vernon, B.C. a 258 bed acute and extended care hospital in the Sunny Okanagan invites applications for the following Senior Management Positions Head Nurse - Operating Room and P.A,R. Head Nurse - Intensive Care Unit (6 beds) Previous clinical and administrative experience required. Post graduate courses and administrative education preferred. To commence June 1st, 1976. Rotating Nursing Supervisor Previous climcal and administrative experience required. Advanced formal preparation at a University level preferred. Responsible for the Nursing Department on evenings, and nights; clinical resource person on days. To commence September 1, 1976 Personnel policies in accordance with R.NAB.C. Contract. Must be eligible for B.C. registration. Apply sending complete resume to: Director of Personnel Vernon -dubilee Hospital Vernon, B.C. V1T 5L2 Women's College Hospital requires Nursing Coordinator Obstetrics and Gynecology Qualifications Extensive experience in Obstetrics, Administrative expertise, degree in Nursing and eligibility for registration In Ontario, are requirements Head Nurse Central Services Dept. Qualifications Previous experienæ in C.S.R. or other related position. Sound knowledge of aseptic techniques, quality control methods. management skills. eligibility for registration in Ontario. Women's College Hospital is a 400 bed general teaching hospital in downtown Toronto. Applications and enquiries to: The Director of Nursing Women's College Hospital 76 Grenville Street Toronto M5S 162, Ontario IIIIII' .......fHlUIQ'1I nU'::I'1:: .....,. I 'V 657 bed, accredited, modern, well equipped General Hospital, rapidly expanding... - . ' ANNOUNCING A NEW PUBLICATION Saint John General CfIoÆPital ðaintc:John,NB. CANADA "Intravenous Drug Therapy Manual" by Marilyn E Brown, M.Sc. candidate q?J:;QUIRES: Genetãlðtaff f\(yrses C& Registered Nursing Assistants . monographs on over 200 intravenous drugs listing indications, dosage, preferred administration routes, hazards and recommended personnel for I. V. administration. . researched and reviewed by a munidiscipJinary committee at the Ottawa General Hospital. . designed to assist nurses with 1_ V. administration, physiCIans with I.V. prescribing and pharmacists with LV. drug information. . available in 3-ring binder with provisions for twice yearly updating. Cost: Single issue: $10.00 each 5 or more: 8.00 each 10 or more: 6.50 each (ThIS laller pnce allows relatIVely InexpensIve dslnbunon 10 nurSing UnitS) In all general areas: Medical, Surgical, Pediatrics, Obstetrics, Chronic and Convalescent, several Intensive Care areas and Psychiatry. I hereby submit a cheque/money order for $ for copies of Intravenous Drug Therapy Manual, payable to the Ottawa General Hospital. . ActIve. progressive in- service educalion program. Special Allenlion 100rienlalion. Allowance lor Experience and Posl Basic Preparalion FOR FURTHUR INFlllMATION APPlY TO -PERSONNEL DIRECTOR CSaintfjohn General Hospital po. BOX 1000 Saint John. New Brunswick ElL 4L1 Send to: I.V. Drug Therapy Manual Drug Information Centre Ottawa General Hospital 43 Bruyère Street Ottawa, Ontario K1N SC8 Applications are invited from'suitably qualified members of the Nursing profession for the position of: Qualifications: Must be eligible for registration with the Nurses Board of South Australia as a Registered Nurse and Registered Midwife, Diploma in Nursing Education, Diploma in Community Health Nursing or equivalent. Senior Tutor Community Health Nursing Course Salary $10.251 under review Duties Plan, organise, implement and evaluate a 26 week Community Health Nursing Course, liaise with Government Departments. Voluntary agencies and other Allied Health Professions. Teach students and evaluate student performance, supervise clinical experience, Other related duties as required, Applications including all relevant details should be forwarded no later than Friday June 4, 1976 to: The Chief Personnel and Training Officer Hospitals Department 158 Rundle Street Adelaide South Australia, 5000. 64 Serve Canada's native people -. ... .. \ .....-- I .. . In a well equiDped hospital. . . Health and Welfare San'é ... Blen-êlre socIal Canada Canada ,--------------- I Medical Services Branch I I Department of National Health and Welfare I I Ottawa, Ontario K 1 A OK9 I I I I Please send. me information on hospital I I nursing with this service, I I Name: I I Address: I City: Pro,,: _ -----------____J The CanadIan Nurse May 1976 Index to Advertisers May 1976 Burroughs Wellcome Limited -- --- Canadian Hoechst Pharmaceuticals Limited The Canada Starch Company Limited Department of National Defence Equity Medical Supply Company Ham pton Manufacturing (1966) limited Hollister Limited House of Appel Fur Company Limited ICN Canada Limited L'eg gs Products International Limited J.B. Lippincott Company of Canada Limited MedoX The C. V. Mosby Company Limited Nordic Pharmaceuticals Limited Posey Company Reeves Company Roussel (Canada) Limited W.B. Saunders Company Canada Limited Schering Corporation Limited Stensystems Limited Three (3) M Limited Uniform Specialty Uniform World Uniforms Registered White Sister Uniform Inc. 2,55 1 Cover 4 61 43 44 51 6 49 9 32,33 56 46, 47 5 43 15 13.57 7 55 17 18 Cover 3 45 40 Cover 2 Advertising Manager Georgina Clarke The Canadian Nurse 50 The Driveway Ottawa K2P 1 E2 (Ontario) Advertising Representatives Richard P. Wilson 219 East Lancaster Avenue Ardmore, Penna. 19003 Telephone: (215) 649-1497 Gordon Tiffin 2 Tremont Crescent Don Mills, Ontario Telephone: (416) 444-4731 Member of Canadian Circulations Audit Board Inc. I3E:] 76 The Canadian Nurse L..u......" .J I t-" l J - I r 1.J J - 6l -111 , U.b r flt T - - -. - ..,. :s t. . . ... -,.. 'Yl'r': . - I ' ....... . ,, I __ _ . ." , T"'" . . 101 .., #. ""'1'.1 ',, . I. : .., - ,..... .. :, - -" . ",. . ,: {:; . ,. , "'" 0, ; .. .... .. -. ';--.1 -' .. J , ... ..' I . . L ./ 1CI"' c .;.A . ' " .., It. - .,. i ' .) . '- ..Ì'. 1 J 01 · , I -, l' '1- . . '.' .... .Å -t' .... ;r . . _ .JI4..,f. .. ': '0"/ .. r' ø. ::.J \. . .. . , ;,-"\t " . "" -. ,; . I " "" " . , . "p þ h. 4 ", J - .. ... ......... , A A. Style No. 46596 Sizes 5-15 Pristine Royale White about $24 B. Style No. 6699 Sizes 6-20 Elite - 80% Dracon, 20% Cotton Bengaline Weave White about $2 ( VVHITE SISTER See our new line of Whitps and Watpr Colours at finp stores across Ca ad, @ . I -. , The first and last word in all-purpose elastic l1tesh bandage. , , Quality and Choice · Comfortable, easy to use, and allergy-free. Widest possible choice of 9 different sizes (0 to 8) and 4 different lengths (3m, Sm, 25m, and sOm). rJ ;r :Fj1 ::'t; I\ . - . . F-n . m . -tJr:; I.J_U :. . r i I r. .. u..(jJ..l.J!'. M ,. ã '.J(,E;r :t.. -.... 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QUEBEC.TEL: (514) 331,9220 TELEX: 05-27206 ---;\L I -:\ "- ,.... f'I"" , .. ...... L'f' We care about nurses THE CLINIC SHOE p kWornm ï",WhJi,@ ABOVE STYLES ALSO AVAILABLE IN COLORS. . SOME STYLES 3 /2-12 AAAA-E, 23.95 to 32.95 For a complimentary pair of white shoelaces, folder showing all the smart Clinic styles, and list of stores selling them, write: THE CLINIC SHOEMAKERS · Dept. CN-6, 7912 Bonhomme Ave. . St. Louis. Mo. 63105 it 76 Input News Names and Faces What's New Audiovisual Books Calendar library Update In. (;Snaa..n Nurse .June lBrtj .j The Canadian Nurse The official journal of the Canadian Nurses' Association published monthly in French and English editions. 6 12 48 50 52 54 56 56 Breast Cancer Mammatherm: A Weapon in the Fight Against Breast Cancer Prejudice in Nursing Legg-Perthes Disease A Clinical Evaluation Tool for Student Nurses Storyboarding - A Teaching Tool Volume 72, Number 6 A. Butler 17 M. Bacon 23 N.J. Briant 26 C, Nichol 31 Morton,A. S#nso J. Wagstaffe, M. Yakimoff 37 G. Dubm,A. Dunsmore D. Pedersen, J, Quiring R. Rubeck 42 P. Nendick 45 D. Scott 46 Extended Care Connection: Home Ec, Anyone? JI': -:ç '..' TitJ> . - - _l ,. ,.. r "II'f. : .. --.:; ';#F.. -.r.p '_' >t., , . _.. ; ... . . -- .. - .. -"oJ, .:.. ::: - . ì ;:< .... " ; .... , "'-4IÞ The final hurdle for nursing students across Canada is the examination for nurse registration/licensure set by the Canadian Nurses Association Testing Service. This month The Canadian Nurse salutes the RN's of the future who are writing these all-important exams in June. The cover photo. courtesy of The Globe and Mail. Toronto, shows a group of 1975 graduates during their exams last year. The views expressed in the articles are those of the authors and do not necessarily represent the policies of the Canadian Nurses' Association. ISSN 0008-4581 Indexed in International Nursing Index, Cumulative Index to Nursing Literature, Abstracts of Hospital Management Studies, Hospital literature Index, Hospital Abstracts, Index Medicus. The Canadian Nurse is available in microform from Xerox University Microfilms, Ann Arbor, Michigan, 48106. The Canadian Nurse welcomes suggestions for articles or unsolicited manuscripts. Authors may submit finisht d articles or a summary of the proposed content. Manuscripts should be typed double-space. Send original and carbon. All articles must be submitted for the exclusive use of The Canadian Nurse. A biographical statement and return address should accompany all manuscripts. A Canadian Nurses' Association, ':::( 50 The Driveway, Ottawa, Canada, K2P 1E2. Subscription Rates: Canada: one year, $8.00; two years, $15.00. Foreign: one year, $9.00; two years. $17.00. Single copies: $1.00 each. Make cheques or money orders payable to the Canadian Nurses' Association. Change of Address: Notice should be given in advance. Include previous address as well as new, along with registration number, in a provincial/ territorial nurses' association where applicable. Not responsible for journals lost in mail due to errors in address. Postage paid in cash at third class rate Montreal, P.Q. Permit No. 10,001. CCanadian Nurses' Association 1976. 4 The Canadian Nurse June 1976 .-P'-SI)P(-. i ,ep Every writer who submits an article to The Canadian Nurse has something original to offer readers. ThIs makes opening the mall a little like Christmas every day and adds greatly to the editor's appreciation of what nurses across the country are thinking. The number of submissions that can be accepted is, unfortunately, limited Of the ones that do get into print, most end up as an article, or maybe a letter-to-the-editor. The one below is an exception: it's on this page because I think the challenge it offers health professionals, while not new, is important. It was submitted by Patricia Ford of Thunder Bay, Ontario and here is what she wrote: What I have to say is going to be as popular as shooting puppies but, in the past year, I have become convinced that exercise is not something exclusively for athletes or the educated few who pound around university tracks. Rather, it is a biological necessity: 10 live to your potential both quantitatively and qualitatively you must exercise. A vivid example occurred recently when a 38-year-old man with a myocardial infarction was admitted to the Intensive Care Unit where I was working. Right away, some of you will suggest that his heart attack was due to some quirk of cholesterol functioning or a stressful situation. Perhaps, but I doubt it. Studies of three groups of people known for their longevity in Kashmir, Russia and Ecuador, found a high level of physical activity was common to aiL The gerontologist involved, Dr. Alexander Leaf, was amazed at the exertion displayed by men and women over 100 years of age. For those who may quibble about their true ages, he states - "It is the fitness of many of the elderly rather than their age that impresses me." These people do not possess some special gene or immunity which protects them from aging. They appear to suffer from many of the same cardiovascular diseases that we do, but their heart muscle is so superior due to activity, that their heart attacks are silent. Consider the human potential this represents. Imagine not just surviving to the age of eighty or ninety, shuffling around the halls of a nursing home, but really living, being able to walk miles, swim and enjoy your grandchildren. What is more exciting is that this possibility is within our grasp. Why should we passively accept a reduced life expectancy just because of the life style technology forces upon us? Why should we allow technology to fatten us like sedentary cattle for a futile kill? We have control over our lives and we must exercise that control to live. Of course, it takes some effort: slick advertising implores us to drive everywhere; the slightest smell of sweat is reason for social ostracism; parents who tell their children to walk a mile to school are cruel; and our highways say "No Bicycles Allowed." What can you do? First, recognize that man has survived as a species not in spite of hardship but because of it. Exercise should be recognized not as an occasional indulgence for a flatter stomach or firmer thighs but a daily biological necessity - whether it is running, swimming, skating, jogging or whatever. Exercise must be approached with intelligence, but as Astrand the noted Swedish physiologist indicated, a checkup by a physician is more important for those who are going to continue a sedentary existence than forthose who are going to start exercising. Depending on your situation, it will probably take you 45 minutes per day including a shower afterwards, to maintain a reasonable level of physical fitness. And, it must Ile.-ei'l Editor M. Anne Hanna Assistant Editors Lynda Ford Sandra LeFort Carol Thiessen Production Assistant Mary Lou Downes Circulation Manager Beryl Darling Advertising Manager Georgina Clarke CNA Executive Director Helen K Mussallem I be regular. Also, every chance to walk I in your daily routine should be taken Can you walk to work? Too far? Then get off the bus one mile from work and I walk the remaining distance. You will not only look and feel better but you will be controlling your own destiny. If you value your life, you will exerCise. Only you can increase the quality and quantity of your life - for less than an hour a day you can add years to what is presently being programmed as your life expectancy. Run for your life and avoid the slaughter! Doreen Scott, the author of this month's "Connection," is program coordinator for the Department of Nursing at the Alberta Hospital, Ponoka, Alberta. She obtained her RN from Calgary General Hospital some time ago and last November received her B. Sc. in Nursing from the University of Alberta. She describes her present work as "exciting and challenging and I love it." She and her family live on a farm and her activities these days include work on a novel which will feature a nurse. Breast cancer CAN be beaten .., but only If nurses make full use of their caring qualities to help women detect and cope with this disease. To learn more about "getting in touch" with these patients, read Ada Butler's feature story "Breast Cancer" beginning on page 17. We suggest that, along with this article, you read "Thermography" by Monica Bacon as well as this month's audiovisual feature section. I I - ,r.v. - II zo\a seru Recently d' Min: cholesterol was' ,.: letary program fish I sota. It included :,rted from the U to reduce Res l :' :ts, and ia n;gt' poultry, f ":::y of a verage of 17 % cholesterollevel % pure com oil. ggs, . s were reduced . F M Important stud a complete r 1orm h ation, B":t r= te :;Ñ t o.n t . this arc Compan DIvIsion T h n JOnal Station AMY' P.O. Box 129' e Canada H3C ICI' ontreal, Quebe ' M c, azola Corn 0 0 1 54% polyu I contains' 14% satur:t:: : fats. and .. : A8tF Jf -- c, Q O \)\. . 100% plJ t '..... ttUILE DE """I 32 oz fI 909"" ___ ..._.._rII""'''''' .... B s Foods LIvIn g up to our nam e. ... \,. 6 The Canadian Nurse June 1976 The Canadian Nurse Invites your letters. All correspondence IS subject to editing and must be signed, ahhough the author's name may be withheld on request. 111))ot A bureaucratic battle lost Beverly MacLellan's article "Matthew My Son," (March, 1976) should occasion no surprise among at least one group of Quebec citizens. I refer to those of us who struggled so valiantly, and so vainly all through the summer and fall of 1973 to convince the Quebec Ministry of Social Affairs under Claude Castonguay, that the closure of the Catherine Booth Hospital with its family-centered maternity care services, was a grave and serious error in judgment. It is difficult. well nigh Impossible to refrain from saying ." told you so," What happened to Beverly and Keith during "prepared childbirth at the General" was good. What happened to Beverly, Keith and Matthew durinq the next four days was not Iragic, but it was sad, and as a nurse I feel ashamed and obliged to say to them in the name of nursing "I'm sorry. It should not have been like that. It would not have been like that at the Booth." Thirty thousand Quebec citizens in 1973 saw fit to sign a petition asking the Quebec government not to close the hospital. Nobody listened. Dr. Sidney Lee, Associate Dean (Community Medicine), McGill University, advised the ministry then: "These units must be effective in both the human and scientific domains. We don't want hospitals which fail in either of these respects....Science without warmth and kindness is unacceptable to our views of what medicine is and should be." Noble sentiments, but one is FURS MUCH BELOW RETAIL PRICES NURSES ARE PRIVILEGED TO BUY DIRECT FROM FACTORY AT SENSATIONAL SAVINGS. Cut down the high cost, avoid the middle-man profits. Buy direct from the manufacturer at lower costs. BUDGET if you wish at no extra charge. LEATHER COAT DEPARTMENT Famous brand of genuine leather coats in latest styles and colours - plain - fur trimned - zip-in lining. 1IDUSBOF- APPIL 1>' U R CO. LTD, Manufacturers of FINE FURS 119 Spadina Avenue Toronto,Ont. M5V 2L 1 Tel.: 363-7209 -- , I I - tloi.JU.iI,D - forced to ask as Susan Pomerantz did in a Montreal Star editorial regarding the Booth closure "What justification is there for ending maternity care in the one place where treatment on the human level is as highly emphasized as treatment on the medical level; where the mother, the individual is still as Important as the mother, the patient?" In 1973 we asked The CanadIan Nurse for moral and editorial support In our battle, and were told that this sort of action would be against editorial policy. Coverage of our loss of this small battle in a big war, was less than negligible, but as Canadian nurses, how could we prevail against the "editorial policy" of our own professional journal? And now, in March of 1976, you editorialize that for Beverly MacLellan "the support and encouragement that she needed....was not available when she needed them most." So, I ask you what else is new? WHEN will you people open your eyes and honestly confront yourselves and your readers with the truth about what is happening to people in hospitals at the hands of the "health professions?" - Mary E. Hal',B.A., R.N., D.N Ed., Chateauguay, Quebec. The editor replies: Your charge that we are not "telling it like it is" is a serious, - indeed, a fundamental one - for a professional journal that exists primarily to do exactly that. In an editorial last January I tried to explain my commitment to this task. That is why the decision was taken to include an article by a non-nurse (Beverly MacLellan) in the March issue. We thought it was essential for the profession to see how people on the receiving end of health care perc ive the system and the providers. It was regarded by the editonal staff as a step in the direction of "telling it like it is" rather than simply describing the ideal in maternal {child care. Whether the profession chooses to work together for the improvement of the health care system depends upon its members. Their Joumal is willing - indeed anxious -to provide the necessary forum. March issue a winner It is a change to write someone a letter to say what a good list of articles appeared in the March, 1976 issue of The Canadian Nurse. The diagrams 111 " A Practical Guide to Successful Breast-Feeding" were excellent. I also appreciate your printing Beverly MacLellan's article. - L. Cliffe, Public Health Nurse, Delta, B.C. I enjoy your new look, espeCially the fact that each issue appears to have a theme. March's issue was of particular interest to me since I am a nurse and also a nursing mother. It's very encouraging to see that nurses are becoming more knowledgeable about the subject since I know from personal experience and the experience of others that too often the nurse has been responsible for the mother I getting off to a bad start. I do have some argument with II Taggart, though. She says "Meticulous washing of the breasts- is necessary before and after each feeding in order to avoid infection..' If one keeps one's clothes clean, nature will keep the breasts clean. A daily bath with warm water is plenty and 01 course no soap or alcohol on the breasts. The purpose of the Montgomery's Tubercles is defeated if one follows a routine of cleaning the nipples before and after every feeding - that purpose being to keep the nipples clean yet supple with their wax-like secretions. In fact this regime of cleaning could easily lead to sore, cracked dry nipples, (even if creams are used) leading to a stasis of milk thus an infection. Free-flowing milk is by far the best prevention of mastitis. A good healthy neonate is in no danger of infection from his mother's breasts unless she has T.B. or whooping cough, of course. What of the mother whom the nurse suspects is not personally clean. Well, let that nurse be thankful the woman IS nursing her baby. Her milk will be fresher and more sterile than any formula she could probably make at home RIght? I think that breast-feeding, among its other advantages, is the simplest, most convenient way of baby feeding. Let us, as nurses, keep it that way. - Judith Vestre, Saskatoon, Sask. GENEROUS NEW GROUP DISCOUNTS on ./1 Items shown. for group øurctaases. graduation gifts. fawrs. etc. 6-11 Same Items, Deduct 10%; 12-24 Same Items, Deduct 15% 25 or More Same Items, Deduct 20% H ' ,* 7k,...;- -------------------------------------. IT'S EASY TO ORDER REEVES NAME PINS FOR YOURSELF OR FRIENDS! I d ' ..;'= /é : : Wu :fiG\ :.r;c rim at . '::1=,::, I boxes ... cIIort, dill thIS section .IId .1txJI 10 .f;-EXAMINING PENLIGHT Whit.. borrel WI", Cllklceus Imprinl .Iv- minum bind and clip. 5" Iona. US. made. batteries included (replacement tte(les "",lab.. In, storel. No. NL-I0 Pen!lllll . , . 3.95 u. In;l;a'. en'....d, Idd 60.. 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Please submit complete Card Number (IncludIng M C. Interbank #), Expiralion Dale, Ind your Signature with order. I I Send to .. Street --. ('tv Stale . ..lID 8 The Canadian Nurse June 1976 I II I) lit More tips for nursing mothers As a nurse and La Leche League Leader, I was very pleased with the articles on Breast-feeding and Mastitis (March, 1976). The education of case room and postpartum nurses is essential since their attitude can "make or break" a nursing relationship. I feel it would be a great service to nursing mothers if information about the local La Leche League was routinely handed out at all hospitals. Most problems in the management of lactation are not medical in nature and could be handled by an experienced. nursing mother rather than bothering the hospital nurses after discharge. I would like to make a few specific comments. Preparatory Exercises: We find it helpful to have the mother actually express a few drops of colostrum daily from each breast in the last trimester. There is some feeling that this helps to open the milk ducts as well as giving the mother practice in hand expression. Hygiene: I feel "meticulous washing" is really unnecessary. Simple rinsing with plain water should be enough. Drainage: If a mother can nurse her baby every two hours or oftener, her problems are greatly reduced. I question the need for emptying the breast after each feeding if the baby has not nursed for half an hour. Not many newborns have the physical stamina to nurse effectively for that length of time. We advise that if baby tends to fall asleep after ten minutes on one side, he be allowed five to seven minutes on the first side and as long as he likes on the second. Alternate breasts are offered to begin each feeding. Studies show that an infant can remove 90 percent of the milk in a breast in five to seven minutes. At-Home Instructions: should include advice about handling a "growth spurt." This often occurs at about six weeks of age. Baby suddenly wants to nurse every hour to one and a half hours . This is simply his method of increasing the milk supply to meet the new growth demand. This frequent nursing will last at the most 72 hours and maybe only 24-48 hours. If allowed to nurse as often as he wants, he will resume a more reasonable schedule as soon as the milk supply Increases sufficiently. This is the time when Mother panics, thinking she is losing her milk and reaches for the bottle which defeats the whole process. We have found that always offering both breasts at each feeding is best. Starting on the side she finished on last time ensures adequate emptying of each breast every other feeding. Lastly, though a "healthy child with a good sucking reflex" is a great help to successful nursing, it is not essential. Many premature, cleft lip and palate. and otherwise compromised infants have been successfully nursed - much to the delight and pride of the anxious and deeply concerned mothers. Once again, thank you for opening R.N. 's eyes to a much needed area of information. - Cheri Purpur, Red Deer, Alla. Non-support Thank you for the article "Matthew My Son" and the articles on breast-feeding. When I trained in the forties great efforts were made to teach us to help mothers breast-feed. However, in 1947, when I successfully was breast-feeding, on departure from the hospital where I trained, my obstetrician handed me a formula to take home. When I told him I was breast-feeding, he remarked: "Oh you'll get tired of that soon," Ever since then I have been appalled at the attitude of many doctors regarding breast-feeding. Nurses have always been taught to work under the direction of doctors. Is it any wonder that the emphasis on teaching nurses to help mothers breast-feed has decreased! I hope there are enough doctors in Canada who are really anxious to have their patients breast-feed their babies that Canadian nurses can put into practice the fine lessons provided by Taggart. - Lois B. Hord, B.A, R.N., Québec, Qué. . Help for abortion patients As a nurse and as woman I take exception to "What are the bonds between the fetus and the uterus?" written by a male. (Adamkiewicz, February. 1976). This sort of article reflects a very narrow and provincial view that helps neither the patient nor the nurse. The idea of a womb being somehow outside the body and separate from the person who carries it, is extremely repugnant and anti-feminine. Surely in an age when women are struggling for their rights in all areas, the only national nursing publication in Canada can do better than to advocate such a position. Our patients are having abortions, we must face this and deal with it as best we can. Do we want them to go back to dYing or sufferinq (as I once witnessed) an abortion well-done, but without anesthetic? Legislation repressing the ability to get abortions will lead to this and will not help our patients. Too often I have seen nurses display an absolute disregard for the feelings of their abortion patients because they (the nurses) felt It was wrong. How cold they were and how they left the patient even more empty and frightened than before. Surely if we are nurses we must be prepared to nurture and teach these women just as we nurture and teach our other patients. It is our professional responsibility to recognize our patients' needs and to put aside some of our feelings. I am not saying that we should not deal with our feelings nor that we should work in areas which are distasteful and frightening to us. But we do not have to treat the abortion patient cruelly, nor do we have to advocate the legislation implied in your article. It seems to me that the patient should come before everything, and her reality is that she will seek abortion no matter what we feel. - Georgiana Kish, B.N, Montreal, Que. A woman's right I thought I had encountered all the arguments of the anti-abortionists but Dr. Adamkiewicz's suggestion that the uterus be accorded extraterritorial status amazed me. I certainly would nOI argue that the fetus has a different biological identity from that of its mother. When women refer to having rights over their own bodies they talk of the uterus, not the fetus, as being part of the female body. When society denies women access to abortion the fetus is given the right to occupy and use the body of another person - a right accorded to no other individual in our society. Dr. Adamkiewicz states that the uterus protects the fetus from rejection by the mother's body. It is my understanding that the placenta is the organ which performs this function. The uterus is a female organ and as long as the fetus can only develop to maturity within the uterus, I believe that only the individual woman concerned should decide whether or not to continue her pregnancy. I - Audrey C. Hall, Prince Albert, Sask. A question of drugs I am Inservice Coordinator in a small 57-bed general hospital. Recently we have been made aware of the fact that most of the training schools and hospitals in our province do not train or allow RN'sto administer certain parenteral medications such as iron preparations, magnesium sulfate and medications in oil suspension form. Many of our new R N's are refusing to administer these medications 1M. Naturally we have become wary of these drugs. The problem is that we cannot find out from any source why hospitals and schools of nursing are not allowing these drugs to be given by supervised students or RN's. What, besides special methods of administration, is the danger? Are RN s now not capable of learning special techniques for the administration of certain 1M medications? I consider an RN always responsible to be aware of and watch for reactions but this does not seem to be the problem. - Nan Holden, Shelburne County, NS. P.S. - Congratulations on a much improved Canadian Nurse. E I FE \.... l- (:. r' J' - 1"1\ '? , , I Burroughs Wellcome Ltd. :.r.ll laSalle, Que. , , NE. Only ACT I FED combines pseudoephedrine HCI with triprolidine HC!. the potent ontihistomine discovered in The Wellcome Research loborotories Drolly effective, ACTIFED reoches areas nose drops con't-for long-term symptomatic relief of ollergic ond vasomotor rhinitis, the common cold. hay fever ond ollergic osthmo. ACTIFED. The different one for initio! treat- ment; the different one for patients who've grown toleront to other antihistomine combinotions. the year-round way to stop sneezes and sniffles ACTIFED Tablets/Syrup Triprolidine HCI/Pseudoephedrine HCI .TradeMark 10 The Canadian Nurse June 1976 1111)111 Nurses' dilemma Nurses in Ontario are worried about the government's decision to close hospitals in order to reduce health care costs. This decision is having a major impact on everyone involved in health care services, especially nurses. Thirty-six hundred nurses will graduate from community colleges and universities this year, but fewer than two hundred positions are open; for those, the new graduates will have to compete with unemployed nurses, many of whom have experience. What will all these unemployed nurses and new graduates do? Does the government really believe that a well-trained nurse will be happy in an unskilled or semi-skilled job earning half or even less of her salary? The Minister of Health states he understands the situation but these are the times we live in. Isn't it the government's responsibility to guide and direct? Ten years ago everyone wanted to increase the supply of nurses. At that time the Health Ministry should have worked out a long-range plan and tried to establish a balance between supply and demand. In 1971, or earlier, the government should have limited enrolment in nursing education. With the current unemployment situation, obviously the government did not look ahead in time. Since the Ministry of Health has created the problem, they are responsible to assist nurses in finding new jobs within the health care system 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 JState Please complete appropriate category Postal Code/Zip .J I hold actIve membership in provincial nurses assoc. reg. noJperm. certJlic. no. o I am a personal subscriber Mail to: The Canadian Nurse, 50 The Drivewav, Ottawa K2P 1 E2 or in starting a new profession. The governrnent should set up a task force to help nurses reestablish themselves. It will be a dillicult time; a lot of reexamining and setting of new priorities must be done. Our lifestyles will change, but it is up to us to make the best of it. Don't sit back and give up, or hope things will change by themselves. The problem has been created... let's solve it. - Konrad and Nila Sadek, Cambridge, Ontario. Nursing ed philosophy In response to Stinson's "Frankly Speaking About Nursing Education," (The Canadian Nurse, January 1976) and the concept of national or regional centers: Anyone wishing training, education, or information, ought to go directly to the source. Teacher preparation should be in a school of education. Administrators should be prepared in a school of administration. Nurses should be prepared in a school of nursing Teaching is a profession. Nursing is a profession. Nurse-teachers must have knowledge and skills from both professions. In Canada we do not have health care. We only have disease care. Government "health care" schemes only pay for care of people who have demonstrated disease. II seems that no money is available for preventive mediane. Up to a point, centralization has value. Probably there is need for both regional health science centers and smaller centers for the preparation of nurses. As long as patients are treated in various types of facilities, nurses should be prepared to work in these situations. We need to take a hard look at "preparing," to the point of doing a needs assessment analysis. I believe that there are alternative solutions to the problems of inadequate preparation of nurse teachers. If part of the problem is lack of teaching skills, one alternative could be for nurSing schools to employ a master teacher to work with the nurse-teachers, In fact, the problem may be in the learning environment, or indeed the basic ph ilosophy of nursing education. When one considers the continuing rapid development in all fields, and realizes that an individual has to work very hard to keep pace with advancing knowledge, techniques and procedures in specific areas of a profession (teaching and/or nursing), the job of a nurse-teacher seems almost impossible in the present structure. - Jane C. Haliburton, Director of Education, Yarmouth Regional Hospital, Yarmouth, N.S. CNJ by pony express The date is April 7, 1976, and I've only just received the March issue of The Canadian Nurse in this morning's mail. I'm wondering why the delay? Most journals are out before time. Had I wanted to apply for a post, or attend any of the meetings mentioned in the "News," I would probably have been too late. I know we live to the West of the Rockies. but nowadays we I don't have to rely on the pony express or the mule train. Pierre Trudeau must have thought B.C. important enough to be on the map, for didn't he come West to marry Margaret? My plea is, please let us have our professional magazine here before it is five weeks late! - Grace Burrows, R. N., Brentwood Bay, B C. Editor's Note: I hear you. If there is anything more irritating than receiving a magazine late, it's producing one on time and finding that readers aren't getting it till much later. Have you taken a good look. at your local post office lately? Does it by any chance have a hitching post near the door? People power We wish to commend you on the excellent issue of The Canadian Nurse (March, 1976). It was most refreshing to receive a journal oriented to infant care which is so vital to those of us in Public Health Nursing Many thanks. - Kathie Wdowiak, R.N, P.H.N, Ann MacDonald, R.N., P.H.N., Gwenda Hartlen, R.N., P.H.N.. Mary Mercer, R. N., PH N., Elizabeth Watts, R. N., P.H.N., Eva Parsons, R.N., P.H.N., Heather McCleave, R.N., P.H.N., Patricia McManus, R.N., P.H.N., GeneVieve Nason, R.N., P.H.N., M. Patricia MacLeod, R.N., PHN., Margaret Martin, R.N., P.H.N., AtlantIc Health Umt, Department of Public Health, Nova Scotia. POSITIVELY.. .. ..... - .... " , ',-' ' - ..:(i' . '. . . . . i ' ""r' ......' '-.. '\ .... 't .".:' ': .f " tI:\ .. . . ... . r ,IA ...'(" . .' ! f' .... . . III ,n .' '.. >/'.f\ 1- '>. \è It ,'I.. . . . '..I f ,. ' , tri l . '1. 1 ... .', ' J!tJ.... . 1,.:' , .()'\ .( J ) .. i ,. .. · \ t" : .' ,'" '. . .;. . I.-' , :y. '1 p ' . .f ,. ..t...., ,', .., ': yo I . r , J THE INFUSION PUMP YOU CAN COUNT ON The IVAC 530, now with battery power, offers you exact I.V. fluid administration-accuracy to within ::t: 2% of the drop rate selected. With the IVAC 530 Infusion Pump you can be positive patients in the ICU, CCU. nursery, or 08 ward receive the precise dose of medication prescribed. In the ER, the stabilized coronary patient can be infused at a constant rate before beginning the trip to the CCU. With battery power, even in an ambulance, fluids can be started and continued at the drop rate you select. When your patients' lives may depend on reliable I. V. infusions administered under pressure, doesn't it make good sense to evaluate the IVAC 530 Pump? Positively! IVAC. . CORPORATION DJ;;;; ; STEMSLTD. 47 Bavwood Road, Rexdale (To onto) Ontario M9V 3Y9 -- ........ , DROPS PI[ll MtN 3 0 ON OF F BT.IIT [Iii . 12 The Canadian Nurse June 1976 Ne\\"s RNAO delegates examine nursing power and process One of Ontario s best known and loved nursing educators believes that the profession has lost its sense ofthe whole of nursing. "We have created a community of boxes related to our specialities, our places of work, our education and our roles in practice," Jessie H. Mantle, told delegates tothe 51 st annual meeting ofthe Registered Nurses' Association of Ontario in Toronto recently. "There is some caring within these boxes but very little across their walls because we defend our territories so ferociously," she said in her keynote address on the convention theme - "The Quality of Our Caring." Mantle, who is a member of the faculty of the school of nursing at the University of Western Ontario in London, is now on sabbatical at the University of Washington, Seattle, where she is enrolled in predoctoral studies in the area of gerontology. She challenged the nurses in her audience to accept change and to develop a peer support system within the nursing community. "Because we are women and nurses," she said, "we still cannot guarantee that the patient will have access to the caring process but nurses who are willing to act as bridging agents can help to reduce fragmentation of the health care system if they learn to practice as a community." -- "- .. )- r- "," .,. \. , , )- v _. Keynote speaker, Jessie H. Mantle (right) with RNAO assistant executive director, Doris E. Gibney. Photos Dy Suzanne E Emond She also urged nurses to develop a positive self-concept about the profession and to work to increase nursing input into decision-making in health care. "We are grossly ignorant of what other health professions are doing and thinking," she charged. "Talk to your colleagues and learn to consult one another. Nurses must speak out but learn to do it effectively and appropnately," - ""L Chairman of the Resolutions Committee, Margaret Kuchmak. More than 1200 RNAO members and nursing students registered for the three-day meeting. Much of the discussion and action on resolutions was colored by recent health care cutbacks and curtailments in the province. Among the resolutions passed during the meeting was one directing the RNAO to "investigate ways to assist new graduates without opportunity for employment in nursing to maintain knowledge and skill relevant to current practice in nursing." Close to 3600 nursing students are competing this year in Ontano for an extremely limited number of openings. Other resolutions were directed towards "identifying and demonstrating the effectiveness of a health maintenance system (a system directed towards improving health levels - i.e. keeping people well) and the creation of a citizens' advisory council "which would provide input for RNAO's response to health care needs and trends affected by social change:' .. RNAO president Norma Marossi. President Norma Marossi described these as turbulent times for young graduates beginning careers and also for experienced nurses seeking employment. She reminded delegates of RNAO's historical interest In and contribution to the field of employment relations. She said that an employment referral service had become an essential service for nurses and one probably best met by the professional association. lor "'\. JI' Irmajean Bajnok, president-elect of the RNAO. Executive director Laura Barr, in her report to the membership, described the essence of nursing as "presence - presence for three tours of duty, seven days a week. 52 weeks of each year. This presence is so essential that it is often required on a one-to-one basis. Is it any wonder that the bulk of hospital budget applies to nursing?" she asked. "We are a cluster of skills required to render the service needed. We do not depend on the expensive hardware demanded by other services." Individual members expressed concern over the need to examine the nursing process in the light of recent cutbacks as well as the need for the association to support nurses at tl1e bedside who may find that it is not possible in the future to provide adequate care. They also stressed the importance of demonstrating as a profession the effectiveness of alternatives to aClJte care, Ontario to study two-year programs A study to determine the effectiveness of the two-year community college training program of nurses in Ontario will be tendered shortly by the Ontario Ministry of Colleges and Universities. Gerry Wright, the Ministry's Administrator of Health and Scienæs Programs, says that the study will be an objective analysis of how well I two-year nursing graduates perform on the job, with an aim to implement any changes indicated as soon as I possible after the study's completion. Wright says that the steering committee for the project includes representatives from various interest groups, including the College of Nurses of Ontario, the Ontario Hospital Association, the Registered Nurses' Association of Ontario, and the Ministry of Health. This committee will formulate objective questions and research specifications for the study. The study will attempt to evaluate the effectiveness of the community college program, a program that has been the source of much opinion and controversy. Before 1973, most nurses were trained in three-year courses given by Individual hospitals under the College of Nurses of Ontario. The course was shortened to two years before the community colleges took over nursing schools in 1973. The study will be contracted outside the Ministry, with its first phase expected to begin in June. The second! phase, Wright says, will probably begin in September, to be completed hopefully, by spring of 1977. The Can.dian Nurse Jun. 1976 13 Canadian Task Force Concludes Annual Pap Smears Not Necessary for Most Women uch of the repetitive annual screening of women whose previous 'apanicolaou) smears have been normal is unnecessary. By reducing the quency of examination in such women and deploying the resources to )ncentrate on women at risk, who presently are not being screened at all, anadian cervical cancer screening programs could become much more ''fective without utilizing more resources than they do at the present time. I The views are those of a seven-member Task Force on Cervical Cancer creening Programmes, appointed by the Conference of Deputy Ministers of ealth following a meeting in December 1973. They are contained in a report Jbmitted by the chairman of the Task Force to the Deputy Ministerof Health nd Welfare Canada, the Hon. Jean Lupien. This report was published in the une 5,1976 issue of the Canadian Medical Association Journal (vol. 114, o. 11). It deals primarily with frequency of screening, quality control and )lIow-up mechanisms. Members of the Task Force reached a number of igniflcant conclusions on the basis of their findings. Among them: Squamous carcinoma of the cervix does lend itself to control by means f a cytological screening program, , There is evidence in Canada that: - cytological screening programs are becoming effective in reducing norta ity from carcinoma of the cervix; - the extent of this reduction is directly related to the proportion of the IOpulation screened; - the prevalence of abnormalities in an unscreened population is of the Irder of 5.5 per 1000. If this population is reexamined the incidence of Ibnormalities is of the order of 0.5 to 0.7 per 1000. A screening program will use resources most efficiently when it oncentrates on bringing women into the program and when the frequency of 'xamination is tailored to the degree of risk rather than when examinations Ire performed on the "customary" annual basis. In considering the category of risk, the report concludes that. - a woman is "at risk" as soon as she becomes sexually active; - within this group, a "high risk subgroup" exists, consisting of women who began sexual activity early, especially with multiple partners; - a woman may be assumed to be "no longer at risk" after reaching the age of 60, having participated regularly in the program, without having had a smear show significant atypia; - women who have never been sexually active are in a "low risk" group. On the basis of the conclusions contained in the report, the members of the Task Force presented a series of eight recommendations, including: . Health authorities should encourage and support the development of cytological screening programs designed to detect the precursors of clinically invasive carcinoma of the cervix. . Appropriate means should be employed: a) to inform women of their degree of risk of developing carcinoma of the cervix; b) to persuade women at risk to participate in the screening program. . Frequency of examination should be as follows: a) initial smears should be obtained from all women over the age of 18 who have had sexual intercourse; b) if the initial smear IS satisfactory, a second smear should be taken within one year; c) provided the initial 2 smears and all subsequent smears are satisfactory, further smears should be taken at approximately three-year intervals until the age of 35 and thereafter at five-year intervals until the age of 60: d) women over the age of 60 who have had repeated satisfactory smears may be dropped from a screening program. e) women who are not high risk should be discouraged from having smears more frequently than is recommended above; f) women at continuing high-risk should be screened annually. . All mass screening programs should have follow-up systems to ensure that normal patients are recalled at regular intervals for repeat smears; that action is taken following the discovery of an abnormality; and that long-term follow-up be provided for patients who have received treatment following the diagnosis of an abnormality. )id you know? increased by approximately 28,000 readers. The Canadian Nurse now reaches a total of 87,786 persons in this country; of these, 82,698 are Registered Nurses. Almost one-quarter of CanadIan readers (21,408) live in the province of Ontario. British Columbia (15,304) and Alberta (13,140) are next largest in size of circulation. The Canadian Nurse is received by 1,667 nurses in the United States and 983 nurses in 102 other countries outside of North America. L'infirmière is delivered to a total of 36,951 persons in Canada and to 42 other countnes. :irculation figures for The Canadian 'urse and its French counterpart, 'infirmière canadienne, are now lose to 128,000 each month. The :anadian Circulations Audit Board 'c., which calculates "qualified irculation" reports that the number of opies of the two official CNA journals istributed in March, 1976, was 27,747. Of these, 90,436 were opies of The Canadian Nurse. A year IgO, in March 1975, the CCAB eported total circulation of the )urnals was 113,944 copies. Since arch, 1972, when 99,018 persons eceived the journals, circulation has N.S. hospice unit A Hospice Care Unit, the third of its kind in Canada, is being planned for the Victoria General Hospital in Halifax. Project originator, Norma Wylie, Associate Professor at the Dalhousie University school of nursing, proposed the hospice as a long-needed unit to care for the terminally ill and their families. The project has been approved by the hospital board, the executive director, the director of nursing service, and senior medical staff. A "Working Party" Committee is being formed to plan the uOlt, establish criteria for admission, and provide for education of personnel. The committee is chaired by Wylie, and will include physicians, nurses, clergy, social workers, consumers, and volunteers. The project evolved from a research project developed by Wylie over the past two years - a demonstration patient care unit known as Project "Back to the Bedside." Wylie spent some time at the most widely known Hospice, St. Christopher's in London, and has been in correspondence with its founder and medical director, Dr. Cicely Saunders, for advice and assistance. 14 The Canadian Nurse June 1976 L , t . V , Ke't'8 !- -...... -,- . -. , r, 1 \. , .::. _. . - , ,'" c.:. - .... - .'11 . ... .. "\, ÍII.... ...... ' .. ,r ....... __ïlllliii. -- - -- - - - .. - . . ')- ... .., J ... .:.. :;- '"" " ...... .S _ ,- -- ,. "'it ' . 1 , .. tt- , .. .t .4- \4 .. -I " f' Ì" , ... ..il Plumptre visits bargaining officers' conference Employment relations officers with Beryl Plumptre during spring conference at CNA house. Representatives are: (left to right, back row) Mane Campbell from N.B.. Malcolm Smeaton, Ntld.; Nora Paton, B.C.; Tom Patterson, N.S.; Gertrude Hotte, Que.; Glenna Rowsell, N. B.: and Allan Rosky, Man.; (middle row) "The government anti-inflation program is not designed to attack wage earners, nor to roll back the gains hard won by organization, solidarity and tough collective bargaining. On the contrary, it is designed to provide a structure for protecting those gains, and for allowing real wages to keep on growing steadily without being eroded by increasing prices for goods and services." This was the message of Beryl Plumptre, vice-chairman of the Anti-Inflation Board speaking at the spring conference of provincial bargaining officers at CNA house in Ottawa. In order to clarify the compensation aspect of the anti-inflation program for the representatives of provincial nursing groups, Plumptre outlined the aims of the program and detailed the procedure used to rule on compensations. She explained the three components of the guidelines and then discussed the discretionary Jan Traynor, Professional Institute of the Public ServIce of Canada; Judy Morry, Ntld.; Joyce Gleason, Man.; Renee Tremblay, Que.; Florence Stemper, Sask.; and Yvonne Chapman, Alta.; (front row) Christine Reynolds, P.E.I.; Anne Gribben, ant.; Beryl Plumptre; and Mary Parchewsky, Sask. powers of the Anti-Inflation Board to take into account special circumstances. The three general provisions to limit wage increases to between 8 and 12 percent are: the "basic protection factor" which allows pay to increase at the rate of cost-of-living increases as forecast by economic experts, Ihat is, 8 percent in the first year, 6 percent in the second year, and 4 percent in the third year; the "national productivity factor" which gives each working person a share in Canada's long-term productivity growth; and the "experience adjustment factor," an equalizer which the AIB can apply yearly to restrict those groups who leapt ahead before the program was instituted and allow those who were left behind to catch up. She stressed, however, that the Board was aware that, in some cases, special circumstances must be considered. "The program is not designed to be a cast-iron Procrustean bed that every settlement has to lie in, with the bits that do not fit lopped off or rolled back." To allow for these special cases the Board "has been given considerable discretionary powers to deal with exceptions to the regulations." For example, a group may argue for an increase above the 9 guidelines on the basIs of an "historical relationship" between themselves and another group of employees in a similarindustry whose salaries have borne a demonstrable relationship in the last two years, and the Board has the power to grant an increase well above the 12 percent. Thus, Ontario public health nurses may supply evidence of an historical relationship with hospital nurses to support a wage increase above the guidelines. The AIB only deals with settlements, however, it does not enter into negotiations. Tough bargaining may be' necessary to get the employer 10 provide even basic economic protection and, as one representative of the nursing profession pointed out, a clear understanding of the provisions of the program is necessary to avoid being duped by some employers who may choose to hide behind the guidelines at the bargaining table. When asked what protection the union has that the employer will present a high wage settlement fairly to the AIB, Plumptre stressed that both the union and the employer have an opportunity to make representation to the Board in support of a settlement that exceeds the guidelines. Plumptre also reviewed the methods of monitoring and restraining prices and emphasized that "the Board means business." She expressed tentative optimism that the rates of price increases are slowing down, with recent statistics showing a rise of 9.1 percent after 20 months 01 double-digit inflation. She also indicated that, according to price reviews, most industries were restricting themselves voluntanly within the guidelines. On the pay side, too, she said the vast majority of settiements are within the 12 percent limit. Figures up to the beginning of April show that of 2300 settlements 2150 were within the guidelines. Finally, she called for the cooperation of all Canadians, regardless of their economic roles, to make the program succeed. The program "is not a price freeze any more than it is a wage or salary freeze. It allows prices to fluctuate as an expression of supply and demand. It allows prices to rise to reflect the real costs of doing business, just as it allows wages and salaries to rise to reflect increases in living costs. What the program is designed to do is bring these increases more closely into line with our rate of growth. Or rather, to help us learn that we can only get more if more IS being produced.'- Inflation hits Accreditation Council The number of hospitals surveyed by the Canadian Council on Hospital Accreditation reached a new high in 1975, according to the recently released annual report of the 17-year-old CCHA. A total of 336 hospitals were visited last year, compared to 294 in 197 4. Teams of surveyors reported on 145 of the institutions visited. The report notes that despite the increase in the quality of visits, "quality of work was maintained by improved surveyor education, intensifying team surveys and other means." The total cost to the CCHA for the survey program and other related activites amounted to $396,152 In 1975. In spite of a fee increase during the year, this cost resulted in a deficit on all operations of $59,738. During 1975, the CCHA Board determined that the accreditation program was of sufficient value to the Canadian health field that it should be self sustaining and should not be dependent upon grants. Directors authorized substantial increases in fees paid by hospitals per surveyor per day to $475.00 per surveyor day; and in membership fees from $5,000 per seat in 1975 to $6,000 per seat in 1976. The report notes that "a further increase will be required in 1977 if there is to be reasonable maintenance of quality of CCHA programs and if the required growth to bring more hospitals up to CCHA standards is realized. I ne ll...ilniiOliln "U'- I 'eaching the TV generation '- "Multi-Media in Focus" I hat is self-learning? How can Ilucators use available tools fectively in teaching and in helping e student learn for himself? Where ) we go from here? These questions ld others were explored by 64 ntano nursing educators at a ilization seminar sponsored by the rsing Education Media Project and e Ontario Educational ommunications Authority (OECA) ld held in Toronto on April 23rd. The theme of the seminar was fhe Teacher and Tools Together- fulti-Media in Focus" and it was imed at examining the meaning of e term 'self-learning," assisting the acher to develop confidence in the se of self-learning matenals, and nhancing teacher creativity. In ddillon to providing teachers with the pportunlty to discuss their efforts and .ommon problems, the seminar itself as an example of creative learning nd the use of audiovisual materials. Most of the day was spent in small roups led by nurse-teachers and )ECA utilization staff. Participants Iscussed common aims and xperiences and attempted to reach a on sensus on what constitutes elf-learning, what problems eXist in sing available resources and eveloplng new ones, and how these roblems can be overcome. The oming was devoted to discussion of he learning process and what eact.ers have to offer their students. In the afternoon excerpts were shown rom an OECA film "Don t Cry for David - Part 2'. on grieving due to loss of body image. As weli as the obvIous choice of using this ftlm to complement the study of grieving, team leaders discussed the feasibility of showing excerpts to stimulate discussIOn of other subjects, e.g. techniques of patient interviewing. Some attention was also given to the use of low-cost audiovisual aids that can be produced easily by the teacher Team leaders stressed that teachers are teaching the . televIsion generation" and that a wealth of aids eXist in this environment ranging from full-length programs relevant to nursing education, to excerpts from serials such as Archie Bunker. The seminar also provided staff of the Nursing Education Media Project with a chance to assess what nurse-educators need in the way of informal ion and instructional materials. The Nursing Education Media Project was established two years ago to develop films and audiovisual materials for nursing education, to evaluate films and projects prepared by nursing programs in community colleges and universities, and to explore ways of using the media in the college system. 11 is supported by the 23 member community colleges, the RNAO and the OECA Membership also includes eight universities, who have been granted observer status, and the College of Nurses of Ontano. For further information about the prOJect, write to Marilynne Seguin, Project Officer, Nursing Education Media Project, Ontario Educational Communications Authority, 4th floor, 2180 Yonge Street, Toronto, Ontario M4S 2C1. All packed? The Registered Nurses Association of Nova Scotia has some last minute suggestions for those who will be attending tne Canadian Nurses Association Convention in Halifax in June. With east coast weather by nature unpredictable, the Association suggests being prepared for rain and chilly sea breezes as well as the June sunshine. If you want to look festive at the Opening Ceremonies or at the Ceilidh at the Chateau HalIfax, formal dress is as acceptable as casual clothes. Slacks or jeans are recommended for the trip to Peggy s Cove, and casual clothes for the water tour and dinner at Clipper Cay. CTRDA nursing fellowship available in 1977 The Canadian Tuberculosis and Respiratory Disease Association IS again accepting applications for the $7,500 fellowship the association awards annually for studies in pulmonary nursing. The award is for study at the Master's or post-Master s degree level at a university offering a clinical specialty in pulmonary nursing. The six universities offering programs acceptable under the conditions of the award are: the University of California at San FrancIsco, the University of California in Los Angeles; The University of Cincinnati; the University of Arizona; the UniverSity of Rochester and the University of Florida. The first CTRDA Nursing Fellowship was awarded In 1973 to Josette Maranda. Notre Dame Hospital, Montreal She completed her Master s Degree Course in Clinical Pulmonary Nursing at the University of California In December 1974 and is now working in the RD Home Care Program at the Rosemont Pavilion, I'Hôpital Maisonneuve- Rosemont, Montreal. Winners of the 1974 Nursing Fellowship were Joanne Perry of Vancouver, B.C. and Pauline Kot of Edmonton, Alta. Perry worked as a nurse clinician prior to completing her course credits at University of B.C. She focused on the educational needs of the patient, the family and the community with emphasis on prevention of illness and rehabilitation of patients suffering from chronic bronchitis and emphysema. She IS now a Clinical Specialist at St. Paul s Hospital. Vancouver. Kot is Associate Professor in Medical-Surgical Nursing at the University of Alberta. Her Interests lie In the area of preventive and rehabilitative nursing as well as research. The CTRDA Fellowship allowed her to complete the Master s program at the University of Arizona School of Nursing, Tucson. Deadline for applications is February of the current year. Inquiries should be directed to the Chairman, Nurses' Advisory Committee, Canadian Tuberculosis and Respiratory Disease Association, 345 O'Connor Street, Ot1awa, K2P 1 V9. How's your image? Health promotion is catching on! Following a two-day workshop on fitness and lifestyle at CNA house in Ot1awa (See The Canadian Nurse, April 1976), representatives from member associations set to work to organize a program with similar content in their home territory. Now, just three months later, most of the workshops have been completed. After the February training session, each respresentative, with the assistance of Jean Everard, CNA's research officer in charge of fitness. and a grant from Recreatior Canada, was given free rein to set up a program that best suited the needs of their area. The resulting workshops were all aimed at spreading the message of fitness for better health to leaders in the health field, but their focus differed from province to province. While some included key people from many health disciplines (such as physiotherapists, occupational therapists, social workers, dietitians and nurses from VON, public health and hospitals), five provinces concentrated directly on nurses in the public health field, in the hope of reaching the maximum number of people in the community who are In a position to change their lifestyle and improve their health. The goal of the national fitness program for nurses is to encourage nurses and members of other health disciplines to change their lifestyles to improve their own health so that they become models of real health to patients and members of the community. The word is spreading. . watch your provincial bulletin for news of fitness programs. Better still, jog to your provincial or chapter headquarters and find out what you can dOl ME? IN SAUDI ARABIA! II I: I . . . . , , . . . I . . \J . I J ----- , I We're excited! The NEW King Faisal Specialist Hospital-a 250-bed referral research center-Riyadh, Saudi Arabia-has a place for you. Members of Hospital Corporation of America management group is staffing. operating and managing this hospital-described as the "World's Most Modern:' WHY NOT! Unlimited opportunities are now available in every specialty. We're looking for the nurse who is really seeking a new. . . different, . . and meaningful experience Nursing in a foreign land in an international community. We'll provide the very best: an excellent and extremely modern hospital with free furnished modern apartments (all new), swimming pools, tennis courts, American TV program system. . . all in the hospital compound area with a professional staff from the USA, Canada, England, Ireland, Scotland, Lebanon, Saudi Arabia, and many other countries: sharing ideas, knowledge and skills;using modern, so- phisticated equipment; working extremely hard; and being challenged as never before, Requirements include: Graduation from an accredited school of Pro- fessional Nursing, current RN license, 3-years' experience in an acute care hospital. . . fluency in English, the official language of the hospital. The person we seek will be experienced, flexible, adventuresome, de- sirous of a challenge. . . and is truly dedicated! We'll give you rewards that are unbelievable-JOB SATISFACTION - TRA VEL-Ultra-modern medical facilities-excellent salaries, free housing, free medical care, free relocation allowance, free return travel from Saudi to Canada annually with 30-day vacation. And. these are only a few! an equal opportunity employer \\ If you are interested, we'd love to tell you much more. Please forward a cur- riculum vitae to: RONALD MARSTON Director, International Recruitment Hospital Corporation of America One Park Plaza Nashville, Tennessee 37203 This could be the first day of the rest of your life-we truly hope so! -.. , II..r:::J \ , " 0 .. \ ,. o. 4 . -.- .. - u. '- ..... . - .. . " men: figures indicate that one in every teen women in this country will develop -east cancer during her lifetime T .At least half : them will eventually die of the disease. Women can protect themselves by >gular self-examination, education, and 1tlcal evaluation of the information they ' I >ceive but it is up to health professionals to 10tivate and support women in these ,ndeavors. If they are knowledgeable about 1e critical stages and problems experienced y victims of this disease, nurses can do a reat deal to help women who are faced with ne of the most agonizing decisions in 1edicine today. This help does not require more health ,ersonnel, physical or economic resources, .ut it does involve more effective interpersonal elationships. It requires the helping person to Inderstand the patient and thereby assist that lerson to problem-solve and move to more 'ffective, higher levels of functioning. Women "ho develop breast cancer almost inevitably 10 through similar stages of physical and Isychological adjustment They share certain :Jelings and problems associated with the lisease. Understanding these stages and 'ommon responses is important if health Þfofessionals are to act as resource persons to , . I:. the woman and her family. It helps them to see the world through the afflicted woman's eyes and to let her know that this kind of empathy and understanding are available. The role of the health professional is to help the person "get in touch" with her feelings and work them through, This involves adjustment and movement to a more integrated level of understanding with a different set of priorities at each step, Dunng this process. it is important to remember the rule, "Never presume anything, no matter how little." Find out where the woman IS at: validation IS an essential aspect of the helping process. Throughout the eight stages described in this article, the implied intervention is therapeutic use of self, based on open and frank sharing and discussion. The helper must reach out to share the thoughts and feelings of the woman she is helping, without censure or judgment. If she can respond in a sensitive, relevant way, the helping person will find her own life enriched by the experience of sharing small triumphs with her patient at each stage in the progress of the disease. 1. Pre-detection stage Who are the probable victims of breast cancer? Research indicates that high-risk categones Include women who are . over the age of 40; . whose menses began before age 16 and continued late in life; . whose frrst pregnancy occurred after the age of 30; . who are obese; . whose family history shows an Incidence of breast cancer, and . who belong to upper socioeconomic groups.1 Since experience has shown that the survival rate is directly related to the stage at which the tumor is found and treated, early detection and treatment are essential if more lives are to be saved. One of the main barriers to detection is denial. Our society, as it reveals itself in the media, is fascinated with full, abundant breasts. Breasts are regarded as functional. aesthetic. and symbolic, The self- image of many women is tied to her feelings about her breasts, When she contemplates the possibility of breast surgery, she feels her personal identity IS threatened. The "I can't bear to think about it" and "It can't happen to me" syndrome often leads to avoidance of practical, easy methods of early detection available today. Denial plus increased anxiety may also exist if breasts are lumpy due to fibrocystic disease. Management and follow-up programs are particularly important in these cases since statistics show findings of breast cancer in six percent of women operated on for fibrocystic disease. Women can be helped to work through the feelings that act as barriers to early detection of breast cancer. Many useful and interesting books have been published recently on the subject. including Rose Kushner's "Breast Cancer, The Canadian Cancer Society provides brochures and other materials, including pamphlets. explaining the procedure used in breast self-examination. There is no scarcity of information from the various media, but, in order to assimilate and apply it, most women need professional support and assistance. For example, in spite of national advertising campaigns intended to publiciz e the importance of self -ex ami nation of the breasts, it is estimated that fewer than 38 percent of Canadian women perform regular breast self-examinations. This simple procedure which should be carried out every month should be taught in a matter-of-fact manner to all girls in their early teens. If this were done, much of the emotional overlay 18 The Canadian Nurse June 1976 1. Mastectomy rehabilitatIon programs are now available in many Canadian centers to provide both pre-op and post-op support end counsel for breast cancer patients. The programs are staffed by volunteers who have personal knowledge of the operation and operate under the auspices of provincial divisions of the Canadien Cancer Society. Below, volunteer Vera Myers, a member of the Rehabilitation Recovery team In Ottawa, demonstrates the "Play Ball" exercIse using a rubber ball on a length of elastic. , . " J , to t. , 4 .. . f f '- I' I t " .. . . f : .. ) 't7 þ y" '1.1 \ ./ \. , , j. " \ , ":. ) "C \ '{S: -./ ::; :f '" .s:: It, a. '" c, t 0 J. J . õ .s:: .' Q. - I .. ... "C 'It 'If " I , 1 0 ... .. i" Ë 0 a >- D '" ...,) . . .. 0 Õ .s:: n. associated with the procedure could be avoided or dissipated and the examination would become an accepted "fact of life." 2. Suspicion Most breast lumps are found by the woman involved, who then asks herself, "What shall I do?" Often, there is a period of delay before professional help is sought. This stage may be short or long. The woman who usually copes well with stress will probably seek immediate medical attention. Other women say,"1'1i go right after my daughter's wedding," or "as soon as the kids are back in school." There may be magical thinking, "If I don't look, it will go away." What contributes to delay? Only a small percentage of palpable breast lumps prove to be malignant. Therefore. most women with breast lumps will receive good news after checkup. However, many women still regard finding a lump as the beginning of the end. A significant number of women lack knowledge about breast cancer and the importance of early diagnosis and treatment They do not know that a lump or thickening of the breast is a warning signal. Less common signals are also unknown to many women. These include: . puckering or dimpling of the breast skin; . scabbing skin around the nipple, changes in skin texture, cracked nipples, or secretion from the nipple; . asymmetry in either appearance or movement of the breast: . hot, swollen or sore breast. Any unusual ache or pain that is persistent and not associated with cylical changes. The fearful woman may become completely disorganized and unable to function after finding a breast lump. She may detay seeking help. Some women say, '" couldn't tell anyone" or "I didn't want my husband to know." Husbands and families are important. One woman recalled, "My husband ignored the lump. He put me down, told me to forget It and it would go away. I ignored it for two years." In contrast, many women are able to share fears and concerns with family, friends and health professionals. Open and honest communication is one of the keys to dealing with this kind of streSS and fear of the unknown. 3. Medical evaluation The evaluation period invokes stress responses that differ according to the experiences. beliefs, attitudes and cultural values of the individual. The stoical woman says,"'t will be O.K." The fatalistic woman says,"My life is in the hands of the gods." There may be displacement of feelings,'Tm I only worrying about my family" Projection c feelings is associated with fear and despair, "I'm just a guinea pig." All women I need help in explaining and examining their feelings, adaptive and maladaptive. I If the lump is found to be malignant, thll woman has a choice; to accept both diagnosi: and treatment, or to reject one or both. She I may choose. as is her right, to seek additiona I professional opinions. Scrupulous honesty, I preservation of hope, frank discussion of outcomes and involvement of family member I or friends are essential if she is to pursue I treatment and become closely aligned with a supportive health care delivery system. She needs caring people to share her hurt and pain and to endure with her over time. Decisions about treatment involve facts but are based on much more than just facts Under stress, many people do not hear, remember or process the information that car enable them to make meaningful decisions. The woman who has been told she has breas cancer needs a caring person to help her perceive and deal with the facts. More and more women are showing a desire to become involved in decision-makin processes regarding medical treatment. In some centers, biopsy is done on an outpatien basis. A woman can then discuss treatment plans with her husband. family and physician while remaining in the comforting, familiar home atmosphere. The trauma of breast surgery is less of a shock for women who remain at home for even a few days before surgery. This brief time permits anticipatory psychological work in terms of the grieving process and also allows time for the staging and testing procedures which are so important at this stage. These procedures determine thE extent of the disease and the feasibility of surgery. In recent years, there has been widespread debate and controversy over the surgical procedures which offer the best chance for long-term survival. Quality of life also enters into consideration at this stage. For some, radical mastectomy seems "worse than death." Most women, however, weigh the risk-reward ratio and decide to have surgery. This attitude is sometimes expressed in the statement that, ''I'd give up my breast in order to save my life." Seven surgical procedures are available The CønlKlløn Nurse June 1976 19 and 3. The "Pulley MotIOn" is other of the exercises patients can irn while still in hospital. Here, lunteer Myers improvises by using an IV pole instead of a door to demonstrate the principle of the seesaw motion involved in this exercise. , f t " , ' J ... t - 1 1 f >o I j i . - .. ,., 1 ' .. \ " , t! \ :\ ,:1 j l: > . \ (' \ " J \:. w .. , \ ,f f , .... -'" \ .... , " =rom least to most extensive, these are I) lumpectomy, tylectomy, and local excision, ) partial mastectomy, segmental resection, :md wedge resection, 3) simple (or total) astectomy, 4) modified radical mastectomy ) halsted radical mastectomy. 6) supraradical astectomy or extended radical mastectomy and 7) subcutaneous mastectomy. Some of these procedures allow for the I pOSSlbility of future reconstructive surgery. The latter should be discussed with the Isurgeon preoperatively. At present. restorative I surgery is available to only a few women but there is hope for the future, espeaally if many women are concerned enough to I press for breast reconstruction. 4. Response to diagnosis A. woman's response to the diagnosIs of breast cancer follows a clearly identifiable pattern, colored by her post-conditioning. The feelings of a woman whose mother IS alive and well 17 years after surgery will be quite different for example, from those of one whose older sister died after a lingering illness. Nevertheless, everyone dies a little on diagnosis. Feelings of denial. anger, depression and fear are common. The woman may also feel abnormal "in an unreal space." She needs to be reassured that this is normal her diagnosis he left the office profoundly upset. This feeling was followed by total loss of memory for the events of that particular day. Fear. This is the most pronounced feeling. The woman not only mourns the loss of her breast but also experiences anticipatory gnef In relation to loss of her life. Both husband and wife have a strong realization of death. Often they are not able to discuss this with anyone, even each other, open communication and acknowledgement of feelings helps both partners learn to face and cope with fear. A middle-aged man with two daughters recalled, "my greatest fear was that my wife would die during surgery. I prepared for the worst. I needed help but was ashamed to ask for it. Everyone seemed so busy. On some days this feeling still lives within me." The wife of this man had breast surgery three years ago. A woman with young children thinks, "What will happen to my children if I die? . She may need help In delegating her life tasks, at least temporarily, to a competent person who understands and respects her feelings and concerns. It is essential that she feel certain that her children are safe and well She also needs to know that her family love her. need her and miss her unique kind of loving care. Children fear that their mother will die. They cannot help but feel the upheaval in family life style, and the anxieties and fears of their parents. Information should be given to children at their level of ability to comprehend: withholding information causes anxiety and resentment. Later, the child may be very angry that he or she was not allowed to participate in the family CriSIS. A ten year old can feel the lump in her mother's breast and realize that it should not be there. This preparation makes the surgical procedure easier for the child to understand. Teenage daughters can be very helpful and supportive If they are allowed to share with the mother in her loss. Teenage sons may have a difficult time during the crisis. A son may refuse to visit his mother or talk about her illness. He may refuse to tell anyone outside the family. It may be helpful to his mother to 5. Reactions to breast surgery know that this kind of reaction is not Shock and Disbelief After diagnosis uncommon. Sometimes it is useful for a boy in there may be a short period of denial, quickly this position to talk to the son of a woman who followed by feelings of shock and disbelief. has made a successful adjustment following Women say, "I can't believe this is breast surgery just as his mother may find happening,' and "I can t think." Husbands, consolation in talking to another mother whose children and friends share these feelings. One son, at one time. behaved in a similar way. man told his wife's physician that on learning Perceptive health professionals can help ( -. / 1 , Ii I fI e 4, ,, I u , 'I 1 t ,,' \ I f .. "' I , ,," " , I' _, I , t #! 'iI' . :--) '- I. - I " " , , I -.' t so she does not think that she IS alone and unable to share "unnatural" emotions. These feelings are cyclical in nature, recurring from time to time over many months. The woman must work through her feelings in order to deal effectively with her loss. The person who is secure in the feeling that she is loved and respected for herself is often able to adjust more quickly. It is harder for the person who feels valued for appearance, physical ability and capacity to work. A frightened woman was recently hospitalized and booked for breast surgery. Her husband visited her the evening before surgery. They talked, and he said "The advice you have given me over the years has meant so much to me. You are so important to me." The woman told the evening nurse that her husband had helped her to view things in a different way and she felt much relieved and less fearful. 20 The Canadian Nurse June 1976 4. "Rope Turning" is an exercIse that can speed the mastectomy patient's return to a normal way of life. The equipment in this, as In the other exercises, is sImple and easy to obtain. Patients must obtain the approval of their doctor before beginning the program. , I" t · It Ie, t t 'I'.' -( · t ,!J. 1 ! f ""t ' \ 1 <: ,It, . 1 :1....1 b, i 1 u 'i \ . · 'f , M -- .. \ Q, t , ,'t-ij . t \ \ v ..' f J ... -- facilItate such valuable learning opportunities. Anger and Depression. Many women are overwhelmed by feelings of hopelessness and helplessness after breast surgery, followed by feelings of anger which may find one or several targets. The woman may be furious at her surgeon, at God, at society or at organized religion, She many say, "Why me," especially if her life style has been exemplary. A well- established older couple may say, "Why us? We can only just now afford to enjoy and relish our lives." It is healthy and cathartic to express feelings of anger, even if they come out as blind, diffuse fury. Problem-solving is difficult when strong feelings of anger are repressed. A mastectomy patient recently said: I didn't know what was the matter with me, I just felt miserable. One morning the head nurse came and sat down close to me. She said she felt I was very angry, I soon realized that she had hit he nail right on the head. I spent the next half hour telling her how much I hated everyone and everything, and how awful everyone was to me. That was the beginning of my recovery. I never looked back. She who was my worst enemy became my dear helping friend. Venting of anger may avert the severe Jepression which sometimes follows breast , z. \. ...._ C. I :-- -- . I f l J "I. I . j. . . , --- .. u. ___ t I .f " >urgery. Some degree of depression is normal and occurs on an intermittent basis for a long time. Many husbands share this feeling which is associated with gnef and mourning. Guilt. Feelings of shame or guilt are sometimes present. The woman relates her loss to a personal flaw or wrongdoing and reviews the "precipitating event" again and again. She may say, '" was careless and hurt myself or, "If only I had not ...." It is as though the disease appears so irrational that the self must be blamed. It is important for the helping person to recognize that such a woman is experiencing feelings of shame or guilt. She should be encouraged to talk about her feelings and to try to determine the reason for them. In what way does she feel inadequate, humiliated or a failure? In what ways does she fall short of her ideal? How did she acquire these expectations? Are they still appropriate? What does she want to do? 6. Crisis following surgery A year following her mastectomy a woman confided to a friend, "At first I felt mutilated and mangled. Someone told me I ought to be able to go home and carry on as though nothing had happened. This made me feel worse." She went on to say; I Nearly everyone on the ward was comforting and helpful to me. During the first week, I was encouraged to look at my scar. I did, and it finally hit me thaI my breast was gone. I cried, talked about it, and gradually got myself together. A few days later I wanted my hus band to see the scar too, so he would know what I knew. This was hard, but he managed O. K. After that he sat and held my hand for a long time. We sort of went through it together. He's been wonderful. Breast surgery DOES make a difference; support people are very important. A husband can be a pillar of strength if he is included and ' not rejected or encouraged to withdraw. With the help and encouragement of understanding health professionals, otherfamily members- sisters, mothers and daughters - can also be key support people. Through them the woman gradually regains her image of herself as a person who is loved and who cares for others. Volunteer Visitors. Throughout Canada, volunteers from the Mastectomy Rehabilitation Programme offer practical help to women facing breast surgery. They are women who have undergone breast surgery and can act as a role model. They are prepared to visit pre- and postoperatively at thel request of the physician. They provide a lightweight temporary prosthesis and can offer expert advice on permanent weighted prostheses. Sponsored by the Canadian Cancer Society, these volunteers present a realistic picture of adjustment to the woman as the works to resolve her feelings following surgery . Health Teaching. After radical mastectomy it is vital to begin exercising immediately, to strengthen the auxiliary muscles of the arm that take over for the removed pectorals. This is also important after a modified radical, even though the chest muscles are intact. In addition to arm exerdses, breathing and relaxing exercises should be routinely taught as one method of tension relief. The woman needs assistance in commencing and carrying out these exerdses. Patient teaching is extremely important and should be reinforced at intervals since, initially, some people do not hear or understand. The woman should be warned that the afflicted arm must never be used for taking blood pressure readings, for immunization, vaccination or injections of any kind. Shaving under the arm is a "no-no" when t The Canadian NUI1I8 June 1976 21 6. and 7, "Wall Climbing" is an .ercise that gets a little easier every tJe, according to volunteer Myers ho advISes patients to "try to climb a little higher up the wall each day Soon your arms will be straight over your head .. "'" - "i t ( , --- .J / i-" \ / . . . .---- or- - ..... eeling is absent. She should also be 'autioned about oral contraceptives because )f their possible role in the nourishment of )reast cancer. Breast self-examination should )e retaught. The monthly t3SE should now 'nclude careful palpation of the area around the incision. Recurrence sometime appears in the incisional site itself. Women with breast cancer must always be on guard for symptoms, Follow-up care should be discussed. This usually includes quarterly examinations during the first two years followed by semi-annual examinations Blood work and X-rays are usually included. The informed consumer finds and remains in contact with a physician whom she trusts. 7. Early months at home GOing home brings the woman face to face with several questions. "What should I tell my family, my friends? Am I different? Do other people see me as being different?" There is a good deal of testing and experimenting with the erwironmentthrough communication. "Is it noticeable?" "Do you think people will know which side?" Self concept is built up gradually and functions in relationship with other people. . The woman should purchase a 'permanent' breast form several weeks to a month or so after surgery. Before doing so, she should check to see whether her medical plan carries an extended benefit which helps pay for prostheses. Some women feel that hospitals or community health centers should make forms available for display and for purchase at cost. She should find the nearest center with a surgical or mastectomy fitter, phone for an appointment and not buy until she is completely satisfied with both appearance and comfort. In answer to the question "Willi ever get over this feeling of incompleteness?" The answer is "Yes, by talking and being with people, over time." This does not mean that the person will view her body change as good, but she will accept it, and see it as a "fact of life. . With the resolution of some of the strong feelings related to her surgery, the woman is able to gear herself for the tasks which he ahead. Additional Treatment. For some women there is no period of health following surgery. The woman must immediately come to grips with the fact that the disease still exists and lives within her. Further treatment is necessary when surgery has not stopped the disease or when many positive nodes are present In the axilla. In some centers, chemotherapy has become the first treatment offered after surgery. Because this era of experimental therapy is just dawning, every drug now known to be effective against cancer has some possible side effects. Further surgery such as ovariectomy and adrenalectomy may offer methods of endocrine manipulation. Radiation may be used to manage palliation of symptoms to improve the quality of the person s life. Immunotherapy, still in the experimental stage. may represent another arm to the therapeutic program. Much more than emotional first aid is required if the woman is to keep in touch and work through her feelings during this time. Communication should be open, with discussion and decision-making concerning treatment jointly involving the woman, her family and concerned health professionals. Ambiguity or uncertainty about any aspect of diagnosis and treatment IS intolerable. Many women report that their greatest frustration is receiving one message verbally and another message nonverbally from people around them. '" knew that I wasn't getting the straight goods" and "I saw a different doctor every time and was never told anything much" are common complaints. Women need to be educated about their right to informed consent, They should be given support in their desire to be treated as equal partners with members of the health care team. Women wish to be treated as mature, intelligent adults. One successful business woman with terminal cancer recently stated. "I was more or less told that I should be a good girl, go home and let someone else worry about it." According to another woman; '" was managing my household and working part time. Yet whenever I went for a checkup, I donned a hospital gown and was wheeled into the room on a stretcher and examined lying down. People talked about me as though' wasn't there. When it was a/l over, I was wheeled out." B. The next ten years The five year survival period formerly applied to all cancers is no longer considered valid for mammary carcinoma, According to Kushner; Breast cancer is a chronic disease. just as diabetes is a chronic disease,.. We can relax and breathe easier after two years the period where more than half of the recurrences and metastases first show up. And we can breathe even more 22 The CanadIan Nurse June 1976 deeply after five years But the definite time for measuring breast-cancer survival is now ten years. 3 Obviously. women must be on guard for ten years: it would be cruel to suggest otherwise because this could .result in unnecessary deaths. Conclusion Confusion, controversy and misunderstanding still surround our present state of knowledge about breast cancer. Research into the causes of the disease and modalities of treatment continues around the world and could, it is hoped, produce a major breakthrough any day. In the meantime. there is a great deal that nurses, working closely and constructively with their women patients, can do to combat the apprehension and pessimism that colors our thinking about this disease. Early detection and prompt treatment are still the best methods of reducing mortality. If a mammary carcinoma is detected when it is still less than one centimeter in diameter, there is a 90 to 95 percent chance that it has not metastasized. By the time it reaches four centimeters, the probability that it will be confined to the breast is reduced to about 60 percent. Obviously, public education is a key factor affecting survival and nurses are in an ideal position to accomplish this important function. Nurses also encounter many women who have reason to suspect that they have breast cancer or who have been diagnosed as having breast cancer. When this happens, they have a unique opportunity to respond with the understanding and support that these women need. Ada Butler (B.A.Sc., M.S.N. University of British Columbia), is assistant professor with the U.B.C. school of nursing in Vancouver. This article, which demonstrates her special awareness and sensitivity to the critical stages and common problems faced by a woman with breast cancer, is based on more than a year of systematic data gathering. The author reports that, in order to gather the information contained in the article, she searched the literature, conferred with health professionals in many disciplines, and interviewed and worked with many women patients with breast cancer. Photos courtesy of the Ottawa unit of the Ontario Division, Canadian Cancer Society. References 1 Miller, Jerry. Editorial overview: reducing the death toll of breast cancer. RNABC News 17:5:8-11, Oct. 1975. 2 Kushner, Rose. Breast cancer: a personal history and investigative report. New York, Harcourt Brace Jovanovich, 1975. ... .Source: 18th Seminar for Science Writers, American Cancer SOCiety, March 27, 1976. (president Dr. B. Byrd) "','Source." 11th Annual San FrancIsco Cancer Symposium, November, 1975. (Dr. L Brady). Ma Q) Q)- 0 Q) '" ._ c >0Q) 0- i...: .c <1> 0> .c.'CIO O .c 00(1) :g õ ... 0 - O! 0 .- oc.